You want to create a national health insurance program that reimburses at Medicare rates for services performed for everyone? What happens when physicians simply opt out? Setting hospitals aside, primary care physicians are having enough trouble paying their bills as it is at the moment. There's no way they could survive based simply on Medicare/Medicaid payment levels. Not to mention the endless bureaucratic red tape that would come when Uncle Sam starts paying the bills. There is too much mindless paperwork and documentation required already. I think it would only get worse with a national insurance plan.

SomeMedStudent:

You want to create a national health insurance program that reimburses at Medicare rates for services performed for everyone? What happens when physicians simply opt out? Setting hospitals aside, primary care physicians are having enough trouble paying their bills as it is at the moment. There's no way they could survive based simply on Medicare/Medicaid payment levels. Not to mention the endless bureaucratic red tape that would come when Uncle Sam starts paying the bills. There is too much mindless paperwork and documentation required already. I think it would only get worse with a national insurance plan.

well you should perhaps ask a canadian physician, who has a simple standardized form for each encounter and gets reimbursed, rather than having a dedicated staff person or persons for handling the variety of forms required by a variety of companies each with its own requirements and opinions regarding what information is necessary in what format and each of which is liable to have a little conversation with the doctor's office regarding the claims.

Yeah, medstudent, gzuckier is right. It's not so much medicare causing paperwork problems (although they create some now with their quality care initiatives), but the various private plans with their, as a whole, loads of paperwork (preapproval, billing etc.) are the real pain. Medicare payments would well support PCPs if there were just some adjustments on the expense of relatively overpaid proceduralists.

So you say medicare would be enough to support PCPs, if only it paid PCPs better?

How is this different from saying Medicare doesn't pay PCPs enough to survive?

im1:

So you say medicare would be enough to support PCPs, if only it paid PCPs better?

How is this different from saying Medicare doesn't pay PCPs enough to survive?

I think what traugott said was more like if some of the paper pushers could be dropped there would be more of the money left over for the actual PCPs, without having to cough up more money.

This doesn't even cover the insurance company's side of paperwork and employees being paid in almost no way at all to help patients with their problems. (Some would appear to be being paid, on my money, to find ways to NOT have to pay to help me...)

Even though I am practising physician, I never inquired too much about third party payors reimbursement, although it becomes pretty clear that:

-private insurance usually pays very well

-medicare pays OK or at the lower end of the reasonable range

-medicaid barely pays at all

I read from reliable sources that medicare pays quite well for certain procedures, some of which are greatly overused. There is no reason why almost all radiologists, interventional cardiologists and most surgeons make between 350 and 700 K (while PCPs usually are between 130 and 250 K). Lower the fees for the interventional stuff and improve reimbursement for office visits (cognitive medicine), and PCPs will be doing well enough.

Doc...how come you don't speak of the outrageous insurance costs you have because of sue crazy people in our country?..That not only deters good people from becoming Drs. but also makes insurance costs to Americans go up and Illegal Aliens getting free medical at our hospitals doesn't help either for all of us legal Americans that pay taxes must pay the burden of this abuse..I find this article biased and untrue..We receive a 3% payraise every year and have a great medical plan with our companies and the cost isn't bad at all

What if your school debt was forgiven for being a PCP? After Eight years or whatever you can go ahead and scalp the rich and insane in a private plastic surgery practice. Put in 20 hours a week as a PCP and the gov covers your malpractice insurance. Would that work for you? Are you only going into medicine for the money? I suggest you head back to school right away for your MBA, cuz socialized medicine is our future, and only dedicated healers are gonna be needed.

Heard the other day that (following Natasha Richardson's death) that the mortality from a closed head injury in the US is 3%, 22% in Canada. (This was from CNBC's medical consultant.) Fewer CT scans, fewer neurosurgeons, more money to pay PCPs. Good for them, bad for you if you get a head injury.

In England they are complaining that their system is letting people die..for instance women with breast cancer...if they deem you too far gone..they just refuse to treat you..same with other diseases...They chose who lives and who dies and you must be put on a waiting list and you can die from that

Stop-truth-decay:

Heard the other day that (following Natasha Richardson's death) that the mortality from a closed head injury in the US is 3%, 22% in Canada. (This was from CNBC's medical consultant.) Fewer CT scans, fewer neurosurgeons, more money to pay PCPs. Good for them, bad for you if you get a head injury.

She turned the ambulance away. I also would love to see a reliable source on that statistic

Jeanne Love:

In England they are complaining that their system is letting people die..for instance women with breast cancer...if they deem you too far gone..they just refuse to treat you..same with other diseases...They chose who lives and who dies and you must be put on a waiting list and you can die from that

Nope. There's still a private health insurance market there, which you're free to purchase.

Btw, many insurance companies in the US consider you too far gone to get treatment. It's called a pre-existing condition

It's not because you are "too far gone", it's just an excuse not to ensure you. You could have had cancer, be completely in remission, and be denied because you had something once. Hell, you could simply have a history of family heart attacks.

Right, I was just trying to relate it to what the original poster thinks of the British system

I'm an American living in the UK. I am privately insured in the United States and enrolled in the National Health Service in the United Kingdom. As soon as I moved to the UK I was enrolled with a GP. I've had several medical encounters since and I'm pleased to say that they have all been spectacular. My physician's office here may not be as aesthetically pleasing as my physician's office in the States but I've received excellent care. All that has been required of me is a phone call. No paper work. No co-pay. No questions.

While this is individual and anecdotal, I view it critically. I have worked in public health policy in Washington, hospitals in London, and am currently finishing a graduate degree in this field. Having both lived experience and professional experience with both systems I can say that neither is perfect and both have been adopting practices of the other for decades.

The United States will adopt a universal system. We just aren't sure how it will look. In the battle between cost, coverage and quality something has to give and we should all be prepared to give it.