Diligent.ME

I'm surprised to see you agree with my statements on "health insurance reform". I had thought you turned to the dark side ;)

Anyway as far as doctors are concerned things will be significantly altered. There are some good sides. For example, because the bill puts a high priority on primary care and related services, certain specialties like Psychiatry will be woven into the primary care infrastructure. This has the possibility to help payments to those groups. However, it's not estimated that primary care docs will be paid much more than they already are.

As for specialists- because medicare is going to be highly regulated, they will begin to arbitrarily pay less reimbursement than they do now "to constrain costs". In some ways, this will have the effect that the congress wants- more primary care doctors and fewer specialists because there is simply no pay-out for specialists who spend more years in training and often work many more hours.

So yes, reimbursement will be a big problem from medicare.

Another reimbursement problem will come from patients with private health insurance. As we know, there is no public option (not that I support that anyway) and all people will be ensured privately (unless they are poor/old). This is VERY bad with the current model. Insurance companies are necessarily going to have to take on more high-risk patients. As you know, insurance depends on the expectation that most people don't use many services.... If the proportion of people draining away resources (the new sign-ups) rises then doctors will necessarily be paid less in order for insurance companies to absorb the cost.

You might ask- what about insurance companies raising premiums? Well, you'd be right, they will raise premiums but high-risk individuals will pay no more than anyone else (that is mandated). There will be no way around it. Some people will have increased premiums, and reimbursement for docs will go down.

It's not all about money, either. As you know, Tort reform is not part of the package. And while liberals are correct when they say that Tort is low-yield (that is, not much cost savings will occur) they are being hypocrites by not including it in their bill. Their bill is based on a moral argument that more people be covered. This has to be true because the cost savings of their plan pale in comparison to some other proposed changes. Thus, while tort reform might not save much money there's simply no reason not to include it in the bill considering it would be a big relief to physicians.

Call me a nut-job but there is also one other big issue with this bill, and it relates to something I've already said.

Consider this analogy. You are a business and you make a widget. Would you rather build the widget in a place of low cost and low regulation or would you rather base your company in a beautiful paradise (except the fees and regulations are strangling)? The choice is obvious.

Here's the deal. Medical School leaves most grads with something like $150,000 in debt. That may seem like a lot, but if you work hard and match into a lucrative specialty you might be able to make say 350,000 a year, right? This makes up for all the costs you endured (not to mention a long residency with low pay). However, now imagine that not only does your reimbursement go down by 10-20%, but you are also paying higher taxes on the money you earn because you need to pay for everyone else's insurance. To add insult to injury, doctors with less training and less hours at work suddenly make a little bit more than they used to. Further, you're caught in all this red tape of increasing regulation and "performance-based" pay.

Frankly, who'd want to be a doctor? I know liberals like to say that being a doctor should only be to "help others" but we're sacrificing a lot. We train longer than virtually any other profession but we get paid the least. JD's and MBA's train far less, pay less, and earn more. We are willing to do the work because it's a calling. But at some point there needs to be some kind of reward.

I can't wait to see the kinds of folks who end up in medicine in 10 years.

Sorry for the rant, but you asked for it :)

i did ask and found this interesting. i'm with you... i just don't see how anyone can be for this damn thing, and yet i look at my friend's cheering for this. Even the one's i'd consider smart on these kind of issues. I think it's like you said, the Repubs pissed off the libs so much that people would have voted for shit on a plate just to see republicans lose. And that is sad!