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More E-mails From Docs Opposed To Obama/Pelosi/Reid Rationing

Thursday, May 7, 2009  |  posted by Hugh Hewitt
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From Dr. O in Sacramento:

I can hardly believe there are that many doctors who want a single
payer system. IMO, the only doctors that would want this are either
lazy, or do not have what it takes to make it in private practice.

A national health care system WILL BE a nightmare and complete
disaster. It will be inefficient on a scale yet not even imaginable.
Americans will also be shocked at how poor, rationed, and delayed their care will be. There will be many people who will be permanently injured or allowed to die because the government will establish some bul**hit evidence based criteria on allowing certain treatments.[# More #]

I have personal experience. As a 10 year old boy living in
Czechoslovakia, my mother would have to bribe a doctor just to be seen and the care flat out sucked.

I would also like to mention the issue of physician quality and
quantity. I believe that my desire for truly helping my fellow man is
shared by the vast majority of my colleagues. That said, the suffering that you have to endure; physically, mentally, emotionally, and financially, to make it through the training process will be too much to endure and too much of a deterrent should they arbitrarily cut and determine our pay. So get ready for the lowest caliber of physicians, mainly foreign grads, and huge shortages of doctors, especially specialists.

I for one am ready to take my wife and 2 small children and relocate elsewhere, as my mother did in 1976 to escape the misery of socialism. To see it happen here is truly mind numbing. Consider me one specialist who will likely not stick around to participate in the forthcoming rationed misery-care.

I am a Board Certified Othropaedic Spine surgeon. I have a busy solo practice in the Sacramento area.

From Dr. E in Omaha Nebraska:

Our current standard of care is to use any treatment any treatment that is both safe and effective for the condition. The new proposed standard is to provide “cost-effective” care. This is nothing but a euphemism for rationing of care to favor those whose contributions to society are most highly valued by society. In a young executive, heart surgery may be economically justified, while the identical procedure cannot pass the test to benefit a senior retiree.

From Dr. G in Northeast Ohio:

First, let’s understand what is wrong with the current system. I believe that a key component to the “health care problem” is that physicians have given over too much control to insurance companies. This is obviously not a ground-breaking observation, everyone knows this, but let’s explore this a little further. Doctors sign lop-sided contracts with insurance companies for the “privilege” of joining their networks. Now the doctor’s training does not go to waste (or does it?), and s/he can now treat in-network patients in exchange for insurance hassle and underpayments. What a deal. Not only are we told what and how to treat, but then we have to deal with denials, downcoding, delays, bundling, preauthorizations, and referrals. We have to pay staff members $30 to chase down and collect $20, the so-called “negotiated fee” which is a misnomer, of course, as there is rarely any negotiation. There are even insurance contracts that are proud to boast that they pay 50% or 75% of the submitted charge. What are we forced to do in response? We raise our fees. Who gets punished? The uninsured, who do not benefit from “negotiated fees”. In essence, the uninsured are forced to pay for the losses incurred by (mis)managed care. The uninsured usually can’t afford to pay this difference, so the doctor must eat the loss. This is why doctors are fleeing primary care and practices are going bankrupt. It is not a viable business model.
So what is my idea? Abolish the concept of the “insurance network”. What does that mean? Let me explain…
The power of the dominant health insurance companies in a particular market lies in the existence of their networks. Doctors need patients, and patients need doctors. If insurance companies only provide adequate coverage when both parties are in the network, both parties become obligated to join. Doctors sign unfair contracts to join, and patients pay high premiums to join. Can a member (patient) see an out-of-network provider (doctor)? Sure, but benefits are substantially reduced. In addition, there is usually a SEPARATE out-of-network deductible that is usually TWICE that of the in-network deductible, so out-of-network benefits rarely kick in.
So how would this no-network thing work? A patient would continue to purchase insurance coverage from any commercial insurance company, but could see ANY licensed physician s/he wants. The physician could then choose, on a visit-by-visit basis, whether or not to “accept assignment” from the insurance company when submitting the claims. If the physician accepts assignment for the claim, then any insurance reimbursement is paid directly to the physician, the physician is bound to accept the insurer’s “standard fee” as payment in full for the service, and must also accept any denials, downcodes, bundling, etc., that the insurance company deems appropriate. All standard fee schedules and policies would need to be fully available on the insurance company’s website. (This would also necessitate that all doctors and practices be treated equally with regard to pay rates, which is not currently the case.) If the physician does not accept assignment for the claim, then the physician would collect the full charged fee from the patient at the time of service, and any insurance reimbursement would be paid to the patient. The actual insurance payment would be the same in both cases.
Example: Doctor’s charged fee for a visit is $100. Insurance “standard fee” is $80. Insurance pays at 80% of “standard fee”.
If physician accepts assignment, insurance pays physician $64 and patient pays physician $16, total reimbursement is $80.
If physician does not accept assignment, insurance pays patient $64 and patient pays physician $100 (net $36, or $20 more), total reimbursement is $100.
This relatively simple system has the power to significantly transform the healthcare landscape. What this system does, in effect, is force insurance companies to finally become accountable to both patients and doctors in classic free-market fashion. If a company pays quickly, fairly, and offers good customer service, doctors will routinely accept assignment and more patients will use that company. If not, the opposite will occur. The insurance companies would still be able to legitimately deny inappropriately submitted claims (abuse) without fear of backlash, as this situation would more than likely backfire for the doctor. If assignment was accepted, the claim was denied. If not, there would be angry patients to deal with.
Without the existence of networks there would be a level playing field for the smaller insurance companies to compete in the market, which would drive down the cost of premiums. To further reduce the number of uninsured there could emerge very low cost insurance plans with “standard fees” well below the average, but that pay very quickly and without hassle. There would certainly be numerous doctors that would accept a reduced fee in exchange for efficient payment and a large patient base.
With this system access to health care across the board would increase, as doctors would be able to afford to return to primary care and be doctors again. With reduced overhead from more efficient payment, combined with the ability to ensure more consistent and fair payment when necessary, the cost to DELIVER health care could actually decrease, so doctors would no longer be forced to “punish” the uninsured with higher fees. Imagine that.
That’s my idea. It’s not perfect, and it would need to be modified for hospital care and other services such as diagnostic testing, but I think it’s a good start. Ponder this: You’d think that insurance companies would lobby vehemently against this system, but given the looming threat of singer-payer, they might ironically offer their reluctant support.
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