This is by no means the norm in this country. Where do you get this data? Very few doctors are doing this because it leaves too much money on the table. Most hospitals and clinics cannot afford to operate without the Medicare patients. Look, everybody in the country goes on Medicare at age 65, not just poor people. Why else would private insurance be the basis of the health care act instead of just putting everyone on Medicare? It will result in a lot more business for the insurance companies. Competitive business. Well, many disagree with that assessment, as you have seen.
1) Oregon not the most conservative state published this a couple of months ago and it was discussed in this forum. I believe there are other studies that agree. Show me any studies that show otherwise. 2) to say it is true competition is laughable. Do the consumers get to negotiate with providers for rates? No they can shop only in limited venues with forced coverage. Nothing truly competitive about it. 3) well you and NC most others here see my side
There are no studies proving a negative. You say that most of the people receiving subsidies live in doctor "deserts". I don't recall the Oregon study saying that, so where did you get it? Where are these deserts? Of course there is. Consumers never have been able to negotiate with providers for rates, that is a straw man. The competition is between providers who set their own rates competitively to try to get the consumers business.
Of course there is. Consumers never have been able to negotiate with providers for rates, that is a straw man. The competition is between providers who set their own rates competitively to try to get the consumers business.[/quote] I don't need to prove a negative. I cited a study that has data and facts. Show me where it is contradicted. 2) doctor desert are in any big city poverty ridden neighborhood in the country where small communities can't attract doctors. The evidence is all over. 3) that is right there never has been the type of competition I noted. It was wrong in the pre AHCA world and is today. Even car insurers get you to check prices for repairs. If doctors hospitals and pharma had to compete for business like repair shops health care would cost less. If you knew what the total cost of your medical treatment was you would shop more wisely. That is the competition I meant.
I can find nothing about people receiving subsidies in doctor deserts in it. I told you that. I don't buy this crap. There are no emergency rooms in those inner city neighborhoods either! Nor are there any doctors offices in my upscale affluent neighborhood. Almost all of the doctors and clinics are in the medical neighborhoods around the hospitals. If a person can get to the emergency room, he can get to a primary care doctor.
Red it is called integration of data and critical thought. You seem to refuse to do it unless it meets your preconceived notions. I suggest you do a little research on the transportation problems the poor face and the lack of all services where they live. I'll keep it simple 1) doctors don't have offices where uninsured and/or poor prople live. BTW Same with grocery stores etc. 2) Many poor /uninsured rely on public transportation. They don't have flexibility to travel as you do. 3) Public transportation does go to or near hospitals. ERs have open hours so making appointments is not required. 4) Without flexibility poor/uninsured only see doctors in emergency situations. They have no time or flexibility to see doctors for check ups etc and build a relationship with a doctor. CONCLUSION the ER is the default doctor for poor/uninsured because it fits their needs better than a regular doctor. There is nothing in the AHCA that will change that dynamic.
I have six clients who are doctors. One is a gastroenterologist, one is a geriatric care GP, one is an OBGYN and the others are GPs. None of them take Medicaid anymore because the re-imbursements are so far in arrears. The OBGYN is my cousin, and she is owed over $600,000 by Medicaid. Payments began to take longer and longer, then there were three consecutive months with 0 re-imbursements from Medicaid. At that point she had to stop taking Medicaid patients. The few still on the roles will end up being charged to her charity care account, and she won't even bother submitting the claims. The geriatric doc has moved to accepting only cash pay for services. He doesn’t want to mess with Medicare and gap insurance at all. Medicare is a system that seemingly encourages fraud. If a doc does CPT code XYZ he will get a $50 reimbursement. If he does XXZ he gets a $25 reimbursement. If he does XXX he gets a $125 reimbursement. If he does XYZ and XXZ he will get a $95, a gain of $20. If he does XYZ, XXZ, and XXX he will get a $45 reimbursement. It makes no sense. Since Medicare reimbursements are in no way tied to costs many docs have turned to gaming the system in order to maximize reimbursements and maybe even make a little money. In the scenario above I have seen docs perform the two procedures that generate the highest reimbursement in one visit Then request the patient make an appointment a few days later to perform the third procedure to get the highest reimbursement. Instead of encouraging docs to do procedures that are medically necessary, it encourages them to strategize for reimbursements. BTW XYZ, XXZ, and XXX are not actual procedures codes, just examples I made up to illustrate how completely fucked up Medicare is. I agree. That is also the way insurers see it, which is why premiums have risen so sharply since the bill was enacted.
Simple is for simpletons. I suggest that you look at a friggin' map. Do you even read my posts? I'll just repeat myself. 1. There are also no hospitals or emergency rooms in these neighborhood "deserts"! 2. Doctors don't have offices in anybody's neighborhood any more. Doctors offices and clinics are mostly in the medical jungles around the hospitals. other are along the main transportation corridors. 3. This means that if there is public transportation to emergency rooms, then there is transportation to doctors offices. 4. The "Urgent care" clinics are right by bus stops and are open 24 hours. No appointment needed. LINK 5. The dynamic that is obviously changed by the ACHA is that poor people will no longer have to get to Earl K. Long or take a non-emergency to an emergency room. They can take their insurance to the clinic or doctor of their choice, many of whom are more accessible than emergency rooms. 6. There are, in fact, many clinics in the inner city. It is the rural suburbs where they are sparse.
The Drs around here have posted signs on their doors "We will not accept any new Medicare patients". The un-insured guys at the shop, and most of their family members, go to the ER for any and everything. Because it's "free". 1 of them just turned 21. His gf is having a baby. This will be his 3rd kid by the 3rd gf. All of them are 1-2yrs removed from high school.
