December 30th, 2014

Does anyone think…

this won’t ultimately end with doctors being ordered to take Medicaid patients, or else find another profession?:

Just as millions of people are gaining insurance through Medicaid, the program is poised to make deep cuts in payments to many doctors, prompting some physicians and consumer advocates to warn that the reductions could make it more difficult for Medicaid patients to obtain care.

The Affordable Care Act provided a big increase in Medicaid payments for primary care in 2013 and 2014. But the increase expires on Thursday — just weeks after the Obama administration told the Supreme Court that doctors and other providers had no legal right to challenge the adequacy of payments they received from Medicaid.

The impact will vary by state, but a study by the Urban Institute, a nonpartisan research organization, estimates that doctors who have been receiving the enhanced payments will see their fees for primary care cut by 43 percent, on average.

Stephen Zuckerman, a health economist at the Urban Institute and co-author of the report, said Medicaid payments for primary care services could drop by 50 percent or more in California, Florida, New York and Pennsylvania, among other states.

I wrote “ultimately end” with doctors being required to take Medicaid patients or leave medicine. But that probably won’t be the ultimate end; government-run health care will.

I wrote about much the same issue a little over a year ago. In that post, I also discussed what had happened to the practice of medicine in the Soviet Union, and its legacy in the Russia of today. It makes very sobering reading.

35 Responses to “Does anyone think…”

  1. Waidmann Says:

    Here’s my prediction. Doctors will go to Med School on Uncle Sam’s dime, on condition that once graduated, they will accept as payment what the government pays. The ultimate goal is doctors will earn a decent living, will never become rich, and health care is subsudised (sp?) and “affordable”. Medicine will become just another skilled trade.


  2. Tom Murin Says:

    I don’t doubt that we’ll be moving in this direction. I guess with Medicaid they could move to another state and practice. Medicare would be a different story. Lawyers have pro bono requirements – so why not have it for doctors? Uncle Sam paid for most of my sister’s medical school. However, she spent 3 or 4 years on active duty with the Air Force in return.

  3. Jack Says:

    @ Waidmann

    How many young would-be doctors will spend 4 years in college, 4 years in med school, 3 to 7 years as an intern and another 3 to 5 years in their residency, before finally taking that awesome government paycheck to “never become rich?”

  4. Ed Bonderenka Says:

    Black Market Medicine. Like the gangster movies where the guy that got shot see the doc that lost his license.

  5. blert Says:

    Nursing is the world’s oldest profession — predating the sex trade by tens of thousands of years. (Paid in pelts.)

    The ‘system’ will shift its standards and accept RN skills for a slew of routine medical practice that was previously (legally) restricted to the doctor’s guild.

    This scheme is exactly how Cuba has so many ‘doctors’ who would rarely meet the standard of an American RN.

    De facto, malpractice torts will be deflated. One simply can’t wrap your mind around how expensive the fusion of law and medicine has become.

    It’s nothing for malpractice insurance to run 20% of medical billings — and more. This is because juries hand out whopper awards — for tragic events that are beyond human prevention/ skill.

    Then you also have the John Edwards effect.

    I would expect — at the final stages — that the ‘system’ caps/ reworks the tort laws WRT 0-care.

    This has ALWAYS been done whenever, wherever socialized medicine has been enacted.

    The usual mechanism is that torts are prohibited… as you’d be suing the sovereign state. The physician need only prove that he entirely followed state mandated protocols… which is now easy, and digitally recorded.

  6. R.Durand Says:

    Obamacare was sold by a lot of politicians saying that healthcare is ‘right’, or that people had a ‘right’ to healthcare.

    The problem with this is healthcare is a person (doctors, nurses, etc.) caring for or serving the patient. The only way healthcare can be made a right is to make these people slaves.

    Now, unless I’m mistaken, slavery is not a ‘right’.

    Government can regulate it all to ‘ell, but they cannot force these people to continue to work when they chose to quit the profession without resorting to ‘point of a gun’ slavery.

    Any politician telling you ‘you have a right to healthcare’ is lying. Simple truth.

  7. Geoffrey Britain Says:

    blert has the right of it and unlike Vermont, the feds can just print more money to ‘pay’ for it all. Until that is it all collapses, as we’re about to witness in Greece.

  8. Clarityseeker Says:

    I was completely unaware that blert was that old.

  9. Clarityseeker Says:

    Both Jack and R. Durand speak to one of the trends occurring at the moment. Having close ties to several doctors (and nurses) it has been heard that among them are those (or their peers) who are giving serious thought to leaving the profession.
    Moreover, there appears to be an atmosphere of depressed morale (not quite as severe as police officers under assault at present) in their field.
    Perhaps it is a good thing that education is being “dumbed down” to the extent it is. This way, a young person contemplating their future today will not view the math that ‘Jack’ posted as a negative.

  10. Waidmann Says:

    @ Jack,

    I spent close to nine years stationed in Germany during the Cold War and post Cold War era. One of our German friends went to German Med School and became a Nuclear Medicine Sepcialist. He did it knowing that he would end up working for the State as a doctor, and making a decent, middle-class income. He was fine with it.

    I think it’s more a matter of mind-set. If one absolutely accepts that the Government has a responsibility to medically care for its citizens, then choosing medicine as a profession isn’t significantly different from choosing Social Work. Why do people become social workers, knowing they aren’t going to make much money? Or Cops? Protect and Serve.

    At this point, it very much seems to me that America is going the same way. Many people will become doctors on Uncle’s dime, accept livable wages for it and feel virtuous about it.

    BTW, I think Blert is correct about the cost of malpractice lawsuits. Germany is a pretty litigatious society-heck, when we got there one of our friends suggested we purchase lawsuit insurance. It was pretty cheap, and we would be covered if someone sued us. I was a hunter over there, and in addition to my license, I had to have a separate hunting insurance. Even so, I don’t think our doctor friend has ever been sued (for malpractice).


  11. Steve Says:

    Another reason to repeal Obamacare. Another reason not to vote for a RINO who will try to manage the big gov’t approach.

  12. DNW Says:

    I agree with Waidmann and some others. Many Americans have come to the conclusion that freedom is just too costly and anxiety producing. They seek comfort and feelings of being unconditionally valued and supported. And they are willing to pay the price as long as things are “fair and equal.”

    They will be begging to have microchips installed in their brains before long …

    On another note, my brilliant and much touted plan involving libertarians and conservatives holding relations to account for their views – much as the left already does – must have leaked to the opposition.

    The result was a recent social occasion wherein a preemptive strike was launched against me by a cousin (sort of) social worker; who in a flash, got himself so worked up over George Bush, that with watering eyes, waving his arms, and shouting voice, he was raving from the edge of his cushion. I do believe that when he began to say that he was ready to do some killing himself, he had me in mind, certainly in focus, until he caught himself, regained some measure of control and began referring to “real enemies of America” rather than those ‘innocent Afghan and Iraqi victims of Bush’s imperialist adventures’.

    For my part I said very little aside from advising him, during the awkward silence that followed, that timelines and facts counted for more than feelings; and suggesting that he take into account small matters such as the attack on the Trade Center, and Osama bin ladin’s having sought and found refuge with the Taliban in Afghanistan.

    I think my suggestion that he look at the timelines came as much as a shock to him as did my composure – the result of my experiencing a kind of distanced amazement more than anything else.

    Now, he’s gotten himself wound up before, but this time was different. This time when we parted, his usually effusive goodby was reserved and perfunctory. It popped into my mind as I walked away from the quick handshake, that I was witnessing the definition of “he looked me askance”.

    Now here’s the point: They, are already wound up and primed to explode. They, have already made the transition from personal-responsibility mores, to solidly progressivist thinking. They, are always ruminating, and always edgy. They, want what they want: and what you think constitutes a worthwhile life, doesn’t really mean a damn thing to them – even though you may have grown up together and shared the same table at times.

    I hate to admit that Eric is right for the most part. Politics, and political action seems to be the only think that has any impact on certain people. Stale as it is to say, it’s their sole social ritual and faith.

  13. DNW Says:

    Read: ” … political action seems to be the only think that has any impact …”


    ” … the only thing that has any impact …”

  14. Waidmann Says:

    @ DNW

    I read that as “…the only thing…” the first time. Didn’t even notice it said “…think…”. Funny how the human brain works.


  15. carl in atlanta Says:

    All the docs I know are getting out of the practice or going concierge….

  16. Ed Bonderenka Says:

    Geoffrey Britain: I heard Vermont decided it couldn’t go single payer.

  17. MHJ Says:

    This is the inevitable path of single payer–budget pressure forces down costs, and service suffers.

    The end game could be government requirements to accept Medicaid patients, at which point physicians will flee those areas with large numbers of Medicaid people and only a few large organizations, esp local public health depts., will provide very minimal, shoddy service in those areas. Good docs with options will move to areas where there just aren’t enough Medicaid people to hurt their economics.

    You may see intermediate steps such as nurse practitioners, but the pressure on costs will continue and that will just be a phase on the way to collapse.

    we saw something like this in Illinois with Medicaid payments to pharmacies being 12-24 months in arrears. You can no longer find an independent pharmacy in “inner city” Chicago–there used to be lots, but they were all run out of business because they couldn’t carry the State’s Medicaid float. Big guys like Walgreens and CVS could because they are diversified into “real” markets, and they are all that’s left in the inner city.

  18. Geoffrey Britain Says:

    Ed B,

    Yes that’s what I meant by “unlike Vermont, the feds can just print more money to ‘pay’ for it all”, which is why on the federal level, the left will never admit that single payer is unaffordable for the country. If Vermont could print their own money, Vermont’s leftists would never have temporarily given up on single payer.

  19. Paul in Boston Says:

    Doctors have been refusing Medicare for years. I ran into this when trying to get my late mother a new doctor about a decade ago because I didn’t like the care she was getting from her current doctor. Sorry, we don’t take Medicare, sorry, we don’t take Medicare, … In the end she had to stay with her doctor, that, or go to the ER for every sickness. I don’t think there has been any movement by the Feds to force doctors to treat Medicare patients, not yet anyway.

  20. neo-neocon Says:

    Paul in Boston:

    Yes indeed, there were always a significant number of doctors who refused Medicare, but nowhere near as many as with Medicaid because (at least so far) the rates of reimbursement with Medicare are higher, and many people have supplemental insurance that makes them even higher. Also, there are a lot more people on Medicare than Medicaid. So there are significantly fewer doctors who take Medicaid, at least as far as I know.

  21. Lee Says:

    Someone over at Bookworm Room posted this link where someone describes medical care in the Soviet Union:

  22. Mr. Frank Says:

    A government which is big enough to give you all you want is big enough to take all you have.

  23. Rae Says:

    I am with Waldmann; there will be a requirement to take Medicare/aid patients in order to keep their licenses.

    It will be a generational shift. if you read medical blogs, many doctors do not see themselves as independent businessmen anymore. I believe that this shift has been going on since the 90s- and not due to Clinton, but Americans’ demand for the best healthcare in the world and its increasing costs.

    And I am sorry, but it is a lie to say that healthcare will suddenly go down because the government is *more* involved: insurance pre O-Care has been leveraging cost vs care since the beginning because of said demand.

    So it will not surprise me that older MDs will be leaving, and be replaced by younger and salaried docs, PAs and NPs who will not have to worry about Medicare/aid or the thousands of HC policies and its impact on their bottom line. It has been this way since the 90s.

    The people who have been complaining the most, I’m afraid, are the people who did not vote for Obama (I didn’t even though I was uninsured) and/or already have healthcare. Absolutely no one complained about RomneyCare until Obama usurped it. Then there were a million complaints about RCare by the very people who supported it when W was in charge.

  24. Ymarsakar Says:

    Then there were a million complaints about RCare by the very people who supported it when W was in charge.

    What does Mass. Care created by the Democrats have to do with W or R?

  25. parker Says:

    It will end with doctors in their fifties retiring and fewer people entering med school. And, of course Palin will prove to be prophetic when the actual death panel bureaucrats pass judgment on who must die.

  26. Waidmann Says:

    @ Parker,

    I’m not so surfe that fewer people will enter med schools. It will just be a different sort of peson. Admittance standards may be lowered–that’s par for the course. But there are more and more idealists every year who want to “help their fellow man”, and, coincidently, make a decent living in the process.

    I have a nephew in Med School right now whose plan is to go to Africa after graduation. He’s not looking forward to any income.


  27. avi Says:

    I have a nephew in Med School right now whose plan is to go to Africa after graduation. He’s not looking forward to any income.


    so how is he going to pay back his loans, or is he wealthy enough to afford Africa?

  28. parker Says:

    A decent living in 95% of Africa is a non-starter. While there may be hordes of ‘idealists’ hungering to attend med school and ‘serve’ in the 3rd world, they are going to be for the most part substandard. Just the type I want operating on one of my grandchildern.

  29. Nolanimrod Says:

    w/ an apology to W.C. Fields

    Grandchildren are fine if they’re properly prepared.

  30. Beverly Says:

    “properly roasted…” (Fields)

    This will lead, like all Leftwing schemes, to de facto slavery. For everyone who gets something he didn’t work for, someone else has to work for something he doesn’t get. I.e., slavery.

    The Slavemasters see no problem with this, of course.

    Simone de Beauvoir, in The Second Sex, said that women largely accepted their subsidiary roles because it exempted them “from the risks and decisions of history-making.”

    The Devil’s bargain in The Grand Inquisitor also comes to mind. . . .

  31. Waidmann Says:

    Two comments:

    @ avi
    I don’t know what his plans are. I (think I) know he’s motivated by Christianity, and sees this as the way to “go into all the world”. Under whose aspices I don’t know. How he intends to pay for all the trtaining? Same answer. He certainly isn’t wealthy.

    @ Parker
    My nephew is a very smart, dedicated young man. How good a doctor he’ll end up being, time will tell. There is certainly no reason to think he’ll be substandard based on his life and undergrad performance. One could argue that a doctor with strong Christian morals would be a better choice than an amoral one. Or at least, so it seems to me.


  32. Kyndyll Says:

    “But there are more and more idealists every year who want to “help their fellow man”, and, coincidently, make a decent living in the process.”

    As a group, millennials are all about wanting to “help their fellow man” and otherwise do things to save the world. Then when they find out that the career path they have chosen will not instantly give them the lifestyle enjoyed by their parents and what they fantasize other adults have, they turn into bitter, screaming brats lashing out at evil rich people and corporations for their own bad choices.

    Ultimately, they are a supremely selfish generation, primarily motivated to impress each other and feel good about themselves; then when they can’t live like people twice their age with actual, in-demand skillsets, they have meltdowns.

  33. MKT 571 (Week 2) Learning Team Assignment / Product Offering * Says:

    MKT 571 (Week 2) Learning Team Assignment / Product Offering *

    neo-neocon » Blog Archive » Does anyone think…

  34. Richard Saunders Says:

    It’s all a plot by the Indian Medical Schools Association!

  35. virgil xenophon Says:

    Following on Richard Saunders, above, “medical tourism” is already a big deal in Thailand and Mexico as well..

    However, I want to be one of two people: (a) The guy who has the flood insurance sales franchise for every island in the Carrib. as they all will sink under the weight of the relocation of every specialist East of the Miss. R. And/Or, b) the guy who has to pass on the act of sale for every piece of property sold within 50 mi South of the US/Mex border, coast to coast when all the specialists West of the Mississippi relocate fleeing Obamacare.

    PS: And forcing physicians to practice? Not even Stalin and his henchman Beria, Head of the NKVD secret police were successful in forcing doctors to practice in rural Siberia–so good luck guys!

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