No Hope For Universal Health Care

... I prefer the imperfections of a universal health care system.

Yeah, everybody feels badly for those "poor" doctors.


Salary of a Doctor
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Bibliographic Entry Result
(w/surrounding text) Standardized
Result
Antell, Gerson, & Harris, Walters. Economics: Institutions and Analysis, Third Edition. New York: Amsco School Publications, Inc., 2001:182. "Table 8.2
Median Weekly Earnings, 1999
Physicians $1,266" $65,832

Physicians and Surgeons. Medical Group Management Association, Physician Compensation and Production Report, 2003. Table 1. Total compensation of Physicians by Specialty; 2002
Anesthesiology $306,964
Surgery, general $255,438
Obstetrics/Gynecology $233,061
Internal medicine $155,530
Pediatrics/Adolescent medicine $152,690
Psychiatry $163,144
Family Practice $150,267
$150,267 - $306,964

"AMA: Doctors' income still rising." Managed Care. (June 1998). "The American Medical Association' annual physician income survey shows that, an average, doctors are making close to $200,000 a year." $200,000

Terkell, Studs. Hard Times. New York: Pantheon Books, 1970: 80. "I just came across a bankbook that I had between 1931-1934, and, by God, I was in those days making $2,000 a month." $24,000

Enzmann, Dieter R.Surviving in Health Care. St. Louis, Missouri: Mosby-Year Book., 1997: 98. "Perhaps because of persistent high salaries ($186,000 average physician compensation in 1994) there is little public sympathy for the physician's current plight." $186,000

In Benton Harbor, more than 300 patients lost access to counseling services after the main provider of Medicaid mental-health services, Riverwood Center, stopped accepting payments from Medicaid HMOs. Riverwood says the reimbursements it was receiving from the Medicaid HMOs for outpatient sessions didn't cover their costs.

Payment delays and other administrative hassles compounded the crunch, says Riverwood's president, Allen Edlefson. The center lost $350,000 in 2003, the year before it decided to quit its Medicaid HMO contracts. "It was a painful decision, but we just couldn't make it work financially," he says.

The Medicaid HMOs helped slow costs by more tightly managing care, such as reducing hospital admissions and assuring that recipients are at least assigned a primary-care doctor. The state estimates HMOs have saved Medicaid more than $300 million annually in recent years.

Nestled along Lake Michigan's southeastern shore, Benton Harbor has been hard hit by job losses. Manufacturers have steadily cut or relocated elsewhere good-paying union jobs with health benefits. About a quarter of the community of 12,000, poor and predominantly black, are unemployed.

As the city's middle class dwindled, most doctors, along with the hospital, relocated in the late 1980s and early 1990s across the St. Joseph River to its much more affluent twin, St. Joseph, a picturesque lake-resort town. Most of those doctors are listed in HMO networks but many don't accept Medicaid patients in their offices. Instead, many spend an afternoon every one or two weeks seeing Medicaid patients at a clinic set up in a building that once housed Benton Harbor's hospital.
[Don Tynes]

The doctors say they prefer the arrangement because the clinic -- which is run by the St. Joseph hospital -- pays them a flat rate for the afternoon, instead of Medicaid fees for each service. They don't have to worry about the administrative hassle of filing claims or no-show patients -- a common problem since many Medicaid recipients don't have ready transportation. But for patients, this can mean waiting months for an appointment.

The specialist crunch means that more of the burden is falling on primary-care physicians such as Don Tynes. Dr. Tynes runs one of the few primary-care practices left in Benton Harbor. Three years ago, he left his job as a salaried physician in a local community health center to set up his own practice in a former dry-cleaning shop across from Benton Harbor high school.

"I don't want to pull any punches taking care of people," says Dr. Tynes. "I'm a spiritual man, not a businessman." In his waiting room, gospel movies play round the clock on a DVD player and patients can sign up for his weight-loss coaching.

On a recent day, 22 out of the 37 patients were on Medicaid, and another 12 had Medicare or other government-sponsored insurance. Only three had commercial health coverage. Dr. Tynes tries to make ends meet with a bare-bones staff. He has also cultivated a loyal patient base by offering specialty services such as sexual-dysfunction treatment and marriage counseling. Depending on how good business is, he tries to pay himself an after-tax salary of $500 to $750 a week to support his family of five children.

But three times so far this year, he's forgone his biweekly paycheck to keep the practice out of the red. Last year, he cut his office staff from seven to four people. "We [primary-care physicians] are the ones keeping this Medicaid system together, but we're the ones getting killed," he says.

cicerone imposter wrote:

... I prefer the imperfections of a universal health care system.

Does california have Univeral Health Care? I thought
we were unique in the Commonwealth of Massachusetts for having this type of health coverage.

So tell us, CI, based on your experiences with Universal Health Care, as an enrollee in such a plan,
what did you like about your coverage?

You don't have any experience either.

Walter Hinteler wrote:

You don't have any experience either.

I live in the CommonWealth of Massachusetts, the first and the only State in the United States of American to require Universal Health Care coverage for all residents of the State.

Do you or CI live in Massachusetts?

Do you know and understand the rules and regulations surrounding this legislation?

If none of the above, than you lack my experience and knowledge in the field of Universal Health Care regulation and coverage.

If none of the above, than you lack my experience and knowledge in the field of Universal Health Care regulation and coverage.

My impression is that Miller is a practicing physician.

I also recognize the greater experience of Walter, Blatham and others here who have lived for long periods under government-managed systems. They, in turn, should recognize that their knowledge of our system is (except perhaps for Blatham) generally confined to what they read - and it includes a good deal of propaganda.