As a doctor working for a hospital system, I think you miss the important points. We work on commission, so we are incentivized to be productive.
With Obamacare, we will have a dramatic increase in Medicaid patients. They have no skin in the game (co-pays) and are far more likely to no show for appointments. The hospital loses money treating Medicaid patients, because the reimbursement is so low. I make almost nothing seeing these patients and they don’t listen anyway.
What is likely to happen, aside from early retirement (which I am considering), is that doctors form private groups that refuse to take Medicaid. A friend works for a group that takes only private pay and Blue Cross. It makes the paperwork easier as well.
“doctors form private groups that refuse to take Medicaid.”
If it isn’t already in the bill, Obama will have Congress pass a law that all practicing physicians will have to follow the rules of Obamacare.
That has been illegal in Massachusetts since 1986, and it soon will be coming to a Legislature near you.
Doctors fleeing to private concierge / indemnity-only practices are in for rude shock. Obamacare rules are very hard on indemnity insurance, its viability is questionable. Moreover, the minute that capacity becomes strained or people start to perceive a two-class system, expect that Obamacare or its successors will adopt to an all-or-none principle — accept government set rates (possibility including expanded Medicaid or even Medicare too) from all patients as payment in full - or be ineligible to accept any government-covered or -subsidized patients at all, maybe even be denied privileges at any hospital that accepts them for any patients.