# Medicare, anyone had a doctor not accept it?



## hvacrsteve (Jun 21, 2010)

http://www.massdevice.com/news/docs-increasingly-abandon-medicare

Times are a changing, has anyone had a doctor not accept Medicare?

Right now we have private insurance, my DW is still on mine, although she could go on Medicare, I have left her on mine because I was afraid of this happening, although we never know until we actually have an issue.

Can anyone offer any other feed back?


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## T_R_Oglodyte (Jun 21, 2010)

hvacrsteve said:


> http://www.massdevice.com/news/docs-increasingly-abandon-medicare
> 
> Times are a changing, has anyone had a doctor not accept Medicare?
> 
> ...


I have a very good friend in his mid-50s who is currently establishing his own internal medicine practice after spending much of his career as a company-employed physician.  He is employed by a health-care organization that operates clinics and hospitals, and within the aegis of that organization he is expected to develop his own caseload.  He has about a two year period in which the organization will carry him until he gets his practice established.  

We have talked about this.  The biggest challenge that he faces is developing a large enough portion of his practice that is not medicare patients.  If he doesn't accomplish that he won't keep his job.

According to him, the current prevailing practice in the medical community is for physicians to not accept new Medicare patients.  If they have existing patients, they will continue to see those patients as those patients transition to Medicare.  That generally serves to limit the Medicare size of the practice to a level that is sustainable.

So, I guess my advice would be to plan now to establish physician relationships that will provide continuity into Medicare coverage when the time comes.  If you start looking around after you reach Medicare, you may find your options extremely limited.


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## rapmarks (Jun 21, 2010)

When I went on Medicare last year, the ob/gyn would no longer accept me and I had to switch to someone else in the practice.


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## Tia (Jun 21, 2010)

A friend whose hub managed a family practice in recent past talked about a certain % of medicare, as a limit, as otherwise they can't pay the bills with reimbursements. Another friends mom visited and needed to see a doctor while on vacation here, medicare plus a supplement, friends own dr would not see the mom. They called a few places and finally an urgent care place gave her an appt.


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## nonutrix (Jun 21, 2010)

About 6 years ago my parents moved from Houston to Austin, Texas.  We had a very tough time finding them doctors that would accept new Medicare patients.  Even the local geriatrics specialist wasn't accepting new Medicare patients!  What I learned from this experience was to make sure you are well established with doctors when it comes time to go on Medicare.

nonutrix


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## beanie (Jun 21, 2010)

according to a story in usa today  , about 13 % do not accept medicare and 19% do not accept new patients .


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## hvacrsteve (Jun 21, 2010)

beanie said:


> according to a story in usa today  , about 13 % do not accept medicare and 19% do not accept new patients .



Those are pretty astounding numbers! So this is what I have to look forward to!  My current Doctor is getting pretty old, maybe I need to find a young one so he will last through this until I expire!


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## barndweller (Jun 21, 2010)

My hubby is medicare eligible but we have a good (and expensive) private insurance since I am not yet 65. Our family practice doc does NOT accept medicare AT ALL. Our private policy covers our visits with a small deductible and also covers any tests and annual physical.  We live in a rural area and have almost no available options for those on Medicare. The big companies don't offer any supplemental plans to medicare folks in low population parts of our state that would be affordable to the average retiree. I don't blame the doctors. It's the middle man that is making all the money from out of control heath care costs. Not only that, they (the insurance companies) also get to decide what is covered and what is not. So much for decisions made by you and your doctor.


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## thheath (Jun 21, 2010)

FYI: This reduction in Medicare payments is not due to the new healthcare reform.  This reduction has been looming for sometime but was held back due to congress providing the extra funds annually; they stopped June 1st. 

Just wait until the new healthcare plan takes effect; you can bet that when they job Peter to pay Paul the Medicare folks will get the short end of the stick even more so.

PS:  What's AARP's position on this; I haven't heard much from them and this sure affects their members.  Could it be because they sell supplemental insurance?


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## hvacrsteve (Jun 21, 2010)

thheath said:


> FYI: This reduction in Medicare payments is not due to the new healthcare reform.  This reduction has been looming for sometime but was held back due to congress providing the extra funds annually; they stopped June 1st.
> 
> Just wait until the new healthcare plan takes effect; you can bet that when they job Peter to pay Paul the Medicare folks will get the short end of the stick even more so.
> 
> PS:  What's AARP's position on this; I haven't heard much from them and this sure affects their members.  Could it be because they sell supplemental insurance?



I thought the healthcare reform bill fixed Medicare also!  I must really need to get my ears checked!


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## hvacrsteve (Jun 21, 2010)

rapmarks said:


> When I went on Medicare last year, the ob/gyn would no longer accept me and I had to switch to someone else in the practice.



Where is the Lemon Law that covers stuff like this? I thought we were protected from abuses like this?


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## hvacrsteve (Jun 21, 2010)

barndweller said:


> My hubby is medicare eligible but we have a good (and expensive) private insurance since I am not yet 65. Our family practice doc does NOT accept medicare AT ALL. Our private policy covers our visits with a small deductible and also covers any tests and annual physical.  We live in a rural area and have almost no available options for those on Medicare. The big companies don't offer any supplemental plans to medicare folks in low population parts of our state that would be affordable to the average retiree. I don't blame the doctors. It's the middle man that is making all the money from out of control heath care costs. Not only that, they (the insurance companies) also get to decide what is covered and what is not. So much for decisions made by you and your doctor.



I thought and I could almost hear that this was an issue covered in the new health reform bill.


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## thheath (Jun 21, 2010)

Personally I won't drink the administration's Kool Aid on this issue...


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## hvacrsteve (Jun 21, 2010)

thheath said:


> Personally I won't drink the administration's Kool Aid on this issue...



I haven't either, but it seems like many already have.  I just feel sorry for the ones that are squeezed without the funds to see a doctor and are supposed to be covered by something when really they are not.

I only pray my health holds up, I can't imagine what the elderly sick actually have to endure.


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## beanie (Jun 21, 2010)

I thought the new healthcare bill doesn't go into effect for a few years ? I live in an area where it would be occupational suicide for doctors not to take medicare and when elgible will shop for a doctor who does take it (13 yrs to go )plus in six months baby boomers start enrolling in medicare and could add to strentgh in numbers as far as doctors accepting it .


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## hvacrsteve (Jun 21, 2010)

beanie said:


> I thought the new healthcare bill doesn't go into effect for a few years ? I live in an area where it would be occupational suicide for doctors not to take medicare and when elgible will shop for a doctor who does take it (13 yrs to go )plus in six months baby boomers start enrolling in medicare and could add to strentgh in numbers as far as doctors accepting it .



Part of it is years away, the issue for you, may be that the doctors move away, that happened to my Mom when they lived in MS, She was forced to drive over 100 miles every time she had to go see a doctor.
Another cause of that was a MS law that made it so doctors couldn't afford mal practice insurance and they mostly left the state.  I couldn't believe what it actually took to go see a doctor, I finally moved her to VA so that was not an issue any more.

The higher number of users will not help it, and will probably hurt it.  I am no expert on this subject, it just seems that if fewer doctors are taking it and more people start using it, then it gets worse.  I certainly hope not since I may be stuck on it myself someday.  I just don't like what I am hearing and reading lately.


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## thheath (Jun 21, 2010)

As a side note this reduction in doctor payments also affects the Military.   Tricare insurance which covers military dependants and retirees is tied to Medicare so the reduced payment schedule went into effect for them too.


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## T_R_Oglodyte (Jun 21, 2010)

beanie said:


> I thought the new healthcare bill doesn't go into effect for a few years ? I live in an area where it would be occupational suicide for doctors not to take medicare and when elgible will shop for a doctor who does take it (13 yrs to go )plus in six months baby boomers start enrolling in medicare and could add to strentgh in numbers as far as doctors accepting it .


From the standpoint of the individual doctor it doesn't make any difference how many medicare patients there are.

The issue is that the medicare reimbursement rates are so low that they don't cover the cost of providing service.  An increase in the numbers of medicare patients won't magically make doctors think  - "Ooops, I'm running out of patients.  Guess I better start accepting more Medicare patients, when doing so would simply mean they would lose even more money than they are now.  

When there cease to be enough non-Medicare patients to make the practice financially viable, doctors will react by closing down the practice, not by accepting more patients so that their practice lose even more money.

*******

If your area in Florida becomes such that there aren't enough non-Medicare patients, the doctors will close shop and relocate somewhere else where there are enough non-Medicare patients to support a practice. 

*******

The other consequence that will happen is that when Medicare patients do get in for medical care, they will spend very little actual time with a doctor.  To eke out a living the doctor is going to have to see some minimum number of patients per hour during office hours - that will likely mean somewhere around ten patients per hour, and the physician still needs time to review each patients records and charts.  

Do the math - you'll be lucky if you actually spend five minutes with a physician, and then some of that time will be spent looking at a charts, readings, and results.

That's actually another key reason why my friend can't afford to handle a lot of Medicare patients.  To provide adequate care requires some minimum amount of time to be spent with patients.  Even if he were to set aside the ethical and moral imperatives of being a practitioner and look at it strictly from a mercenary standpoint, controlling malpractice liability requires more time with patients than can be provided under Medicare.

The Medicare system is broken. It has functioned to this point because the proportion of the population on Medicare has remained sufficiently small.  As the proportion of the population on Medicare increases, the system is going to start completely unraveling.


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## Liz Wolf-Spada (Jun 21, 2010)

We are hoping to move to the Palm Desert area in about a year. DH is already on Medicare. I will have to be buying our school district's policy, which is really expensive ($1100 per month and I will have to be paying all of that instead of the $400 I pay now). I guess I will be exploring that. Hopefully in an area geared to retired people we will find good doctors and hospitals accepting new Medicare patients.
Liz


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## pgnewarkboy (Jun 22, 2010)

hvacrsteve said:


> I thought the healthcare reform bill fixed Medicare also!  I must really need to get my ears checked!



Here is the problem.  Medical costs in this nation are totally out of control.  They were out of control before the new law and they are likely to be out of control after the law.  The question is why is this so?   Private health insurance, Medicare, and Medicaid are all becoming more expensive because basic medical costs - the amounts doctors and hospitals charge to provide care is going up.  The private insurance companies have been squeezing the doctors and the patients for decades. Many medical specialists no longer accept private insurance.  More and more are going that route.     The question is why are costs so high that private insurance and government insurance cannot afford to pay what the doctors and hospitals want?  

Some blame malpractice claims and insurance costs.  Yes, that is a part of the problem but study after study proves it is a small part of the increases in costs.  Where is the rest of the increases coming from?  Any serious discussion has to address this question.


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## pgnewarkboy (Jun 22, 2010)

hvacrsteve said:


> http://www.massdevice.com/news/docs-increasingly-abandon-medicare
> 
> Times are a changing, has anyone had a doctor not accept Medicare?
> 
> ...



You need to take a look at your health coverage.  As far as I know, all private insurance becomes secondary insurance once a beneficiary is eligible for Medicare.  Check it out before you receive a bill you won't want to pay.


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## Kal (Jun 22, 2010)

hvacrsteve said:


> I thought the healthcare reform bill fixed Medicare also! I must really need to get my ears checked!


 
Until such time that the cost curve of insurance premiums decreases there's very little that can be done to help medicare.  Medicare is a buyer of health care services, just like everyone else.  There is a limited supply of money to buy the services and that supply is substantially decreasing.  Unfortunately the demand on Medicare is increasing.  The Baby Boom generation is entering the "customer base" but more importantly, people are living much longer and thereby increasing demand for services.

What do you see in the Health Care bill that reduces the cost curve of insurance premiums?  Absent that, Medicare cannot continue as currently structured.  The "something for nothing" crowd will have a rude awakening.


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## Tia (Jun 22, 2010)

Kal said:


> The "something for nothing" crowd will have a rude awakening.



I think this is the jist of the whole thing on both ends of the spectrum, those demanding more and more profits VS those wanting service for nada. There is less and less middle ground leading to the increased cost for the rest of everyone.


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## pgnewarkboy (Jun 22, 2010)

Tia said:


> I think this is the jist of the whole thing on both ends of the spectrum, those demanding more and more profits VS those wanting service for nada. There is less and less middle ground leading to the increased cost for the rest of everyone.



There are various studies that show that Americans get tested excessively and often needlessly.  Further, American receive treatments that are expensive and not proven to extend life.  Additionally, these tests and treatments can actually shorten the patients life.  I read recently that "Medical Care" is the third leading cause of death in the United States.  That includes everything from medications, tests, and surgical procedures that result in death by accident or as a side effect.  Just read the label of most prescriptions drugs and you see that many drugs can kill you.

Basically, and to an extent understandably, Americans want every test and treatment available.  The health care industry sells the public on the idea that they must have these interventions because the health care industry makes money by selling them.  

There is no counter balance to the propaganda of the health care industry.  Americans are basically uninformed so we demand more and more even though it probably won't help us and may actually kill us.  The studies and articles on this topic are out there but they are hard to find and few in number and easily drowned out by the constant sales pitch for MORE and EXPENSIVE health care.

Another problem with rising costs is the doctor shortage.  Why is there a doctor shortage?  Is the medical profession always acting in good faith or are they sometimes acting to pad their own wallets by making it hard for the public to get to health care professionals.  Medical school is outrageously expensive.  Why?  Is this totally justified?  Do you always have to see a doctor or will a para-professional suffice in most situations?  Why is that Medical Doctors have a monopoly on providing health care? 

In line with the statement quoted above, it appears that the American public wants everything and doesn't want to pay for it and doesn't realize that its outrageous demands for my doctor, any test I want, any procedure I want, and any drug I want is absolutely unsustainable.


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## pgnewarkboy (Jun 22, 2010)

*Oops!*



pgnewarkboy said:


> You need to take a look at your health coverage.  As far as I know, all private insurance becomes secondary insurance once a beneficiary is eligible for Medicare.  Check it out before you receive a bill you won't want to pay.



It turns out that the issue of when Medicare becomes a primary or secondary payor if a spouse is on another spouses coverage at work is more complicated then I first thought.  Here is a quote from an article on the subject that highlights some of the issues.

If a Medicare beneficiary is over age 65, and the beneficiary's spouse is employed and is covered by an employer-sponsored group health insurance policy, Medicare generally becomes the beneficiary's secondary insurer whenever the spouse's company has more than 20 full-time employees. In that case, the spouse's employer-sponsored group health insurance policy represents the Medicare beneficiary's primary insurer. However, if the spouse's company has less than 20 full-time employees, Medicare generally represents the beneficiary's primary insurer.


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## T_R_Oglodyte (Jun 22, 2010)

pgnewarkboy said:


> There are various studies that show that Americans get tested excessively and often needlessly.


You don't need to ascribe deep motives to something that has a simple practical explanation.

Americans get overtested because of the liability system.  Even if a physician does not believe a test is necessary the test will be ordered up anyway. That's because if the test *might possibly* have given some indication that something else was wrong, the doctor - as well as the clinic, hospital or anyone else involved - is a sitting duck for a malpractice claim.  So if there is even the slightest possibility that a test will might indicate something, the doctor will order that the test be done.

Of course testing gets ever more complicated, with more and more elaborate techniques and routines.  But the doctors can't afford to not order the test, using the latest and most expensive technologies.

Now, the logical ones to try to put the brakes on that are the insurance companies. But if they try to rein in the needless testing face the burden of being cruel heartless pecuniary who are denying coverage to their members. 

******

Upthread someone mentioned that malpractice isn't that big a cost in the system.

The information I've seen on that topic that I've seen is flawed, because it only counts the costs of direct costs of malpractice premiums and awards.

The real cost of malpractice is the indirect costs. The big cost items there are the many tests and procedures that are performed only to provide liability control, and the costs that go into documenting everything that happened and why it was done so that the information can be produced in case a claim arises.

That documentation cost is far from trivial.  In my experience in consulting engineering, I have seen projects in which 205 of the project labor was devoted simply to creating a documentation paper and electronic trail in the event of litigation.

***

Frankly I wouldn't be the least surprised if liability control was responsible for 25% or more of the total health care cost in this country.


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## John Cummings (Jun 22, 2010)

pgnewarkboy said:


> You need to take a look at your health coverage.  As far as I know, all private insurance becomes secondary insurance once a beneficiary is eligible for Medicare.  Check it out before you receive a bill you won't want to pay.



That is not true. I have been eligible for Medicare for 5 years now. I have a Medicare Advantage plan with Health Net. Health Net is totally responsible and Medicare is not involved. Medicare Advantage Plans have to offer at least the same coverage as Medicare does. My parents had private insurance that had no connection at all with Medicare.

What you are referring to are the Medigap policies that basically fill in the holes that traditional Medicare doesn't cover.

Being eligible for Medicare does not mean that you are covered by it. You have to apply for it if you want it and there is no obligation to do so.


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## bogey21 (Jun 22, 2010)

1) I was still working when I was over 65 and had Medicare and Employer Insurance.  Since I was still working Employer Insurance was Primary and Medicare was Secondary.  After I retired I still have Medicare and Employer Insurance.  The day I retired Medicare became Primary and Employer Insurance became Secondary.  

2)  I have one group of doctors I use where only one of them will accept Medicare patients.  I get in but it takes longer to get an appointment.

George


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## thheath (Jun 22, 2010)

Tia said:


> I think this is the jist of the whole thing on both ends of the spectrum, those demanding more and more profits VS those wanting service for nada. There is less and less middle ground leading to the increased cost for the rest of everyone.



I'm not so sure about people wanting something for "nada".  Most of us paid for years into Medicare via payroll deductions; we just want what we paid for...


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## pgnewarkboy (Jun 22, 2010)

John Cummings said:


> That is not true. I have been eligible for Medicare for 5 years now. I have a Medicare Advantage plan with Health Net. Health Net is totally responsible and Medicare is not involved. Medicare Advantage Plans have to offer at least the same coverage as Medicare does. My parents had private insurance that had no connection at all with Medicare.
> 
> What you are referring to are the Medigap policies that basically fill in the holes that traditional Medicare doesn't cover.
> 
> Being eligible for Medicare does not mean that you are covered by it. You have to apply for it if you want it and there is no obligation to do so.



You understand, I am sure, that Medicare PAYS for your health care.  So Medicare is involved.  As far as Medicare as a secondary payor goes that has nothing to do with Medigap insurance.  Medicare is sometimes a secondary payor in certain situation. I was not aware of that.  I posted the information in a post on this thread entitled Oops!


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## PStreet1 (Jun 22, 2010)

Until about a year ago, I was a Mayo Clinic patient in Arizona.  I received a letter that Mayo would no longer see Medicare patients if they were seeing internists or general practicioners.  I have a good supplemental insurance policy, but that made no difference.  Since Medicare is primary, it doesn't matter what supplemental insurance the patient has.  The only way I could continue to see the same doctor was to pay the entire cost.

Mayo, currently, still accepts Medicare patients for specialists----but for how long? 

It is absolutely true that doctors simply cannot afford to accept Medicare reimbursement in many cities/parts of the country.  I'm sure there are areas where rents/salaries are lower where doctors are not as affected by the cuts, but in some cases, giving the care costs more than the doctors will be paid.


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## pgnewarkboy (Jun 22, 2010)

*Over testing is not due solely to liability issues*



T_R_Oglodyte said:


> You don't need to ascribe deep motives to something that has a simple practical explanation.
> 
> Americans get overtested because of the liability system.  Even if a physician does not believe a test is necessary the test will be ordered up anyway. That's because if the test *might possibly* have given some indication that something else was wrong, the doctor - as well as the clinic, hospital or anyone else involved - is a sitting duck for a malpractice claim.  So if there is even the slightest possibility that a test will might indicate something, the doctor will order that the test be done.
> 
> ...



I simply don't know the details of the various studies and how they came to their conclusions.  It is probable that in some instances people are tested to avoid liability by doctors but that is certainly not the only reason. If that were the case I would have zero respect for doctors and they would be entitled to zero respect.  They should do what is best for the patient - not for themselves.  Many tests, if not most, have risks associated with them.   The entire medical industry sells the benefits of certain tests.  I am sure that most doctors and most patients think they are beneficial.  In many cases the patients demand that every possible test be done.  In the news recently there have been reports about studies that demonstrate that certain tests do not offer a benefit.  The public doesn't want to hear it. Some doctors don't want to hear it. The public has been told by the medical industry that they are selling miracles.  The truth is different.  Mammograms come with risks caused by radiation.  If a long term study demonstrates that they are virtually worthless for people under a certain age, nobody wants to hear it.  Everyone wants to throw science out the window.  The makers of mammogram equipment are happy.

Now perhaps you think that doctors shouldn't have to document what they do.  I think it is extremely important that they document what they do.  It is important for medical science because this information is used to find out what works and what doesn't work.  As medical databases grow, such information may be useful in finding patterns of disease and finding eventual cures.  Documentation is critical when people go to see a specialist or change doctors.  Documentation saves money and cuts down on medical errors and duplication.

You guess that liabiity is responsible for 25% of total health care cost.  You have nothing to back that up but for the sake of discussion I ask what about the other 75%?  Why are costs being driven so high so fast?


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## pgnewarkboy (Jun 22, 2010)

thheath said:


> I'm not so sure about people wanting something for "nada".  Most of us paid for years into Medicare via payroll deductions; we just want what we paid for...



I agree.  I want what I paid for.  The problem is that people don't know what they paid for.  Medicare does not guarantee that you get health care.    In our society, doctors don't have to accept Medicare.  If the cost of care keeps getting driven up one of two things have to happen and we all  know what they are.  Either we pay the doctors more or the doctors accept less money.  If we pay the doctors more the cost of running Medicare escalates as it already has and someone has to pay for that increased cost.  That would be me, you, and every other taxpayer.  Some people object to paying more in taxes.  They object to doctors refusing to accept Medicare. They want the doctors and they want Medicare to pay the doctors so they don't drop out and they object to paying more taxes.  They also strongly object to budget deficits.

There are numerous ways to curb medical costs that might help the tax and deficit situation.  One is to do away with medical care that costs too much and does too little.  But we don't want that either.  That is health care rationing and "death panels".   The other thing is to create more doctors through cheap loans etc  and cut the medical doctor stranglehold on the health care industry by getting more para-professionals into the industry.  But people don't want that either - they want "their" doctor.  They never want to leave that doctor for any reason.  But when their doctor refuses medicare they are furious.  Which just takes us round and round again.

To summarize this long post - People want something - everything - but they refuse to face reality.  A baby wants what it wants and just screams until it gets it.  Many times babies just scream for no apparent reason or because they don't know what or they want conflicting things like staying up when they need to nap.  Babies have an excuse for that behavior.

Please note that none of the above is directed at the poster of the above quote.  I am not attributing any of my remarks to him personally but using his quote as a jumping off point for an expanded discussion.  My comments are general in nature.


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## hvacrsteve (Jun 22, 2010)

pgnewarkboy said:


> Here is the problem.  Medical costs in this nation are totally out of control.  They were out of control before the new law and they are likely to be out of control after the law.  The question is why is this so?   Private health insurance, Medicare, and Medicaid are all becoming more expensive because basic medical costs - the amounts doctors and hospitals charge to provide care is going up.  The private insurance companies have been squeezing the doctors and the patients for decades. Many medical specialists no longer accept private insurance.  More and more are going that route.     The question is why are costs so high that private insurance and government insurance cannot afford to pay what the doctors and hospitals want?
> 
> Some blame malpractice claims and insurance costs.  Yes, that is a part of the problem but study after study proves it is a small part of the increases in costs.  Where is the rest of the increases coming from?  Any serious discussion has to address this question.



I researched it before doing what we did.  I didn't want to get caught in this problem.  I want to keep our private insurance as long as possible.  Its expensive, almost to the point of being ridiculous, but a huge medical issue can easily bankrupt you.


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## pgnewarkboy (Jun 22, 2010)

*Medicare Part A is automatic at age 65*



John Cummings said:


> Being eligible for Medicare does not mean that you are covered by it. You have to apply for it if you want it and there is no obligation to do so.



Medicare Part A becomes available to you at age 65 and is basically hospital insurance.  As long as you or your spouse paid into Medicare during your working careers there is no premium.  Medicare Part B essentially covers doctors and there is a premium.  If you don't want Part B, you don't have to pay for it.  Once you are getting social security you automatically get Medicare Part A at age 65 without further paperwork.   I don't know how it works if you turn 65 and are not yet taking social security.  You probably have to register for it - but you get it automatically at no cost.


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## John Cummings (Jun 22, 2010)

pgnewarkboy said:


> You understand, I am sure, that Medicare PAYS for your health care.  So Medicare is involved.  As far as Medicare as a secondary payor goes that has nothing to do with Medigap insurance.  Medicare is sometimes a secondary payor in certain situation. I was not aware of that.  I posted the information in a post on this thread entitled Oops!



I am well aware that Medicare pays for the Medicare Advantage plans. What I am saying is that if you have a Medicare Advantage Plan, then Medicare is not involved with the insurance as you have opted to have the Insurance company cover you.


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## pgnewarkboy (Jun 22, 2010)

John Cummings said:


> I am well aware that Medicare pays for the Medicare Advantage plans. What I am saying is that if you have a Medicare Advantage Plan, then Medicare is not involved with the insurance as you have opted to have the Insurance company cover you.



Now, I get it.


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## John Cummings (Jun 22, 2010)

pgnewarkboy said:


> Medicare Part A becomes available to you at age 65 and is basically hospital insurance.  As long as you or your spouse paid into Medicare during your working careers there is no premium.  Medicare Part B essentially covers doctors and there is a premium.  If you don't want Part B, you don't have to pay for it.  Once you are getting social security you automatically get Medicare Part A at age 65 without further paperwork.   I don't know how it works if you turn 65 and are not yet taking social security.  You probably have to register for it - but you get it automatically at no cost.



I am well aware of all that. After all, I have been through the process. You still have to apply for Medicare Part A even though there is no premium. Social Security is a separate application. You can sign up for one and not the other. You can apply and receive Medicare at 65 without taking Social Security. I applied for and received both at 65 even though I continued working.


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## Kal (Jun 22, 2010)

thheath said:


> I'm not so sure about people wanting something for "nada". Most of us paid for years into Medicare via payroll deductions; we just want what we paid for...


 
First do a quick back of the envelop calculation of what you paid into Medicare by salary deductions.

Now, you have a choice of getting all your money back, or accepting Medicare AS-IS without all the fear mongering.

Do you believe in a free lunch?


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## thheath (Jun 22, 2010)

Kal said:


> First do a quick back of the envelop calculation of what you paid into Medicare by salary deductions.
> 
> Now, you have a choice of getting all your money back, or accepting Medicare AS-IS without all the fear mongering.
> 
> Do you believe in a free lunch?



My friend, if doctors won't accept it then it's a mute point wouldn't you say?


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## pgnewarkboy (Jun 22, 2010)

John Cummings said:


> I am well aware of all that. After all, I have been through the process. You still have to apply for Medicare Part A even though there is no premium. Social Security is a separate application. You can sign up for one and not the other. You can apply and receive Medicare at 65 without taking Social Security. I applied for and received both at 65 even though I continued working.



Maybe when you did it but no longer.  You get SS you get Part A automatically without an application - not part B.


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## Conan (Jun 27, 2010)

Interesting article on Medicare and the oldest old:

*What Broke My Father's Heart*
http://www.nytimes.com/2010/06/20/magazine/20pacemaker-t.html?src=me&ref=general


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## Patty (Jun 27, 2010)

I started on social security at age 62 when I retired from teaching.  When I started medicare at age 65, my social security payment was reduced by the $96 a month taken out to pay for medicare. I think that amount has gone up now, but I don't know how much. Medicare is not free.  For all of those who like to travel, just be aware that medicare does not cover any medical costs  that occur while not on US soil.


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## Liz Wolf-Spada (Jun 28, 2010)

I believe that money taken out of social security is for Part B, not part A.
Liz


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## rapmarks (Jun 28, 2010)

Since I went on Medicare with my insurance as secondary, my out of pocket costs have dropped tremendously.  I was able to get a flu shot and a pneumonia shot and they were paid by Medicare.  very few things have not been covered by medicare.  
When I was on my old plan, any cat scan or mri had to be pre approved.  they would never approve them.  I just happened to be cleaning out some old paperwork and found this letter of denial of a cat scan of my sinuses from my pre-Medicare days.  Here is the reason given not medically necessary, symptoms must be present for 8 plus weeks despite appropriate medical therapy including at least 2 courses of antibiotics, nasal corticosteroids, and management of all allergic conditions, presence of nasal polyps.    I ended up taking 8 courses of antibiotics, two courses of steroids, back to an ENT and then to an allergist,  ran up about $2500 worth of bills with at least $1000 being out of pocket, was miserable for 9 weeks before they would okay a $200 cat scan.  Last week, the ENT ordered another Cat scan and I needed no pre approval.


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## kkan (Jun 28, 2010)

beanie said:


> according to a story in usa today  , about 13 % do not accept medicare and 19% do not accept new patients .



Depending on what part of the country you live in, it can be considerably harder to find a doctor to take medicare than these numbers suggest.

The numbers also do not reflect the % that reluctantly take a few new medicare patients and the % that add medicare patients with low priority scheduling.

Medicare is a goofy program that pays doctors better in high cost of living areas than in low cost areas (although too low in all areas).  This is goofy because doctor shortages and high cost of physician recruitment are far more common in low cost of living areas.  The result of this practice is that it is easier to find a doctor who takes medicare in the expensive east and west coast cities than in the middle of the country.


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## Wonka (Jun 28, 2010)

PStreet1 said:


> Until about a year ago, I was a Mayo Clinic patient in Arizona.  I received a letter that Mayo would no longer see Medicare patients if they were seeing internists or general practicioners.  I have a good supplemental insurance policy, but that made no difference.  Since Medicare is primary, it doesn't matter what supplemental insurance the patient has.  The only way I could continue to see the same doctor was to pay the entire cost.
> 
> Mayo, currently, still accepts Medicare patients for specialists----but for how long?
> 
> It is absolutely true that doctors simply cannot afford to accept Medicare reimbursement in many cities/parts of the country.  I'm sure there are areas where rents/salaries are lower where doctors are not as affected by the cuts, but in some cases, giving the care costs more than the doctors will be paid.



That's strange...my understanding of a supplemental medicare policy is it pays what Medicare doesn't.  I don't doubt your post, but I'm wondering why practices would choose to ignore those Medicare patients with a Supplemental plan.


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## thheath (Jun 28, 2010)

I guess the question is if the secondary insurance pays the remainer of what was billed or just the percentage of the allowable charge that Medicare didn't pay.  As we all know the allowable charge is what's so low.  I can't see the secondary insurance paying whatever the doctor/hospital bills over this amount. 

Could be wrong though...


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## pianodinosaur (Jun 28, 2010)

I currently refuse to see Medicare patients who have part A only.   There is a population of Medicare patients who think they are saving money by not enrollng in part B.  However, if that patient fails to enroll in part B, the physician gets paid nothing.   

What does this mean?  A patient wants free medical care and does not enroll in part B.  This same patient never sees a physician in the office because it is not covered by part A. This same patient gets sick and shows up in an emergency room and gets admitted to the ICU under the care of whoever is on call.  The physician on call never gets paid and the patient doesn't care.  

However, if the physician on call needs another specialist to help, that patient may be out of luck.  Very few specialists will currently accept a consult under those cirucmstances.  The liability is enormous and you are never going to get paid.  Furthermore, once the patient has been admitted, the patient is no longer covered under EMTALA (Emergency Medical Transfer and Labor Act), so seeing the consult is not mandatory.  Most of us can no longer afford to work for nothing.  Forcing us to work against our will without compensation is commonly known as slavery.  However, EMTALA (Emergency Medical Transfer and Labor Act) forces physicians on call to work without compensation against their will.  The only option we have is to not take call.  This is why so many emergency rooms and hospitals are closing.  Many physicians are refusing to take call.  There have been mass resignations from hospital staffs over call.  Hospitals are no longer in a position to mandate call.  I can no longer afford to take call.  

factoid:  Medicare is not an insurance company.  Medicare is a law. EMTALA is an example of the law of unintended consequences.  The government forced physicians to work without compensation against their will inorder to provide free medical care to indigent patients.  It never occurred to the goverment that physicians would ultimately quit.


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## bobby (Jun 28, 2010)

The trick might be to get a physician in a relatively large practice. When my doctor retired (pre to my medicare), they offered me a few choices of other doctors in the group. My group also has pediatrics. Group practices periodically add new doctors who need patients for start up time.


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## thheath (Jun 28, 2010)

pianodinosaur said:


> I currently refuse to see Medicare patients who have part A only.   There is a population of Medicare patients who think they are saving money by not enrollng in part B.  However, if that patient fails to enroll in part B, the physician gets paid nothing.
> 
> What does this mean?  A patient wants free medical care and does not enroll in part B.  This same patient never sees a physician in the office because it is not covered by part A. This same patient gets sick and shows up in an emergency room and gets admitted to the ICU under the care of whoever is on call.  The physician on call never gets paid and the patient doesn't care.
> 
> ...



Interesting, thanks for the knowledge.


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## John Cummings (Jun 29, 2010)

Patty said:


> I started on social security at age 62 when I retired from teaching.  When I started medicare at age 65, my social security payment was reduced by the $96 a month taken out to pay for medicare. I think that amount has gone up now, but I don't know how much. Medicare is not free.  For all of those who like to travel, just be aware that medicare does not cover any medical costs  that occur while not on US soil.



Part B has not gone up and is still $96 /mo. My Medicare Advantage plan does have world wide coverage.


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## Jennie (Jun 29, 2010)

pgnewarkboy said:


> You need to take a look at your health coverage.  As far as I know, all private insurance becomes secondary insurance once a beneficiary is eligible for Medicare.  Check it out before you receive a bill you won't want to pay.



Medicare Part A is basically free. For Medicare Part B the premium is $96.40 per month. Many private insurance companies *require* that you enroll in Medicare A&B as soon as you become eligible. This may not a bad thing. 

The private company will then become "secondary" meaning basically that they will cover many of the co-pays after Medicare has made the first payment. Some private insurance companies will even re-reimburse you for the $96.40 premium you pay for Medicare Part B each month.

The premiums you have been paying for the private insurance should go down significantly for you because Medicare will be "on the hook" first for the services your company had to pay in full for you up until now. Medicare will cover much of the cost of hospitalization. You will owe a $1100. deductible. But with secondary insurance, the private company will pay the deductible for you and be very glad the big $$$ will come from Medicare.

When a person has Medicare plus a supplementary insurance, doctors are much more likely to accept them as a patient--new or otherwise.


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## pianodinosaur (Jun 29, 2010)

Jennie said:


> Medicare Part A is basically free. For Medicare Part B the premium is $96.40 per month. Many private insurance companies *require* that you enroll in Medicare A&B as soon as you become eligible. This may not a bad thing.
> 
> The private company will then become "secondary" meaning basically that they will cover many of the co-pays after Medicare has made the first payment. Some private insurance companies will even re-reimburse you for the $96.40 premium you pay for Medicare Part B each month.
> 
> ...



It is against the law for a physician to collect more than what Medicare allows.  A medicare provider who tries to collect more than what Medicare allows has committed a crime.  He can be fined, lose his licence to practice medicine, and go to jail.  Medicare pays 80% of what Medicare allows.  If the physician forgives the remaining 20%, he or she has committed fraud and abuse as defined by the government.  The physician can be fined, lose his licence to practice medicine, and go to jail.


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## thheath (Jun 29, 2010)

pianodinosaur said:


> It is against the law for a physician to collect more than what Medicare allows.  A medicare provider who tries to collect more than what Medicare allows has committed a crime.  He can be fined, lose his licence to practice medicine, and go to jail.  Medicare pays 80% of what Medicare allows.  If the physician forgives the remaining 20%, he or she has committed fraud and abuse as defined by the government.  The physician can be fined, lose his licence to practice medicine, and go to jail.



Can he charge more then Medicare allows and bill the patient for the remainder?


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## Numismatist (Jun 29, 2010)

pianodinosaur said:


> It is against the law for a physician to collect more than what Medicare allows.  A medicare provider who tries to collect more than what Medicare allows has committed a crime.  He can be fined, lose his licence to practice medicine, and go to jail.  Medicare pays 80% of what Medicare allows.  If the physician forgives the remaining 20%, he or she has committed fraud and abuse as defined by the government.  The physician can be fined, lose his licence to practice medicine, and go to jail.



All well and true; however, many physicians charge a nice fee for a 'non-covered' service which is perfectly permitted.  Physicals are non-covered services and they can charge whatever they want.


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## John Cummings (Jun 29, 2010)

Numismatist said:


> All well and true; however, many physicians charge a nice fee for a 'non-covered' service which is perfectly permitted.  Physicals are non-covered services and they can charge whatever they want.



I didn't know that physical exams are not covered. I have a complete physical every 12-18 months and it is covered 100% by my Medicare Advantage plan.


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## The Conch Man (Jun 29, 2010)

*For info Only on Medicare*

Since I became eligible for Medicare this past February, 1st, cost for Part B is $111, yes, 1st timers get the new rate regardless what Congress does, most of you didn't have to pay extra this year, not bout next year & 2nd, you also get a free Physical the 1st year you are eligible if you fill out On-Line application. Even tho I filled the app out, didn't use it cause my Doctor knows what my problems are & I have a lot of them but he said just go do a Blood Plate at the Lab so he's up to date other than my Heart Doctor.

Been to all of my Doc's this year & I haven't paid any money to them due to Medicare takin care of the payments, includes Lab testin' as well. I pay no more Co-Payments to BC/BS anymore other than Dental & have MetLife for secondary coverage for my Dental program which 55% of the charges are paid by MetLife to Dental when BC/BS doesn't cover my charges to my Dentist which is hardly nothin' other than two cleanin' visits per year. The cost for my BC/BS is $114 a month which includes MetLife.

It looks like this year might not be good for our taxes as we had lots of deductions on Medical for the difference the insurance didn't pay but we'll have to wait till tax time for all of that!


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## pianodinosaur (Jun 29, 2010)

thheath said:


> Can he charge more then Medicare allows and bill the patient for the remainder?



The physician can charge more than what medicare allows but he cannot collect more than what medicare allows.  That is the law for all physicians who signed the government contract to see patients on medicare.  Medicare HMOs are another story.  I do not participate in any medicare HMOs.


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## pianodinosaur (Jun 29, 2010)

Numismatist said:


> All well and true; however, many physicians charge a nice fee for a 'non-covered' service which is perfectly permitted.  Physicals are non-covered services and they can charge whatever they want.



The moment a patient shows up to my office with any kind of complaint or medical problem other than male infertility, that visit is a covered service.  For example, a patient comes to my office because he is 70 years old and wants his prostate checked.  That is a covered service.  His physical examination is a covered service. The physician may charge all he likes but he cannot collect more than medicare allows under the law.

On the other hand, cosmetic surgery is not covered.  Most cosmetic surgeons I know refuse to take medicare or any insurance of any kind.  They can charge and collect whatever the market will support.


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## Numismatist (Jun 29, 2010)

Preventative care, like a physical, is non-covered with standard Medicare.


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## rapmarks (Jun 29, 2010)

we each pay something like $138 a month for Medicare Part B.


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## Wonka (Jun 29, 2010)

thheath said:


> I guess the question is if the secondary insurance pays the remainer of what was billed or just the percentage of the allowable charge that Medicare didn't pay.  As we all know the allowable charge is what's so low.  I can't see the secondary insurance paying whatever the doctor/hospital bills over this amount.
> 
> Could be wrong though...



You're probably correct.  I believe my Supplemental insurance (AARP) will only pay amounts in excess of the Medicare allowable amount.   Also, it must be an approved Medicare procedure.  If a physician believes the Medicare allowable amount is too low, they might indeed refuse patients with a supplemental policy as well.

However...I've never experienced a problem with acceptance of Medicare with the AARP Supplement in Florida.  It may vary from state to state.


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## pianodinosaur (Jun 30, 2010)

Numismatist said:


> Preventative care, like a physical, is non-covered with standard Medicare.



I am glad you are in such good health.  If you have history of hypertension and tell the physician you have hypertension and the physician takes your blood pressure, that is a covered visit.  If you just want your prostate checked for an annual screening, that is a covered visit.  If you are a diabetic and want your eyes examined just because you are a diabetic, that is a covered visit. Unfortunately, most people on medicare have at least one or more medical problems to justify a covered visit.  I have yet to see a patient on medicare where the physical examination would not qualify as a covered benefit under part B since I graduated medical school in 1977.  On the other hand, I cannot order labwork or xrays without proper justification.

On a more pleasant note: I collect antique coins and have them set as pendants for my wife.  I just love the history and they look good, too.


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## Liz Wolf-Spada (Jun 30, 2010)

I think Part B costs more if you aren't getting it automatically taken out of social security. I remember this, because as a California teacher, I won't be getting social security. I think it was a STRS retirement advisor who mentioned this.
Liz


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## Wonka (Jul 1, 2010)

pianodinosaur said:


> The moment a patient shows up to my office with any kind of complaint or medical problem other than male infertility, that visit is a covered service.  For example, a patient comes to my office because he is 70 years old and wants his prostate checked.  That is a covered service.  His physical examination is a covered service. The physician may charge all he likes but he cannot collect more than medicare allows under the law.
> 
> On the other hand, cosmetic surgery is not covered.  Most cosmetic surgeons I know refuse to take medicare or any insurance of any kind.  They can charge and collect whatever the market will support.



Doesn't AARP Supplment (and others) pay you what Medicare doesn't pay?  So, I guess what I'm learning is some physicians won't accept a Medicare patient because even if they're paid the full amount...they don't think it's enough.  And, if they charge more they are violating the law?  Is that correct?


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## falmouth3 (Jul 1, 2010)

pgnewarkboy said:


> You need to take a look at your health coverage.  As far as I know, all private insurance becomes secondary insurance once a beneficiary is eligible for Medicare.  Check it out before you receive a bill you won't want to pay.



I think you are correct.  I'm not on medicare yet, but Mom is.


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## thheath (Jul 1, 2010)

Wonka said:


> Doesn't AARP Supplment (and others) pay you what Medicare doesn't pay?  So, I guess what I'm learning is some physicians won't accept a Medicare patient because even if they're paid the full amount...they don't think it's enough.  And, if they charge more they are violating the law?  Is that correct?



Unless I'm looking at this wrong having a secondary insurance doesn't add anything to the doctor's allowable charge/bottomline; that's fixed by law and medicare contract.  The secondary insurance just pays you or the doctor for your copay amount of the allowable charge.


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## PStreet1 (Jul 2, 2010)

pianodinosaur said:


> The physician can charge more than what medicare allows but he cannot collect more than what medicare allows.  That is the law for all physicians who signed the government contract to see patients on medicare.  Medicare HMOs are another story.  I do not participate in any medicare HMOs.



Thank you for the explanation.  I knew why Mayo Clinic stopped accepting Medicare patients (even those with supplemental insurance), but didn't know how to explain it well; you, obviously, do know.

I believe as provisions of Obama's Health Care Plan become obvious, people are going to be very startled, indeed.


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## John Cummings (Jul 2, 2010)

The supplementary insurance doesn't pay the doctor anything extra. It only benefits the patient by covering deductibles etc. that the patient would have to pay.


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## Clemson Fan (Jul 2, 2010)

thheath said:


> I guess the question is if the secondary insurance pays the remainer of what was billed or just the percentage of the allowable charge that Medicare didn't pay. As we all know the allowable charge is what's so low. I can't see the secondary insurance paying whatever the doctor/hospital bills over this amount.
> 
> Could be wrong though...


 
That is correct.  The primary insurance is the one that determines the "allowable charge" and the secondary insurance just picks up the co-pay.

Here's an example using simple math.  The Medicare "allowable charge" for a certain procedure is $100 with the patient co-pay being 20% or $20.  On the other hand, a private insurance's "allowable charge" for the same procedure is $150.  If medicare is your primary, then it doesn't matter how good your secondary insurance is b/c they will only pay for the co-pay of the medicare "allowable charge" which in this example is $20.  They won't make up the difference between medicare's "allowable charge" and theirs.  

IOW, with Medicare as the primary the doctor will get paid $80 by Medicare and $20 by the secondary insurance.  They won't get paid $80 by medicare and $70 from the secondary insurance.

So, you can see how important it is as to what your primary insurance carrier is.


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## PStreet1 (Jul 2, 2010)

I knew it was important--but was told that since I qualify for Medicare, I HAVE to have Medicare as primary.  Is that not true?  How does one get around that?  Is it possible to purchase other insurance and have Medicare as secondary?  I would think not since Medicare pays less that other companies.


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## pianodinosaur (Jul 2, 2010)

Wonka said:


> Doesn't AARP Supplment (and others) pay you what Medicare doesn't pay?  So, I guess what I'm learning is some physicians won't accept a Medicare patient because even if they're paid the full amount...they don't think it's enough.  And, if they charge more they are violating the law?  Is that correct?



Medicare pays 80% of what Medicare allows. No medicare supplement will pay more than the remaining 20% if even that much.  If the physician tries to collect more than what medicare allows, that physician has committed a felony.  Medicare patients are much sicker than the average population and take up a great deal of time.  The pay is much less and the liability is much greater.  I like taking care of sick old people.  However, the government is doing everything calculated to force physicians out of this business. The reason is fairly obvious.  It is much cheaper to simply let some old person die than to spend money taking care of them.


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## Clemson Fan (Jul 3, 2010)

PStreet1 said:


> I knew it was important--but was told that since I qualify for Medicare, I HAVE to have Medicare as primary.  Is that not true?  How does one get around that?  Is it possible to purchase other insurance and have Medicare as secondary?  I would think not since Medicare pays less that other companies.



A lot depends on if you're still working and what state you live in.  The answer can be very convoluted.  I know in Hawaii if you're working more than 19 hours a week then your employer is obligated to provide you with medical insurance.  So, if you're over 65 and still working more than 19 hours a week, you may very well have another insurance other then Medicare that acts as your primary insurance.

If you're retired and over 65, then I think you're just pretty much SOL and Medicare acts as your primary.


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## Clemson Fan (Jul 3, 2010)

Jennie said:


> When a person has Medicare plus a supplementary insurance, doctors are much more likely to accept them as a patient--new or otherwise.



Not true.  As stated numerous times in this thread, if Medicare is your primary then it doesn't really matter what your supplemental is b/c all they will pay is for the deductible portion of Medicare's allowable charge.


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## Clemson Fan (Jul 3, 2010)

Jennie said:


> Medicare Part A is basically free. For Medicare Part B the premium is $96.40 per month. Many private insurance companies *require* that you enroll in Medicare A&B as soon as you become eligible. This may not a bad thing.
> 
> The private company will then become "secondary" meaning basically that they will cover many of the co-pays after Medicare has made the first payment. Some private insurance companies will even re-reimburse you for the $96.40 premium you pay for Medicare Part B each month.



I hope it's obvious why some private insurance companies do this.  They're not doing you a favor and are just doing this so they can jettison themselves from being your primary insurance, thus making them only responsible at most for the 20% co-pay of Medicare's allowable charge.


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## Clemson Fan (Jul 3, 2010)

The reason medical care is so expensive in the US is b/c there are frankly too many “middle men” that get in between the doctor and the patient.

On one hand you have the attorneys who greatly drive up the cost of medicine.  There’s at least one attorney on this thread who scoffs at this suggestion, but I can assure you it’s true.  One of the biggest contributors to the Democratic Party are the trial attorneys.  That’s why tort reform is always taken off the table by the Democrats.  Also, 99% of our legislators are attorneys.  Approximately 95% of the medical malpractice awards worldwide come from within the US.  How do you think John Edwards amassed his fortune.  Only in America my friends.  So, to say this only plays a minor role towards the cost of medicine in the US is just not accurate.

Here in Hawaii, on the outside binding of our major yellowpages book is an ad for a personal injury lawyer.  I also advertise in this same yellowpages and I asked the sales rep how much that ad costs and she told me it’s their top priced ad and it costs 6K/month.  So, just on that one ad he’s spending 70K/year.  He also has TV commercials and the like so I bet his yearly advertising budget probably approaches 200K.

Then there’s the whole massive medical insurance industry which employs tons of people.  They are one of the major contributors to the Republican Party which is why they get so fervently protected by the Republicans.  As a physician, the insurance companies are not my friend.  I have 2 full time employees who do my billing and deal with the insurance companies.  That’s 80 hours/week I have to employ someone to deal with the billing aspect of practicing medicine.

So, in the end there are just layers and layers of “middle men” who get in the way of the doctor patient relationship and who drive up the cost of medicine.  Somebody has to pay all the attorneys and all the tons of insurance company employees.

IMO, we can’t have any effective reform without both reforming the tort side AND the insurance side of the equation.  With the trial attorneys in the back pocket of the Democrats and the insurance companies in the back pocket of the Republicans I just don’t see it happening in my lifetime.


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## bogey21 (Jul 3, 2010)

Jennie said:


> Medicare Part A is basically free. For Medicare Part B the premium is $96.40 per month. Many private insurance companies *require* that you enroll in Medicare A&B as soon as you become eligible. This may not a bad thing.
> 
> The private company will then become "secondary" meaning basically that they will cover many of the co-pays after Medicare has made the first payment. Some private insurance companies will even re-reimburse you for the $96.40 premium you pay for Medicare Part B each month.



*Another reason that the private insurance compainies like you to have Medicare Part B is that if doctors accept Medicare, the maximum they can charge for a procedure is the discounted Medicare rate.  This is often lower than the rate negotiated by the Private Insurance Company.  Not only that but the Private Insurance Company only has to pick up a fraction of this highly discounted rate as Medicare has picked up the rest.

George*


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## JudyS (Jul 3, 2010)

pgnewarkboy said:


> Here is the problem.  Medical costs in this nation are totally out of control.  They were out of control before the new law and they are likely to be out of control after the law.  The question is why is this so?...



Yes, US medical costs are definitely too high. Most other industrialized nations both pay less in health care per person,* and * many have substantially better outcomes (people live longer.)



Clemson Fan said:


> The reason medical care is so expensive in the US is b/c there are frankly too many “middle men” that get in between the doctor and the patient.
> 
> ... there are just layers and layers of “middle men” who get in the way of the doctor patient relationship and who drive up the cost of medicine.  Somebody has to pay all the attorneys and all the tons of insurance company employees....



This is one reason for the high costs, I agree. I've seen claims that about 30% of US health care costs goes to cover the costs of having insurance companies. 




pgnewarkboy said:


> Another problem with rising costs is the doctor shortage. Why is there a doctor shortage?  Is the medical profession always acting in good faith or are they sometimes acting to pad their own wallets by making it hard for the public to get to health care professionals.  Medical school is outrageously expensive.  Why?  Is this totally justified?  Do you always have to see a doctor or will a para-professional suffice in most situations?  Why is that Medical Doctors have a monopoly on providing health care?....


Oh boy, do I agree with this!  I'm going to add something else. I think doctors get paid too much. Physicians make, on average, about $200,000. (Of course, some make much less, but a few make millions.) There is no other profession that pays anywhere near as well, including other professions that have extremely long training periods and require extremely high qualifications. For about $60, my cats' veterinarian will drive 20 miles each way to *make a house call*, and she had to train as long as a "human" doctor. I know that doctors often go through h*ll during residency, but this is largely something the medical profession has chosen themselves. Residents work 100-hour weeks because it's a rite of passage, not because there's anything inherent in medicine requiring it. 



On another topic:


pgnewarkboy said:


> There are various studies that show that Americans get tested excessively and often needlessly....
> Basically, and to an extent understandably, Americans want every test and treatment available.  The health care industry sells the public on the idea that they must have these interventions because the health care industry makes money by selling them.  ....



Steve replied:


T_R_Oglodyte said:


> ...
> Americans get overtested because of the liability system.  Even if a physician does not believe a test is necessary the test will be ordered up anyway. That's because if the test *might possibly* have given some indication that something else was wrong, the doctor - as well as the clinic, hospital or anyone else involved - is a sitting duck for a malpractice claim.....



I think overtesting and overtreatment are both huge problems, and I think both pgnewarkboy's and T_R_Oglodyte's reasons are true. Some overtesting and overtreatment is because of liability, but much is due to a mistaken philosophy that more medical treatment is always better. Americans regard side effects and complications as avoidable and preventable errors, when in fact they are inherent consequences of treatment. 

Pgnewarkboy's example of mammography is an excellent one, and one that I was thinking of myself.  The evidence is that mammograms are only worth doing when a woman has possible breast cancer symptoms (such as breast pain) or is in a particular high-risk group (due to a strong family history of breast cancer, say.) Otherwise, the health risks outweigh the benefits. But when researchers try to tell the public this, they don't want to hear it, and some women become very angry. 

There are plenty of reasons why medical care costs so much -- liability, insurers, overtreatment, high physicians' salaries, huge drug company profits. There aren't enough tax revenues to fully cover the cost of care for medicare recipients, so doctors get paid less for treating medicare recipients than for treating those with private insurance. Unsurprisingly, a lot of doctors would therefore like to limit how many medicare patients they see.  (And they get paid even less for medic*aid* insurance -- finding a physician who takes medic*aid* is really hard!) The underlying system really needs to be fixed. 

(By the way, one thing I think *won't* help in the long run is reducing smoking, getting people to have healthier lifestyles, and more preventative care. If people live longer, their lifetime medical expenses will likely go up, not down. And certainly, the amount of social security people can collect goes up the longer they live. Being healthy and living a long time is great, but it doesn't save taxpayers any money.)


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## Clemson Fan (Jul 3, 2010)

JudyS said:


> Yes, US medical costs are definitely too high. Most other industrialized nations both pay less in health care per person,* and * many have substantially better outcomes (people live longer.)



That’s actually not true.  When the life expectancy rate gets corrected across all industrialized nations to exclude death by trauma (guns, car accidents, etc.), then the US actually comes out near the top.  Death by trauma in the US is extraordinarily high and it usually occurs to younger people which has a big affect on the overall life expectancy statistic.

Medical treatments and care in the US are the best in the world.  There’s a reason the uber rich from around the world travel to the US when they need top medical care.


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## e.bram (Jul 3, 2010)

JudyS:
When you don't feel good, call a vet.




ps. My wife is a doctor and I think she is UNDERPAID!


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## rapmarks (Jul 4, 2010)

I don't think 200,000 is overpaid for a doctor. 
a friend of mine, with a bachelor's degree,( retired 5 years ago teaching kindergarten and made 100,000 a year.  Is she had a master's , she would have made more.


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## John Cummings (Jul 4, 2010)

Clemson Fan said:


> That’s actually not true.  When the life expectancy rate gets corrected across all industrialized nations to exclude death by trauma (guns, car accidents, etc.), then the US actually comes out near the top.  Death by trauma in the US is extraordinarily high and it usually occurs to younger people which has a big affect on the overall life expectancy statistic.
> 
> Medical treatments and care in the US are the best in the world.  There’s a reason the uber rich from around the world travel to the US when they need top medical care.



I agree with you and even go farther. I believe that our lifestyle also is a factor in lowering life expectancy with our high rate of obesity and lack of fitness.


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## John Cummings (Jul 4, 2010)

rapmarks said:


> I don't think 200,000 is overpaid for a doctor.
> a friend of mine, with a bachelor's degree,( retired 5 years ago teaching kindergarten and made 100,000 a year.  Is she had a master's , she would have made more.



I agree with you 100%. I made more than $200,000 /year without a degree as a computer software consultant. I retired in December, 2006.


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## JudyS (Jul 7, 2010)

Clemson Fan said:


> ...
> Medical treatments and care in the US are the best in the world.  There’s a reason the uber rich from around the world travel to the US when they need top medical care.


 Sure, probably the "uber rich" do get great care in the US. But that's better care than people with HMOs get, and certainly better care than the uninsured get. The best care in the world -- if you can pay for it.



e.bram said:


> JudyS:
> When you don't feel good, call a vet...


I think my cats' vet is an excellent doctor. I would* love *to pay her for advice on my health problems. Unfortunately, it would be a felony for her to accept that offer. 




rapmarks said:


> I don't think 200,000 is overpaid for a doctor.
> a friend of mine, with a bachelor's degree,( retired 5 years ago teaching kindergarten and made 100,000 a year. Is she had a master's , she would have made more.


If your friend retired 5 years ago, I would guess she started teaching 30 years ago or more. Since then, the educational requirements for teachers have been tightened (generally, a master’s is required) and the salaries have gone down. (And few teachers ever made $100,00 in the first place.) Full-time teachers are getting laid off all over the place. Many school districts hire permanent "substitutes" and pay them minimum wage. I have a PhD, and the most I've ever made teaching is $18,000 a year (and no benefits.) And I had to teach 700 students a year to make that amount of money. 

It's all well and good to say that MDs should make $200,000, but when people in other occupations make a tenth of that, how are they going to pay for health care? This isn't a rhetorical question -- my husband and I may be driven to bankruptcy by our medical bills. We’ve had three friends and relatives in the past few years who postponed getting medical treatment because they couldn’t afford it, and then died of the illnesses they postponed treating. I’m terrified that this will happen to me or my husband.

The impression here seems to be that all highly skilled workers get paid a lot, not just doctors. I have not found that to be true. I’m *very* interested in suggestions of careers that might allow us to pay for medical care (and hopefully the mortgage, too!) My husband is an excellent electrical engineer, but he has no degree. (He’s never made anything like $200,000 a year as a consultant, even when times were good, which they certainly aren’t now, especially for someone with an automotive background like his.) He hasn’t worked in six months (and wasn’t paid for the last month of work he did) and isn’t eligible for unemployment insurance. I’m a social psychologist (which is more like sociology than psychology; I’m not licensed to do therapy). I have a strong interest in research design and a couple of medical publications (including one in the New England Journal of Medicine.) I also have a partially-written book (a psychological biography of Michael Jackson), but I’ve written to almost 100 agents, and they aren’t interested. If anyone has suggestions on getting an agent or publisher for my book, that would be great, too.  

And before anyone says I should sell my timeshares to pay my bills, I’m trying to do that, believe me! I’ve removed mention of my ownerships from my profile to avoid the appearance of advertising.


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## ricoba (Jul 7, 2010)

I think the pay issue may be an issue of location.

Here in Southern California making $200,000 per annum is not a lot of money, whereas in less expensive cost of living locations it would be a more than adequate wage.

just my two cents


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## rapmarks (Jul 7, 2010)

Judy S - you would be shocked at what teachers make.  there is a website that broadcasts Illinois teacher salaries, individually.  when we still taught in Illinois, they had an expose in the paper yearly, listing those that made over 100,000.  I taught in a poor paying district, my friend who is still there with just a masters (and I say this because most of us went to Master's plus 60 grad hours) makes 90,000 after 25 years.  Yes they are laying off teachers and changing the pension system too.  You would faint if you knew how big some pensions are, even triple figures.  we know retired couples who are getting very close to $200,000 a year pensions between them.  
My school superintendent made the top 10 in Illinois, one school, a high school, with about 2500 students and he was paid $268,000 a year back in the year 2000.  would retire at 75% of the last 4 years average with a 3% raise each year with 35 years in the business.


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## tlwmkw (Jul 7, 2010)

200K is not an outrageous salary.  I know a plumber who makes more than that.  I think fewer and fewer students want to go to med school because of the long time training (four years of med school and then four or more years to specialize) and the huge cost ($100k or more as well as interest).  The veterinarians around here make more than doctors because they don't have to deal with insurance companies and they don't have to pay huge sums for malpractice (though even vets have to have some coverage).

tlwmkw


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## pgnewarkboy (Jul 8, 2010)

Clemson Fan said:


> That’s actually not true.  When the life expectancy rate gets corrected across all industrialized nations to exclude death by trauma (guns, car accidents, etc.), then the US actually comes out near the top.  Death by trauma in the US is extraordinarily high and it usually occurs to younger people which has a big affect on the overall life expectancy statistic.
> 
> Medical treatments and care in the US are the best in the world.  There’s a reason the uber rich from around the world travel to the US when they need top medical care.



I have no dispute, in general about the quality of care in the U.S when you can get it.  It is NOT, however,  the best in the world.   The cost, however, is extremely excessive and probably the highest in the world..  I posted in another thread about my wifes medical care in a french hospital on the french side of St. Marten.  I don't have to guess about the cost of medical care in the U.S versus other nations.  I know what it is all about.  My wife received ambulance, er, surgery by an orthopedic surgeon, anasthesiology, hospital stay, meds, and everything else involved with wrist surgery (implanting pins) for the grand cost of 1800 U.S. dollars.  No itemized bills.  One price for the foreigners (my wife) and no price for citizens.  My wife returned to the U.S for after care including removal of the pins and rehab on the wrist.  It is close to three months since the pins were removed and we are STILL getting bills.  The cost for the 30 minute, outpatient, removal of pins has already far exceeded the ENTIRE bill in the french hospital.

The charge for removal of the pins was 2000 dollars.  Just the surgeon.  The charge for the use of the operating room for one-half hour was 5000 dollars.  We just received a bill from the Anasthesiologist.  Thankfully we have insurance.  However, our COPAYS already exceed the entire bill for french care.

The care my wife received was good in the french hospital and good in the U.S but the COSTS in the U.S are completely unjustifiable.

Now, you can blame the lawyers all you want.  You can blame the insurance companies all you want.  What I don't see you do is blame the DOCTORS.  I for one don't think I as an individual or a taxpayer should be financing my DOCTORs million dollar homes, expensive schools for their children and on and on.  

HEAL YOURSELF DOCTOR.  Stop blaming the world for the excesses of your profession and your stranglehold on medical care in the U.S.    The simple reality is that DOCTORS and HOSPITALS charge too much.  Period.

Furthermore, the doctors all want malpractice claims eliminated, the lawyers who file them eliminated as a result, the insurance industry, eliminated, higher payments by medicare and medicaid.  Great.  Do it all.  What will the doctors give back - by law.  I know we can trust them to do the right thing.  Their costs and their charges will go down dramatically.  If you believe that I have a bridge in brooklyn that I want to sell you.


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## pianodinosaur (Jul 8, 2010)

What a physician charges and what a physician collects are two different things.


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## pgnewarkboy (Jul 8, 2010)

pianodinosaur said:


> What a physician charges and what a physician collects are two different things.



That may be so but that doesn't change a thing.  They charge too much they collect too much, they force people who can't pay up into bankruptcy.  When you go to a doctors office they won't even SEE YOU much less TREAT YOU unless you sign a contract saying you are responsible for the whole bill including what the insurance company doesn't pay. If you don't have an insurance company that pays well or don't have any insurance at all you are totally shafted. The doctors will hound you and your family for the money and then hire collection agencies to do even worse.    I have seen many a charity event to keep a poor child alive who needs treatment for cancer or an organ transplant.  I haven't seen any for doctors because they don't need them.  

Before the average person can see a doctor YOU MUST SHOW THEM THE MONEY.


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## Clemson Fan (Jul 8, 2010)

pgnewarkboy said:


> I posted in another thread about my wifes medical care in a french hospital on the french side of St. Marten.  I don't have to guess about the cost of medical care in the U.S versus other nations.  I know what it is all about.  My wife received ambulance, er, surgery by an orthopedic surgeon, anasthesiology, hospital stay, meds, and everything else involved with wrist surgery (implanting pins) for the grand cost of 1800 U.S. dollars.  No itemized bills.  One price for the foreigners (my wife) and no price for citizens.  My wife returned to the U.S for after care including removal of the pins and rehab on the wrist.  It is close to three months since the pins were removed and we are STILL getting bills.  The cost for the 30 minute, outpatient, removal of pins has already far exceeded the ENTIRE bill in the french hospital.



You are correct, the French do have an excellent system.  Why??  It’s because they’ve eliminated the middle man between the doctors and the patients.  There are NO insurance companies to deal with and NO malpractice lawyers to deal with.  What if something went wrong with your wife’s surgery in France?  Try bringing up a medical malpractice case because it just wouldn’t happen.

I would actually take France’s system in a heartbeat including the lower reimbursement rates because I would be able to practice medicine without all the red tape we need to deal with in the US.  Politically, though, in the US I just don’t see it happening in my lifetime.  The Republicans are in bed with the insurance companies and the Democrats are in bed with the trial lawyers and until that changes I just don’t see any meaningful change to the US system.


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## pgnewarkboy (Jul 8, 2010)

Clemson Fan said:


> You are correct, the French do have an excellent system.  Why??  It’s because they’ve eliminated the middle man between the doctors and the patients.  There are NO insurance companies to deal with and NO malpractice lawyers to deal with.  What if something went wrong with your wife’s surgery in France?  Try bringing up a medical malpractice case because it just wouldn’t happen.
> 
> I would actually take France’s system in a heartbeat including the lower reimbursement rates because I would be able to practice medicine without all the red tape we need to deal with in the US.  Politically, though, in the US I just don’t see it happening in my lifetime.  The Republicans are in bed with the insurance companies and the Democrats are in bed with the trial lawyers and until that changes I just don’t see any meaningful change to the US system.



Glad to hear you would take the french system.  So would I.  I think the opposition comes from more than trial lawyers (med/mal specialists) and insurors.  It is a tougher problem.  Once again, it is heartening to hear a doctor say what you just said.  It seems to me that you care about your patients and the practice of medicine.


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## Liz Wolf-Spada (Jul 8, 2010)

Wow, my district pays well for California and the top of our salary schedule with a master's plus 60 units was $85,000 until we had 10 days of furlough.
Liz


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## swift (Jul 8, 2010)

Clemson Fan said:


> You are correct, the French do have an excellent system.  Why??  It’s because they’ve eliminated the middle man between the doctors and the patients.  There are NO insurance companies to deal with and NO malpractice lawyers to deal with.  What if something went wrong with your wife’s surgery in France?  Try bringing up a medical malpractice case because it just wouldn’t happen.
> 
> I would actually take France’s system in a heartbeat including the lower reimbursement rates because I would be able to practice medicine without all the red tape we need to deal with in the US.  Politically, though, in the US I just don’t see it happening in my lifetime.  The Republicans are in bed with the insurance companies and the Democrats are in bed with the trial lawyers and until that changes I just don’t see any meaningful change to the US system.




This thread has gone on way past it's time with political rules being broken. Time to close.


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