Coverage Denied

[drkaje]

" think one of the problems is that people tend to only consider hospital costs. Has anyone studied what effect the proposed changes will have on private practices who are already struggling with cutbacks? It just doesn't seem affordable, as proposed"

Great post drkaje.  This evaluation needs to happen.  I am not opposed to a single payor system if they can prove that it will not hurt private practices, will not increase our administrative costs, and not cut our reimbursements (which are already low).

Jag, we can blame everyone, even the doctors for rolling over and not sticking together.  Groups like the AMA are nearly worthless because they are so political.  I suppose everyone operates within a budget and makes mandates that trickle down.  The issue is that as the systems get bigger (ie the bigger hospitals), the more the doctor looses their autonomy, and the more the patient is treated like a # (or revenue source).  Hospitals see primary care physicians as expendable...they also see us as the gateway to referring patients on to other services and specialists within their system, where they make more money.  Hospitals often loose $ on primary care practices but make money on the in network referrals to specialists, surgeries, radiology procedures, hospital stays, etc.  So, they have nursing managers who treat us like crap and also force us to keep seeing more and more patients.  If you solve these issues and not increase taxation, I'll vote the plan.

People think running a medical practice is free.

I don't know any guys in private practice who would survive if a Govt plan were run like Tricare, LOL!

Higher taxes and less coverage is what this plan equals. There'll be more waste too because the underinsured will end up in emergency rooms and already crowded clinics for basic care.

[MM2K]

individual health insurance premiums have been deductible on your Schedule A for a few (3-4?) years now.

regarding spreading the risk, the exact same insurance companies are providing group and individual policies.  why aren't they spreading their risk, and therefore calculating their premiums over their entire customer base?

group health insurance through your work is fine, until you get a serious disease and can no longer work.  Once your COBRA benefits run out, then you usually can't get insurance because of a 'pre-existing condition'

Since 1999, employment-based health insurance premiums have increased 120 percent, compared to cumulative inflation of 44 percent and cumulative wage growth of 29 percent during the same period.

I dont think it is currently deductable per se. If you choose to itemize deductions then it is deductable, but only to the extent that your total medical expenses exceed 7.5% of your AGI, which apparently for most people is zero. You're right that group health insurance is risky. That's why I want to get away from it. And it doenst seem that Barack Obama is expressing much interest in that. Health insurance has shot up in cost because of many factors. Some of them are natural (rising number of old baby boomers; higher quality care; better technology). Some are unnatural (frivolous lawsuits, government mandates on what insurance companies have to cover, mandates that keep insurance companies from competing across state lines, people not being concious of what thier services cost).

[paul84]

People think running a medical practice is free.

I don't know any guys in private practice who would survive if a Govt plan were run like Tricare, LOL!

Higher taxes and less coverage is what this plan equals. There'll be more waste too because the underinsured will end up in emergency rooms and already crowded clinics for basic care.

This is all too true.  People are too quick to say that malpractice costs are such a small part of the healthcare equation.  While that's true in the grand scheme, it's a MASSIVE cost for your average family practice or OB doc.  It's already forcing most FP docs to relinquish deliveries, OB/GYNs to drop OB altogether, or move to healthcare conglomerates.  drkaje is right on the money that it'll wind up with more and more docs in botique medicine, and underinsured crowding ERs and clinics.  Both drkaje and shoot seem to have some fantastic insight into the less discussed, more subtle problems in healthcare.

[shootfighter1]

Exactly, the argument that we shouldn't address malpractice and tort reform because its a small part of the overall problem is ignorant.  It directly affects medical practice and patients negatively...particularl y small practices (where patients often get the most personal care) and if you combine defensive medicine practices into the equation, now you have a substantial savings.  Its something we need to address anyway, why not talk about it under the current proposed reforms.  Under a nationalized system, it is still a big issue.

[The True Adonis]

Exactly, the argument that we shouldn't address malpractice and tort reform because its a small part of the overall problem is ignorant.  It directly affects medical practice and patients negatively...particularl y small practices (where patients often get the most personal care) and if you combine defensive medicine practices into the equation, now you have a substantial savings.  Its something we need to address anyway, why not talk about it under the current proposed reforms.  Under a nationalized system, it is still a big issue.

Bernie Sanders and Dennis Kucinich are currently working on a bill where Single Payer can be adopted on a State by State basis if they are so inclined on it.

Perhaps once a few states adopt it, and the effective results are proven, then the rest of the Nation may wake up to it.

[paul84]

Bernie Sanders and Dennis Kucinich are currently working on a bill where Single Payer can be adopted on a State by State basis if they are so inclined on it.

Perhaps once a few states adopt it, and the effective results are proven, then the rest of the Nation may wake up to it.

Very interesting, TA.  This sounds like a better idea than adopting it nationally.  If a state or two ran the system on a smaller scale, it would be much easier to troubleshoot and tweak any problems than it would be on the national level.  I'd be much more supportive if I could see the effectiveness here in the US demonstrated, problems addressed, and fixed before the whole country is brought into it.

[Cap]

Very interesting, TA.  This sounds like a better idea than adopting it nationally.  If a state or two ran the system on a smaller scale, it would be much easier to troubleshoot and tweak any problems than it would be on the national level.  I'd be much more supportive if I could see the effectiveness here in the US demonstrated, problems addressed, and fixed before the whole country is brought into it.

Better yet, the people who want this coverage can be taxed for it and the rest of us don't have to pay anything. 

[Soul Crusher]

Bernie Sanders and Dennis Kucinich are currently working on a bill where Single Payer can be adopted on a State by State basis if they are so inclined on it.

Perhaps once a few states adopt it, and the effective results are proven, then the rest of the Nation may wake up to it.

Hell is freezing over.  TA is now becoming a states' rights advocate and he does not even realize it. 

[drkaje]

This is all too true.  People are too quick to say that malpractice costs are such a small part of the healthcare equation.  While that's true in the grand scheme, it's a MASSIVE cost for your average family practice or OB doc.  It's already forcing most FP docs to relinquish deliveries, OB/GYNs to drop OB altogether, or move to healthcare conglomerates.  drkaje is right on the money that it'll wind up with more and more docs in botique medicine, and underinsured crowding ERs and clinics.  Both drkaje and shoot seem to have some fantastic insight into the less discussed, more subtle problems in healthcare.

OB's have to insure children until the age of 21. That's not cheap.