My gynecologist on the topic of “Medicare for All”
Yesterday I had my regular exam at the gynecologist. At the end of the visit, I was discussing with my doctor the issue of how often Medicare reimburses for visits at this point, and what are the reasons that restriction can be overridden.
She sighed in frustration and said that Medicare makes the doctors jump through a lot of hoops. And then added (even though she knows nothing of my politics), “If this Medicare-for-All thing passes, all the doctors are going to quit.”
I was surprised not so much by what she said as that she said it to me at all. I sort of chuckled and nodded, and then the visit was over. But where I live I just about never – and I mean never – hear anyone these days make an anti-leftist comment without prior knowledge that they’re talking to someone who already agrees with them. What’s more, this doctor is quite young; I’d say in her 30s. And yet she didn’t hesitate to say it.
I take that as a good sign.
Neo, the main reason she said this is because you asked. Dr.s everywhere have had about enough government meddling. Many are practicing past retirement age because they love it, but they still want to be paid without a mass of government red tape. A majority have probably not really bought in to the “advantages” of the electronic health record. These advantages seem to all benefit payers and regulators. Kudos to your doc.
Also note, as government controls the cost, Medicare for All will quickly become Medicaid for All where the main feature will be rationing.
Scott Robinson:
The only question I asked had to do with current Medicare reimbursement policies, and it was just a question not about policy in general but about a very specific picayune point. I think it’s very surprising that she stuck her neck out with general comments not just about Medicare but about Medicare-for-All.
You should try to find a way to feed back to her that you agree …
In January I had a colon resection done to treat diverticulitis that I’ve had for many years. The operation has been a great success and now I have a wonderful digestive system again.
The last few weeks have been eye opening as we are getting statements from our Medicare supplemental insurance. The hospital charged around $50k, Medicare paid $20k, supplemental paid $1k. Surgeon charged $15k, Medicare paid $10, insurance paid $1k. Surgical nurse charged $5k, Medicare paid $200, ins paid $100…and it goes on and on, preop APRN charges, anesthesiologist, nurse anesthetist, etc. There’s quite a game being played here. Obviously the health providers have calculated out what they need to charge to get what they actually need when dealing with Medicare.
Just had my car towed by Jose here in lefty-loony L.A. My guess would be that Jose is an American-born Hispanic. He asked me the dreaded question here on Super Tuesday: Who are you voting for?
Since answering that question is very dangerous around here, I judiciously said, “No comment.”
He said he’s voting for Trump. Said he doesn’t necessarily like the way Trump talks, but he does the right thing. He said his boss is a strong Trump supporter too.
I wasn’t surprised that someone who gets their hands dirty at work is a Trump supporter.
Medical professionals we’re close to who have remarked on the point dislike electronic medical records. I gather one severe problem is that it was designed by software engineer with their own shticks in mind, and doesn’t take account of the preferences of the practitioner.
One of these professionals said she lost a great deal of informational content when they took her written marginalia away from her. Another said that the bean counters at his practice took the transcription service away from the primary-care physicians, because coffee’s for closers only. So, he was expected to enter data directly into the electronic medical record, which, he tells me tripled the amount of time he was compelled to devote to recording notes on visits. A third has been beside herself about the amount of time she spends ‘charting’.
A generation ago, you could tell from looking at records (and could tell by listening to your doctor and others) that they were increasingly demoralized by the amount of time they spent doing administrative tasks. The malinvestment is staggering.
One thing that’s odd: medical office staff often stink. I don’t understand why the economics of medical practice haven’t generated the development of a corps of technicians to take the clerical burden off the doctor’s back, or why the clerks they do employ are so often drawn from the chronically under par.
physicsguy–maybe I’m just not getting it, but this billing process–where the hospital charges astronomical amounts and, then, they accept a small fraction of what they’ve charged, strikes me as just a crazy and far too involved waste of time, energy, and paper.
Wouldn’t it just be far simpler for the hospitals to charge what they know they will get from insurance payments, and for insurance to just pay out that standard amount?
Or, is this all about charging sky high fees so that those who don’t have health insurance–but do have a ton of money–will just pay those “retail” prices, and, thus, it’s a win-win situation; the hospitals get large profits, and these large profits offset–to one degree or the other the lesser–or no–payments they get from everyone else?
.
Snow on Pine:
I believe that regular insurance pays a lot more than Medicare, and the fee schedule takes that into consideration.
Check into direct primary care practices. I pay a flat amount per month. My doctor has a small supply of drugs and passes it along at cost. She has contracts with the local labs and radiology groups so they bill her and she passes the cost on to her patients. There may be a small mark-up, but it is still far less than what I had to pay when I was with her at a university based practice.
The big plus – she talks with me, asks questions, and is not buried in the laptop. I can email her with questions and she responds. She has a Saturday walking group and she is encouraging us to do the 5K at the Memorial Marathon weekend.
I still have Medicare & a supplemental insurance as backup, but I am much happier with a doctor who is also happier with her practice.
The “supplemental” policy that everyone on Medicare is advised to buy seems to be sort of a secret. Do the “for all” advocates ever mention it? Not that I’ve heard. If you have a good one, the system seems to work very well. But behind the scenes there’s a demented labyrinth. And a good living for consultants and such who can navigate it.
I don’t see how anyone can deny that our system is a mess. But whenever I hear someone say “Why can’t we just…”, with the ellipses usually filled in with either “have Medicare for all” or some variant of “do it like they do in Europe,” I know I’m talking to a person who is either thoughtless or clueless or both. You don’t have to be any sort of expert to see that any wholesale replacement of our system would necessarily threaten a lot of people with a lot of financial pain. Among many other obstacles.
Medicaid for All where the main feature will be rationing.
You can ration with prices, you can ration with queues, you can ration with administrative directive, you can ration with coupon books. You must always ration. Medical services are as subject to considerations of scarcity and cost as any other service.
Medicare farms everything out to my supplemental insurance. I never hear a peep from Medicare. I’m satisfied. YMMV
“She sighed in frustration and said that Medicare makes the doctors jump through a lot of hoops. And then added (even though she knows nothing of my politics), “If this Medicare-for-All thing passes, all the doctors are going to quit.”
The more directly livelihood is threatened, the more quickly political positions change.
Everyone is conservative about what they know best. Also, most people don’t think of their personal financial situation as having a left/right valence. I’m sure the doctor is convinced that the Republicans want to make her bear her rapist’s child and enslave immigrant children, while a mysterious, non-partisan “they” is threatening her livelihood.
Art Deco,
Most of the staff you are complaining about make the same wage as folks at McDonald’s. However, they are in charge of getting your medical records accurate unlike the fast food employees who never get the order right. Resident care providers at assisted living centers also earn much less than $15.00 an hour. If you haven’t seen how hard these people work, caring for the unloved and forgotten you should spend a day in their shoes.
As, likely, one of the few moderate to liberal commenters here I can acknowledge that many Democrats I know [in a liberal state] don’t want a health plan that makes a Medicare-for-all mandatory and tosses out private insurance all together. It’s a bridge too far. A public option as a choice, yes. But as the one and only choice, no. I do realize the future of the Democratic party is likely to embrace Medicare-for-all but that’s why we are seeing a Bernie / Biden split at the moment.
Most of the staff you are complaining about make the same wage as folks at McDonald’s.
Per our Bureau of Labor Statistics, the median wage for medical office clerks is $16.16 per hour, summing to $33,600 per year. They receive benefits atop that. Median wages for “Counter Attendants, Cafeteria, Food Concession, and Coffee Shop” are currently $10.74 per hour and sum to $22,330 in a typical year. I think McDonald’s franchises usually have benefit plans.
However, they are in charge of getting your medical records accurate
They may be in charge of assembling them according to protocol. They don’t edit them unless its a very peculiar place. AFAICR, neither coders nor analysts change content, either. Been out of the trade for a while.
unlike the fast food employees who never get the order right.
I’ve seen this happen. It’s an occasional problem with one place we frequent. I can hardly remember it happening anywhere else.
Resident care providers at assisted living centers also earn much less than $15.00 an hour. If you haven’t seen how hard these people work, caring for the unloved and forgotten you should spend a day in their shoes.
1. Median wage for nursing assistants is currently $13.72 an hour, summing to $28,500 a year. Pretty sure benefits packages are bog standard among nursing home staff and assisted living center staff.
2. I never mentioned nursing home staff or home health aides, so I have no clue why you brought it up except that you have your resentments.
3. I’ve seen them at work. I wasn’t dissatisfied globally. Some places have better institutional cultures than others. Some employees are more assiduous than others. My mother wasn’t unloved or forgotten, just too ruined physically and mentally for anything but 24 hour care. Perhaps there was an unloved or forgotten person on her floor, but I don’t know who it was. Plenty of family bustling in and out.
==
There’s always variation from one situation to another and one person to another. That having been said, I’ve had too many bad experiences with medical office staff to think of it as an occupation with exemplary standards. In my experience, DMV clerks are vastly improved over what the standard was 40 years ago. Medical office staff, not so much. (This observation does not extend to dental practice employees, with whom I’ve not had trouble).
I have no complaints about any medical staff I’ve dealt with over the last 40 years, in Utah, Texas, and Colorado.
Well, there was that one ER doctor when my mother got sick not long before she passed away….
And the doctors that wanted to pull the plug on my friend after her stroke; but the staff was fine.
Maybe the quality of the staff depends on the quality of their boss?
Ladies quit their fields early compared to men anyway…
which is one of the problems given the costs are not cheaper
Research shows that almost 40% of women physicians go part-time or leave medicine altogether within six years of completing their residencies.
so you pay for more years of education than they actually work…
and now with so few men… well… thats going to be great
they fall in love with the image and everything, and are not realistic about it
to quote:
“When you invest more than a decade of your life to learn a skill and you’re willing to walk away from that early in your career, that’s more than a red flag. It’s a burning fire.”
Sasha Shillcutt, MD
ever notice that the problem is everything for them? everything affects them negatively, they are a victim of being alive… nothing is as it should be, even after they rearrange it, its worse… eternally unhappy and dissatisfied… which as a wife kind of works to get the husband to do and get more, but as the subject, well, not so much
According to the research, within six years of completing training, 22.6% of women physicians were not working full-time compared to 3.6% of male physicians. The gap between men and women expands for those with and without children (30.6% versus 4.6%). That compares to 10% of physicians overall who were working part-time (30 hours or less) in 2018, according to a recent survey of nearly 700,000 physicians conducted by the research firm Merritt Hawkins.
in any other reality that would mean they are a bad investment comparatively
[and this has been known for a long time, at least in the mens areas, but we be evil and are never valid anyway]
“The emergence of this gap so early in physicians’ careers may contribute to later gender inequities in compensation and promotion and suggests the importance of expanding social and institutional support for work-family balance moving forward,” Frank says. “Until system-wide reforms are made within the institution of medicine to better support women in their roles as mothers and physicians, significant gender disparities in physician retention and advancement will persist.”
oh.. ok… without changing it, a small amount of the men leave, but women leave so the whole thing has to be revamped… great… thats efficient…
actually even if you make those changes they wont stay and the men will
why? they have options to leave and still live and survive and have family and men dont… ie… women can marry and be supported… men dont really get that, so they have no real choice…
if ya want the ladies to tough it out, take away those choices…
your never going to revamp it to match what they can get from not working..
who told them they could bring home the bacon, fry it up in a pan, and so on?
besides, they arent having children in any great numbers given the (other) stats..
in fact, the up and comers cant even find mates… [and are freezing eggs]
[by the way, they dont count the work men do… ie. she does the house work, and his mowing the lawn isnt in the figures… it doesnt count… been like that for decades in case anyone wondered how come it never changes and remains a justification that no matter what they do, just doesnt go away]
my source? AAMC
then you have some of the ladies commenting about ladies..
[the mens comments fall on deaf ears… or get negative returns… ]
The transformed wife:
Women are Destroying the Medical Profession
if she was a man writing it everyone would yell that this was a MCPig…
but since she is religious… dont pay attention either..
want to know why the men make more? you think the ‘studies’ make allowances for the amount of time and so on? of course not… those studies that do do that find no disparity… and you cant use that to revamp the whole field to make the nest suitable for birds
dont worry, is all the guys fault…
The female problem: how male bias in medical trials ruined women’s health
What’s Holding Women in Medicine Back from Leadership
https://hbr.org/2018/06/whats-holding-women-in-medicine-back-from-leadership
[none of it takes into account they leave… its just one long litany of everything is wrong and the men make it so]
anyone want to do the math as to how to employ people who dont stay long enough to rise up to a position with experience?
heck… we have to change the patients too.. one study is complaining that the patients are rude.. “Inappropriate/offensive words or actions from patients. 23%”
here is one from the lancet that you know from the title:
Why do women leave surgical training? A qualitative and feminist study
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)32612-6/fulltext
and they found six new problems in the never ending list of them
Six new contributing factors emerged: inaccessibility of leave, a distinction between valid and invalid reasons for leave, poor mental health, absence of interactions with other women in the surgery section and other supports, fear of repercussion, and insufficient pathways for independent and specific support.
a report from the Association of American Medical Colleges that “projected a shortage of 42,600 to 121,300 physicians by 2030, up from its 2017 projected shortage of 40,800 to 104,900 doctors.”
remember the changes since the 1968 revolution
but then again… blame it on all the politicians listening to the complainers and going in and ‘fixing’ it more and more and making it less and less… it was better before… i am old enough to remember when they made house calls…
So the OBGYN complaining about leaving really might leave anyway..
even without socialist medicine!!! the odds are that with other choices like a professional husband, she can just decide to halve the family money, and put the burden on him, and thats that… (its not uncommon for the two earner family to suddenly have her not earn and he be holding the bag without any say in it!!!)
well..
at least its interesting to watch.
Medicare-for-All wouldn’t be something that you pay into and then use late in life. It will be more Medicaid-for-All, don’t you think?
My family doctor, who is considered one of the best in our state, employs a full-time scribe, who just follows him around and records the data into the EMR. Saves him a ton of time.
My family doctor, who is considered one of the best in our state, employs a full-time scribe, who just follows him around and records the data into the EMR. Saves him a ton of time.
I like the idea. In the last eight years, most doctors I have visited have been pre-occupied with data entry during the course of the visit, in one case to the exclusion of everything else. This needs to stop. We send these people to medical school (170 credit-hours over four years), put them in residency for 3, 4, and 6 years, then put them in fellowships for two years. We need technicians with associate’s degrees to be handing the data entry and the correspondence with the insurance companies.
Where is the health-scribe HAL computer AI able to accept voice input?
When you read about computer advances, remember 2001, the movie from ’68, was expecting much better human voice communication with computers. Maybe Siri or Alexa … in a few more years. Or decades.
Data entry should be by voice.
Montage says Dem friends:
“don’t want a health plan that makes a Medicare-for-all mandatory and tosses out private insurance all together.”
Well, those friends who support Sanders or Biden are supporting Medicare-for-all. Whether they “want” it, or not.
You support what you vote for. I used to not want Trump to tweet so much, but voted for him anyway. Now I’m OK with his actual tweets, plus there’s the game of seeing how Dem media is dishonest about what he actually tweets / says.
I don’t see a lot of details about Canada, Denmark, or Sweden’s “great” health care in terms of results. More folk from those countries come to the USA for health care than the reverse.
I flatly do NOT believe most doctors would quit, tho there might well be a big increase in going to part time.
My doctor trained wife in Slovakia, after having 3 kids (in 3 years), switched to become a Professor because family first. Plus Slovak socialized doctors in 1995 were getting paid about the same as janitors.
It’s generally good to have more part time workers who are almost full time mothers. Civilization needs more good mothers with husbands living with their children, and needs this more than single doctors, whether female or male.
Both in Slovakia, the EU, and the USA, there are not enough med schools. A huge need to reduce health costs is more doctors, which means more med schools. I’m certain the increase in numbers of Law Schools after WW II is far more than the increase in numbers of Med Schools, and graduates. I understand Trump is pushing a bit to get another med school, but I don’t hear much about it.
Just for the record…that Canadian Health care is not so great.
https://www.americanthinker.com/articles/2020/03/the_canadian_health_care_myth.html