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We have socialized payments with free market expenses.
21 Jun2009
I saw this somewhere recently – apoligize that I cannot give direct attribution.
We have socialized payments with free market expenses.
I do believe that this is the big problem for developing the proper workforce.
Related posts:
- Free market theory does not apply to medicine
- Socialized medical payments – we already have them
- Not a free market
- The lack of a free market
- Thoughts on lobbying for HR 2350
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7 Responses to We have socialized payments with free market expenses.
solo dr
June 21st, 2009 at 2:34 pm
Likely half the US population is covered by Medicare, Medicaid, Tricare, civilian Federal jobs, state jobs, and/or other government related plans.
In my area a level 3 routine office visit from Medicare is 59.98, public knowledge and available on their website. Medicare is fair in that it pays all FP and IM physicians the same fee in my zone. Unlike private plans, where 10 different doctors will have 10 different fee schedules for the same code from the same insurance plan, Medicare is fair. As a solo doctor I receive a take it or leave it fee schedule from each insurance plan, with 80% of my private insurance plans at fee scheduels that are 10-20% below Medicare.
The current system encourages more frequent office visits to make up for the low fees and more patients to see daily to maintain overhead and profits. Quality is rewarded through Medicare with between a 2-4% bonus on certain meausures, which often comes out to about $1-$2 a patient. Since Medicare is less than 25% of my visits, this means that I can make a massive $2,000-$4,000 bonus by spending hours going through quality measures.
A true free market would eliminate office visit coverage and good doctors could charge more for good care and poor doctors would get paid less for each office visit. Insurance and government coverage would be limited to hospital care and large studies only. I would be willing to see cash patients for about $55-$60 a visit, just to not have to deal with the insurance companies.
JPB
June 22nd, 2009 at 9:08 am
to solo dr: I have made this point many times – office visits should be the responsibility of the patient. Most of us could afford to pay $55-60 and get the insurance companies out of our business. This would also hopefully allow the companies to lower insurance rates (yes I am hopelessly naive). If all doctors would do this and abandon the 2 tier fee schedule (i.e. accepting a lower fee from insurance but charging self-pay patients a much higher fee), that would be a start on real medical care reform!
Bohdan A. Oryshkevich, MD, MPH
June 22nd, 2009 at 11:18 am
We also have free market tuition charges for medical students making it difficult to accept socialized payments. Hence the migration from primary care.
Bohdan A. Oryshkevich, MD, MPH
solo dr
June 22nd, 2009 at 8:43 pm
A full premium for a young family of 4 is running over $8,000 a year, even if the children are past most immunizations and the family takes no chronic medications. For all the visits, assuming the adults each come in twice and the kids come in once a year, I would get between $200-$300 for the visits. Where does the rest of the premium go?
JPB
June 23rd, 2009 at 9:41 am
Good question solo dr! I have wondered the same thing about my family’s insurance premium – but wait, could it be that it goes to profits for the insurance company?!?! Until we take the profit margin out of medical care (and I am not talking about salaries), we won’t be able to change anything.
brian
June 24th, 2009 at 3:42 pm
I commented this on your “what’s wrong with healthcare” blog on June 8th.
I dont need or want any recognition… just makes me happy to know you see and understand my point. I’ve said this a few times in the Doctor’s lounge at the hospital and got blank stares… LOL.
keep up the good work. love your blog.
brian
brian
June 24th, 2009 at 3:56 pm
As another quick point…
NPR recently ran a story on Medical Advocacy.
http://www.npr.org/templates/story/story.php?storyId=105161828
When did Primary Care Doctors stop being their patients advocates? maybe thats the problem?
insteed of looking to “others” to be patient advocates. shouldnt we just pay our primary care doctors to do that job? seems awfully important to me…..