There’s no question that the possible inclusion of a public plan is one of the most contentious issues that will be debated as health reform moves forward.
As I wrote previously, I’m somewhat indifferent about the option, but, feel strongly that doctors need to maintain the ability to opt out of the plan, and stress that reimbursements need to be competitive with those of private insurers.
Well, it appears that some politicians are hearing the same message. Charles Schumer, the third-ranking member of the Senate Democratic leadership, tried to allay some physician fears by proposing several “principles” of a public plan.
Among them include, “pay[ing] doctors and hospitals more than what Medicare pays,” and that “the government should not compel doctors and hospitals to participate in a public plan just because they participate in Medicare.”
Good start.
Those two points should be non-negotiable if there’s any hope of the medical profession accepting the option of a public plan.
Related posts:
- Should a public plan option be part of any health reform initiative?
- Will doctors get a pay cut under a public health option?
- Is the public plan option supported by doctors?
- Why this private health insurance CEO is against a public plan
- The Mayo Clinic opposes a public plan, and the dissonance facing progressive health reformers
- Analysis of the Max Baucus health care reform plan
- Does the Max Baucus health reform plan do enough for doctors?
{ 18 comments }
Kevin,
Those pushing for single-payer have been very clear about the pathway to it. It is a two step process. The first is introduction of a public plan (that pays well and can be opted out of). Then when that plan has put private insurers out of business and the majority of patients are tied down to the federal plan they initiate cost controlling measures. This WILL include cuts in reimbursements and with the private market dead you are now a gov’t employee. And to those of you who would say that just because the gov’t controls the revenue stream doesn’t make you their employee…well if one person is responsible for paying all of my revenue…that person (or institution) is my boss.
RD
Kevin is being foolish if he thinks that there will be a plan that pays more than Medicare. As the govt takes over, there will be immense pressure to cut costs.
I can’t see why anyone in private practice would want this. If you want to be a government employee who has 100% government-paid patients, go work for the V.A. or the Bureau of Prisons or the DOD as a contractor. Join the military as a medical officer. If that is what you want, the options are there. The jobs pay predictably, have benefits and with the right expectations, are pleasant to tolerate.
But if you think practice on your terms with entirely government-funded insurance–not really insurance, just government-paid fees at government rates–will be the way forward, you may be in for a shock. You may also be out of business.
The poster above who said that it will get no better than Medicare is right; Medicare is the government’s vision of government-paid medical care on a non-employee basis. So look at that and ask yourself whether you could survive and be happy on what Medicare pays right now for services, the way they pay now (with their incredibly difficult and inscrutable claims process). If you are a primary care doctor thinking that the U.S. Government is going to save you by paying you more for that 99214, think again. You will be played, and in the end paid so little that you will wonder why you didn’t become a nurse practitioner.
They are the government. They answer to voters, voters who really want everything as long as someone else pays for it, and they really don’t care about you or what you think is fair. If government insurance squeezes out all private carriers so that you are left with Medicare payment or worse for everything you do, that will be just your tough luck.
By the way doc, would you mind filling out my FMLA forms and my application for disability? And do I have to pay a co-pay again when I come in next time?
For physicians, Anon 2:14 is spot on. We really should know what to expect from a government-paid system by now.
For patients, the question should arise: With insurance, you could appeal a decision to not pay a claim, or if worst came to worst, take them to court to seek justice. How does one propose to seek justice from the government, when that government is the same party with whom you have a grievance? Anyone know of any successful suits against a government agency?
There are a number of reasons government should not he in the health care business. Separation of powers is one of the more obvious ones.
If doctors bite on this one they are truly insane in that they are expecting the same process to somehow give a different result–than with Medicaid and Medicare. What we need to use our limited bargining power for is to bargin for maximal freedom. We will get screwed on rates. Freedom to opt out. Freedom to balance bill on a case by case basic at our discretion. The future of the doctor-patient relationship, our patients well-being, the remnants of professionalism left require this.
Sooner than most of us imagine, the modern welfare state is going to collapse under its own weight. With worthless currency and no one to bail us out, the federal government will collapse as did the soviet union. When it does, will there be an unbroken continuity of Hippocratic private medicine or will it have to slowly rebuild from the ashes?
I am very leary of the public “option”, but if they truly make it self-sustaining and keep it that way, I might be able to live with that.
won’t also if it is government run then later the government will decide what is good and not, like ivf and abortion and end of life care and so when the democrats are in it will be one thing and then the republicans in the majority it will be something else.
Supposedly the public option is going to play by the sames rules as all of the private companies. Ask your congressman this, “would the gov’t allow a private insurance company to fail?” Answer- “Of course”.
Next ask, “Would you allow the public option insurance to do the same?” …that’s the key question. They will not be held to the same standards or exposed to the same risk as the private companies…and it will NEVER be allowed to fail.
In a time when the financial future of Medicare is very much in doubt how can we responsibly add another program to the pile?
RD
medicaid and medicare pay inadequately, and are both insolvent. Good job uncle sam.
If anybody reading this blog thinks things will be any different with another govt run plan, come back to reality with the rest of us.
Medicare is broke. The hospital insurance trust fund is cash flow negative. That’s your part A insurnce should you ever get admitted to the hospital. In seven short years the negative cash flow will empty the Medicare National Bank. What we have in Medicare is a giant Ponzi scheme. To cover 3 trillion dollars of health care expenditures on a single payer government plan would require every citizen in this country to pay $10,000 a year just to keep it funded , dollar for dollar.
Now. The question I have for you. How do you make a family of four pay $40,000 a year in health care tax to fund a health care system. Unless of course you excuse 1/2 the population from their obligations. In favor of votes and further put the burden on the backs of those who already pay a disproportionate amount
Socialized medicine will collaps on it’s own Free=More weight, and it will in every country in the world, unless overt rationing is in place.
When doctors start leaving government sponsored plans out of economic necessity, and they will, insurance without access will bring us closer to a cash only business for those that can afford. And long government waits for those that can’t. And those with money will get preference to care. We will have our codified two tiered system.
YOU FIRST
Kev .. this is just another ploy by the single-payer crowd, many from Harvard Medical School.
Well .. in single-payer countries, the MDs make MUCH LESS than in the U.S.
Does that mean the HMSers involved with single-payer are offering to take an immediate 35% pay cut? What is good for the goose is good for gander?Also: no new plan should be foisted on the public — without FIRST being tested on Congress for five years. Let them live with it for a while, before the public does. If they really want to lead — and not just eat lobbyists’ lunches.
The top priority in gaining the support of a future public option must be the guaranteed ability of physicians to balance-bill patients. This is the only way that future reimbursement cuts, which are sure to come with the public option, can be offset with higher amounts paid by the patient.
At least there will be some semblance of market forces in this case, instead of the complete price fixation within Medicare.
What if the docs who claimed to believe in this just let their income drop 30% now by increasing the proportion of patients they treat for free accordingly?
Would there even be an access problem? Are there really a lot fewer doctors for this than the press leads us to think or are they all mouth, no action? How many of these “leftist” docs at the elistist institutions go to their chairman and say “Look, I am going to spend 1/3 of my time treating people for free so put me on 2/3 status and pay”
No, they don’t say that. They want to nurture their delusions of moral superiority by dissociating themselves from revenue generation but without taking responsibility for reduced revenue consumption. They want someone else to pay the freight for their moral fancies.
Anyone know of any successful suits against a government agency?Well, that’s a very broad question but the EPA has definitely been sued with success for failing to promulgate regulations.
Dialysis companies provide a unique 25 year look into the future of what a single payor system will look like.
Initially, doctors and nurses did treatments, then finally highly trained technicians monitored 4-5 patients at a time. It was a profitable business that took to looking at ever shrinking margins (and actual decreases in reimbursement) to stay barely viable. If not for medication reimbursement, it would NOT stay afloat.
The point being… the reimbursement rate stagflation means that technicians, not physicians (or even nurses) now run dialysis companies.
Technicians are amazing, fantastic and wonderful… but if this is the model you want for primary care medicine… go ahead and vote for the public option.
The misinformed railing against Single Payer is contrary to the usual scientific approach most physicians use to solve problems. Patients in counties with National Health Insurance get more care, not less, and everyone is covered. Physicians may be surprised to learn that their internist and pediatrician counterparts in Canada earn $215,000 and $186,000 respectively, while surgeons earn over $300,000. Malpractice rates are generally 1/3 of that in the US and doctors are in private practice for the most part, not salaried as a growing proportion of US doctors are. All this at half the cost and with better health outcomes. True there are always problems, but no one is saying we have to duplicate mistakes as we reform our own system. The statements here can be checked at pnhp.org under research. These documents are resourced from reliable data collection.
As an ob/gyn, I am convinced that the stagnation of physician salaries has more to do with supply/demand than any public policy or Medicare re-imbursement. In ob, our salaries haven stagnated as well… and we have almost no Medicare influence.
But we do have midwives, which have taken over a large number of deliveries in our community. perhaps this is for the best since it reduces overall costs, but if residencies keep pumping our new docs and CNM programs keep pumping out new midwives… do the math.
The angst that physicians will see reduced pay with single payer or public option are misguided. Just stop seeing Medicare pts if you don’t like the reimbursement . If you are all saying the free market is ideal, then act like it.
I have a chronic back problem and have asked all the (many) health practitioners I have encountered, including three physicians, about health care reform. The unanimous response: “We need a single-payer system.”
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