” (Massachusetts has done this for Medicare and Medicaid since 1986 without a ripple), but it’s more probable that we will have collapse and full nationalization by 2018 at the latest. “
I’m in MA and had a doctor( an Endocrinoligist) say that he didn’t accept Medicare in the late 90s. It is the only time that it has happened.
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MA had an escape clause in the law - if you didn’t accept Federal or State payments AT ALL, you could see patients outside the “system”.
I think Romneycare made this illegal.
Any national system has to break the doctors first. My reaction since graduation in 1976 to all the plans and all the planners has been consistent - “Who’s gonna fly it, kid? You?”
But the planners are gaining strength and increasing the scope of the pain they can inflict. Turning residents and fellows into hourly workers in the 1990s was a triumph, because those shift workers are now mid-career.
When I was a clinical clerk, we used to say, “what’s the only bad thing about being on every other night?” (36 on, 12 off, for several years). The answer: “You miss half the good cases”. They’ve killed that, they’ve killed solo practice except in cash businesses like boob jobs, they’ve basically destroyed psychiatry, they’re engaging in mop-up operations in pediatrics and so-called “primary care”.
They’re going to win in the end.