Posted on 08/18/2008 10:09:30 AM PDT by Graybeard58
Two years ago, the good people in my native Massachusetts came up with a solution to the health insurance crunch. Every adult in the commonwealth must have health insurance — or face legal penalties. Residents now can choose from a panoply of new, cheap policies — some as low as $250 a month.
But there's a catch.
You have to find an internist — which is fast becoming like finding a parking spot in Kenmore Square. Many doctors in the Bay State balk at the penurious reimbursements they're offered, an encumbrance with which Gov. Jodi Rell's fledgling Charter Oak Health Plan is already wrestling here.
But even if you could coerce internists into acts of charity, there simply aren't enough of the doctors to go around. We're facing a massive shortage of primary care physicians, who receive the lowest reimbursements of all medical specialties. Twenty percent of patients in this country don't have a primary care doctor, reports the American Academy of Family Physicians. And half of those patients have health insurance. In the 1970s, when experts worried about a doctor glut, two-thirds of all doctors were primary care physicians. Now, only one-third are. And the internists who are left are a disgruntled, harried — and endangered — lot.
"You clearly are feeling rushed to get it all done," said Dr. Peter Levinson, a Waterbury primary care doctor. Levinson says that like many internists, he must see nearly twice the number of patients as he did 15 years ago to meet his rising costs. Consequently, many primary care doctors, including Levinson, no longer visit patients in the hospital because it makes no economic sense. "You feel rushed. The patient feels rushed... You gotta keep rolling. It's a very difficult day."
"The more 15-minute visits we do in a day, the more money we will make," Dr. Thomas Bodenheimer, professor of family medicine at the University of California at San Francisco, told WBUR-FM. "So that means that we've been hamsterized: we've become a hamster on a hamster wheel, seeing patients as fast as possible because we're really reimbursed for quantity not quality."
So, even if a genie from the Commonwealth of Massachusetts descends on the dome of the U.S. Capitol and starts sprinkling insurance policies on the 47 million Americans who don't have them, we're still stymied because there aren't enough internists to handle the demand.
With the average medical student starting out with a $139,517 medical school debt (on top of their undergraduate debt), they need real money real fast — which means they're going to gravitate to lucrative specialties and forgo internal medicine.
"It's pretty simple," said Dr. Benjamin Doolittle, program director of the Yale Medicine Pediatrics Residency Program at Saint Mary's Hospital. "It's money. If you are a specialist, you get paid more money."
An internist, for instance, makes $160,130 a year, reports the Bureau of Labor Statistics — and is lucky to work a 50-hour week. Compare that to an anesthesiologist, making $321,686 annually, or a dermatologist, working 40 hours a week and earning an average of $390,274, according to Medical Group Management Association.
So strapped are some doctors that some have added cosmetic procedures to make ends meet.
"It is an unfortunate circumstance that you can spend an hour with a patient treating them for diabetes and hypertension and make $100, or you can do Botox and make $2,000 in the same time," Dr. Eric C. Parlette, 35, a dermatologist in Chestnut Hill, Mass., told The New York Times.
"If a plumber comes to your house and says, 'This job will cost $100,' you'd give them $100," says Yale's Doolittle. "But if the physician says, I just treated your diabetes and high blood pressure, that costs $100 — that's if you have good insurance. If you have Medicaid, the insurance (reimburses) you $30. That's obscene."
That's part of the reason that between 1997 and 2005, the number of U.S. graduates entering primary care residencies dropped by 50 percent. Of the 50 medical residents who could have gone into primary care at Massachusetts General Hospital in 2007, only one did.
Somehow, insurance companies have got it in their collective heads that doing something is more valuable than thinking about something. Unless they correct this knuckleheaded matrix, the number of primary care doctors will continue to shrink and patients will continue to pinball through the labyrinth that is this country's health care system.
bump
Compulsory health insurance is a violation of the 13th Amendment.
Massachusetts and New York lead the nation in idiotic mandates. Politicians still think they can actually change human behavior by passing a law....
I called around and no doctor's office or even the insurance company would/could tell me what a "reasonable and customary" fee for this type of visit would be.
The idea that the "industry" wants to keep costs down is absurd.
I have to go for an outpatient procedure next week. The doctor ordered blood screen and an EKG. Try to get just an EKG from a doctor's office. It's impossible. They won't do it. They want to do a complete pre-op physical including a blood screen that I already had done.
They all run up the bill.
If only that still mattered.
This article backs up what I’ve been saying about “free” health care and what its short-sighted supporters keep missing; there are more patients then there are doctors to take care of them, therefor by trying to make it so everyone has “free” health care, they’re only going to make it more expensive.
Possibly but when I complained about the same situation the doctor told me that it was purely a CYA type deal; if he didn't do it and there were complications a John Edwards type lawyer could claim that any complications were because the doctor didn't take proper precautions. Thus he ended up doing tests that he didn't think were medically necessary but required to eliminate as much liability as possible.
It would be unlikely that he'd lose but more likely that his insurance company would settle resulting in higher premiums and bucketloads of his time.
I wouldn't want to be a doctor....
Remember Clintoon’s wanting reduce the number of Doctors?
Then think of the consequences when you no longer shop for price (A fill-up's $20 out-of-pocket no matter which in-network station you visit) and the provider gets paid 90 to 120 days later after filling out reams of paper and arguing over 25% of the bills.
We need to get the insurance genie back in the insurance bottle, the public policy genie back in the public policy bottle, the doctors back in the doctor bottle, and then perform a trial-lawyerectomy on the system. Then we might see some improvement.
Actually they wanted to reduce the number of Specialists. They wanted GP’s who would see you and basically give you the bad news, and thank you for dying for your country.
BUT YOU WON’T GET A BILL. LOL
Lawsuits run up the bill. Get sued and not have one of those stupid tests checked off, well let’s just say that lawyers love that.
I disagree. There were no lawyers involved in my trying to find somewhere to get and EKG.
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