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03-22-2010, 06:22 AM
Good summation.
As mentioned, plenty are more upset about the negotiations and tactics used in passing the legislation than the plan itself, although there is plenty here to question. Most of us agree that some element of reform is necesary, perhaps I'm out of line in thinking that the average citizen would have preferred some basic changes rather than another sweeping social program. After all, Medicare, Medicaid, and Social Security are failures in their own right. Should we expect this will be different?
A few thoughts on the reform plan:
1. Very few if any docs take Medicaid patients in the office. Aside from the lousy reimbursement, unfortunately the clientele tends to be poorly compliant and more litigious. Even matching Medicare rates will convert few (see #2).
2. There is an increasing trend for docs to drop Medicare as the reimbursements have not matched private insurers in many areas and the system is so onerous to deal with that it drives office overhead up. On a yearly basis, an approximate 22% doctor "fix" is passed in the eleventh hour. This is not factored into the CBO calculations for the reform. While there is fraud and waste in the system, there is no $500 BILLION to be found.
3. Lack of docs. An example: As a specialist, I am currently operating at 97% of the national average in volume. It isn't possible to absorb a greater load without sacrificing quality of care or relying on secondary extenders. I'm not certain that's what patients want or expect. There is a massive shortfall in MDs already absent this legislation. Who wants to study medicine now?
4. Tort reform? The costs of this are difficult to quantify but there is no question we are practicing defensive medicine. I would argue there is more cost savings here than looking for massive fraud within Medicare.
5. Private insurers. I for one, feel that the market should be completely opened to allow patients to purchase/transport plans from other states. While I agree with the legislative changes requiring continued coverage for preexisting conditions etc, there will be costs associated with this. Over time, my guess is that it will ultimately price insurers out of the marketplace creating a de facto universal health-care plan.
6. Is fining an individual for not purchasing a service constitutional?
As mentioned, plenty are more upset about the negotiations and tactics used in passing the legislation than the plan itself, although there is plenty here to question. Most of us agree that some element of reform is necesary, perhaps I'm out of line in thinking that the average citizen would have preferred some basic changes rather than another sweeping social program. After all, Medicare, Medicaid, and Social Security are failures in their own right. Should we expect this will be different?
A few thoughts on the reform plan:
1. Very few if any docs take Medicaid patients in the office. Aside from the lousy reimbursement, unfortunately the clientele tends to be poorly compliant and more litigious. Even matching Medicare rates will convert few (see #2).
2. There is an increasing trend for docs to drop Medicare as the reimbursements have not matched private insurers in many areas and the system is so onerous to deal with that it drives office overhead up. On a yearly basis, an approximate 22% doctor "fix" is passed in the eleventh hour. This is not factored into the CBO calculations for the reform. While there is fraud and waste in the system, there is no $500 BILLION to be found.
3. Lack of docs. An example: As a specialist, I am currently operating at 97% of the national average in volume. It isn't possible to absorb a greater load without sacrificing quality of care or relying on secondary extenders. I'm not certain that's what patients want or expect. There is a massive shortfall in MDs already absent this legislation. Who wants to study medicine now?
4. Tort reform? The costs of this are difficult to quantify but there is no question we are practicing defensive medicine. I would argue there is more cost savings here than looking for massive fraud within Medicare.
5. Private insurers. I for one, feel that the market should be completely opened to allow patients to purchase/transport plans from other states. While I agree with the legislative changes requiring continued coverage for preexisting conditions etc, there will be costs associated with this. Over time, my guess is that it will ultimately price insurers out of the marketplace creating a de facto universal health-care plan.
6. Is fining an individual for not purchasing a service constitutional?
Eric Mayer
2013 MB G63
2012 Audi R8 GT #232
2011 GT3 RS
1988 928 S4
1988 MB 560SL
2014 MB GL 550
2013 MB G63
2012 Audi R8 GT #232
2011 GT3 RS
1988 928 S4
1988 MB 560SL
2014 MB GL 550