Irrelevant. Doctors are supposed to treat based on the information you provide, NOT what they “surmise” about you based on race, age, or gender stereotypes.

Any doctor who assumes
you are a liar is NOT a good doctor, and this has no connection to medical sense or good judgement. When you fill out insurance info, they ask you if you are a smoker. Well, if you
say “no,” they don’t then investigate you on the matter or assume you’re lying, even though you could be
lying to benefit yourself. The same goes for when you go to the doctor and need a new prescription.
If he asks, “Is there any chance you could be pregnant,” and you say “No,” he doesn’t then give you a
pregnancy test, even if the medication could kill a fetus.
With doctors, it has entirely to do with whether the doctor has respect for the patient. Some believe you and some don’t; there is no consistency to it. Even when the situation is an emergency or the potential consequences of a lie would be serious.
Particularly in an emergency, it is a BAD idea to assume a patient is lying, as the doctor may
waste valuable time on tests that the patient knows are not necessary. As with my case, I was taken by
ambulance and in a very bad way, and the doctor was wasting time asking further sexual questions instead of
diagnosing me and treating me properly. His narrowminded view and prejudiced attitude *hindered* his
ability to give me good treatment, as he diagnosed me incorrectly (twice), and did not even listen to what I was
saying. THAT would be a greater concern for litigation: when a doctor is so convinced
that the patient is lying that he cannot correctly diagnose, and discriminates against patients just because they don’t fit his stereotypical views. The patient is the one who suffers for that, and would seem to be in an ideal position to litigate based on it.

http://www.healthdecisions.org/News/default.aspx?doc_id=96071&source=rss

I don’t think it is fair at all for the following reasons:
a) There is no cost savings in most of the popular screenings. The cost of testing many, false positives, overdiagnosis is several times higher than any savings for less treatment for very few. Why should refusers pay more when they are more likely to save money than to use more of it?

b) It sends the wrong message and misleads the public. Screening has benefits, but they also has risks. Some people benefit greatly from it, but some are harmed. Penalties and incentives turn screening from personal choice made based on evidence and personal preferences into “a responsible thing to do”. It is already happening in today’s climate, and it is wrong, IMHO.
c) This emphasis on testing as a risk-free activity and something “responsible people do” increases public expectation of tests. This in turn leads to huge payments in “not found early enough” lawsuits. The doctors respond with the increase in false positives, biopsies and cost. It may even lead to doctors not willing to do some tests and decreased availability for those who want them. It’s already happening with mammograms. Here is an interesting article on the subject from a professor of radiology.

You mentioned that your doctor trusts that you are celibate . But the insurance company or plans like West Virginia’s wouldn’t – they would just follow the common guidellines. So you’d still have to pay this penalty under the plan in its current form. By the way, don’t judge doctors who don’t believe you – there are plenty of women who lie and then sue doctors later. I don’t understand why they lie, but there were precedents and lawsuits when a “virgin” turned out to be pregnant.

I suspect that what some may see as over testing or unnecessary care may be, in large part, attributable to the culture of defensive medicine which is, in turn, a defense mechanism against a litigious society.
This is exactly why people should be able to refuse them without penalties. I understand why doctors do them, but some warning that a particular test is ordered for defensive reasons (with a release form for refusers) would reduce both the number of these tests and the cost. I just think that public education on the risks associated with extra testing and the fact that “incidental finding” is not a good thing, may reduce at least some of the lawsuits or at least lead to more understanding juries.

I don’t think of West Virginia plan as specifically a plan for the poor. I see it as a dangerous precedent that some employers may decide to follow. Some already have small incentives for what they consider “healthy behavior”. Why I don’t mind such incentives with respect to things like smoking or exercise, I strongly object to incentives for screenings, taking preventive drugs and the like. By the way, employers are more likely to save money on encoraging people to stop smoking than medicaid since they don’t pay insurance for lifetime only until retirement.

I get impatient with the view that poor people were just dealt a bad hand in life, and nothing is their fault, and they can’t do anything to improve their lot and we should not expect them to even try. Why should poor people be allowed to impose their healthcare costs on society without limit and without requiring any proactive participation on their part to help themselves? We routinely charge smokers more for life insurance, for example. I say again that personal responsibility should count for something (within reason). Separately, if someone lives in an area with little or no economic opportunity, perhaps they should consider moving to a location with more promise, especially if taxpayers are prepared to help with relocation assistance.

So that is another issue, that not all doctors are competent or really know what is important to recommend. Plus, they assume I’m a liar, and then try to make recommendations based on that, so there is NO quality care possible when the doctor does not believe what the patient is saying. Again, that means money is going to be wasted on unnecessary tests, because some doctors are retarded. If even doctors can’t agree on what to recommend, the situation seems hopeless. Particularly the green ones will naturally over-recommend.

Turkoise, you realize of course that when they say non-compliant they don’t just mean those who refuse to stop smoking or loose weight. You mentioned that you refuse some tests because you are celibate. Under West Virginia’s plan the way it stands now (based on NY Times description), you would be penalized for doing just that – refusing recommended screenings or not following doctor’s advice.

You can argue all you want that Medicaid patients are on the taxpayer’s dime and we therefore have a right to make demands of them. I submit that we don’t.

Anyone who’s in a health plan of any kind, whether it’s publicly funded or not, is in a sense paying for everyone else’s “bad choices.” If we’re going to penalize the poor, then let’s penalize everyone else.

In fact I would argue that the poor are probably the least in control of their environment and the least able to make the “choices” we are demanding of them. There are social factors at play here – lack of education, low literacy, substandard housing, lack of access to reliable transportation, and possibly addiction and mental health issues, to name just a few. And let’s not forget that when you are poor, your lack of money means you have fewer options in life, period. This doesn’t mean you can’t rise above it, but it takes a tremendous amount of determination and often support from a mentor or counselor to get past the rough patches.

I would echo the commenter above about the proportion of Medicaid dollars spent on the elderly. Most of the stats I’ve seen indicate that more than half of Medicaid dollars are spent on the elderly and long-term care.

As far as the younger Medicaid recipients are concerned: Do you know the average length of time someone is on Medicaid in your state? I’d venture to guess that the majority of folks are not on Medicaid lifelong. I’d also be interested in knowing how many of them are children.

It’s ironic how we preach about choice and getting the government off our backs. Then we turn around and start mandating personal behavior for certain segments of the population. Deep down I suspect this isn’t at all about noble issues such as saving money or encouraging personal responsibility. It’s class warfare, pure and simple.