IT'S TIME FOR UNIVERSAL HEALTH CARE

@Advocate,

Advocate wrote:

The Times' article mentioned New York, where the situation is probably atypical. Most doctors accept Medicare, and need to in order to make a living. Insurance companies pay little more than Medicare, and some pay less, depending on the procedure. I wager there is only a very small percentage of the population enrolled in concierge practices, which cater to the well-to-do. Doctors often charge too much, and this should somehow be controlled. Quite a few doctors make over a million per year.

I'm afraid you're incorrect in nearly everything you said. How do you know what insurance companies pay in relation to medicare? And how do you know that doctors "often charge too much" ? What exactly is "too much" ?

How many doctors make over a million a year? I can guarantee you they aren't primary care physicians, which is what we've been talking about for the last several posts.

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Stain, you have not shown that I am incorrect. You do say that I have not given proof for my statements. What I said is pretty much common knowledge, which you can easily find on the net or elsewhere. I didn't say that those making over a million are family doctors. Your reading comprehension is a bit low.

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@sstainba,

At one time, I read that most insurance paid about 80% of the self pay rate. Medicare allows my doctor about 35% of the self pay rate. What they allow is fixed, so a doctor that has a lower base rate will receive a higher percentage. It seems to follow that a very unpopular doctor with relatively low rates might actually like Medicare compensation.

My suspicion is that the rates paid by insurance to physicians and hospitals is probably close to what the actual charge would be, if everyone actually paid their bills. This does not apply to ambulance service. I once took a ride in an ambulance, and the bill before adjustment per insurance agreement worked out to $3,000 per mile. Ain't no way that approximates their cost + reasonable profit.

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@Advocate,

I don't need to show that you are incorrect. You haven't shown that you ARE correct. My reading comprehension is just fine, thanks.

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@roger,

That sounds about right, but I think Medicare is slightly higher than 35%. Paying the bill is the other part of the issue. For example, I know of a particular hospital that, in all of the billing it generated last year, it only reclaimed funds to cover about 40% of it.

In most cases, Medicare/Medicaid reimbursements are so low that they don't cover the cost of equipment/materials for treatments. That's why you're ambulance ride is so expensive, they have to stick it to those of us with insurance or self-pay so compensate.

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@roger,

when I was living in Denver there was a couple (both Docs) who quit their hospital practice and opened private practice, no employees except a nurse, accepted no insurance etc-- cash only from their customers and their charges were exactly the same as what medicare pays, they had a very successful practice due to the lower overhead (billing etc)

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@Advocate,

Median physician pay scale... nowhere near a million:

http://www.payscale.com/research/US/People_with_Jobs_as_Physicians_%2f_Doctors/Salary/by_Skill

1 Reply

@rabel22,

That's what I said . . . the whole nation knew what was going on. So, the question remains . . . if the Republicans have so many ideas on how to solve the health care crisis or the insurance crisis, why didn't they present those ideas during the bush years?

Can you say hypocrites, boys and girls?

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@Advocate,

Quote:

Quite a few doctors make over a million per year.

And this is a problem for you?
Considering all the scholing that a doctor has, then consider the unusual hours a dr can work, especially someone that delivers babies, they are entitled to get paid for their work and knowledge.

If you think a doctor is getting paid to much, then dont go to the dr and dont give him any money.

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It looks like the dems have lost another vote in the house.

http://hotair.com/archives/2010/03/08/lipinski-flips-to-no-on-obamacare/

Quote:

According to John McCormack, we can put Rep. Dan Lipinski (D-IL) in the firm “no” column on the upcoming ObamaCare vote.

If the dems keep losing votes like this, the bill wont pass at all.
I wonder who they will blame for that?

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So, after learning about the rates that medicare pays vs what private insurance and cash pays.....

How is it fair to compare medicare costs to private insurance costs. I mean, private insurance is SUBSIDIZING medicare. Medicare, in addition to having deficit projections w/in a decade or two, isn't even paying the doctors enough to cover their costs.

1 Reply

@maporsche,

maporsche wrote:

Medicare, in addition to having deficit projections w/in a decade or two, isn't even paying the doctors enough to cover their costs.

So a physician, who medicates a Medicare patient not only doesn't get some income for it but has to pay some of his/her costs from his/her private pocket?

Totally different to here - though private insurances (still!) pay a bit more than the mandatory insurance companies ... .

1 Reply

@Walter Hinteler,

Walter Hinteler wrote:

maporsche wrote:
Medicare, in addition to having deficit projections w/in a decade or two, isn't even paying the doctors enough to cover their costs.

So a physician, who medicates a Medicare patient not only doesn't get some income for it but has to pay some of his/her costs from his/her private pocket?

That's what I'm understanding to be true. I'm not a doctor, nor do I know any so I cannot verify.

Here's about how I understand it to break down.

Cash person pays the most (100%) for a procedure.
Private insurance pays 70% of cash person for the same procedure.
Medicare (and presumably Medicade) pays 35% of cash person for same procedure.

That 35% cannot be enough to sustain a practice on, much less make an income that will allow you to live and pay off medical school.

So cash people subsidize private insurance and medicare/aid. And private insurance subsidizes medicare/aid.

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@maporsche,

That's about right. Though, the Medicaid/Medicare reimbursement varies as it's both Federal dollars and state dollars. The state reimbursement can be vastly different.

To give you an example of how crappy these rates can be, in a clinic near me, the medicare/medicaid reimbursements paid as little as $4 for a standard 15-min office visit.

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@maporsche,

maporsche wrote:

That's what I'm understanding to be true. I'm not a doctor, nor do I know any so I cannot verify.

Here's about how I understand it to break down.

Cash person pays the most (100%) for a procedure.
Private insurance pays 70% of cash person for the same procedure.
Medicare (and presumably Medicade) pays 35% of cash person for same procedure.

That 35% cannot be enough to sustain a practice on, much less make an income that will allow you to live and pay off medical school.

So cash people subsidize private insurance and medicare/aid. And private insurance subsidizes medicare/aid.

Well, I don't know that many (if any) people pay cash (I'm quite sure that would be looked at as if the was coming from a criminal background and/or the person had some skeletons in the closet).
The various medical procedures are negotiated between the "Association of Statutory Health Insurance Physicians" and the association of the mandatory insurance companies resp. the associations of the hospitals. Same is done by the private insurers.

Since the doctors have to list their costs (as for the mandatory insurers) all of them are covered (which doesn't mean, however, that physicians think it's not enough covered).

My father had been for more than 40 a leading physician of a larger hospital departments and a sanatorium plus 'normal' consultation hours in his medical practice.
Several of our friends are physicians in hospitals and/or practise.

1 Reply

@Walter Hinteler,

What I meant by 'cash' was 'people w/o insurance or medicare'. Those people are billed the highest dollar amount.

For example, a visit to the doctors office could cost.

$100 for people w/o insurance.
$70 that the insurance company pays.
$35 is what medicare pays.

1 Reply

Here's an interesting video to demonstrate the problem with medicare/medicaid.

http://money.cnn.com/video/news/2010/03/02/n_no_medicare_opt_out_MD.cnnmoney/

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@maporsche,

Keep in mind that those figures are very approximate. I don't know if Medicare has fixed rates nationwide or not, but at least in my area, primary care physicians have a Medicare assignment of $88.00 for an office call. In the case of my own doctor, his total compensation (Medicare pmt + Roger's pmt) is $88.00. This works out to about a 35% discount. Medicare is paying 80% of $88.00. I am paying 20% of $88.00. If the doctors' base rates are higher, the percentage of discount is higher. If there were physicians charging less than $88.00 per visit, the Medicare assignment would still be $88.00 per visit, and all doctors would love to see us coming.

Walter, I am sure that the Medicare system pays more than the variable cost of treatment. I mean, if there is an empty spot in the schedule, the additional cost of treating one patient is going to be less than the compensation. Still, overhead costs must eventually be recovered.

I continue to believe that the rates contracted between medical providers and insurance companies are very close to the costs of service plus a reasonable profit. Since the self-insured (cash customers) sometimes do not pay at all, or the costs of collection can be high, they pay a higher rate.

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@sstainba,

sstainba wrote:

Median physician pay scale... nowhere near a million:

http://www.payscale.com/research/US/People_with_Jobs_as_Physicians_%2f_Doctors/Salary/by_Skill

Your cited piece is about salaried doctors, duh!!!!! How many self-employed specialists make over a million?

1 Reply

@Advocate,

Advocate wrote:

sstainba wrote:

Median physician pay scale... nowhere near a million:

http://www.payscale.com/research/US/People_with_Jobs_as_Physicians_%2f_Doctors/Salary/by_Skill

Your cited piece is about salaried doctors, duh!!!!! How many self-employed specialists make over a million?

Well I don't know how many. As you may recall, it was YOU who insisted many doctors make over a million - not ME. So then tell me, how many doctors make over a million?

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