There are some misconceptions in this thread.
1. A lot of doctors don’t accept new Medicare patients. As far as I know, there is no reg reqiring Medicare providers to take on Medicare patients. I know of no case where a doctor was fined or sanctioned for not taking a new Medicare patient.
2. There is a specific process to opt out of Medicare. However, relatively few do because they are employed by a large hospital group, or if independent, they may accept other plans that require Medicare participation, or the hospital requires it for hospital privileges.
3. Most independent physicians accept self pay at the time of service. IOUs are not typically accepted. However, large hospital groups don’t
cater to self pay patients because the secretarial staff are not typically instructed to give out price quotes to prospective patients. In the past, self pay patents for elective procedures were simply sent a bill. But with inpatient costs so high, most large groups have generally avoided these situations. I would imagine that if the volume of self pay and high deductible policy patients become more prevalent, the hospital groups will need to find a way to cater to this sector on a more systematic basis.
4. Doctors are not as altruistic as Dr. Siegel likes to think. I can’t think of a time when doctors have been more demoralized. Working harder for less, the ruinous rules and regs do not bode well for the future. Doctors will not cheerfully chant patriotic tunes while skillfully performing surgery in the FEMA camps and city hospitals.
The other problem with self pay and high deductible patients is once they are seen by a physician, they are yours for 30 days, the amount of time it takes to fire them. There is a bunch of scenarios for this situation.
1. A patient pays for the first visit, then makes another appt for a different new problem the next week. The patient cannot afford the second visit, but the doc has to see them anyway because they can be charged by their medical board for abandonment if they refuse the second visit.
2. It is hard to quote an accurate price for the visit. The patient may have a much more complicated medical history, and the cost of the visit becomes much higher than initially quoted. Then, you have an angry patient screaming in the waiting room about their bill.
I think for the future, that patients may have to post some sort of bond, or bank a deposit in order to be accepted by a physician. It may something along the lines of $500 deposit that always needs to be fully funded by the patient as long as they are a patient of that practice.