Some troubling thoughts for the future of American medicine:
With these decreasing payments and increasing regulation, I think that there will be an increasing number of physicians opting out of Medicare in the next several years. Indeed, it would not surprise me if it becomes difficult to find a decent physician who will be willing to accept any Medicare-eligible patient, even with the world’s most generous secondary insurance. This is a difficult process to imagine for the Internist — the vast proportion of patients we care for are on Medicare. But if it costs more to provide the care than we can get reimbursed, then there is no future in seeing these folks. Kinda like the guy who said that even though he lost money on every business transaction, he would try to make up the difference by increasing his volume.
Related posts:
- Hospitalists assimilate inpatient medicine, is resistance futile?
- Supplement regulation
- Physician job security in the recession
- Does coordinating care save money, and if not, is it worth the effort?
- When primary care refuses to accept Medicare
- My take: Preventive medicine, Rhode Island, C-sections
- Internal medicine, circa 2007
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I’ve been waiting for this to happen. It’s only a matter of time, and it’ll be interesting to see what the government does in response.
The first step will be tax breaks for MDs who see Medicare patients, I’m betting. But will it be enough? Probably not. Hmm.
Two possible scenarios with this trend: one is a massive shift to low-cost extenders, with a very high ratio of extenders to supervising physicians (think 10 or more to one). The average person never sees a doctor and doesn’t get to see one unless admitted to the hospital. The other follows the market: very small numbers of doctors see patients who pay cash for their care, perhaps receiving no coverage for this service under Medicare (at least if it is working as it presently does); the rest simply do without or if the first option above is available, they do that.
If there is insufficinet payment to pay for services, there is no market for those services. Why does that seem so impossible to imagine?
There is railroad track all around the country yet such abysmal and infrequent passenger service to so much of it. Few companies make passenger cars anymore. Pullman cars are a thing for transportation museums. Ever wonder why? And if you are seeking a m=edical comparison to airline service, remember what happens with that in small cities.
Beware the “Medicare for All” bill lurking in the shadows of the House HR676 by dimwit Conyers. There is a section in it that bans all private insurance similar to what occurs with current Medicare patients over 65 years of age. I don’t see how these socialists think that banning the purchase of private insurance is in anyway Constitutional, but then again they have no regard for the rule of law if it affects them. How is it Constitutional that currently our seniors can not purchase private whole medical insurance and that physicians can’t have private contracts with patients over the age of 65 unless they go through the onerous 2-year opt-out. If the AMA had any balls they would have crushed this in the courts by now.
Beware what you ask for. Many private plans pay the same or less than Medicare. Why? Because they have market power and physicians are forbidden the same by antitrust statutes capriciously applied.
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