Health Care Passed

[AMoore]

emayer wrote:

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).

A bit of an overstatement I think. I taught the poor for 12 years before becoming a lawyer. My students had access to Dr. Offices; although I agree that given a choice, a doctor would prefer alternative coverage. Offering loan forgiveness (yes another govt. program) would provide incentive for doctors to work in clinics in poor urban or rural areas. Moreover, not all doctors went to med school in order to become rich.

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.

Agreed that the system is onerous. Changes are needed, but we have to be carful that an easier system does not result in fraud. I'm not qualified to opine on the details.

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?

See response to #1.

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.

Runaway jury verdicts have decreassed substantially in the last 15 years. Have your premiums? I doubt it. The big variables in determining malpractice insurance rates is competition and whether the investment return on the premiums is high enough. Pennsylvania now requires that Certificates of Merit be filed by Plaintiffs, certifying that a doctor/specialist in the relevant field, believes that a case is viable based on the facts alleged in a complaint. Also, venue shopping is no longer permitted in Pennsylvania. Caps are not the answer. Cut my arm off by mistake and my economic damages will be minimal. My loss of life's pleasures, however, would be devistating. A few million dolars would certainly ease that pain, and hopefully ensure that that doctor is more careful in the future.

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.

Agreed that insurance companies should be able to cross state lines, and this could happen since insurers will no longer be permitted to offer garbage plans that cap and limit coverage. I do fear redlining of certain regions and states.

6. Is fining an individual for not purchasing a service constitutional?

Good question since there is no opt out provission. I can be fined for not having car insurance, but I am not required to drive a car. Cars, however, are necessary for our economy to work so, in a sense, there isn't much difference. While an individual is not legally required to own a car, the vast majority of us are nonetheless required to own a car in sense.