No, you probably can't keep your doctor

[dutch508]

Star Member Recursion (53,440 posts)
https://www.democraticunderground.com/100212281922

No, you probably can't keep your doctor

If we can't be honest about this we have no business trying to reform health care.

We have too many specialists and not enough GPs, too many hospitals and not enough multi-physician clinics, and too many providers in lucrative areas and not enough of them in less lucrative areas. If we want universal coverage that means we're going to be changing where providers are, who they see, and what they do. American ideas of continuity of care are pretty much unknown in most of Europe: you go to the clinic or hospital and see the doctor on duty; they have your chart and history available. You don't have "your doctor" to begin with.

In particular, this means that it is a lie to claim people will be able to keep their doctor. Because a lot of people won't. If we actually go to a universal health care system, a lot of practices will have to consolidate, a lot of hospitals will have to close down, a lot of specialists will have to become GPs, and a lot of providers in general will need to move to less wealthy areas.

People know this. This is why Medicare For All polls at about 22%: people are perfectly aware of how disruptive it would be. I think it would be worth it, personally. But there's no point in even trying if we are closing our eyes to how actually disruptive it would be.
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Star Member Recursion (53,440 posts)

3. And yet. We can't all get the best doctor.

A whole lot of us (the vast majority, in fact) are going to have to accept perfectly average doctors.   

 

Star Member Hortensis (31,381 posts)

71. What DO all those doctors in our towns do if we can't have then?

Who gets to have them if not us? Do they just stop practicing medicine? Move? Let's not be silly.

Of course most of us will both be able to keep our local doctors and any specialists farther away we might have -- if we want. We will also have other choices in case we don't want the old ones.

Anti-ACA Republicans have been able to drive many insurers out of many coverage districts, especially rural. But before they did that, people in most districts had a choice of a number of insurers. I'm in semi-rural Georgia and I remember Kaiser still wouldn't bother with us out here, but that was as before and at that time a pleasingly long list of other companies did.

The coverages and practitioner choices I purchased were far superior to the one, take-it-or-leave-it choice the corporation I'd worked for offered. I no longer had to choose a physician from the list the insurer contracted with and no longer had to have insurer preapproval for specialist visits.

Even out here I had to scan down very long lists of properly licensed physicians to see that our PCP was acceptable to every company I looked at.

 

Star Member Recursion (53,440 posts)

74. Well, a lot of them will have to move, yes

At least as of a couple of years ago there were zero pediatric nephrologists in Mississippi, so at least 2 or 3 pediatric nephrologists will need to move there. In general doctors will need to move from currently overserved areas to currently underserved areas, and since we aren't talking about nationalizing the physicians themselves (yet) that's going to have to be through financial incentives.

 

Star Member Hortensis (31,381 posts)

76. Not because of the ACA or MfA. This is a RW meme presented

from a different angle. We all remember when a few people having to change physicians, most of them because they'd had junk insurance, while millions continued with theirs was turned into an "OBAMA LIED. HE PROMISED YOU'D BE ABLE TO KEEP YOUR OWN DOCTOR." lie.

Of course healthcare reform has been addressing, and has to continue to address all the trends you mention. But if it's not terribly effective now, what do you expect after so many people chose to elect, or enable election of in the case of "Dexit" and nonvoter types, a Republican president, Republican congress, and Republican state governments?

The Republicans promised for over 10 years to destroy government-organized healthcare, for heavens' sake, and are still doing their very best to accomplish that. And only scoundrels blame the ACA for their sabotage.

Everyman Jackal (170 posts)

100. Why won't we able to pick our own doctor or at least stop seeing a bad one?

I am in the VA system and I have had doctors I didn't like. I just switched doctors. I have also changed clinics and hospitals when I moved and my new doctors with my permission have had full access to all of my records through the VA healthcare system, not just doctors notes or prescriptions but also all my x-rays, labs and MRIs. When I moved if I didn't need to see a doctor I could order my prescriptions through the same system and they were mailed to me. I know some veterans have had problems usually because they were in an area where the VA needs to do more. I was in the private sector for 28 years and now the VA for 24 years and the VA system is far superior plus for me, it is totally free and they even pay me travel.

Voltaire2 (5,996 posts)

7. Bullshit.

The only thing that has to happen under MFA is that the billions in profits extracted by the private insurance industry will disappear.

Star Member Recursion (53,440 posts)

8. ROTFLMAO

Yes, it's a tempting fantasy, and it's complete bullshit. Insurance overhead and profit is about 4% of our total spending.

Germany, Switzerland, the Netherlands, and France all also have private for-profit insurance, and they also pay about 4% of their total spending for its overhead.

The problem is our doctors make twice as much as the OECD average. Outpatient providers are the biggest single category of health care spending we have, and it dwarfs what other countries pay.

We need our doctors to make less money while seeing more people. And that means we can't pretend everybody's going to get to keep their current doctor.

so- why would any dr. do that? Or anyone, really?

Voltaire2 (5,996 posts)

9. So we need to lower doctor costs under the current system. How are we going to do that?

The only thing that has to happen under MFA is that the billions in profits extracted by the private insurance system will disappear.

Star Member Recursion (53,440 posts)

11. No, you're vastly overestimating how much insurance profit there is

It's miniscule. The problem is provider profit. We have too many hospitals and too many of them are for-profit. Most doctors' practices are for-profit and there are too many standalone specialist practices and not enough combined GP practices.

Removing insurance profit doesn't get us there, or even a tenth of the way there. It would lower our health care spending from 19% of GDP to about 17.5% of GDP. The providers themselves would still be unaffordable.

 

Star Member Recursion (53,440 posts)

16. Here in France physicians start at 30K or so

The highest a doctor can realistically make (except for a few specialties) is €120K, towards the end of their careers; most doctors max out at about €75K

If we had the political will to pay doctors like that in the US, we could have affordable health care too.

 

[Old n Grumpy]

Star Member Recursion (53,440 posts)

3. And yet. We can't all get the best doctor.

A whole lot of us (the vast majority, in fact) are going to have to accept perfectly average doctors. 

Yeah, we need to save the best ones for the politicians and illegal aliens. The peons get what's left.

[ChuckJ]

Star Member Recursion (53,440 posts)

8. ROTFLMAO

Yes, it's a tempting fantasy, and it's complete bullshit. Insurance overhead and profit is about 4% of our total spending.

Germany, Switzerland, the Netherlands, and France all also have private for-profit insurance, and they also pay about 4% of their total spending for its overhead.

The problem is our doctors make twice as much as the OECD average. Outpatient providers are the biggest single category of health care spending we have, and it dwarfs what other countries pay.

We need our doctors to make less money while seeing more people. And that means we can't pretend everybody's going to get to keep their current doctor.

What we really need is for lounging DUmp monkeys to take less government money and work for money instead.

[SVPete]

Star Member Recursion (53,440 posts)
https://www.democraticunderground.com/100212281922

No, you probably can't keep your doctor

If we can't be honest about this we have no business trying to reform health care.

We have too many specialists and not enough GPs, too many hospitals and not enough multi-physician clinics, and too many providers in lucrative areas and not enough of them in less lucrative areas. If we want universal coverage that means we're going to be changing where providers are, who they see, and what they do.

So Star Member Recursion is advocating the repeal of the 13th Amendment?

[Carl]

Recursion at least touches on some of the issues that as always the gimme crowd ignores.

[FlaGator]

Several years back my GP and I had a conversation about this. Turns out that after paying malpractice insurance premiums and some other overhead she took home less per year than I did and she worked much longer hours. Specialists do make the big bucks but your average GP doesn't make all that much compared to some other professions.

[SVPete]

Several years back my GP and I had a conversation about this. Turns out that after paying malpractice insurance premiums and some other overhead she took home less per year than I did and she worked much longer hours. Specialists do make the big bucks but your average GP doesn't make all that much compared to some other professions.

I don't work in the medical field, but my impression is that, possibly excepting specialists, the insurance companies and government have squeezed a lot of the profitability out of the medical profession. I'm well aware of all the touchy-feely blather about profit and medical practice, but I also know that if doctors cannot make a good living in proportion to their education, skills, and hours, they're going to leave practice. I think we are seeing this happen, though at this point it's often early retirement rather than career changes.

[Ralph Wiggum]

I don't work in the medical field, but my impression is that, possibly excepting specialists, the insurance companies and government have squeezed a lot of the profitability out of the medical profession. I'm well aware of all the touchy-feely blather about profit and medical practice, but I also know that if doctors cannot make a good living in proportion to their education, skills, and hours, they're going to leave practice. I think we are seeing this happen, though at this point it's often early retirement rather than career changes.

As FlaGator mentioned above, malpractice insurance is absolutely outrageous.  At the hospital where I worked a decade ago, one would not believe the sizes of the checks I saw.  That alone adds a giant boost in healthcare costs.

[SVPete]

As FlaGator mentioned above, malpractice insurance is absolutely outrageous.  At the hospital where I worked a decade ago, one would not believe the sizes of the checks I saw.  That alone adds a giant boost in healthcare costs.

States vary, but CA caps non-economic damages in medical malpractice cases to $250K. Given CA's culture, I suspect doctors would be unable to practice medicine in CA.

[Ralph Wiggum]

States vary, but CA caps non-economic damages in medical malpractice cases to $250K. Given CA's culture, I suspect doctors would be unable to practice medicine in CA.

Was dealing with research doctors, not OR docs or GP's.  And the research doctors malpractice rates were astronomical for merely performing primarily academic work or clinical trials.

[BadCat]

Was dealing with research doctors, not OR docs or GP's.  And the research doctors malpractice rates were astronomical for merely performing primarily academic work or clinical trials.

And why would anyone go to college for 8 years and intern/residency for two more just to make a lousy $30k/year??

[67 Rover]

And why would anyone go to college for 8 years and intern/residency for two more just to make a lousy $30k/year??

Because they cannot turn a wrench, weld or stand the thought of getting dirty. 

[SVPete]

Because they cannot turn a wrench, weld or stand the thought of getting dirty. 

I'm pretty sure good wrench-turners and welders make more $$ than $30K a year.

[Ralph Wiggum]

Because they cannot turn a wrench, weld or stand the thought of getting dirty. 

Hoity toity beta liberals think such work is beneath them.

[freedumb2003b]

tar Member Recursion (53,440 posts)

8. ROTFLMAO


We need our doctors to make less money while seeing more people. And that means we can't pretend everybody's going to get to keep their current doctor.

Look behind you. See that stampede of doctors behind you who agree?  Even with protest signs: "Pay cuts for us doctors! Make it happen now!"  "Doctors against high salaries! Stop paying us so damn much!"

Sure.

[SVPete]

Star Member Recursion seems to have a special hatred for doctors. Kind of looks like a resentment of success Star Member Recursion has not had in life.

  Someone (s)he hated in school is now a doctor and doing well?

  A doctor married a (wo)man Star Member Recursion fancied?

 

[Ralph Wiggum]

Star Member Recursion seems to have a special hatred for doctors. Kind of looks like a resentment of success Star Member Recursion has not had in life.

  Someone (s)he hated in school is now a doctor and doing well?

  A doctor married a (wo)man Star Member Recursion fancied?

 

Although the jealousy factor isn't a bad theory, I suspect a doctor one touched them/her/it in a funny place.

[landofconfusion80]

Although the jealousy factor isn't a bad theory, I suspect a doctor one touched them/her/it in a funny place.

Unforgiven- the colonoscopy exam

[J P Sousa]

Several years back my GP and I had a conversation about this. Turns out that after paying malpractice insurance premiums and some other overhead she took home less per year than I did and she worked much longer hours. Specialists do make the big bucks but your average GP doesn't make all that much compared to some other professions.

Even that is changing. In the past year and a half, my wife and I had to switch Cardiologists three times. The first one retired, the second one was in the process of retiring BEFORE we could even get the appointment, the third changed fields (went into administration), our fourth and current doctor sounds like he is not too happy with the government intrusion into his practice, but not able to retire yet.