David Catron, the human BS detector, weighs in…
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- Doctor salaries: The free-market experiment
- Can a free market in health care really exist?
- Free healthcare
- The cost of “free” healthcare redux
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{ 26 comments }
Sigh. Did no one here take basic economics in college? The domestic healthcare market is NOT a free market, regardless of who is paying or how the payment is being made.
Your constant cries of limited supply are growing tiresome. There is a limitless supply of foreign grads who come to the US every year to practice medicine. If the supply were so limited, US grads would not leave the practice to do other things, which some are.
The supply of physicians is no more limited than the number of lawyers (by virtue of law school seats), bars (by virtue of liquor licenses), professional engineers, CPAs, veterinarians, or economists. Unlike those other professions/businesses, however, government regulation (Medicare) has restricted the ability of physicians to adjust their rates based on their expenses, or allow the price for services to seek its own level.
Arguments that physicians can “not sign Medicare contracts” are specious – analagous to the argument that bars can limit their business to tea-totallers.
Tiresome or not. Call a waaaambulance if you can’t handle a dissenting opinion in an open forum.
I will continue to point out the problems as long we get the continued incorrect pablum of “free market.” Do you even want to start comparing the number of domestic medical school seats to seats at engineering schools, accounting schools, etc? Go for it. It might be an eye opener for you to actually see how few seats there are for medical schools when compared to every other profession. Can we compare California accredited only law schools (open in conjunction with ABA accredited schools) that require no LSAT examination and instead require on the BAR examination for eliminating potential candidates? Can you point to a single domestic medical training facility that fits this model? Do you want to compared engineers, who do not have to have a PE to practice in most fields (automotive, aerospace, etc.)? Again, go for it.
If physicians wish to trade in their government provided oligopoly over the healthcare system in return for freedom with setting rates… I am all ears. Until then, the providers need to get used to the bed that they made when they colluded and continue to collude (see the specious attacks against clinics staffed by NPs) with government to protect their market position.
“(open in conjunction with ABA accredited schools)”
Better stated as open in addition to ABA accredited schools.
Can you point to a single domestic medical training facility that fits this model?
Sure. Its called “Foreign medical graduate.” They graduate from a foreign school, and they receive DOMESTIC training. No MCAT! They rely on the USMLE! (No student loans either).
Can you, by name, show me one foreign medical school that has no MCAT (or equivalent) from which students are eligible to be seated to take the USMLE?
Doesn’t matter, because the US allopathic system has no control offer foreign medical school admission practices.
Show me a US law school that doesn’t require a bachelor’s degree. Many foreign med schools do not, and accept students directly from secondary schools. (In some places, medical school is in lieu of college/university).
Of course, you have now traded your “limited supply due to flexner” argument (limited med school seats) for a “limited supply due to licensing requirements” argument (needs to pass the USMLE). All of the above listed businesses have licensing requirements, so I guess they do not operate in a free market either (bars, restaurants, taxicabs, dentists, accupuncturists, CPAs, contractors, and plumbers all have licensing requirements).
“Arguments that physicians can “not sign Medicare contracts” are specious – analagous to the argument that bars can limit their business to tea-totallers.”
Well, if you don’t quit signing those contracts, how exactly do you expect things to change? Is it not pretty basic that doing the same thing over and over usually doesn’t change the result?
There are two domestic producers of unlimited-license physicians in the USA, the MD’s and the DO’s.
There is a big growth underway in the number of DO schools, relative to current production.
As to physician immigration into the USA, there is no country in the world that accepts doctors like the USA. Go to the WHO compendium of world medical authorities, check the individual countries. See how hard it would be for a USA physician to get unlimited licensure in the countries that send so many of their physicians to the USA.
Why doesn’t Canada open their doors to physicians? Why not Australia? Actually, they did, and got burned. Patel in Bundaberg was a big scandal there, see their Queensland press.
Well, if you don’t quit signing those contracts, how exactly do you expect things to change? Is it not pretty basic that doing the same thing over and over usually doesn’t change the result?
This premise assumes that a large number of physicians can continue to practice medicine full time without signing those contracts. The fact is that they cannot – just as bar-owners can’t sell liquor primarily to tea-totallers. Nor can they band together to do so – it is collusion. Small numbers of physicians opting out of the system because they live in wealthy demographics will have no impact on the system anyway, as their withdrawal does not affect the supply of physicians. For most of us, opting out means throwinf away years of training to do something else, like selling life-insurance.
But you are getting your wish, as more and more people see the writing on the wall and choose other careers.
California probably has the most competitive environment for medical practice in the United States. Coupled with high taxation, ridiculous real estate prices thanks to the decoupling of taxes from market value due to Prop 13, and low reimbursements, it is not desirable to anyone who want to be out of debt or live the “good life” anytime soon. The uninsured actually encourage free market forces; do away with them as your governor has proposed and market forces are essentially eliminated. The interesting thing about the “opt out” argument is that many primary care M.D.’s do not accept new Medicare patients and a very significant portion of M.D.’s do not participate in Medicaid. As for private plans, my group terminated our agreement with a private plan just this week.
“This premise assumes that a large number of physicians can continue to practice medicine full time without signing those contracts. “
Why can’t they? What do you think will happen if large numbers of people can’t go see their doctors anymore because they’re not on their health plan? They’ll get sick less? No, they’ll come find you and pay you for the service. This system of payment has not existed since the beginning of time, so why do you feel it is so sacred that we cannot live without it now?
How else do you expect to change things if you keep doing the same thing?
Because unless physicians do this en masse the effect will be diluted by the overwhelming of available physicians who do not. And coordinating and doing so en masse has been ruled illegal by our esteemed justices, calling it collusion. So, yes, I could “opt out” and go hungry for a long time. Perhaps in my lifetime, 2 or three of my neighbors will do the same. The patients will moan and groan about their greedy physician on their way to someone else’s office.
But your argument can bve reversed. If the “public” wants health care to change, why do they keep doing the same thing? Why sign up for employer sponsored health plans? Why not seek care from physicians who do not participate, if the system is so bad? Well, because they expect the legislature to change things for them. If it’s OK for them to continue to do the same thing and hope that the legislature will make things better, why is it not OK for me, too?
Of course, there is no law prohibiting patients from banding together and refusing to participate, is there? And yet, with fewer barriers, they continue to do so. It is much more costly for a single physician to walk away from his entire income than for an individual to pony up for inexpensive primary care, yet the don’t – they go somewhere else.
I know. There are plans with which I have terminated participation because of lousy policies and poor reimbursement. Do you think the patients who have that plan continue to see me? They could, it would cost them about 400-500/year, and they would still have coverage for labs/ xrays/ hospital, etc. In othe words, other than my bill, it would cost them no more. Do they come? No. They go someone else, and occassionally call me to complain how poor the care is, and to ask if I have reconsidered participating in their plan. I ask them if my services are worth 400-500/year, and they say they are, but they do not make appointments.
So please continue to ignore reality. Until large numbers of doctors can act together, large numbers of patients will not have a problem finding someone willing to provide service. And I do not think the current system is sacred. The difference is that for a large portion of the population, that happens to be the majority of patients we see in primary care, it is not a choice. It is the law of the land. That is what is making it difficult. The patients consider it sacred.
” If the “public” wants health care to change, why do they keep doing the same thing? Why sign up for employer sponsored health plans? Why not seek care from physicians who do not participate, if the system is so bad? Well, because they expect the legislature to change things for them. If it’s OK for them to continue to do the same thing and hope that the legislature will make things better, why is it not OK for me, too? “
The public is not as unhappy as you is the deal. The public feels about healthcare the same general way they do about lawyers and politicians. Collectively, everything is bad, but they love their lawyer, doctor, rep. That’s why they keep going back.
I’ve asked before, but can you point me to the case that makes you talking to your colleagues about refusing a particular reimbursement offer illegal?
And why do you pay your lobbying organizations if not to advocate to make you more money? The AMA works very hard for your liability carriers – can they not help you? Surely the insurance cos. are as easy to demonize as the victims of malpractice?
“Collectively, everything is bad, but they love their lawyer, doctor, rep. That’s why they keep going back”
You don’t read to well do you. The previous poster just stated THEY DON’T COME BACK AFTER HE STOPS TAKING THEIR INSURANCE PLAN. Please do read for comprehension next time.
“The public is not as unhappy as you is the deal.”
Then who is it exactly that is clamoring for universal health care?
It is the “do good” politicians, not the public.
What is the public doing to stop their elected officials from doing something they do not want?
Are they rallying against the persidentail candidate who is the number one proponent of universal, socialized healthcare? Is that person leading or trailing in the polls?
Well, the public certainly hasn’t made any big moves or protests regarding Iraq or oil prices, so I guess it is all OK. The only thing I hear is the bleating of sheep. Let the politicos figure out what the issues should be. No need to sprain your brain.
I am done wasting my breath/fingertips. It is clear that YOU (whoever you are, anon) have made up your mind, and it is not open for a differing viewpoint. While I understand your presmises, you seem to disregard the stark reality that makes your positions less than credible. They are great in a textbook, but ignore some serious realities, such as a extreme degrees of regulation, that make such arguments as “don’t pariticpate” equivalent to “don’t practice medicine,” at least for the overwhelming majority if us.
But if you keep your head in the sand long enough, you’ll find that we are all unavailable when you need us.
“But if you keep your head in the sand long enough, you’ll find that we are all unavailable when you need us.”
Well, since you all say you’re leaving anyway because of declining reimbursements, what’s the big deal?
You’re not much on negotiation, are you? No wonder you keep selling yourself to the govt. at a cheaper rate every year.
Negotiate –
I have tried to negotiate. The answer is: “take it or leave it.” And when told that, I have left it. The reality is that a solo practitioner has no leverage, unless he is the only one for miles around.
The patients don’t stay, know matter how much they say they want to. They find other docs who take their poor paying plans, and call to complain how poor the care is. You get what you pay for.
I guess it’s no big deal, after all.
Bye!
This article:
http://www.john-goodman-blog.com/health-reform-part-iii-sound-and-fury
addresses the issue of dropping plans, negotiating contracts, etc.
John Goodman asks whether any proposed plan meets the following:
4. Does the plan allow doctors and patients to freely recontract, so that a better, higher-quality bundle of care can be provided for the same or less money?
5. Does the plan allow providers to freely contract with each other to reduce costs or raise quality?
6. Does the plan allow the insured and the insurers to freely recontract in order to change the boundaries between self-insurance and third-party insurance and arrive at more desirable allocations of risk?
And points out that not only do none of the currently proposed programs allow the above 3 points, the current system doesn’t either.
Good article.
Some of these comments are comical. Here is why we keep signing up for company sponsored health ins. Because once I didn’t have ins. and was more than willing to pay cash to a dr. except there wasn’t one Dr. in town who you could get an appointment with if you didn’t have ins. And yes, they told you that up front…”What kind of ins. do you have?” “none, well sorry we just make it our policy not to see patients who have no ins.”
Oh please, I take cash paying patient’s in a heartbeat. That stated, I do expect you to pay your bills. self pay does NOT mean no pay in my practice.
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