Doctors support universal health care

Hmm. Despite their support doctors seem to be voting with their feet. The number of general medicine physicians continues to be insufficient to handle universal health care.

Paul, the major block to this deal is not so much doctors...it is the insurance companies.

About a year ago I saw a report on ABC News tonight of how insurance companies in the northeast were regularly stiffing doctors and hospitals on payment. One hospital administrator produced faxes of bills sent to one insurance company and confirmations of receipts...while the insurance company claimed no bills had ever been received, so they didn't have to pay out.

It was surreal. Like the Monty Python "Dead Parrot Sketch". The hospital administrator was stupified as he did not know what to do. Keep sending faxes, send couriers...the insurance company claims no receipt, and thus no need to pay out.

I wonder how many doctors get screwed over.

Health care in America is a national scandal. Paul, you are right to point your political finger too.

I am a conservative (a Tory really, and so don't have the, what seem to me bizarre, Republican antipathy to universal health care), yet I am supporting HRC because of this issue (well, and the economy too).

I think that Marlowecan is right about the obstructionism of insurance companies. I also imagine that no one hate the insurance companies as much as doctors.

Read the report carefully. Psychiatrist are the most supportive because they are the least likely to have patients with insurance. The mental health community would love to make every diagnosis reimbursible from the government.

If you also read the report, it does not imply that private insurance would go away. The physicians would still be covered with high quality private insurance while the masses would be left with government insurance.

If you want an obscure reflection on healthcare, look at this months Washingtonian Magazine. Many of the best physicians do not take insurance at all. It is up to the patient to deal directly with their insurance companies. I would asusme that they would increase in a single payer world.

Many doctors go to fields where they make a quick/easy buck. ER physicians and neurosurgeons are in short supply because optometrists doing lasik surgery on Medicare patients is easier and more lucrative(market forces).

"Psychiatrist are the most supportive because they are the least likely to have patients with insurance. The mental health community would love to make every diagnosis reimbursible from the government."

Depends upon one's view of the mental health field. My interpretation of that would be that the mental health community is interested in helping as many people with mental health issues as possible.

SD, I have no problem with those rich enough or picky enough seeking out pricey doctors who opt out of the universal system. I have many physician friends. One won't deal with insurance companies as you suggest. It's because he despises them and chooses not to pay his staff to fight with them. He doesn't refuse Medicare because it's easy and quick to pay.

My own physician is in every single preferred network, because his business model is to make it easy to bring in new patients to his rapidly expanding practice, and build the practice by bringing more doctors and nurses to handle the load. He has two people on staff who do nothing but deal with the dozens of insurance companies and their individual rules, forms and 'patient care' specialists (i.e. 'payment prevention and delay' staff). What a waste.

There is one huge reason we will eventually have "government insurance". It's the 35% overhead and profit of insurance companies. We can't afford it as a nation and no other modern advanced nation submits to it. Cutting that cost by 30% to the "government insurance" overhead cost of 5% allows us to cover everyone, pay for everything, relieve the burden on emergency rooms and finally, finally, take care of the health needs of the entire population of the richest country on earth.

GreenDreams wrote:

"There is one huge reason we will eventually have "government insurance". It's the 35% overhead and profit of insurance companies. We can't afford it as a nation and no other modern advanced nation submits to it. Cutting that cost by 30% to the "government insurance" overhead cost of 5% allows us to cover everyone, pay for everything, relieve the burden on emergency rooms and finally, finally, take care of the health needs of the entire population of the richest country on earth."

WELL SAID!

SD, it's an embarrassing shame that every citizen of the United States doesn't have access to at least a basic basket of healthcare services. Not only am I okay with supplemental insurance for those who can afford it, I see it as a good thing. You protect the well-being of the weakest among us while offering those can afford it greater choice. Will some of the better doctors opt out of the system and only see private patients? Yes. But that's already the case with many specialists who are prominent enough to only accept direct pay and let their patients deal with getting reimbursement after the fact. And supply and demand will dictate that there are just so many physicians who will be able to afford to be private insurance only, thus ensuring there will be plenty of good physicians to go around for the plebes.

Idiosyncrat ,

Supply and Demand curves have little to do with medicine since all physicians are paid the same amount for the same procedure. The best in any field will go the non-insurance rout where they can charge much more than the CMS reimbursement. The poor will be stuck in the worst hospitals with the least skilled practitioners (See the inner city public schools for the model to apply).

The question is whether, like the public schools, the federal government will let the middle class in the suburbs fight for better healthcare or will try to keep everyone on the level of the worst provider.

Greendream, physicians who can turn down medicare depends upon the practice. CMS has one of the lowest reimbursement rates today. If PET/CT centers depended upon the reimbursement of CMS for everyone they would all be out of business.

A single payer system means that GS-12's in DC will be determining what your cancer treatment will be because they will be setting the reimbursement rates and do not care if they cover costs or not.

Cutting out the insurance companies entirely is a pipedreadm, Grrem Dreams.
There are political realities to face, and compromises will need to be made in order to get anything passed.

That's why I think Hillary has the best plan. She starts out from a strong position, realizing full well that she couldn't get her plan in place in its entirety. I agrree with her when she said that any weaker proposal will be nibbled to death by the opposition.

It's a tragic reality that our government moves by fighting ideological and political
battles instead of pagmatic ones.. It's what killed the immigration bill, and I predict the fight over health insurance will be just as bloody. I just hope it odesn't end up the same way.

If we move towards a single payor system perhaps we will also move towards a subsidy of medical education in exchange for some years of service. Most of the potential impact of a universal care program would be preventative care and early intervention while costs are relatively modest.

Great discussion here. Thanks to everyone who chimed in. It's been fun to read.

For my part, I agree with Ezra Klein on this issue. Costs are going to go up in universal health care system eventually. Even if we reduce overhead and all that. More people will be getting care, people will be living longer, etc. But these are costs worth paying. Right now we pour gazillions of dollars into a system that doesn't produce good outcomes for large parts of America. Universal healthcare would be better, if not perfect.

SD, just to be sure we're on the same page, i'm talking a system where we have a general system of universal healthcare which offers a to-be-determined basket of healthcare services to all citizens. This basket needs to be rock solid, with efficiency of care and physician reimbursement not far off from any alternative system so that there's less incentive for large amounts of people to buy private insurance and also less incentive for physicians to run for the hills to private insurance. But there should be that private insurance, which offers something "more" -- whether it be premium services, easier access... whatever it is people are willing to pay more for. Yes, this implies rationing, but that's something that a modern society has to confront. With more and more research showing that some of the super expensive newfangled medical technology advances don't necessarily correlate with better outcomes, it's a complicated issue since you don't want to inadvertently stifle innovation.

Is it creating medical apartheid? It could, which is why it has to be carefully implemented. But I'd argue that we have that system now in that many people have access to no care whatsoever, let alone to top physicians. And not all insurance plans are equal. Employers are increasingly raising premiums and co-pays in order to shave costs. And if you happen to be lucky enough to have healthcare benefits but don't like the questionable plan your employer offers, enjoy paying a gazillion dollars for a private policy... Apartheid just the same.

Nevertheless, the devil is in the details. I'm under no illusion that such a new system will be perfect nor easy to implement. I don't trust the government one iota to effectively run such a bureaucracy. But you know, the insurance companies haven't exactly proven to be the model of efficiency either, and at least with the government you can keep down the profits and thus have more money to distribute elsewhere.

Too many smarty pants people in this country for us to not be able to develop and implement a system where there's universal access, limited profits, but incentive for efficiency... It won't be perfect, for sure, but it won't be the shameful mess that we have right now.

Marlowe, it is indeed amusing that when you look at Europe, people across the political spectrum agree on some form of universal health care for its citizenry yet here in America it's a left-right wedge issue. I'd like to see us fighting over the "how do we implement it" rather than "why we should" part, but we're just not there yet...

"Supply and Demand curves have little to do with medicine since all physicians are paid the same amount for the same procedure."

So far as I know this is completely false. Does anyone besides SD really believe it?

"Supply and Demand curves have little to do with medicine since all physicians are paid the same amount for the same procedure."

Jim,
This is true within a particular insurance structure, but not true in a general sense..
Some doctors have always opted out of dealing with insurance. Some just cater to the wealthy. Some have different rates for different patients. sliding scales).
Many hospitals charge different prices for the insured than the uninsured.

Right now, it's a sloppy mix, and that's why I find SD's doom's day scenario to be very shallow. In France, for example. there are private hospitals serviced by doctors charging fees outside of the state system. Surprisingly, they are no better, and sometimes worse than the hospitals within the state system.

When the pool of the insured is increased to include everyone, the dynamic changes dramatically., and so do incentives for insurers and doctors to act in certain ways.

Of course, there will be problems. One has to die and go to paradise to find the perfect system. Many of the problems predicted for universal health care are actually problems we have now.and will be inerited by a universal health care, not created by it. The most glaring of these is the shortage of doctors and nurses, the twin of our shortage of scientists. We are always two steps behind in addressing the needs in our society.

Would universal healthcare hurt the pockets of healthcare professionals and would it cause further goverment control over the american people?