Doctors prepare for Obamacare race to the bottom

posted at 8:31 am on October 19, 2013 by Jazz Shaw

Brought to you courtesy of the always intuitive Vodkapundit, Doctors in New York aren’t too sure about signing up the people who somehow make it through the failed internet maze of Obamacare to get on the government health insurance train.

New York doctors are feeling queasy about ObamaCare — and many won’t participate in the new national insurance program because they fear they’ll go broke, The Post has learned.

“ObamaCare is going to send me more patients to see and then cut the payments to provide the care — that’s what’s going to happen,” predicted Donald Moore, a primary-care doctor in Prospect Heights, Brooklyn. “I will not accept it.”

Moore claims that President Obama made a big mistake by requiring uninsured residents to obtain medical coverage from for-profit insurers through the ObamaCare health exchanges instead of through public health programs like Medicaid.

Under tremendous pressure to keep costs down and profits up, Moore said he’s concerned that commercial insurers will pay doctors less for patient visits and services than either Medicaid or Medicare.

Let’s be fair here… who could possibly have predicted this? A system which is now signing up a fair – if not large – number of high risk, high usage patients on programs where private providers are relying on a ton of healthy, low cost patients paying into the system. What could go wrong? I know you’re shocked, but these plans which are going to offer little to no cost offset to people of still fairly modest means (read: 40K of income or so) may find them willing to pay the initially small penalty and not participate. So the providers in question will rely on being compensated by private insurance companies who suddenly aren’t seeing the promised income boost. And that’s a formula for what?

Despite a much publicized rollout, many other doctors said they haven’t decided whether to become ObamaCare providers, because they haven’t been notified by insurers or the state about ­reimbursement rates.

“I have not spoken with anyone who has made a decision to participate in the exchanges. We simply don’t have any information about which we can make a decision,” said Dr. Paul Orloff, president of the New York County Medical Society.

“We have no idea what the reimbursements will be or what the claims-form process will entail.”

A few word from McQ:

Yes, the enthusiasm for the new system is, well, overwhelming, isn’t it? Of course they want to see the impact on the bottom line – they’re small business owners. Government is involved in price fixing and they’d like to see if they can live with the fixed price or not. If any other entity was involved in doing what the government is involved in here, they’d have been arrested.

But hey, when government decides it can make legal for itself what is illegal for you (consider the lottery, for instance) then you know you’re on the fast road to total decline. The sign posts are whipping by so fast, no one can even read them anymore.

When you stop and think about this for the umpteenth time, doctors are looking at a system which is relying on the cost model of a privately run, profit driven industry (the insurance part of it) to pay for something being driven by a not for profit government scheme. And when the government’s anticipated participation levels don’t materialize, either from a lack of interest in a bad deal or the fact that potential customers can’t even access the system, the profits for the insurers don’t show up on their bottom line. Do they suck up the loss or attempt to pass the cost on to the health care providers? That one should be obvious. And if the doctors, who are also private business owners in large part, can’t recoup their own costs to deliver their services, where does the plan go from there?

Let’s all put on our thinking caps and play the Jeopardy music.


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Now HILL60.. You are stating not only the obvious, yet the most common sense “back to basics” medicine. If only this were attainable, yet we have this “major medical” issue. How does one go about paying for surgeries, catastrophic injuries, cancers etc.. I know you will have an answer for me. I haven’t the slightest!

justonevictory on October 19, 2013 at 1:07 PM

astonerii on October 19, 2013 at 11:49 AM

There are no real craftsmen left. Makes me wonder if it would make a good Cable show: Jesse James making prosthetics. Maybe not.

Insurance companies make money by managing risk. That’s the point of actuary tables. I cost Blue Cross almost $500,000 before they found a way to drop me. I paid them about $80,000 over 7 years. They lost money in none of those years. Obviously, they get the money from people who don’t use medical services as much. I imagine mostly people who receive health insurance from their employers. I was on health net for 10 years, provided by Mattel, and never used it once.

danielreyes on October 19, 2013 at 1:09 PM

The reason doctors and other medical providers were able to overcharge for services for decades was precisely because of medicare, medicaid and the VA. With no checks and competition they asked for more and more and government paid. Private insurance was likewise forced to jack up rates and pay more or else be forced out of the market. Plus, the fact that the AMA still controls entry to medical practice. They were perfectly happy to rig the system when it suited them, but now they want my sympathy? Get lost.

legalimmigrant on October 19, 2013 at 1:09 PM

Doctors prepare for Obamacare race to the bottom

Proctologists, specifically?

KS Rex on October 19, 2013 at 1:14 PM

Love it..ammo accepted as payment, yet not too far from the truth. My pediatrician who died at the age of 101yrs. and was my mothers pediatrician, did actually live through the depression and accepted such things as…livestock, canned food etc.. as payment. He was a brilliant man who graduated from the Univ. of PA, yet was able to provide his Dr. services and feed the fam too. Talk about the old country doc!

justonevictory on October 19, 2013 at 1:16 PM

But hey, when government decides it can make legal for itself what is illegal for you (consider the lottery, for instance) then you know you’re on the fast road to total decline tyranny.

Fixed

bgibbs1000 on October 19, 2013 at 1:20 PM

Back in the 50′s when I was growing up, my parents paid the family doctor in cash. He made house calls and my mom would write him a check. The only insurance my parents had was major medical which covered hospitalization and used it when my sister’s and I had our tonsils out. This is what we need to go back to, not obozocare that covers hangnails and aroma therapy.

BeachBum on October 19, 2013 at 1:24 PM

BeachBum on October 19, 2013 at 1:24 PM

The policy I’m looking at covers acupuncture. I think that comes with aroma therapy.

danielreyes on October 19, 2013 at 1:33 PM

You got it BeachBum….Yet how do we go”BACK TO THE FUTURE”?

justonevictory on October 19, 2013 at 1:34 PM

Obamacare is doing more damage to social liberalism than any frontal assault by classical liberals, libertarians, or conservatives.

When you see your enemy damaging itself, stand aside.

The takers will eat their leaders.

islandman78 on October 19, 2013 at 1:47 PM

You got it BeachBum….Yet how do we go”BACK TO THE FUTURE”?

justonevictory on October 19, 2013 at 1:34 PM

Or “Forward to the Past”?
Wait, no, that sounds like what Obamacare already is.
Things get confusing when our politicians make things worse than they used to be.

Count to 10 on October 19, 2013 at 1:50 PM

In the 90′s during the run up to HillaryCare’s failure, I saw her give a speech to a group of medical students. During the Q&A, a young woman stood up and said that her life’s dream had been to practice a certain specialty (forgotten) and she was worried that the with the emphasis on GPs in the bill she might not get to do so. Her Highness stared at her with the standard stony expression and then said, and I paraphrase, in her usual warm and fuzzy way, that the student would have to sacrifice her dreams for the “common good”. Met with applause.

Hucklebuck on October 19, 2013 at 1:52 PM

I’m betting doctors will start to charge “sitting fees” if they can’t get insurance to reimburse enough to pay clinic expenses.

bwhittak on October 19, 2013 at 2:03 PM

The next natural step for ObamaCare communists is to only allow doctors to practice medicine only if they participate and follow ObamaCare to the letter.

In other words, the government will own your skills and services…it’s coming, no doubt. That’s the only way it can work…like environmental nuts, if you can’t get people to agree with you…legislate it, fine people, and eventually, arrest them.

Get ready for the doctor underground…..As one walks past a dark alley way: “Psssst, Hey! you want some good medical care? I can get you in to see me in less than a two days. Cash.”

mcra99 on October 19, 2013 at 2:27 PM

The reason doctors and other medical providers were able to overcharge for services for decades was precisely because of medicare, medicaid and the VA. With no checks and competition they asked for more and more and government paid. Private insurance was likewise forced to jack up rates and pay more or else be forced out of the market. Plus, the fact that the AMA still controls entry to medical practice. They were perfectly happy to rig the system when it suited them, but now they want my sympathy? Get lost.

legalimmigrant on October 19, 2013 at 1:09 PM

Shush now, can’t let folks know the truth about the other reasons our healthcare system sucks. Why do people think we have run away costs already? Duh, government involvement in the market and cartel like rules. Don’t talk about the healthcare industry’s gov protected monopolies. Things that would get people arrested in other industries. Can you say price fixing? No importation/re-importation of drugs that are cheaper over the border etc..

Sort of like reminding those oh so civic minded doctors who promote banning guns because they’ve seen too many kids shot in their ER’s. Uh, so doc, how many people died to medical malpractice last year? How many to just honest mistakes? Far more than guns you say? Who woulda thought. We must reduce malpractice lawsuits! Sure, no problem but make it an actual competitive industry that doesn’t screw over the customer and I’ll start to care. That usually means getting the government out of the way for the most part.

I had a democrat gal running for state rep in my district last year knocking on doors. We talked about healthcare. Her rebuttal to my criticisms (cost, principles etc.) of obamacare/socialized medicine was “but the gov has done so well with medicare etc. for the last 40 years!”. I just rolled my eyes at that point. You should have seen her when I compared abortion rights to healthcare rights aka “my body, my choice”. It was like, “huh, what? Durrrr.” But she was a life long resident of the valley, and an engineer of some sort in construction or electronics.

Then again I remember arguing with people back in 2009 who thought that doctors/nurses/care providers etc. really should be slaves to the “people” and work in a command economy for the better of the “many”. All while they had every right to work harder and get promotions based on their performance at Starbucks or the Widget Company. You can’t reason with these people.

This is one reason why the whole shutdown debate was/is silly. All we have left is principles to fight for. Fighting over the scraps to maybe win CONgress next year is more of the same stuff, different day.

But hey, I’m just some wacko bird independent voter who started waking up almost 10 years ago now.

oryguncon on October 19, 2013 at 3:00 PM

Obamacare was designed by liberals to lead into Single-Payer, but designing a system to fail slowly is a very difficult task, which is clearly beyond their abilities. By collapsing this fast they’ve lowered their chances of going to Single Payer anytime soon. Because, after this roll-out, who would ever trust these people to handle a program 10 times as difficult? Certainly not a Republican House.

Fred 2 on October 19, 2013 at 3:02 PM

Oryguncon, doctors aren’t getting rich from Medicare. If I hired a newly trained anesthesiologist and they did nothing but Medicare cases, I would not be able to cover their salary and benefits. Look at this analysis of Medicare pay from a few years ago:

http://www.americanthinker.com/blog/2010/04/what_obamacare_will_cost_docto.html

misterdregs on October 19, 2013 at 3:14 PM

Sorry orygoncon, my comments were meant to address the post that you quoted. Government-paid reimbursement has NEVER been more than private insurance. And VA docs are salaried employees and don’t send the VA a bill for their services.

legalimmigrant has no idea what he is talking about.

misterdregs on October 19, 2013 at 4:04 PM

Doctors are IDIOTS for not openly opposing this during it’s inception.

TX-96 on October 19, 2013 at 4:25 PM

Sorry orygoncon, my comments were meant to address the post that you quoted. Government-paid reimbursement has NEVER been more than private insurance. And VA docs are salaried employees and don’t send the VA a bill for their services.

legalimmigrant has no idea what he is talking about.

misterdregs on October 19, 2013 at 4:04 PM

No problem, I get what your are saying. I think doctors have benefitted from the system in the past to a degree but clearly do not now. My late mother worked for an insurance company in customer service. One thing she told me that stuck with me was that, for medicare the government demands that providers be paid by insurers within 30 days of a bill being submitted. The gov gave itself 60 or 90 days to pay the insurance companies.

I agree TX-96, it boggles the mind.

oryguncon on October 19, 2013 at 4:49 PM

There are no real craftsmen left. Makes me wonder if it would make a good Cable show: Jesse James making prosthetics. Maybe not.

Insurance companies make money by managing risk. That’s the point of actuary tables. I cost Blue Cross almost $500,000 before they found a way to drop me. I paid them about $80,000 over 7 years. They lost money in none of those years. Obviously, they get the money from people who don’t use medical services as much. I imagine mostly people who receive health insurance from their employers. I was on health net for 10 years, provided by Mattel, and never used it once.

danielreyes on October 19, 2013 at 1:09 PM

How did they drop you? That is not insurance if they find false reasons to drop people.

astonerii on October 19, 2013 at 5:13 PM

TX-96, the majority of physicians DID oppose Obamacare. You likely think that the support of the AMA indicated the opinions of most physicians, but a rather small minority of doctors belong to the AMA.

The AMA doesn’t represent American medicine any more than the AARP represents most seniors. And like the AARP, the AMA exists in no small part to sell products (life and disability insurance and the manuals required to code medical claims).

misterdregs on October 19, 2013 at 5:16 PM

“Meanwhile, contrary to those doctors selected to legitimize ObamaCare in the staged media event (where the White House actually handed out white lab coats to generate the image of official credibility), an overwhelming 70 percent of doctors said, even back in 2011, that they disagreed with the AMA’s position on health reform, while only 13 percent agreed with it. In fact, almost half of doctors in that survey even went so far as to say that the AMA stance on ObamaCare was the factor causing them to drop AMA membership.”

http://www.forbes.com/sites/scottatlas/2012/10/11/what-do-actual-doctors-think-about-obamacare-now/

misterdregs on October 19, 2013 at 5:26 PM

I will say it again, Obamacare was purposely designed to fail. When the doctors stop taking the ACA, and when the healthy start paying the fines instead of buying the ridiculous insurance, there will be one insurer of last resort, the government, and voila! that is how
you get to single payer. I am expecting the government to announce any day now that it has no choice but to start offering its own plan on the Exchanges.

paulsur on October 19, 2013 at 5:42 PM

TX-96, the majority of physicians DID oppose Obamacare. You likely think that the support of the AMA indicated the opinions of most physicians, but a rather small minority of doctors belong to the AMA.

The AMA doesn’t represent American medicine any more than the AARP represents most seniors. And like the AARP, the AMA exists in no small part to sell products (life and disability insurance and the manuals required to code medical claims).

misterdregs on October 19, 2013 at 5:16 PM

I quit the ACP over their support for Obamacare.
I stayed in the ACC whose support was lukewarm (ie they were afraid to speak out too loudly against it because they were sure it would go through and didn’t want to lose favor). I think docs only join the AMA to get their life insurance/disability insurance products. They just stopped publishing their newletter last month after many decades, but still publish JAMA.

Now is a very bad time to go to medical school. As total outlays are ratcheted down, provider salaries will come down, physician’s assistants and nurse practitioners will be treated more and more as physician equals as care becomes more regimented-you already have to follow a clinical pathway for a lot of conditions or your malpractice insurer won’t cover you. If a computer is telling you what tests and treatments you have to order, why spend 7 years and $250,000 plus to become an MD when it takes much less time and money to be a NP or PA and do almost the same thing and make almost as much? Those of us who have been out a while and paid off our loans will be fine, but I feel really bad for people partway through the pipeline-they’re screwed.

talkingpoints on October 19, 2013 at 5:46 PM

The next step is when they pass the law to force Doctors to take these patients. Don’t say it won’t happen; Obamacare should have never happened.

Theophile on October 19, 2013 at 5:53 PM

astonerii on October 19, 2013 at 5:13 PM

They claimed I was a day late on a payment. This is anthem blue cross and the policy has no grace period plus you can’t make payments in advance, so you wind up with a payment window.

I was not late, I think they held the check, but they canceled and when I complained to the California oversight commission I got crickets. Complete black hole.

Now I mail insurance checks with tracking and signed receipts. Of course now my checks go to the USDA (figure that one out) and that’s another black hole.

danielreyes on October 19, 2013 at 6:18 PM

legalimmigrant on October 19, 2013 at 1:09 PM

Every single sentence of your post is wrong.

Medicaid/medicare has never paid well, it’s a volume proposition at best, and often a loss per visit. Furthermore both of those plans are the biggest deniers of care. They also take the longest to reimburse and are often so wrought with errors and resubmissions that it costs a provider more to pay the staff than the reimbursement. Medicaid patients are also well know to be extremely non-compliant, demanding & lawsuit happy.

The VA employ their own medical staff – MA, CNA, LVN, RN, NP, PA and MD’s. They are the largest employer of PA’s – that is likely who you are seeing in a VA system.

The AMA does not control entry into practice and less then 17% of MD’s are a part of the AMA. The AMA controls the ICD-10 system and if you want to use it for reimbursement you have to pay the AMA for the copyright. Everyone has to use the ICD system for any reimbursement so everyone pays. It makes the AMA a good chunk of change every year.

batterup on October 19, 2013 at 6:27 PM

talkingpoints, for the first time in my career (26 years in practice) I would not recommend going into medical school, especially going to a private school and taking on a couple of hundred thousand in debt. The ROI doesn’t make sense given that you’re at least 30 years old before you get your first real paycheck.

misterdregs on October 19, 2013 at 6:29 PM

“Every single sentence of your post is wrong.”

Well put.

misterdregs on October 19, 2013 at 6:32 PM

Doctor Martin Sheen in the top photo seems upset.

Sherman1864 on October 19, 2013 at 6:46 PM

I know you’re shocked, but these plans which are going to offer little to no cost offset to people of still fairly modest means (read: 40K of income or so) may find them willing to pay the initially small penalty and not participate.

This quote is a gross distortion of a sentence.

williampeck1958 on October 19, 2013 at 7:00 PM

As far as insurance companies go, I would think they would err on the high (cautious) side — assume people will generally act rationally, not as politics wants them to act — and price their product accordingly. It would be easier to reduce premiums if the political assumptions do pan out rather than raise premiums if they don’t.

Russ808 on October 20, 2013 at 12:55 AM

danielreyes on October 19, 2013 at 6:18 PM

That is pretty disgusting business practices.
Should be like mortgages, 15 day grace period. With a interest charge that is reasonable. Mortgages automatically accrue that interest, but an insurance premium would need to be a separate charge.

I thought California was all about taking care of the little guy against those big mean companies!.

Hope things go well for you! I saw how losing a leg affected my grandfather’s ability to do as he pleased. But he worked through it and continued to work at his shop. He was at his shop when he had some kind of brain attack.

astonerii on October 20, 2013 at 11:44 AM

Obama will issue a decree demanding that doctors accept less or nothing at all. Problem solved…

Pest on October 19, 2013 at 10:04 AM

Pretty much. Rather few MDs can afford to turn away all Medicare patients. If you make too many waves, and they’ll merely have to threaten to block all such payments to you forever. With the current economy, and with most private reimbursements falling as well, few would feel able to afford that loss.

And, with increasing emphasis on the development of “Expert Systems” (i.e. cookbook medicine) you won’t really need someone with expertise or judgement – besides, there won’t be any room for “judgement”, and the vagaries of “judgement” make it hard to pre-plan your healthcare budget cleanly. The reimbursement rules will soon demand a predefined course of therapy for a given diagnostic code, with threat of loss of reimbursement for non-compliance. Actually, you won’t even need a PA or NP, merely a minimally-skilled technician. Even surgery – you can teach anyone with reasonably good hand skills to perform surgery if they don’t also need to exercise any judgement. Again, it just becomes a technical exercise. And technicians cost less than Doctors, Nurses, or PA’s.

bofh on October 21, 2013 at 12:08 AM

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