Health Care: To Reform a la Socialists, or WTH?
Today we had some very interesting conversations about Health Care, kicked off by Cool Arrow by his link about the Catholic Church threatening to close hospitals if Comrade Obama required them to perform abortions.
We got into some very interesting discussions about not only the Catholic Church, but also about funding for the Church and other charitable institutions here, on the OT....and finally, stratman chimed in with this amazing post:
I was waiting for someone to bring up that little tidbit, Blonde.
IMO, as a physician who has worked in Catholic hospitals and clinics as well as come to understand the various factions of physicians within Medicine, Obama and the insurance industry rely on the ethical, moral and financial obligations physicians believe or experience to continue to work no matter what.
Let me back up for a minute and address something KC posted which had me writing and revising a response several times even though I eventually did not respond.
Physicians by and large are not trying to make insurance companies happy. the dynamic between insurance cos. and physicians is more like the imprisoners in a Stalag and the prisoners, respectively. Currently the InsurCo. guards have phsyician's convinced that they , the InsurCos., are in full command. Physicians, the prisoners, must follow specific rules or be punished - rejected claims with no clear reason, contracts without detailing reimbursements, claims scaled down despite documentation (bundling), non-negotion of contract, holdbacks (InsurCo keeps portion of reimbursement and may "give" to physician at end of year), forcing financially burdensome plans on physicians that only want certain viable plans in the contract (anti-cherrypicking), ability to recoup funds retroactively for significantly longer periods of time than that allowed to physicians that discover underpayment by the InsurCo., etc.
Here's a sweet little example. BJ Clinton signed into effect legislation that mandates a translator must be provided by the physician if the patient does not speak English appropriately. This law may be applied even if the patient is accompanied by a friend or family member who can translate. Sounds good, right? Well, if the reimbursement is only $75 but the translator costs more than that (and they do typically) , then the physician must eat the loss. And forget about writing off these practice losses from your taxes! Now think of the losses if you work in an area serving a sizable immigrant (legal or illegal) population. You're not just giving away free care, you're paying for that patient's care out of your own pocket! Thanks gub'mint.
Sure, some physicians have drunk the kool-aid or have succumbed to Stockholm Syndrome, but most have not... as of yet. Physicians must follow the rules but most would love a way to tunnel out of the Stalag.
Make no mistake, as the fate of physician's goes, so goes the patient's fate. The problem is what physicians will do in order to change their circumstances. Like the old joke about opinions being like arses and everyone has one, so is it true for physicians.
InsurCos. and government know and count on the benevolence, morality and ethics of physicians to do very little to fight back against the barbarians looking to squeeze and marginalize them on a near daily basis. Additionally, physicians are afraid to tip their rice bowl - they have made financial obligations (house, family, lifestyle, retirement) and are fearful to rock the boat too much.
So, physician representative groups like the AMA deal from a known base of weakness, their little power used only to "negotiate" the downfall piece by piece. Then these groups cock-a-doodle-doo on how succesful they were in slowing down yet another 5% decrease in reimbursements this year (but who knows next year) or how they softened yet another governmental/InsurCo. intrusion into how medicine is practiced all the while ignoring they just agreed to a permanent negative change in the practise of of medicine.
Another part of the problem is that the kool-aid drinking physicians are by in large the ones running the AMA and other official entities.
The disgusting result is that the barbarians will come back next year asking for even more, chipping away at liberties and medical practice until they eventually get what they want. And the physician leadership will give it to them.
Sound familiar? It's exactly the approach the Democrat Socialist have been using until now. Now these usurpers in government are unleashed and running unfettered changing the landscape of American governance and culture. The critical mass has been breached and a nuclear chain reaction will continue till the fuel (money) is gone... or the public wakes up and end it. The same will happen to medicine, both patients and physicians.
Where, then, do physicians retain power to keep the Obama Borg from socializing medicine? The only weapon available is to not provide services. This is already happening where primary care physicians are no longer accepting Medicare and Medicaide patients at all or after accepting smaller numbers into their panels than in years past. Subspecialists are severely curtailing the number of Medicare/Medicaide/OtherPlans, with some not seeing certain plan's patients at all! Even Tricare, the Military's insurance, is being turned away by a few.
Why not accept all patients? Because the reimbursement either does not cover your costs of providing care or does not provide enough profit compared to other plans. It is one thing to provide charity or reduced fee care on one's own; it is another ball of wax to be forced to provide charity care.
BTW, did you know physicians may be commiting a federal crime if they provide charitable or reduced fee care to one/some members of a plan but not to all?
So, Obama, the government and InsurCos. believe that the masses physicians are paper tigers who will never go on strike. And they are currently correct. A work stoppage goes against the grain of most physicians' ethics, morals, and financial interests.
Unless physicians find a different mechanism of brokering power, or are willing to use the one method that will immediately alter the playing field, then the practice of Medicine as we know and rely upon will wither away.
In that case, be prepared for more foreign medical graduate physicians (not necessarily bad), less intelligent physicians, more lesser trained physician "extenders" (Physician Assistants, Nurse Practitioners, etc), greater waiting, less innovation, rationed care, and in some instances, no care available for certain issues.
And you will pay more out of pocket one way or another (if you have a job, that is). Ultimately, there is NO guarantee of health care costing less than it does today for any individual.
Medicine can be
But you can only have two at a time.
What do you want for your healthcare?
I read it and am shaking my head. Alot. I want to consider all of strat's points before I get into a discussion about it....but it is a fabulous and timely topic, with The Comrade preparing to shove something totally unpalatable down our throats...and I thought we might take this opportunity to discuss at some length.
Be warned...trolls are not desired here. This is a serious topic for serious people.