1- lowest payments from insurers

2- least likely to pay copays

3- most likely to call after-hours for stupid things (“generics don’t work on me, because i’m special, so you need to call the pharmacist STAT – oh, and can you call in some antibiotics for my husband too, even though you’ve never seen him?”)

etc.

When I get a Medicaid patient I just don’t bother billing. It’s not worth the effort.

The other problem is that with Medicare and the private plans that simply follow Medicare’s lead I get to take care of the rich for the same low compensation as the poor. We do not need to limit this to the poor, as it increasingly applies to all patients. In fact, many of the poor pay cash and actually always pay better than Medicaid.

Not so.

When I was last in private practice, Medicaid patients were 1/3 of my inpatient practice–and I just wrote it off without billing because the system was itself demeaning to my professionalism and the reimbursement rates insulting. In taking zero payment, I at least preserved my dignity.

I know a great many physicians who still do that–treat the Medicaid patients that come to their service and just write it off without billing.

My apologies, but if you read the article cited, it appears that physicians are in fact turning down the payment offered by MediCal for services rendered. I thought that was clear.

In doing so, the physicians are opting out of a system that does not work. That is the only redress they have. Surely you would be displeased if your employer announced a 10% cut in pay? It would be your right to seek more profitable avenues for your skills. This is precisely what the physicians are doing.

There is no other solution available to the doctors who would care for the poor, other than watch their business die in slow motion, and therein lies the tragedy.

The next time a physician turns down a dollar will be the first.

You are of course quite right. That being said, when doctors treating the poor are losing money, rather than breaking even, there is a certain disincentive. A derisory payment for service rendered is an insult, and as such is quite rightly refused.

Many doctors are charitable, and will give free medical care by donating their time. Offering them pennies on the dollar for the majority of their patients is not a way to reward charity, but rather, cheapens it.

Taking care of the poor under any circumstance in nearly every facet of their lives is not terribly profitable, and no matter what happens physicians won’t be stampeding into caring for them.