If we get a public plan (along with private plans) will we allow doctors to refuse public plan

[CTyankee]

patients? Do we have safeguards against that happening in the public plan design?

I guess the underlying question is, will doctors treating public plan patients get a lower reimbursement than for the private plan patient? Can we fund the public plan sufficiently and still save money?

Are doctors now allowed to refuse to treat people with Medicare part B only?

[Captain Hilts]

1. Right. We can't permit private entities to pick and choose for whom they treat. THAT's the problem

right now.

[CTyankee]

2. Then the only way is to fund the public plan with the same level of reimbursement as the private

ones. But then my question is, have the numbers been crunched to anticipate what this would cost?

Also, will we continue to let the private plans cherry pick the people they want by virtue of charging high risk patients absurdly high rates, thereby forcing them into the public plan? Then the public plan becomes crowded with the sick and the cost to the taxpayer goes thru the roof...

[enlightenment]

4. Which is why this 'plan' won't work.

Insurance is NOT care.

We don't need another form of health insurance. We need health care.

[Warpy]

3. They shouldn't be allowed to refuse anybody, period

including the Medicaid patients they now avoid.

Insurance companies should not be allowed to delay treatment or to refuse it in most cases.

Patients need protection. They're not getting it from anyone now.

[tritsofme]

5. Doctors already don't have to accept any Medicare patients.

But most still do.

But to answer your question, its almost certain the reimbursement rate will be lower than the private plans, and some providers won't be interested in participating.

[endarkenment]

8. "its almost certain the reimbursement rate will be lower than the private plans"

Ok - I'll bite. Why exactly is it almost certain that a public plan would pay lower reimbursement rates to health care providers than a private plan?

[CTyankee]

14. Medicaid is a public plan. Are you saying it doesn't pay a lower reimbursement rate

to doctors? The evidence suggests that it does, why else would some doctors refuse to take Medicaid?

[endarkenment]

16. An interesting point: the problem with medicaid.

Medicaid is underfunded. It is quite simple - an underfunded public plan will deliver poor quality, will have to cut corners. The reason why government gets away with underfunding medicaid is that it is viewed as 'welfare for poor people'. Any public system can of course be Thatcherized, it will be up to us to fight against the kleptocracy to prevent this sort of shenanigans. A public universal plan is far more difficult to misrepresent as 'welfare', so we have a better chance of keeping such a plan at least adequate.

[CTyankee]

18. That's also a good point about misrepresentation and you are right.

But I think there are some docs who won't take Medicare part B. That's why we retirees are constantly told "you must have a supplementary plan."

But what if the public plan starts out "universal" but, because the private plans compete for the healthier enrollees, the public plan becomes the plan for the sickest and poorest?

I recently attended a private fundraiser for a woman whose health insurance only covered her surgery for colon cancer, but not her follow up chemo treatments. She wasn't old enough for Medicare and she was not poor enough to qualify for Medicaid. My question is: what if we get a public plan that does just this? We're back to where we started.

I agree that we cannot allow thatcherization of the public plan. But it could become the one we pay lots of taxes to support if it is populated by the sickest people in our society.

[endarkenment]

20. All the plans must be required to take anyone and be forbidden

to charge different rates for high risk clients. If all plans are in the same game the public plan will win as it does not have to extract ANY profit from transferring funds. This is why the kleptocracy is going to fight a public plan tooth and nail and why they rightly view it as 'the back door to single payer'. Rightly done, the public plan will be the 'last plan standing' and we will then have single payer. I personally have grave doubts about the 'rightly done' part as I view our federal government as too corrupt to do anything other than serve its corporate masters. I guess we will find out if, first of all, a public plan will even get a chance, and secondly, if it will not be pre-crippled to fail.

[CTyankee]

22. My only hope is that Obama is well aware of the danger of "pre-crippling" the

public plan to fail. He surely knows that if he allows that, then all this talk and effort to get universal health care will be for naught. Eventually, it will fail and people will view his plan as unworkable.

I don't think Obama wants that to happen. He has the momentous opportunity to leave a great legacy to this country, and it will be ruined if he doesn't ensure the viability of the public plan. He's just bet too much on this to let it all crumble...

[endarkenment]

24. I can both hope and have grave doubts.

The insurance industry can survive but it will have to adapt. Some European countries have hybrid systems where private insurers offer supplemental insurance - I think France is in this category - and insurers continue to do business however they do so at a far lower scale than the insane corrupt system we have. The Japanese system relies on private insurers but the government sets all the fees, an approach unlikely to work here. So perhaps faced with a reality that public health care is inevitable, the insurance industry will focus on making sure they can retain some sort of viable business in the new system.

[Sgent]

23. The supplement has nothing to do

with doctors not accepting Medicare -- it has to do with the somewhat significant gaps in Medicare coverage.

Medicare has a 20% copay for EVERYTHING, a $900 hospital per admission deductible, a $150 outpatient deduction, and NO out of pocket maximum. The supplemental picks up those costs.

If a doctor doesn't participate in Medicare -- then they can charge what they want and Medicare will cover nothing. If they do participate, they still have the option to limit their practice to a certain percentage of Medicare patients.

[KharmaTrain]

6. Options Need To Be Provided...

The basic questions are about making sure there are safeguards to make sure everyone can get medical treatment. The complicated ones are how this can be done in a system that doesn't turn the healtcare system inside out or replaces one beauracracy with another. It needs to be an open and competitive system where price is dictated by the actual service rather than the billions squandered now on paperwork...liability insurance and price excesses in the pharmacutical and insurance industries. While some would love to outlaw or nationalize the whole process, that would turn the system inside out and I can't see any politician voting in favor of that...it'd give the GOOP a big bone to shut the who process down and we're stuck with the current mess.

When I worked with my father's practice, he NEVER turned away a Medicare patient despite many hassles we had in filing and collecting, but we knew of others who turned down those "assignments"...not cause of the people but more due to the hassles they faced in getting reimbursed. It was tough enough dealing with insurance companies who were the ones really calling the tune here. They controlled the costs, approved the procedures and created the divide in quality of care between those with the means and those without.

There's a lot of voices that need to be heard here and more information put forward so we all can learn what is really wrong with the healthcare system...what is realistic to accomplish and how to make the system accessible to all...focus on prevention and make the government an agent to encourage competition, not create an administrative nightmare.

Cheers...

[noamnety]

7. The best safeguard

is to have congress be in same plan they propose for the rest of us.

[Mudoria]

10. Wasn't that one of the themes that the President talked about

so much on the campaign trail (that Americans should have the chance for health care like Congress)?

[endarkenment]

9. Health care providers are not the problem.

For a public plan to be successful what is essential is that no plans be allowed to exclude people or deny coverage and that no plans should be allowed to set rates based on prior conditions - which is the other way to exclude people. The health care providers are not the problem. The health insurance industry, which does nothing other than charge rent for transferring money from one account to another, is the problem.

[CTyankee]

11. But if a doctor gets reimbursement of $50 to see a public plan member

and $75 to see a private plan member, what's to prevent him/her from just refusing those on thepublic plan?

OR, what's to prevent said doc from providing a lower level of care (i.e. you're seen by a nurse practioner instead of the doc)for the public plan holder? And yes, I know that nurse practioners are great. Evidently, this is happening now with HMO vs. PPO patients...

[endarkenment]

12. Why would FOR PROFITS be paying more?

They are FOR PROFIT. They attempt to squeeze every cent out of both ends of the system IN ORDER TO MAXIMIZE THEIR PROFITS.

So to answer your question: this particular health insurance for profit plan would quickly go out of business as it would be LESS PROFITABLE than competing plans that paid health care providers at lower rates.

The hypothetical situation makes no sense.

[CTyankee]

13. My daughter's experience with her HMO plan is the example I was giving.

PPO paid higher. I don't know why. This is in CA.

Anyway, during her pregnancy she never saw the ob/gyn for routine office visits, only nurse practioners. She developed toxemia in the latter part of her pregnancy and had to have an emergency C section (she and baby were fine but it was scary). She had just seen the nurse practioner in an office visit and her bp was "fine." One week later she was in the ER with a skyrocketing bp and her platelets were going fast. She believes it is because of her plan that she got a lesser level of care.

[tritsofme]

17. Medicare pays a lower reimbursement rate than private plans.

If a provider wants to accept Medicare patients and get paid, they have to accept the lower Medicare rate.

For the same services, a provider can get a higher rate from the private than from Medicare.

Consequently, providers can elect to refuse all Medicare patients.

I think the OP is trying to raise the problem of providers refusing to take public plan participants because of a lower reimbursement rate.

[Dr.Phool]

19. The only reason it's lower is because Bush cut it by 30%.

10% per year over a 3 year period.

And my asshole, former, doctor, who always voted Republican, was screaming about it.

[endarkenment]

21. Thatcherization is always a risk. nt.

[CTyankee]

26. All my docs are liberal Dems. My surgeon and her doctor husband were my group of

CT Planned Parenthood supporters who went to NH in late September to door knock and phone bank about John McCain's miserable record on choice.

Needless to say my gyn is herself a strong Dem, as is my cardiologist (his wife was a delegate to the Dem Convention), primary care doc and gastroenterologist.

[imdjh]

15. Of course doctors should be allowed to refuse to accept the public plan.

Once their student loans are paid, and assuming they didn't go to school on a publicly funded scholarship, don't accept any government grants,

But seriously. I have no problem with there being doctors who opt out. I think they will be few. I do think that there need to be hard and fast rules about such things so that doctors can't do to the public what my dentist has done to me.

I have a DMO. I chose it because it had the most benefits and the lowest cost. Apparently, a lot of dentists don't like my DMO so I have to drive a piece to go to the dentist. But that's not the problem. The problem is that I have to drive 10 miles to my dentist office when the main office for my dental group is a few blocks away. But because I live in a somewhat affluent area (on the edge of one to be more precise) the main office doesn't accept my DMO. They make me go to their satellite office which needs business. When that office gets enough customers, they'll drop me too. I'll find this out when my DMO sends me my annual package telling me I have been assigned to some office 20 miles away that doesn't answer their phone. I know this, because it has happened, twice.

My dentist got the most priceless look on his face when I first met him. This is the one at the satellite office. He welcomed me to "Smiley Dental Group" and I looked up at him and said, "I have been with Smiley Dental Group for years off and on. I have DMO, so once your office has enough cash customers, you'll drop me." He almost looked embarrassed, and what he said loosely translated to, "Oh, you figured that out." Maybe that changed something. I haven't been dropped in three years now.

I think that the rule should be something like "If you accept NSP, then you have to accept it for a period of five years, and re-up in five year increments. You only have to accept up to a stated percentage of your customers, but that percentage is not flexible. If you accept 50% NSP then you cannot refuse new NSP customers to reduce that percentage , nor can you accept additional NSP customers in a given year only to transfer them out the next. Nor can you use NSP to segregate the offices of your medical practice. You cannot accept NSP in Dirt Yard City and refuse them in Pretty Lawn Estates."

[slipslidingaway]

25. I gave this a rec for more discussion...

http://www.dailykos.com/story/2009/5/5/727968/-Theyre-Going-To-Make-A-Mockery-Of-The-Public-Option

"I was pretty incensed when I read this article in the New York Times this morning about the "so-called middle ground" for the public option to appease the murder-by-spreadsheet insurance industry. Here's Senator Schumer's ridiculous compromise outlined below:..."

[CTyankee]

27. Holy sh*t! Schumer?!

His plan sounds to the right of Gengis Khan. Some liberal...:puke: