But in the UK, docs have NHS practices and parallel private practices. You can see them in the NHS, with whatever waits accompany that, or you can see the same person privately, with quick access, but you pay for it.

http://tinyurl.com/33eebd

So? What do you care? Does the press or board pay your bills? Do you really want those in town who bitch about having to pay as your patients?

Who cares? You’re not running a charity.

Again, this is how the free market works.

Don’t practice in Massachusetts. That will change things really quick. It appears, though, that a pretty decent living can be had in Mass., because they have plenty of docs.

Because the law prohibits it. I CANNOT charge what I want to a medicare eligible patient and balance bill. No matter what you say, it is ILLEGAL. Now, I can choose to opt out of medicare, and bill what I want, but the patient can then not choose to apply what medicare would have paid against my bill. That is a condition of opting out – receiving no payments from medicare, and the patients cannot be reimbursed by medicare.

So they have NO choice. I can offer all of the distinct features I like, and the patients CANNOT apply the medicare payment against my bill under any circumstances – unless I agree to take only what medicare allows – a price control.

Please pay attention, class.

It’s not the same as insurance work for lawyers. Even in insurance work, the lawyer is not prohibited from charging the client for other services, not related to the insurance claim, based SOLELY ON THEIR AGE. Thats right, students, if your patient is 65 or over, or totally disabled, there is NO mechanism to apply medicare reimbursement against your larger-than-medicare-allows bill for better/unique/distinct services, ever. The lawyer can offer additional service to his insurance clients, like drafting a will, or whatever, without restriction.

I am still waiting for someone to name another profession wherein reimbursement to the professional for services provided by an individual professional are mandated by law, for an entire class of clientele.

I’ve had my share of patients present, saying they have no insurance, they’ll pay fee-for-service.

They pay, then just as a certain “look-back” window hits, they say, “oh, by the way, I had Medicaid”, or “my sprained ankle is a ten-year-old Comp claim from another state, so reopen it”.

By law, I have no choice. Well, the patient is shown the door, but aside from that. This, of course, is accompanied by the usual badmouthing, in the town, in the press, and sometimes with the Board, for not playing ball with the system and being only concerned about money.

They don’t because no one is requiring them to. If the providers ever stopped agreeing to take their insurance, then they would find a different way of paying for their healthcare.

How do you know patients wouldn’t participate in an alternative scheme? If you offered them something distinct, which is what the free market requires, they may very well flock to you. After all, for decades doctors didn’t have the third party payers, and patients paid in other ways.

Lawyers who do insurance defense work are in the same situation as you are. You hit someone in a car, and you’re not paying for your lawyer out of your pocket. Those lawyers choose to do that work because it’s consistent work with a solvent party paying the bill. They argue over charges just like you do with health insurers, and so on and so forth.

The truth is that most physicians make a damn fine living in the current system, and for all their bitching are either financially unable or just too scared to take the risks a different system would entail.

You forgot the 36-hours in a day the lawyers use for billing.

Take third parties out of the middle of the physician-patient relationship. You decide if my bill is worth it, and you deal with your insurer, to get reimbursed at whatever rate you have negotiated with them. That way, I can negotiate my rates with you, and not be restricted by phony price controls and unfunded congressional mandates.

You keep reiterating that I choose to participate in the existng system, as if there is any real alternative other than not practicing medicine. But for most of us, in most geographic locations, there is no alternative that has any practical reality (e.g. No patients would participate in it.)

So we agree that my patients are the ones who should decide how much I am worth. Should they have to forego their insurance coverage in order to make that determination? (See Medicare rules for opting out) Or should they be allowed to pay the difference between what their insurance covers and what I charge? Why o the patients not have that choice? And I’ll tell you, they do not.