Another ObamaCare Shoe Drops: Docs not participating

[jrogers]

I don't know much of anything about this affordable care act.

Don't let that stop you from having an opinion! In this thread the consensus seems to be that the ACA means that physicians will be forced into slave labor.

 

[Hotdoger]

Yea being told what to do, how to do it and how much you will be paid, all by the government is not being a government slave!

 

[jamil]

I'm not "mistaking" anything. I know what it costs because I have paid out of pocket for services without insurance. I know from my own experience that your claim is not true. But if you have evidence that makes my experience an outlier, I'll happily entertain it.

I've been through this insurance thing enough to know what's going on.

I think what you're saying is true when you're on a plan where service rates are not already negotiated. If you're not in the network, which an uninsured person would not be, then no discount and you pay a higher cash price. With my insurance, regular checkups are free when I go to a certain doctor. If I went to the same doctor without insurance, the cost of that visit would definitely be higher.

Don't let that stop you from having an opinion! In this thread the consensus seems to be that the ACA means that physicians will be forced into slave labor.

I'm not confident that you understand or even care about personal liberty.

But then when you're forced to do something you'd do voluntarily, I suppose you might not notice it.

 

[jrogers]

I'm not confident that you understand or even care about personal liberty.

Believe what you like, but changes to medical service compensation rates is not the same as slave labor. Luckily for those of you enlightened enough to recognize that ACA is literally the work of the devil it will be repealed forthwith when it becomes clear that medical services cannot possibly be performed at the new rates and all doctors' offices, clinics, and hospitals nationwide fold.

 

[Hotdoger]

"Believe what you like, but changes to medical service compensation rates is not the same as slave labor. Luckily for those of you enlightened enough to recognize that ACA is literally the work of the devil it will be repealed forthwith when it becomes clear that medical services cannot possibly be performed at the new rates and all doctors' offices, clinics, and hospitals nationwide fold"

In first month, the vast majority of Obamacare sign-ups are in Medicaid:


In first month, the vast majority of Obamacare sign-ups are in Medicaid



LOL at the koolaid drinkers.

 

[AtTheMurph]

Believe what you like, but changes to medical service compensation rates is not the same as slave labor. Luckily for those of you enlightened enough to recognize that ACA is literally the work of the devil it will be repealed forthwith when it becomes clear that medical services cannot possibly be performed at the new rates and all doctors' offices, clinics, and hospitals nationwide fold.

Being forced to service people against your will is indeed slavery. You will see that once the known shortage of primary care physicians is realized after these 40 million uninsureds get pushed into forced preventative care that the government will be faced with a quandary. They will then pass a law that says something to the effect of - doctors have to accept Obamacare reimbursement rates and patients or else they will lose their medical license.

It will be the only way to do it unless the government can force people into the medical fields........ I guess that's an answer too as the Soviets and the Chinese did it.

 

[firehawk1]

Exactly what I said up thread. Glad I'm not the only one to see this coming...

 

[jrogers]

Being forced to service people against your will is indeed slavery.

Forcible labor does qualify as slavery, but that is not the case here unless the following comes to pass:

They will then pass a law that says something to the effect of - doctors have to accept Obamacare reimbursement rates and patients or else they will lose their medical license.

But there is no evidence to support this claim. Under current law there is no compulsion.

 

[HeadlessRoland]

Cool, black market medicine will be awesome.

This was my first thought too: "Awesome, a dual market." Cash pricing versus insurance? Most doctors prefer cash anyhow, even if it means reducing the cost - insofar that the cost can be reduced - in exchange for rapid, non-refundable payment. Whereas CMMS (or even private insurance) can take months to process and if they later decide it was paid in error (wrong diagnosis code, elective versus exploratory versus diagnostic), they can steal back payments from healthcare providers. Unintended consequence prevails.

 

[jamil]

Forcible labor does qualify as slavery, but that is not the case here unless the following comes to pass:



But there is no evidence to support this claim. Under current law there is no compulsion.

You don't think that will be the logical conclusion of a shortage of doctors willing to take medicare and medicaid patients?

 

[88GT]

I think what you're saying is true when you're on a plan where service rates are not already negotiated. If you're not in the network, which an uninsured person would not be, then no discount and you pay a higher cash price. With my insurance, regular checkups are free when I go to a certain doctor. If I went to the same doctor without insurance, the cost of that visit would definitely be higher.

Higher than what? Your co-insurance portion? That's not the cost of the procedure. That's your out-of-pocket payment. The cost is the total of what you pay and what the insurance company pays. I was never discussing the out-of-pocket cost to patients. It's only a "higher cash price" because patients don't see the insurance company's portion of the payment. But the actual total cost of treatment is almost always lower for non-insurance coverage than for insured coverage.

Let me take the opportunity to correct myself though. I just re-read it for clarify for the first time, I was less than clear in my first post about this issue and I can see how the wording, pathetic as it is, clouded my intended point. It should read like this:

Higher cash-only prices? I think you have that backward. My out-of-pocket cost before the deductible is met for a regular doctor office visit is $85. Do you know what it is when [STRIKE]the deductible is met?[/STRIKE] I pay non-insurance prices? $55. Do you know what that means? It means the doc only needs to charge me $55 to meet his income requirements. But he tells the insurance company that he needs $123. Then the insurance company tells him he doesn't, and they'll reimburse costs up to $85. And THAT is why medical care in this country is so damn expensive.

I apologize for missing this glaring error before. I originally was going to add what the cost was after the deductible, but realized that that the patient's OOP costs weren't the issue. I knew what I was trying to say anyway. I either just royally screwed up the wording or fumbled an edit job. Either way, it wasn't clear and it looked like I was saying something I wasn't. For that, I am sorry.

So, yes, I concede that the patient's OOP costs with insurance are generally lower than the cash-only rates. However, the point I had hoped to make, but failed miserably at doing so, was that insurance is the reason costs are going up because it forces providers to jack costs to make sure the negotiated amount is sufficient to keep doc in business. And when all is said and done, I'm not sure that insurance OOP costs are really lower than the OOP costs in the long run anyway. Between the several thousand dollars annually in premium payments and the $2500 deductible, the amortized price of all of our medical care is far higher than the cash-only price. I understand this becomes null and void when the treatment becomes super expensive, complicated, and/or long-term. But that only highlights the arguments for treating medical care insurance more like car insurance in terms of having catastrophic coverage and not daily health and maintenance coverage.

 

[Roscoe38]

No, there are docs now who don't take any insurance and survive quite well. They're good enough they don't have to, even though I'm sure most of their patients already have insurance, and could choose to go elsewhere that would cost them less.

Name one, how large is his practice? With what hospital is he is affiliated?

Do you even understand "Mal-practice" insurance? (the basic reason there are few single doctor practices)

Just askin.....

 

[jamil]

Higher than what? Your co-insurance portion? That's not the cost of the procedure. That's your out-of-pocket payment.

Yes, I thought you were talking about out of pocket expense. Thanks for clearing that up.

So, yes, I concede that the patient's OOP costs with insurance are generally lower than the cash-only rates. However, the point I had hoped to make, but failed miserably at doing so, was that insurance is the reason costs are going up because it forces providers to jack costs to make sure the negotiated amount is sufficient to keep doc in business.

I completely agree with this but I would also add as causes, government meddling and removing consumers from the cost/decision loop. This eliminates natural free market controls.

And when all is said and done, I'm not sure that insurance OOP costs are really lower than the OOP costs in the long run anyway. Between the several thousand dollars annually in premium payments and the $2500 deductible, the amortized price of all of our medical care is far higher than the cash-only price. I understand this becomes null and void when the treatment becomes super expensive, complicated, and/or long-term. But that only highlights the arguments for treating medical care insurance more like car insurance in terms of having catastrophic coverage and not daily health and maintenance coverage.

It's like a casino. There has to be more losers than winners or the house goes broke. That's why Obamacare HAS to increase the cost of healthcare overall. It can't NOT increase cost. Assume every American had no insurance at all and that they consume x dollars worth of health care per year. Now compare the situation with Obamacare, assuming consumers maintain the same need for health care (which they will consume more when someone else is paying for it, especially figuring in preexisting conditions). Consumers will now spend x + y + z dollars per year where y is insurance companies' cost + proffit and z is the government's subsidies and administrative cost.

The scam is that a lot of Americans think that they're paying less because the cost is spread out among more people. But in such a system, the ONLY people who's out of pocket expenses actually decrease is people who are unhealthy and consume more healthcare than they pay for. Part of the scam is also that since someone else is paying for it, why not consume MORE!

This is the exact opposite of what we need and will only cause it to be worse. We need the free market back where cost of service is checked by availability, value, and people's willingness to pay; and supply/demand is not artificially affected by shielding the cost of frivolous consumption.

 

[Mustang380gal]

Name one, how large is his practice? With what hospital is he is affiliated?

Do you even understand "Mal-practice" insurance? (the basic reason there are few single doctor practices)

Just askin.....

My doctor here in eastern Ohio is in practice alone, inherited from his father. He does not take insurance, or Medicare/Medicaid. We pay cash, then his office will fill out an invoice that the insurance companies like, so that reimbursement directly can happen.

I can't tell how large his practice is, but he seems to be busy. His practice is largely Amish/Mennonite, with a few of us who aren't either tossed in.

He dropped malpractice insurance several years ago, which meant he can no longer be affiliated with a hospital. His reasoning was that he'd have to raise his prices quite high to cover his insurance premium. His cash-paying patients could not afford that, so he dropped the insurance. The patient population is not likely to sue, anyway.

 

[Dean C.]

The ACA was the reason I decided not to pursue a career in medicine. And a lot of my friends either abandoned their goals of med school or decided to become nurses. What is going to happen when we run out of trained doctors because of this law?

 

[jamil]

The ACA was the reason I decided not to pursue a career in medicine. And a lot of my friends either abandoned their goals of med school or decided to become nurses. What is going to happen when we run out of trained doctors because of this law?

Conscription?

 

[Dean C.]

Conscription?

You never know with these crazies....