When doctors go Galt

posted at 12:15 pm on April 18, 2009 by Ed Morrissey

What happens when government regulation makes it more expensive to bill for medical services than providers receive?  More and more, providers opt out of those systems like Medicare and Medicaid, and patients have to go out of pocket to see specialists.  And if you think that will change in universal health care, think again (via Instapundit)

Here’s something that has gotten lost in the drive to institute universal health insurance: Health insurance doesn’t automatically lead to health care. And with more and more doctors dropping out of one insurance plan or another, especially government plans, there is no guarantee that you will be able to see a physician no matter what coverage you have.

Consider that the Medicare Payment Advisory Commission reported in 2008 that 28% of Medicare beneficiaries looking for a primary care physician had trouble finding one, up from 24% the year before. The reasons are clear: A 2008 survey by the Texas Medical Association, for example, found that only 38% of primary-care doctors in Texas took new Medicare patients. The statistics are similar in New York state, where I practice medicine.

More and more of my fellow doctors are turning away Medicare patients because of the diminished reimbursements and the growing delay in payments. I’ve had several new Medicare patients come to my office in the last few months with multiple diseases and long lists of medications simply because their longtime provider — who they liked — abruptly stopped taking Medicare. One of the top mammographers in New York City works in my office building, but she no longer accepts Medicare and charges patients more than $300 cash for each procedure. I continue to send my elderly women patients downstairs for the test because she is so good, but no one is happy about paying.

The counterargument will be that the only solution to this is a single-payer health system, along the lines of Canada and “England”.  In a single-payer system, providers would be forced to accept all patients, since the payment source will be the same for each.  Prices will get controlled via Medicare-style diktats, so providers will have to settle for the compensation set in Washington or nothing at all.

That may control prices, but not costs, which is the entire disconnect in socialized systems in any industry.  Marc Siegel’s piece highlights the disconnect between prices and costs that occur in highly regulated and socialized systems, but not in free-market systems.  Medicare and Medicaid set prices without regard to the cost to bring services and products to market, making the transaction less desireable — and in some cases, actually damaging to the business.  In those cases, providers will withdraw from the market, leading to shortages and higher costs; in the medical field, those costs will eventually include unnecessary illnesses and deaths from lack of care.

This scenario is not academic.  The health systems in Canada and the UK have shortages of doctors, especially specialists like dentists, transplant surgeons, and the like, which is why it takes months to get testing and diagnosis even for serious illnesses.  Why?  It costs a lot of money to go through medical school and residencies for surgical specialties.  The limited amount of compensation for the work they do makes the debt burden of training too heavy.  Instead, more doctors stop at the general practice level, leaving artificial shortages in the specialties.  Others move overseas to nations without single-payer systems in order to ply their trade for a proper level of compensation.

If we want to create shortages of medical services here in the US, single-payer care is the way to go.  The red tape of Medicare and Medicaid is already creating such shortages among those patients the system is designed to help.


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Comment pages: 1 2

Try reading, Seven Seas, and you’ll actually learn what’s going on in medicine. But if ignorance is your cup of tea, keep sipping.

inmypajamas on April 18, 2009 at 3:32 PM

I accepted Medicaid for about 2 months of my practice. Even thought the reimbursement was substantially lower than my stingiest insurance, I figured it would allow me to treat kids that needed it and at least cover my staff costs. How wrong I was. They denied procedures all the time, delayed billing ( I didn’t get paid for up to 8 months post-op) and were a pain in the ass generally. The support was rude and clueless. Now insurance companies suck too, but Medicaid was like dealing with Nazi nurse Wratched. So I dropped out and now just see poor kids for free. No way in the world I will ever deal with a Government controlled care system again. Ever.

drballard on April 18, 2009 at 12:49 PM

Sorry guys but if you treat a Medicare enrolled patient and do not bill Medicare for the visit you are breaking the law.

OkieDoc on April 18, 2009 at 1:31 PM

So does what OkieDoc say apply to not charging medicare patients anything at all, like what drballard does? Because I’m hoping to become a doctor and I was going to do what drballard does, treat some poor people for free, but if what okiedoc says applies, would that be illegal? Is it just something you do totally off the books and nobody is any wiser?

AdrianG on April 18, 2009 at 3:32 PM

inmypajamas on April 18, 2009 at 3:32 PM

nothing to do with medicine, or even this particular article. it was just full of recycled talking points.

it’s not like i don’t agree with his premise. i do. i just like to read something entertaining.

Seven Seas on April 18, 2009 at 3:36 PM

OkieDoc on April 18, 2009 at 1:31 PM

Free country?

Johan Klaus on April 18, 2009 at 3:56 PM

As more and more doctors opt out of gov’t health plans, the gov’t will begin prohibiting the issuance of licenses to anyone not accepting government health plans.

This will be the death of healthcare in the usa. Veterinarians will end up providing better care than what’s left working under government regime “health care”.

Spiritk9 on April 18, 2009 at 4:07 PM

I have 3 neices and 1 nephew either in or recently graduated from med school. Of the four only one is actually planning on providing patient service and he will probably stop at the general internist level. The other 3 intend to go into research due to things like the malpractice insurance/govt meddling/etc.

katiejane on April 18, 2009 at 4:17 PM

Britain has a two-tier system, where those who don’t want to deal with the NHS can get private care.

Tzetzes on April 18, 2009 at 4:21 PM

katiejane, when all the research dollars are coming from the govt your kids will spend so many hours seeing patients whether they want to or not.

SDN on April 18, 2009 at 5:18 PM

The post mentions Medicare and Medicaid, but there is another big government insurer-Tricare. It covers the military and it’s dependents (if they don’t have access to on base care) and military retirees and their spouses.
Tricare pays the same rates as Medicare, which is often way below Usual and Customary.

thuljunior on April 18, 2009 at 5:39 PM

If we want to create shortages of medical services here in the US, single-payer care is the way to go. The red tape of Medicare and Medicaid is already creating such shortages among those patients the system is designed to help.

Hells Bells Captain, that’s pretty much the whole (unstated) point of nationalized health care in the first place. Why are you surprised? The point is to ration health care. One way of doing that is to explicitly refuse to pay for various tests and treatments. But, another is to just make it plain hard for patients to get in to see a doctor. That’s something that the HMOs have done for many years by refusing to allow certain competent physicians on their panels even though those physicians would have been happy to accept the level of reimbursement the HMO was offering.

This is a disaster waiting to happen. Americans are not going to tolerate the kind of system they have in Canada or the UK. Too bad most of them won’t have a choice. I don’t think the Democratic Party has any idea how much damage nationalizing health care is going to do to them. The GOP better have the balls to step aside and make this a Democratic issue.

eyedoc on April 18, 2009 at 5:46 PM

I have 3 neices and 1 nephew either in or recently graduated from med school. Of the four only one is actually planning on providing patient service and he will probably stop at the general internist level. The other 3 intend to go into research due to things like the malpractice insurance/govt meddling/etc.

There will be increasingly less and less government money available for medical research, especially with the massive federal budget deficits we’re going to have because of Obama’s idiotic economic policies. And, money from the pharmaceutical companies is going to dry up as reimbursements for medications continue to fall (especially if we go to a socialized system). The drug companies make very little money in Canada, Britain etc. because of price controls, and they will have much less money available to fund research. Academic medicine is already dying a slow painful death, and Obama is going to speed up the process.

eyedoc on April 18, 2009 at 5:57 PM

eyedoc on April 18, 2009 at 5:57 PM

I think they may realize that but figure research is still the better option as of now. The one that has finished all her schooling/training is currently working for a pharmaceutical company and only deals with figures/rats & computers. While I love her, IMO she is better off there due to her temperment, a little too OCD for my doctor.

katiejane on April 18, 2009 at 6:09 PM

Yep … I agree with the conclusions of this since I’m a military retiree and I have TRICARE. Now … I pay for that … but it’s government insurance and my choice of providers is WAY limited because of it. Conversely, my wife (who’s also covered by Tricare – but she also purchases her company’s med plan) – has A LOT of choices.

Another thing not mentioned is – well, it seems all the doctors in places like the UK and Canada are foreigners. Lots of Indians and Asians. I’m not slighting those guys – but they ARE working for less than native doctors would. This is what happens when you make doctors government employees. The government doesn’t pay enough and you will end up importing the employees.

HondaV65 on April 18, 2009 at 6:22 PM

If we can get more good people into congress, that could make a big difference. And the more we get people to wake up, and to stop falling for the silly lies that those who seek to control us tell, the greater the momentum will be.

Peggy Snow Cahill on April 18, 2009 at 2:49 PM

I found this website today that may provide some good info on where we go from here and how we get there:

http://aftertheteaparty.com/

koz on April 18, 2009 at 6:53 PM

We need a whole sale flushing of Congress…and the White House.

GarandFan on April 18, 2009 at 7:21 PM

AdrianG on April 18, 2009 at 3:32 PM

Think DrB was discussing Medicaid patients.
I saw exactly one MA pt early in my career and said, “Enough”.
So for a long time I have done school physicals for free.
I also see recent vets free, too, but only through personal contact or direct consult with another Doc.
This is usually when a long term treatment plan is the only way to “get back to normal”-whatever that is.
Single visits and shorter plans are cash, baby.
I do see families at a reduced fee as well, and yes I know this could spell trouble as one is not supposed to have separate fee schedules.
But, here is where the revenue hungry missing links can kiss my ass.
If they can dictate fee schedules, along with every other entity out there, so can I.
Like I said, don’t get me started.

OkieDoc on April 18, 2009 at 7:43 PM

OkieDoc on April 18, 2009 at 7:43 PM

Thank you! And I’m from Canada, so as far as government healthcare goes, don’t get me started, either!

AdrianG on April 18, 2009 at 7:53 PM

FYI, Dental is NOT covered in Canada…(at least not in Ontario). Unless you are covered by your employer plan, you either pay out of pocket or purchase separate insurance.

pcbedamned on April 18, 2009 at 7:54 PM

There is a critical shortage of primary care physicians in Canada, as well as the US. Why? Because the government of Canada funds far too many specialty residencies (at least too many for the positions they are willing to fund in practice). It works out well for us in the United States, they usually wind up practicing here and are well trained (at Canada’s expense. Thanks!).

I don’t have the option of going Galt, at least not without giving up my specialty (Emergency Medicine). Thanks to a federal unfunded mandate called EMTALA I have to give my work away, even if there is NO chance I’ll ever be paid for it. I should have gone to law school: There, the losing side in an argument usually doesn’t get sued for malpractice, there are no federal controls over billing, billing is by the hour instead of piecework, and it didn’t require 7 years of graduate education.

HBowmanMD on April 18, 2009 at 8:01 PM

I don’t want to derail the comments to reply to those who had responded to my (admittedly already offtopic) post, but I want to thank TheMightyMonarch and catlady for their thoughtful responses.

It’s through intelligent discourses that challenge thought and change minds. I am more than willing to admit that maybe I’m wrong on my stance. (I’m not saying that I’ve changed positions, but those arguments are filed in my “Consider This” section in the back of my mind.)

Having spent, now, more than 2/3rd of my life in and out of hospitals (and, no, I’m not 12), I’m not one to quickly dismiss a doctor’s opinion. Nor am I fan of a government agency tying that doctor’s hands. That’s it. That’s my opposition. I fear government, for I know that, if you give government an inch, they’ll take a mile. Forcefully.

But now I’m digressing back to my original post, so I’ll cut myself there. Thank you two again.

Oh, and the real real reason: at least I’m not getalife arguing how necessary Universal Health Care is…

CatsGodot on April 18, 2009 at 8:04 PM

This scenario is not academic. The health systems in Canada and the UK have shortages of doctors, especially specialists like dentists, transplant surgeons, and the like, which is why it takes months to get testing and diagnosis even for serious illnesses.

Well yeah. But part of that shortage is due to Canadian doctors heading south where the pay is higher. If America goes single payer, where will doctors run to? Answer: they’ll stick around as there is no place else to go.

So for at least the first 10-20 years after Obamacare starts, there won’t be a shortage of doctors. But once today’s doctors start retiring, not many people will want to spend 10 years in medical school, internships, etc to work for the low pay.

angryed on April 18, 2009 at 8:07 PM

One, you’re not a Conservative. Two, if you can’t do the time, don’t do the crime. Three….uh, genius, the aborted baby is part of your family. Four….what are you, 12?

xblade on April 18, 2009 at 2:40 PM

Who the hell are you to say who is and isn’t a Conservative. It is getting pretty lame, accusing anyone who does not agree with ‘hard-right’ principles of being either a RINO, or a non-conservative. I too am a Conservative who is Pro-Choice. As far as I am concerned, it is between the person and their God; my God tells me not to judge, lest ye be judged. Telling people that they can’t ‘belong to your little Conservative Club’ if they don’t agree is childish and asinine. The Right needs all the voters it can get if it hopes to be in power again. And that means you need the Independents, RINO’s,, Reagan Democrats, etc. There is saying my mother was always very fond of: Don’t cut off your nose to spite your face. Think on it, if you are capable of independent thought.

pcbedamned on April 18, 2009 at 8:26 PM

My sister is a cancer doctor. We once figured out that Medicaid paid her $7 per hour for the time she spends with a cancer patient (she nukes them). That was several years ago. The reimbursements are less and slower, so now the government expects my sister to work for less than minimum wage to treat someone with a life or death illness. That just offends me. My sister came from a poor family, got no help to get through school, and paid off an enormous school loan debt. Then to add insult to injury, she is considered “rich”, so the “spread the wealth” Dems have eliminated her personal deductions and personal exemptions. So she doesn’t even have “equal” status in the tax code as her medicaid patients. In fact, with tax credits, the government is actually TAKING my sister’s medicaid reimbursement money and giving it to her medicaid patients in the form of a low income tax credit. This is just too evil for words.

karenhasfreedom on April 18, 2009 at 8:46 PM

Oh, I forgot to add, my sister is a flaming, pro choice liberal Democrat who voted for the dirtbags who are screwing her. Go figure. LOL

karenhasfreedom on April 18, 2009 at 8:48 PM

It’s not just that doctors stop seeing Medicare patients. Sometimes, hospitals stop doing procedures which Medicare will not reimburse them for.

I remember when the hospital I worked for stopped doing cataract surgery because we had so many Medicare patients, and the reimbursement didn’t begin to cover the expense. So we stopped doing them.

I believe we are doing them again now, but it’s because we now have a smaller percentage of Medicare patients.

didymus on April 18, 2009 at 8:53 PM

The “Doctor” in the photo is looking at the chest x-ray backwards. Government doctor, I guess.

bofh on April 18, 2009 at 9:13 PM

Why work hard and become a doctor if you’re reduced to a poorly paid civil servant? You’ll get a to a point where the only fiscally viable solution is to import foreign doctors whose training costs can afford them to participate in these state run systems. The greatest force for reducing prescription costs? Walmart. The solution is Health Savings Accounts and genuine competition in the Health Insurance business.

Stickeehands on April 18, 2009 at 9:14 PM

I know one doctor who’s quit taking payment from insurance programs, and quit carrying malpractice insurance. He’s transferred his assets to his wife’s name in an attempt to render himself “judgment proof”. (He has a notice at the front desk warning all comers of this. Those who object are welcome to take their business elsewhere.) But his charges are quite low, since he doesn’t have to split them with a malpractice insurance provider.

Whether this is effective or not … I’m not prepared to say. It hasn’t been tested yet. But in a big way, he’s definitely dropped out of the system.

karl_lembke on April 18, 2009 at 9:14 PM

Britain has a two-tier system, where those who don’t want to deal with the NHS can get private care.

Tzetzes on April 18, 2009 at 4:21 PM

However, as is the case with Australia, you must pay TWICE!

OldEnglish on April 18, 2009 at 9:17 PM

I am the head of a Nuclear Medicine department here in East Texas. We recently stopped doing Octreotide studies, a cancer and infection-seeking test we had offered for more than 19 years because our cost for the procedure was about $1500.00 and our reimbursements were south of $700.00. Even with the hospital donating all services, we were losing money on the Indium 111 radioactive dose.

After losing tens of thousands of dollars in 2008 on this procedure, I was informed that we no longer offered this service. Now my patients are referred to a facility 60 miles away, a difficult and uncomfortable drive if you are sick and miserable.

I don’t blame my hospital; we are laying off and cutting costs just to stay viable in our network. We know who is to blame; Medicare and Medicaid reimbursement.

Texan on April 18, 2009 at 9:55 PM

Oh, I forgot to add, my sister is a flaming, pro choice liberal Democrat who voted for the dirtbags who are screwing her. Go figure. LOL

Meet ‘em everyday.

Lib: “My 401(k) is disappearing!”

Me: “Ummmmm, you voted for Obama. He’s spreading your wealth.”

Lib: “Shut up.”

Heh.

ex-Democrat on April 18, 2009 at 10:56 PM

I suspect that once the administration starts their version of government run healthcare, there will be an executive order making any healthcare license issuances subject to a pre-requisite PLA (Project Labor Agreement). This may be at the Facility level, wherein anyone who practices at any facility has to be a member of “The Union”. Or where in order to just hold a license you have to be a member of the union.

The union will make their members take Medicare.

These PLA executive orders are the model for how to control the workers. All the so called “stimulus” money that is supposed to go for any sort of construction, now by executive order, only goes to the 16% of construction companies that are union run.

There is a lot of talk out there about “forgiving” student loans – will the new grads trade liberty for prosperity?

batterup on April 18, 2009 at 11:06 PM

Oh, I forgot to add, my sister is a flaming, pro choice liberal Democrat who voted for the dirtbags who are screwing her. Go figure. LOL

Meet ‘em everyday.

Lib: “My 401(k) is disappearing!”

Me: “Ummmmm, you voted for Obama. He’s spreading your wealth.”

Lib: “Shut up.”

Heh.

ex-Democrat on April 18, 2009 at 10:56 PM

Instead of “shut up”, I hear a twisted fictional tale about how it’s still all G.W.’s fault. The left wingnuts just can’t admit they are wrong, and will never admit that they really screwed themselves big this time.

Spiritk9 on April 18, 2009 at 11:07 PM

This thread has been very enlightening! It won’t be long now until I am supposed to enroll in Medicaire. My company with whom I’ve had insurance up to now will no longer provide primary health insurance, only secondary after Medicaire. So what is a person to do to get good healthcare? Find independent insurance and disavow Medicaire? Or are we just stuck?

Christian Conservative on April 18, 2009 at 1:39 PM

My wife has Medicare primary and GM insurance secondary (for the time being anyway). Medicare pays pennies on the dollar, BCBS pays what they pay. The medical practitioners all have contracts with BCBS to accept what they pay as full payment. I don’t know how doctors and hospitals can possibly cover their costs with what they are paid.

My wife does pay a little copay, something like $17 for a $90 office call.

FWIW, I only have her BCBS and had MAJOR medical bills last year and it didn’t bankrupt us. On the down side, her health benefits are part of the reason GM is circling the drain.

darwin-t on April 18, 2009 at 11:11 PM

Largest Employer in the USA? The Healthcare Industry! Oh, and produces 17% of our gross domestic product!!!!

Did anyone think this is about poor people not having medical insurance? No one is concerned that poor people don’t have homeowner/rental/auto insurance.

This is about control. About Money!!

Cost, not care, will be the rule of socialized healthcare. Hidden in the Stimulus Bill calls for a Federal Coordinating Council for Comparative Effectiveness Research (190-192). Our seniors will be hardest hit as treatments for younger patients are more likely to be approved.

BTW, Canada has a term called “Medical Tourism” due to the many patients traveling to the US for treatments instead of enduring long waits (months) for tests….

(bloomberg.com 02.09.2009 – Ruin Your Heath With the Obama Stimulus Plan)

TN Mom on April 18, 2009 at 11:38 PM

If one is serious about providing care for those in need, just make the unreimbursed cost of charity care tax deductible for the providers of that care. This provides a check and balance against underfunded taxpayer care. It also would get providers, many who provide little to no Medicaid/SCHIP/Medicare falling over each other to provide charity care under their terms, without the hassles of taxpayer red tape welfare care, for the freedom from taxes and red tape it would provide.

My clinic currently provides about 30k/yr of Medicaid care to existing patients, which is likely to continue as some folks just tend to move in and out of insurance due to jobs and they tend to market to others who can pay. We don’t take new Medicaid/SCHIP patients, and ration the number of Medicaid/SCHIP appointments available in a time period. Medicare doesn’t do dental…

Also, as one of the few dental clinics with an online fee schedule, there hasn’t really been much of a slow down. We do see more and more NEW cost conscious patients who’ve mentioned visiting our web site. We also offer CareCredit for patients with good credit, but no insurance, to help them pay for care. For dental care, the marketplace works just fine, if the clowns in government would just get out of the way and promote it work at it’s max.

FYI, if dOhbama’s and the Dem’s tax increase looks to include me, I’ll probably take a few more weeks of vacation each year. It’s either that or raise fees a bunch and I sort of like time off better… If forced to accept dOhbama fees and patients, expect rationing to get worse, and vacation time to increase… Whatever it takes to keep me happy providing quality care.

droofus on April 19, 2009 at 12:54 AM

Another thing not mentioned is – well, it seems all the doctors in places like the UK and Canada are foreigners. Lots of Indians and Asians. I’m not slighting those guys – but they ARE working for less than native doctors would. This is what happens when you make doctors government employees. The government doesn’t pay enough and you will end up importing the employees.

HondaV65 on April 18, 2009 at 6:22 PM

That’s increasingly the case here as well, at least where I live in Arkansas, and for all intents and purposes, it’s giving us a taste of what we’re in for if these loons in Washington are successful in nationalizing health care. We are already suffering a shortage of qualified doctors in my area. When my 93-year-old grandmother came to live with me a few years ago, it took over six months to find a PCP who would see her, irrespective of the fact that she carries supplemental insurance from BCBS. The reason? No one was taking new Medicare patients. And the reason for that, of course, is that Medicare nickels and dimes these doctors to death. When my mother was sick, before they even diagnosed her with cancer, she had to wait months to see a pulmonary specialist, despite being a lifelong smoker and having shortness of breath. I can’t say whether that had to do with the fact that she was a Medicare beneficiary or not, but it wouldn’t surprise me. I’ve seen what BCBS pays out on my own private-pay plan and it’s bad enough (in fact, the clinic I go to where most of the town’s doctors practice dropped BCBS for a time, ostensibly because of their meager reimbursements) so I can only imagine how little they get reimbursed from Medicare and Medicaid. It doesn’t take a rocket scientist to figure out this will only get worse when we’re ALL covered under the same plan. With only so much money to go around and 300 million people looking for care (many of whom will do so rather indiscriminately), it is inevitable that there will be rationing. For all the left’s complaining about how evil HMOs were to deny treatment to people back in the early 90s, it sure is puzzling that they would endorse a government-funded system that is bound to make HMOs look like a model of efficiency.

Once again I argue that the way to control costs is to take the subsidies out of the equation altogether, whether they be provided by Medicare or Medicaid, or private-pay insurance. If we had no option but to pay for health insurance out of pocket, by way of an HSA for instance, then the costs of providing such care would inevitably go down. Doctors and hospitals would be forced to find more efficient ways of treating people because if they did not, patients would shop around until they found a provider who did. Will this result in substandard care in some instances? I suppose it might, but I see no reason that the principles of capitalism wouldn’t apply to health care just as they do to other industries. I invite the doctors in the thread to correct me if I’m wrong in my thinking.

NoLeftTurn on April 19, 2009 at 12:55 AM

I briefly flirted with the idea of opening an insurance agency to take advantage of the aging demographics, but quickly found I would starve to death. I was with a commission only company that had really fantastic medicare supplement insurance and a really good long term care plan. However, I could not find Seniors just turning 65 where pre-existing conditions don’t matter (there is a 6 month window on either end of the 65th birthday that precludes underwriing qualifications for first time medicare beneficiaries at 65). At the time, the WW2 babies were just starting to turn 65, so there aren’t that many of them, compared to the boomers that were born a few years later.

But what I did learn was those supplement policies can be fantastic. However, they didn’t teach us in insurance class that the problem would be for the customers to find the primary doctors who took medicare, which is the primary insurance. So in a way, it makes it kind of funny to get a great secondary policy, but if you can’t find a care giver, it is kind of pointless. So there is a future mess brewing as more of the boomers begin to hit that magic 65 age in 2011 (first year a boomer hits 65).

Another thing I did learn was about long term care. Those who had the money to buy it, could not qualify to get it medically (speaking in generalities), and those who could qualify to get it, either could not afford it or didn’t want to spend the money on it. Thus, I starved and quit after a few weeks of trying this massive career shift back in 2006. This is another thing that is going to bankrupt our country, which is already bankrupt. As more boomers age, and “spend down” in a nursing home, then there is more public money that will be sucked dry in nursing home care.

We have a HUGE social security pension demographic time bomb coupled with the medicare time bomb, coupled with the care for the aged after they spend all their meager resources time bomb, and we have these idiots in Congress worried about global warming and cap and trade, etc. AUGH!!

karenhasfreedom on April 19, 2009 at 1:04 AM

Shorter version: Lawyers hate Doctors

rhodeymark on April 19, 2009 at 8:17 AM

nce again I argue that the way to control costs is to take the subsidies out of the equation altogether, whether they be provided by Medicare or Medicaid, or private-pay insurance. If we had no option but to pay for health insurance out of pocket, by way of an HSA for instance, then the costs of providing such care would inevitably go down.

I would say go even further, although you are certainly on the right track. At the beginning of our nation, when we were nothing but a group of poor immigrants, we had the best health in the world. Better than those in Europe. Part of it is was that you had to pay out of pocket and the other part was that if you wanted to see a Witch doctor you could. True free market was at work there. If that witch doctor was getting better results than the over-educated hack down the street you could go to him.

Noelie on April 19, 2009 at 9:08 AM

FYI, Dental is NOT covered in Canada…(at least not in Ontario). Unless you are covered by your employer plan, you either pay out of pocket or purchase separate insurance.

pcbedamned on April 18, 2009 at 7:54 PM

This is the case in Norway also – I visit there often and all my friends there constantly complain that the government isn’t providing them dental insurance too.

It’s funny … the discussions I have with them. Curiously – it appears that European governments keep nationalized Health Care by “scaring” their populations that the alternative is an American system where people die because they don’t have medical insurance.

One of my Norwegian friends told me “I like the fact that if I get run over at a traffic crossing – and i don’t have ID – I will be picked up and taken to a hospital and treated … which is a measure of security you Americans don’t have,”

LOL … I told him there was a FEDERAL LAW that said you had to be treated in such a case.

He looked at me dumbfounded.

The fact is … Europeans are just as ignorant of us as we are of they. But I have seen both systems … and ours is superior – there are more choices. We can fix some problems sure – but we don’t need National Health Care.

By the way … my Norwegian friends who are considered “lower middle class” … pay 40 percent of their income to federal taxes.

Sexy huh?

HondaV65 on April 19, 2009 at 9:20 AM

And by the way – the only reason the Democrats want National Health care is to give it to 30 plus million illegal aliens so that they vote Democrat after they give them amnesty.

It’s the only reason. Next time a Democrat starts talking about the need for National Health Care – tell him … “Okay sure – but illegal aliens won’t get it right?”

Watch ‘em change the subject real fast.

FACT: When National Health Care comes – it’s going to the illegal aliens in this country. People who don’t contribute a cent to the Federal Tax base. Sure they pay taxes – when they buy a pack of cigarettes – but that’s it.

HondaV65 on April 19, 2009 at 9:24 AM

I see a future where large companies set-up in house medical facilities.

izoneguy on April 18, 2009 at 2:39 PM

It’s interesting you should mention that. My company still has a full-time nurse, and basic medical facilities. She can do a quick exam and write prescriptions, and I would guess that she covers 90% of my medical visits. Rather than pay $50-$100 for a doctor visit to cover small aches, pains, and sniffles, I visit the nurse, who either gives me advice for a recovery regimen, writes perscriptions for painkillers or antibiotics, or recommends a visit to the doctor if it may be more serious.

Since I wouldn’t take the time or expense to visit the doctor for most of these ailments, I get a much better standard of care than I would otherwise. The position of the company is that the nurse is there for industrial ailments, and the rest of the time, she helps keep the workforce health by providing that sort of care, and by running various “wellness” programs for the employees.

HammerToss on April 19, 2009 at 11:02 AM

Sorry guys but if you treat a Medicare enrolled patient and do not bill Medicare for the visit you are breaking the law.

OkieDoc on April 18, 2009 at 1:31 PM

If you run a cash-only practice, and never ask the patient about their insurance status, does this still hold?

unclesmrgol on April 19, 2009 at 11:20 AM

FACT: When National Health Care comes – it’s going to the illegal aliens in this country. People who don’t contribute a cent to the Federal Tax base. Sure they pay taxes – when they buy a pack of cigarettes – but that’s it.

HondaV65 on April 19, 2009 at 9:24 AM

I hate to defend illegals in any way. But I must in this instance.

Illegals wouldn’t pay taxes even if they were paid legally. That’s because they make too little, usually, to have a federal tax liability. The dirty little secret of the tax code is 50% of people pay no income tax at all. Of the 50% that pay anything, 10% pays 75% of the bill. Which means that about 80-90% of the public pays jack shit in taxes and yet expects the world in return.

So the FACT is really this: people who don’t make much money (including illegals) will get free health care. These same people pay nothing in federal taxes. The FREE healt hcare will be paid for by “the rich”. Yet these very same “rich” people who will pay the bills, won’t qualify for the programs, because they’re too rich.

And soon enough this will also apply to social security where “the rich” will start paying an ever higher % to the program, but receive nothing in return since again, we’re too rich and don’t need it.

angryed on April 19, 2009 at 11:21 AM

Ever listen to a Canadian rave about their health care system? Next time ask them how long it takes to get an MRI. They suddenly switch from adulation to depressed acceptance of the weaknesses in the system.

These dolts are like hermits who live in caves using candles for their only source of light and never see the sun. OF COURSE they are going to rave about their health care. The dumbasses don’t know any different!

csdeven on April 19, 2009 at 12:00 PM

unclesmrgol on April 19, 2009 at 11:20 AM

I guess if they never said, “Do you take MC?”, you might have an argument, specious as it is. Hell, there may be a requirement that you have to ask, don’t know on that.

Here are some other things to consider.
In 2006, the nations healthcare bill was $7K per person which was rung up by 10% of the populace.
Those 10% account for 60% of all healthcare costs.
State/local and Fed govts pay 47% of that $7K.
Who pays the rest? Who paid in the first place?

Also, @ angryed we see that the top *1% of all income earners take in about 18% of all income and pay out a (measely) 38.8% of all income taxes.
*This is somewhere north of $400K

“tax the rich, feed the poor, ’til there are no rich no more…” -TYA w/ A. Lee

OkieDoc on April 19, 2009 at 12:45 PM

From a Libtard POV, it’s very simple. If one is not a worker, then he is a burden on society. Of course they won’t come out and say it, but by rationing healthcare, they will ensure that the worker stays “healthy” while those at the end of their “useful” lives will be hastened along by withholding care.

Another key agenda is to ensure higher employment by using mandatory retirement to purge the older folks from the worker ranks. They really don’t care about “science, science, science, science”, since enabling longer lifespans defeats the purpose of reducing costs. Unless of course, it is the type of science that enhances the workers’ usefulness.

That said, there will be nothing but the best of care for the elites who are tasked with guiding the masses — think China and USSR.

AH_C on April 20, 2009 at 2:56 AM

Frankly, I don’t know why I’m bothering commenting on this post. I don’t think I’m going to change any minds, but I feel obliged to say something.

I’m from the UK, and the NHS has been good to me. That’s it. It’s looked after me when I need it, and it doesn’t cost the Earth in taxes. If I’m in difficult circumstances financially I still get treatment, and I don’t feel obliged to hang on to a job I don’t want because to move may mean a loss of healthcare benefits.

But I know this won’t make any difference. For some reason, conservatives get very, very passionate about national health care. It verges on irrationality. The system is effective: you can buy drugs more cheaply because the NHS buys in bulk, you don’t have to wait long for treatment unless you need a specialist, and then it only takes a few weeks before you’re seen. If you have an emergency you get treated immediately. And if at any time you want to get private health care, you’re free to do that, too. Oh, and if you do get private health care and it costs too much, the NHS will still treat you.

Incidentally, many people are of the view that private health care in the UK is better than the NHS. It isn’t. Private health practitioners treat the ‘easy’ cases, but they pass on their harder, more expensive patients to the NHS for treatment. If they botch an operation, they call an ambulance and send the patient to the NHS hospital. This is public knowledge, and the private companies do not deny it. So the emergencies almost always gets treated by the public sector, and the nice rooms and maid service is provided by the private.

There are many problems with the NHS, but if I reiterate them you will cling on to them like a liberal protesting the Iraq war. You have to be realistic. At the end of the day, public health care is the only efficient way to make sure that everyone gets treated safely, with no-one falling through the net. It works. Poeple use it every day, and its fine.

But like I said, you guys will not want to accomodate the point of view of someone who actually uses public health care. It does not figure into your ideology.

I accept you may have some good, rational reasons for rejecting national health care. But on balance, I favour being taken care of by the NHS. Does that make me weak? Does that mean that I do not have the balls to go out and do things for myself? Perhaps it does. Or perhaps it just means I’ve taken your criticism on board, weighed up the options, and made a choice. And my choice is for the NHS.

dcpolwarth on April 20, 2009 at 6:49 AM

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