Skip to comments.Is Obamacare Driving Doctors to Refuse Insurance?
Posted on 11/12/2013 5:01:50 PM PST by grundle
Eliminating insurance billing cuts 40% of the practices overhead expenses, enabling them to keep fees low, doctors say.
(Excerpt) Read more at finance.yahoo.com ...
When you pay out of pocket, you can see any doctor you want, and no one can boss you around.
Who goes round, comes around. That s how it was in the 40s and 50s.
trend has been to this for the last few decades. Has become even more so now with O care
Now is a good time for all kinds of better ideas and designs for health care to pop up. Entrepreneurs wake up and start your engines. Compete against the behemoth of government.
Wonder if they’ll bring back house calls.
If healthcare was completely privatized, everybody would be taken care of and people would have an incentive to take care of themselves. In fact, a lot of chronic illnesses and diseases like diabetes would decrease drastically.
I have been going to doc who didn’t take insurance for nearly a decade...He has saved me Beaucoup bucks...because he works for ME...not insurance Co or govt
“Eliminating insurance billing cuts 40% of the practices overhead expenses, enabling them to keep fees low, doctors say.”
Why hell yea it does! Also, if doctors and hospitals would just charge what insurance pays then many wouldn’t even need insurance.
My MRI last year supposedly cost, or was charged at 3,000 bucks. Insurance paid 450 I paid 200. If they charged 650 for an mri then I wouldn’t need insurance. Now, if I didn’t have insurance they would charge me 3,000. How fair is that? That is how people go bankrupt paying their medical bills.
Except the doctor I want is quitting.
Paying cash for an ordinary office visit is fine, and there are a number of primary care physicians who are turning to the concierge care or cash practice model.
But there are a LOT of medical procedures that the average person can’t afford to pay cash for. Labwork, surgical procedures (even minor ones), and some imaging are more than people can come up with on a regular basis. Many people have medical problems that need care constantly and paying for it is just not possible. This is especially true of old people who have a constellation of problems.
I work for a physician and I have a good bit of insight into what it actually costs to run a practice and thus what a doctor needs to charge to stay afloat. We get so little from Medicare and Medicare supplement plans that the doctor is already giving charity just by seeing these patients. As some patients next year lose their insurance coverage due to Obamacare and can’t afford to pay out of pocket for treatments, this practice may have to close. It will be a great loss, if so.
my great grandfather was a country doctor down in Warwick, GA. He took chickens, wild turkey, eggs and yard work for his services. They didn’t have health insurance, but he took care of people and was loved.
screw Obama and his control freaks. Bring in the bartering!
House calls would be perfect. Think about it. No office(except home). Very little overhead. Don't take any insurance. Cash on the spot. Most doctors visit, think about it, are not for anything particularly life threatening. Primary care physicians send their patients to specialists anyway.
We have a chiropractor here in town. Been in business 40 years. Yea, he has a small office. He and his wife. Charges 20 bucks for an office visit. He's made a pretty good living over the past 40 years or so.
It can be done and should. Sure would take a lot of pressure off the Doc's too.
Thanks for knowing how to express the plural of years when the prefix of "19" (or "20") is left out.
Now, if only others would learn the lesson that one does not make the plural case for proper names (and years) by adding an apostrophe and an "s." The "s" alone suffices nicely.
If you got Fedzilla out of the medical industry completely there are estimates out there that say prices would drop up to 86%.
Doctors gave up making house calls after they started making high incomes. Believe it or not, once doctors’ incomes varied as much as lawyers do now.
“But there are a LOT of medical procedures that the average person cant afford to pay cash for. Labwork, surgical procedures (even minor ones), and some imaging are more than people can come up with on a regular basis. Many people have medical problems that need care constantly and paying for it is just not possible. This is especially true of old people who have a constellation of problems.”
I disagree. I just went in for a battery of tests, and the bill was right around $420. As it happens, my insurance was cancelled about a year and a half ago. Not related to 0’care, related to...never mind. I suppose I could have spent $592 a month times 18 which is $10,656. Or, I could have spent $420. which was a 30% discount for cash.
You or I can go to the Oklahoma Surgical Center and pay approximately 1/5th of nominal rates for surgical procedures. They do not take insurance. They take cash money. There are 2 takeaways from this.
One is: The medicare co-pay is 20%. One fifth. If you are a medicare patient and go in for surgery, you will be charged 20% of the total as your co-pay. Now think very carefully: What the hell difference does it make whether I pay the 20% to medicare or to the OK Surgical Center? Answer: Absolutely nothing. Question what do you get for medicare? Answer NOTHING.
Now there are a lot of people who can not come up with $50K cash on the spot but arguably, those who can, are in many cases older people. That’s not the point. People go into debt ALL THE TIME for gambling, stock market losses, harebrained business ideas. Peopl take on $50K in debt all the time, and it’s irritating, it’s a pin in the butt, but they do it, and maybe they take a few years to pay it off but it is not life-ruining, it is not the end of the world.
You may work at a doc’s office and have an insight into what it takes to operate such a business with the attendant overhead. But your view of that is absolutely skewed, and I say that without reservation, by the compensation rates for insured medical care. I saw this in my Mom’s last year, when she needed all manner of medical care. Procedures that were billed at $1327 and paid out at $58. Billed at $732 and paid out at $37.62.
The fact of the matter is that nobody works for free. When you add an insurance company into the picture, they must be compensated. When you add the overhead into the doctor’s infrastructure, the person or persons who do that clerical work must be paid, and the delay in receipt of payment from the various ins companies must be taken into account.
I recommend you view this:
The second takeawy from the OK Surgical Ctr is: Healthcare costs are 5 to 10 times their real world costs. And the system is designed to preserve this gouging, primarily by the insurance companies. never mind the incredible assault on liberty and personal freedoms implied and mandated by 0’care, as long as this is the case and the free market is foiled, there is no solution other the egregious cost shifting we have seen.
this works for routine office visits, but once you need surgery or hospitalization you have to deal with institutions
for’a lot of’those procedures many go to good hospitals/docs outside the us and pay a ton less, even including flights and recovery.
Doctors incomes vary a whole lot now.
Doctors have always make “high incomes” compared to the average. Even the “ole country doctor”
I know. My dad is an “ole country doctor.”
He’s been paid in fish, chickens, vegetables, and a whole lot of time nothing. At one time he was the only Pediatrician in 3 counties that took medicaid. Medicaid paid 13 bucks for an office visit. It has gone up recently. Until recently a Pediatrician was required to be at the birth of a baby. Paid a whole 30 dollars. Total. Doesn’t matter how long Moms in labor. When you are the only Pediatrician in town and you have 5 OB/Gyn’s how much time do you think he spent at home. After taking care of his own practice?
But, after 50 years of practice he’s still done alright. But he is far from rich. If rich means having lot of money. He takes a lot of satisfaction in his life’s work tho, and that means more to him than all the money in the world.
Means a lot to me too....although.....a larger inheritance would mean a lot too..
My experience with the system (which has been far too extensive in the past 2 yrs unfortunately) is that doctors costs are a small fraction of big medical bills.
On a $60,000 surgery the knife guy got $3500.
So “bending the cost curve” as Caliph Baraq likes to say is really mostly about other areas.
I’ve heard it suggested that for advanced medical procedures you could pay into a regional Hospital/clinic system where they would charge a monthly or annual fee, insurance companies would be eliminated so the fees would be much cheaper. This would cover you for catastrophic illnesses or serious injuries. You could choose the best system in your area for competition. Basic visits to your family doctor would be paid in cash, or you could pay your doctor a similar monthly fee to cover minor illnesses. All much cheaper than insurance. Your thoughts?
Before the war, it was even more so the case. My family doctor was himself a farm boy, and when after the war his practice made him more than comfortable he bought a nice place outside town where he could enjoy the weekends doing chores he hated as a boy. ;).
The best thing would any system that would re-establish the personal link between doctor and patient.
I would be fine with something like that. Certainly: Routine doctors’ office visit should be paid in cash. I mean, that much is inarguable. At some level, I don’t care how damn good your insurance is, I believe you should have to pay ten bucks to go see the doctor. You don’t get out of a freaking oil change joint for less than $30, do you? What about your food market? 3-5 items, nothing, and you’re up to $20. What is it about medical care that makes people think they should be getting it for free? Are you/I/they not consuming it? Is not the education of a doctor the single most expensive “trade” a person normally, if not in their lifetime, a consumer of same comes into contact with?
There are many, many ways in which the capital cost of an expensive whizbang machine might be amortized. I could even see (and this is in some ways absurd so brace yourself) a doctor’s office or hospital offering revenue shares in such a machine....to patients.
I think catastrophic insurance should be by far, by MASSIVE far, the normal mode of insurance.
People always talk about the military industrial complex. The medical industrial complex is quite possibly 3x as large. We have been brainwashed into thinking med care is a right and somehow we should not have to pay for it. The fact is that the healthcare industry has ensconced itself into our economy in jaw-dropping ways. Another fact is, that when people do not see money being extracted from them, they think stuff is free. Withholding taxes, anyone?
Do you know that the state of Maine is being sued for importation of prescription drugs? The costs of those drugs sourced domestically is in many cases 20 times and in some cases ONE HUNDRED TIMES the generic substitute cost. (You will see dozens of examples if you watch that vid I linked in my prior post) Why are there laws prohibiting importation of Rx drugs? And perhaps more alarmingly, do you know what the penalties are?
Talking $100 million and 10 years. I kid you not. Why would there be such insane penalties if the protective measures were not being instituted by the drug companies themselves?
Did you know that in most counties, doctors or hospital administrators sit on boards that govern the permits for say, MRI machines. This is a topic known as CON (certificate of need) law (and there could be no better name) Many times, these docs sit on hospital boards and thus have an interest in the scarcity of medical care within their jurisdictions. So, if you want to come into an area and set an MRI lab where, judged on volume, you could provide the service for say $350 when the going rate is $2500, you’re likely to be denied permission to do so. Another example of the ensconced nature of the officially sanctioned monopoly power given the healthcare. It’s unconscionable and in any other business would be a black-letter violation of all the anti-trust and anti-competition laws written in the 20’s.
But like most other aspects of our economy, it’s scam-based.
Concierge Medical Care. On the horizon (and those who can afford it, welcome it).
State medical boards have docs by the ba**s. Eventually, in order to get a license to practice, docs will be required to see medicaid and medicare patients. Checkmate on the “concierge” crowd.
If you're having a major surgery--a transplant, a THA, something big and costly--gettng on a plane and spending a fortune to go to another country might be an economically viable option. But if you need a cardiac cath right now, you don't have time to get on a plane to have it done. If you need a Mohs reconstruction for skin cancer on your nose, it's not worth going abroad; it's not typically going to be done in a hospital anyway. But it is too expensive for the average person to pay for himself even if the physician reduces his prices dramatically.
I'm unenthusiastic about medical tourism. For most major procedures, I want my surgeon and team a short drive away so I can be followed easily. Go to India to have a mastectomy and you're 12000 miles and a lot of hard traveling away from the guy who would need to follow your cancer case. Not practical.
Elective surgeries, like plastic surgery and lasik for eyes, are affordable for many people, because they don't take insurance. Those docs make a good living. There are enough routine procedures that I can see where cash only practices will become more common, especially with Obamacare and the high deductibles.
The government will crack down on this.
My wife just turned 64 three weeks ago and had her medical insurance policy cancelled about two weeks ago. Happy Birthday from ObamaCare. When she checked on getting replacement insurance, it would have cost her a whopping $856 a month with a $6000 deductible and 20% co-pays after that. She is retired and on Social Security. The medical premium would have taken 2/3 of her monthly income. She is healthy and will be eligible for Medicare in a year, so she decided to ride out this next year as uninsured.
She needed her prescriptions refilled so her doctor agreed to keep her on as a cash patient until she went on Medicare. Today she went in for her first appointment to get her prescriptions refilled. She paid cash for the visit and saved 20% and got her medicines at Walmart. Her total cost was just under $200. Her refills every 3 months will be about $60 each time.
So with the insurance, it would have cost her just over $16000 with premiums and the deductible. By paying cash to her doctor and buying her prescriptions at the lowest prices available, she will spend about $380 for the year, unless she has to go in for more visits. We’re not math majors or financial wizards, but the option she chose was a no-brainer. $380 versus $16000. There is some risk involved obviously, if she were to get injured or real sick but we will take that risk rather that fork over a big hunk of money to the insurance company that we can’t afford. Even if she pays the tax penalty for not being insured, she is still way ahead of the game money-wise.
A lot of elective surgery like cosmetic procedures and LASIK are paid for with credit. There’s a company that offers credit for these non-necessary surgeries (can’t recall the name of this but I’ve seen their brochures).
We could reduce the cost of doctors’ office visits if doctors didn’t have to pay so much for malpractice insurance, but there are other operating expenses of a practice: rent, equipment, staff salaries, waste disposal charges, utilities, taxes, workers’ comp/unemployment, TAXES, supplies, CME, etc. I try all day to find ways to minimize the ceaseless expenses. A doctor who spends twenty minutes with a patient can’t keep his practice going if he accepts ten dollars for that service, or thirty dollars an hour. He is paying his staff (together) more than that thirty bucks an hour.
The hard truth is that many patients, especially the elderly and those of humble means, won’t come at all if they have to pay out of pocket, because there is nothing in their pockets now. Many Freepers who talk about paying out of pocket must be fairly prosperous and have a lot in savings, but these days most of us don’t.
When my son had a serious blow to the head four years ago, his symptoms mandated first a CT scan, then an MRI later. The charges were below the level of the deductible typical for catastrophic care coverage, but were orders of magnitude more than I had in the checking account. I could not have paid for these procedures and subsequent care and subsequent necessary care without the excellent insurance he had.
The clinic would either need to have a pre-existing condition exclusion, or a “life time maximum” that starts at a very low amount and increases every year. Otherwise they’d get the guy who gets diagnosed with AIDS and signs up the next day. You’d also need some kind of coverage for major expenses in areas that the hospital/clinic can’t handle. Reinsurance companies specialize in that kind of coverage. Given those elements, it’d work just fine.
Since, as you indicated, medical care is provided by people, a “right” to free medical care is a right to enslave the physician.
” a right to free medical care is a right to enslave the physician.”
Well...it is. This is the critical line between worldviews of the utopian and the individual. The utopian believes that the government is this massive blob of money and power protoplasm that can afford anything, and certainly, there is ample evidence that the government can spend astronomical amounts of money on the most absurd things imaginable.
Individualists, OTOH, are just that. Not permitted in utopia, no thought is given to the amount of time and effort it takes to become an MD. The individualist thanks his lucky stars that his doc was somehow motivated to go to school for 11 years and learn his craft and do it....even if it’s expensive. (And the doc thanks his lucky stars that his plumber can fix the doc’s toilet)
But what the utopians leave out of their calculus, if you can call it that, is that getting the govt to spend money on YOU (and your healthcare) and/or what YOU think is important is strictly a matter of some spending arm of the govt perceiving you as a thing of value.
Once your anticipated medical contribution to the economy is placed into the hands of the government, a simple piece of math emerges.
Is your vote/my vote worth (let’s say) $1 million? An individual with a serious chronic illness or a multiple-episode heart condition (think Dick Cheney) could very conceivably consume $1 MM of medical care.
I would posit that for $1 million, the Democrats could import between 100 and 500 illegals, virtually ALL of whom would vote for Democrats if it were legal for them to vote, but the effort to ALLOW them to be able to vote will in and of itself gather perhaps 1000 more illegals to the Dem cause. And that holds true even if 30% of them die from...wait for it....crappy medical care!
When it’s all said and done FRiend, your vote and my vote, with these pigs, ain’t worth spit.
As long as they can manipulate the system to keep them in the position to make the decisions. Their vulnerability is having to give at least lip service to democracy.
The utopian gene and the competence gene are rarely found in the same individual, so even though they achieve the 50% +1 vote, they usually screw things up in a way that ticks off the majority. These days, I live for opportunities like that.
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