Are plans in the exchange losing 214,000 doctors?

[Horatio Parker]

It's not so easy for a doctor to change their specialty. An internal medicine doctor cannot just up and say "I'm now a plastic surgeon!".

Upcoming doctors have the incentive to go into elective surgery.

I had a GP who was a surgeon. He said it was a strange combination of stress and boredom, plus it became hard to make money. Operations for things like ulcers are no longer done. IIRC, a surgical residency is five years.

 

[solutions]

Has anyone here every read the 1964 paper from Kenneth Arrow about Healthcare? "The Uncertainty and welfare economics of medical care" I think if you read his work it will give you a foundation to start from on where you can address the problems and address the solutions.
from this paper you can learn the following.

1. Illnesses occur randomly.

2. The cost of the medical care to treat these illnesses usually entail high costs.

3. These high costs need to be paid for by a third party. Insurance

4. The private sector insurance will introduce a moral hazard into the equation because of profits needed.

5. Government healthcare will eliminate the moral hazard.

These points should give you the basic foundation of healthcare debate.

Next, is the fact that the whole debate is about increasing the amount of people with insurance and lowering cost. Both sides want this and can agree that this is not left or right in nature. How is it every story out there deviates from this basic debate. It's what the whole debate is about if you strip it down.
Supply and demand in the area of healthcare. Take every story you here and look at it in a way that is is supply side or demand side and if it increases or decreases on that side. Fewer doctors lowers the supply side. More patients raises the demand. Price goes UP! Take every story you hear and ask yourself how it changes the supply or demand. We basically need the supply side pushed out more than the demand to lower the cost a lot! The new healthcare has done very little to the supply side and yet even lowered it with the bad incentives.
This should be the foundation to everyones thinking. Without a solid foundation with definitions to your solutions we end up with going in circles and not forward.

 

[Sabine Grant]

It's not so easy for a doctor to change their specialty. An internal medicine doctor cannot just up and say "I'm now a plastic surgeon!".

Upcoming doctors have the incentive to go into elective surgery.

When we speak about a medical specialty such as elective plastic/cosmetic surgery, we need to take into the account the reality that most insurance plans do not cover elective plastic/cosmetic surgical procedures of a nature not related to a diagnosed health condition. Most plans will cover reconstructive surgery following a mastectomy however not cover a surgical procedure such as breast enhancement or reducing. Which means that such surgeons specialized in elective cosmetic/ plastic surgery will have to depend on a clientele able to pay the cost out of pocket, meaning an exclusive clientele. Meaning the geographical location of their practice will have to take into account the demographics and economical status of such demographics.

And that greatly affects "upcoming doctors" in their choice of pursued medical specialty. To include the amount of student loans they will accumulate in the course of completing their specialty focused education. To compare with an "upcoming doctor" specializing in oncology and sub specialty hematology to where there is a constant flow of patients diagnosed with chronic illnesses, cost covered by the vast majority of plans, and where the local demographics are representative of a variety of economical status. I frankly cannot see how such in great demand health care providers would reject the high number of plans provided under the AHCA Exchanges considering they all guarantee a constant flow of covered patients. The cost of oncology/hematology pharma protocols, imaging tests etc...being very high to where relying on patients who can afford it out of pocket is totally unrealistic.

The only plan I have so far seen rejected by the largest oncology/hematology treatment/provider center in Florida (Florida Cancer Specialists and Research Center, 80 locations in the State) is Humana. Specifically the Humana complement or supplemental coverage for Medicare dependent cancer patients.

 

[Jimmy Higgins]

Both sides want this and can agree that this is not left or right in nature.

Actually, it became an anti-Obama thing in nature. Obama made RomneyCare national and the right-wing attacked it. Did everything they could to block it. They don't care about shit other than winning elections.

How is it every story out there deviates from this basic debate. It's what the whole debate is about if you strip it down.
Supply and demand in the area of healthcare. Take every story you here and look at it in a way that is is supply side or demand side and if it increases or decreases on that side. Fewer doctors lowers the supply side. More patients raises the demand. Price goes UP! Take every story you hear and ask yourself how it changes the supply or demand. We basically need the supply side pushed out more than the demand to lower the cost a lot! The new healthcare has done very little to the supply side and yet even lowered it with the bad incentives.
This should be the foundation to everyones thinking. Without a solid foundation with definitions to your solutions we end up with going in circles and not forward.

The right-wing has poisoned the well so thoroughly, it is impossible to actually talk about anything, forget about Health Care reform in the country.

 

[ZiprHead]

It's not so easy for a doctor to change their specialty. An internal medicine doctor cannot just up and say "I'm now a plastic surgeon!".

Upcoming doctors have the incentive to go into elective surgery.

Still doesn't address my original question.: Where do these doctors that are (supposedly) leaving expect to go?

 

[Sabine Grant]

Actually, it became an anti-Obama thing in nature. Obama made RomneyCare national and the right-wing attacked it. Did everything they could to block it. They don't care about shit other than winning elections.

How is it every story out there deviates from this basic debate. It's what the whole debate is about if you strip it down.
Supply and demand in the area of healthcare. Take every story you here and look at it in a way that is is supply side or demand side and if it increases or decreases on that side. Fewer doctors lowers the supply side. More patients raises the demand. Price goes UP! Take every story you hear and ask yourself how it changes the supply or demand. We basically need the supply side pushed out more than the demand to lower the cost a lot! The new healthcare has done very little to the supply side and yet even lowered it with the bad incentives.
This should be the foundation to everyones thinking. Without a solid foundation with definitions to your solutions we end up with going in circles and not forward.

The right-wing has poisoned the well so thoroughly, it is impossible to actually talk about anything, forget about Health Care reform in the country.

The right-wing has managed to propagate untruths which unfortunately millions of Americans (again not doing their "home work") have digested. Remember Mitch McConnell's victory speech and his mention of the " mother whose insurance plan was taken away by the government"? His talking about his promise to her? Of course, he will never talk about any promise made to the millions of people who have finally been able to access insurance plans which will adequately support their access to vital care. People like me, for example.

The reality is that the GOP has NO viable alternative for medically needy people in this nation, The GOP attention and interest is not on needy people in general. Let alone medically needy folks who prior to the AHCA were stuck in the under insured category or non insured category.

We are never going to see GOP initiated "promises" of affordable access to vital and indispensable health care to people in my category.

 

[Sabine Grant]

Upcoming doctors have the incentive to go into elective surgery.

Still doesn't address my original question.: Where do these doctors that are (supposedly) leaving expect to go?

Maybe they will all move to D.C where they can cater to US Congress members benefiting of a "Cadillac" plan.. Seriously...the reality being that before the AHCA, Insurance providers were already NOT paying up the actual amount charged by health care providers. Rewinding on what our Insurance provider paid between 2005 and 2009 (at the time we still had access to a solid Group Plan with excellent coverage), never did I see our provider shell out the 8000 dollars they were billed for a PET/CT Scan by the imaging facility I would use for my twice a year PET/CT. Similarly under RX coverage, during my monoclonal treatments from July 2005 to January 2007, they certainly did not pay up the billed amount of over 10.000 dollars per infusion!!!

 

[whichphilosophy]

http://www.cnsnews.com/mrctv-blog/barbara-boland/over-214000-doctors-opt-out-obamacare-exchanges
ver 214,000 doctors won't participate in the new plans under the Affordable Care Act (ACA,) analysis of a new survey by Medical Group Management Association shows. That number of 214,524, estimated by American Action Forum, is through May 2014, but appears to be growing due to plans that force doctors to take on burdensome costs. It's also about a quarter of the total number of 893,851 active professional physicians reported by the Kaiser Family Foundation.

It seems that doctors are not simply going to resign but refuse to participate in the Obamacare program. In the UK some doctors work for the National Health while also sometimes taking private patients. It's perfectly legal. The main problem for government programs are the huge waiting rooms. Then someone can wait a few hours to see the doctor.

If the US does find itself short of doctors, there are plenty from Cuba

Can you find me an actual neutral source? cnsnews doesn't fit that bill - plus this is a blog. Thanks!

I would agree there is no such thing as unbiased news in most publications but the contents are quite feasible.
I doubt if any doctors are going to give up medicine because off OBAMACARE? Of course they may participate. In the UK we had a huge NHS revolution in 1949 with up to 100% free healthcare and prescriptions. Yet people continued to use private healthcare. In the past few years National Health doctors also give the option for using private health care from the same doctor in the same hospital. The difference is you get a hip transplant in a few days or hours rather than wait two years. The system has adjusted to both state run and private run medicine, often under the same roof.
It is true that government health programs while offering low cost or in some cases no cost, patients have to queue. This is what happens in the UK. Also some private doctors sometimes work for the National Health system one or two days a week. Likewise as explained some NHS doctors doe some private consulting

 

[Emily Lake]

Upcoming doctors have the incentive to go into elective surgery.

Still doesn't address my original question.: Where do these doctors that are (supposedly) leaving expect to go?

They aren't "leaving being doctors", they just aren't seeing patients who have exchange plans. They'll still see patients who have employer plans and off-exchange plans and medicare and such. They're not "leaving" at all, they're just not participating in the exchange networks.

 

[Underseer]

I'm trying to find a non-partisan article on this but can only find conservative crap bashing "Obamacare" ad nauseum. Can someone tell me if this is accurate and how it will impact the ACA exchange plans in 2015? My son has to choose between his work plan and the exchange so I want to know about this without all the right wing rhetoric.

Obamacare is proof that freedom is dead and that we are living under a communist dictatorship.

If only we could have freedom like they have in third world countries, instead of slavery like they have in the other developed, industrialized nations.

 

[whichphilosophy]

Upcoming doctors have the incentive to go into elective surgery.

Still doesn't address my original question.: Where do these doctors that are (supposedly) leaving expect to go?

That is because there is no evidence they will or intend to give up medicine.

 

[NobleSavage]

Doctors are not slaves. Why would they agree to take on patients if at best they break even or worst incur losses?

For a typical quick visit like this, Gerard could get reimbursed $100 or more from a private insurer. For the same visit, Medicare pays less — about $80. And now, with the new private plans under the Affordable Care Act, Gerard says he would get something in between, but closer to the lower Medicare rates.

That’s not something he’s willing to accept.

“I cannot accept a plan [in which] potentially commercial-type reimbursement rates were now going to be reimbursed at Medicare rates,” Gerard says. “You have to maintain a certain mix in private practice between the low reimbursers and the high reimbursers to be able to keep the lights on.”

http://kaiserhealthnews.org/news/a-doctors-perspective-on-obamacare/

They can keep the lights on.

With a base pay offer of $189,000 a year, on average, family practitioners, pediatricians, and psychiatrists are offered the lowest pay of all physicians, according to the medical search and consulting firm Merritt Hawkins & Associates’ 2012 Review of Physician Recruiting Incentives.

That might seem like serious money, but it pales in comparison an orthopedic surgeon’s $519,000 paycheck. Cardiologists make an awful lot, too. They are guaranteed an average base salary of $512,000, according to the Merritt Hawkins data. The third highest-paying specialty: Urology. These specialists earn an average of $461,000, not including production bonuses or benefits.

http://www.forbes.com/sites/jacquelynsmith/2012/07/20/the-best-and-worst-paying-jobs-for-doctors-2/

 

[ZiprHead]

Doctors are not slaves. Why would they agree to take on patients if at best they break even or worst incur losses?



http://kaiserhealthnews.org/news/a-doctors-perspective-on-obamacare/

They can keep the lights on.

With a base pay offer of $189,000 a year, on average, family practitioners, pediatricians, and psychiatrists are offered the lowest pay of all physicians, according to the medical search and consulting firm Merritt Hawkins & Associates’ 2012 Review of Physician Recruiting Incentives.

That might seem like serious money, but it pales in comparison an orthopedic surgeon’s $519,000 paycheck. Cardiologists make an awful lot, too. They are guaranteed an average base salary of $512,000, according to the Merritt Hawkins data. The third highest-paying specialty: Urology. These specialists earn an average of $461,000, not including production bonuses or benefits.

http://www.forbes.com/sites/jacquelynsmith/2012/07/20/the-best-and-worst-paying-jobs-for-doctors-2/

Doctors of Gerontology work almost exclusively under Medicare and Medicaid.

"For example the median expected annual pay for a typical Physician - Geriatrics in the United States is $177,936"

http://www1.salary.com/Physician-Geriatrics-Salary.html

Yeah, I agree. I think they can keep the lights on.

 

[whichphilosophy]

They can keep the lights on.

With a base pay offer of $189,000 a year, on average, family practitioners, pediatricians, and psychiatrists are offered the lowest pay of all physicians, according to the medical search and consulting firm Merritt Hawkins & Associates’ 2012 Review of Physician Recruiting Incentives.

That might seem like serious money, but it pales in comparison an orthopedic surgeon’s $519,000 paycheck. Cardiologists make an awful lot, too. They are guaranteed an average base salary of $512,000, according to the Merritt Hawkins data. The third highest-paying specialty: Urology. These specialists earn an average of $461,000, not including production bonuses or benefits.

http://www.forbes.com/sites/jacquelynsmith/2012/07/20/the-best-and-worst-paying-jobs-for-doctors-2/

Doctors of Gerontology work almost exclusively under Medicare and Medicaid.

"For example the median expected annual pay for a typical Physician - Geriatrics in the United States is $177,936"

http://www1.salary.com/Physician-Geriatrics-Salary.html

Yeah, I agree. I think they can keep the lights on.

When the National Health system was set up in the UK we didn't lose doctors. Quite interestingly some private doctors do NHS work on some days and some NHS doctors do private work. One thing is for sure; they are not short of money.

 

[Bronzeage]

Doctors are not slaves. Why would they agree to take on patients if at best they break even or worst incur losses?

]

What would an average Doctor's income be if he had to depend upon cash paying patients? Let's imagine a world with no health insurance at all. Doctor's are not immune to market forces. Insurance compensation is the only reason doctors do as well as they do. When your largest customer says, "I can't keep paying these prices," what should a doctor do?

Look at another insurance dependent industry, the automotive collision repair industry. A body shop accepts the insurance company dictates because the insurance company is the customer, not the car owner. If there were no auto insurance compensation, most wrecks would be total losses and become scrap metal. The body shop figures out how to deliver the service for the price offered.

The US has the highest healthcare costs in the world. Why would anyone think that any kind of reform to control costs would not include paying doctors less?