“Why no Medicare? Don’t you have an ethical duty to see sick people as they come to you to the extent of your ability and regardless of their insurance?”
No, I don’t. Grow up, if you believe this.
I don’t, and neither do any other doctors - a growing percentage - who refuse them. Mostly such patients are refused because the insurance payments are set so low that we lose money and go broke if we see enough of them. And we face federal prison time if we allow them or their family to pay us anything to make up the difference. The Feds dictate how much any other insurance they have can pay us as well. There are clinics and doctors who still do see them, and they can get their care with those doctors for as long as their practices remain financially viable, which is becoming increasingly difficult for most.
In many specialties, mine included, patients with good insurance are almost never referred to specialists for care that falls within the scope of that specialist unless the primary doctor absolutely has to do so, whereas they will routinely send patients to the specialist if Medicare is involved, thus allowing them to have a more lucrative practice at the expense of the specialist.
Medicare also insists we prescribe older generic medicines, such that our ability to render good care is often limited. The fear of Federal audits and other actions - with significant compliance burdens, and financial ruin or incarceration hanging in the balance - also limits our enthusiasm for taking Medicare, which increases our risk of exposure to such trauma enormously.
There are, BTW, a number of other criteria that also preclude me from taking many other patients into my practice, criteria independent of their insurance coverage. I have a highly select and professionally satisfying practice at this late stage in the profession, and I prefer to keep it that way. I feel no obligation to take just any patient who just wants to come see me for whatever reason.
So far, at least, docs still have the freedom to stay in business and do a good job with the patients we do see. It is a modified triage model of sorts. Our decision to do so presents me no ethical dilemmas or qualms, and anyone who thinks it should can simply go ahead and vote for left wing politicians who will further expand the forces that are ruining the perfectly good healthcare system we once had.
The old timers I knew back when I was in my training would voice their opposition to Medicare even back then, when it was much less of a problem. They saw that it would ballon out exponentially until it either bankrupted the country, or bankrupted the fine medical system we’ve always had here. It started off very slowly, like any good idea the lefties have, but even back then many knew it was the camel’s nose under the tent - and it was.
I hope you simply forgot the “/sarc” after your post. If not, there’s nothing more to talk about.
I would bet I am more conservative than you by many measures. That said, I have many medical people in my family, including an M.D. husband who went to one of the top ten med schools. I know that is doctors who think like you, with $ and comfort as primary motivators are also doctors who see medicine as a business and ego trip rather than a mission to the sick. Frankly, you are the very doctor ofwhom patients should be wary.