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Post 45 made on Wednesday October 2, 2013 at 17:35
Long Time Member
March 2005
First of all I would like to tell all you Custom Installers to "Hire a Pro" on this issue!!!jk!! I am impressed with the knowledge on this issue. I am sure many have you have been forced to learn about this as employers.

I am a primary care physician in a Multi-specialty group that owns its own health plan that provides group insurance to employers.
I would respectfully disagree with OneRemote on a couple of issues.
First, I think it is ridiculous to try to fix the healthcare system on the backs of physicians by reducing their pay. You guys all know about overhead, well we have that too and it is going up because of the ACA. If our fees stay the same or decrease you know what happens to an owners pay. I did not go into medicine for the money(If I did, I wouldn't be in primary care), but wouldn't want to get paid less for what we are asked to sacrifice. I can raise fees all I want, but a government run health system will only pay what they are going to pay.

Second, I don't think the ACA is a good thing. Straight Medicare and Medicaid don't even pay enough to cover overhead, so most physicians would go out of business if a majority of their business was from government run payers. The ACA will place more patients into the system with pay scales similar to government pay structures, thus bankrupting many practices. You can then extrapolate what a Nationalized Health System would do to physician practices. Many of the plans people will get on the exchange will have ridiculously large deductibles, so patients will forgo the primary care they need. This being the exact opposite of what the ACA was supposed to accomplish. When physicians are polled on the ACA most are against it. The Government likes to say that physician groups like the AMA are in support of it, but only 17% of physicians are in the AMA. I dropped out because of their support of the issue, like many of my colleagues.

Our physician owned health plan will kick any government plan in quality, cost, and efficiency of care. The reason is because we know what is best for our patients. Patients get what they need based on evidence based care and we don't do tests or scans on patients who want them because of evidence based medicine as well. We keep our administrative costs low and sell directly, so brokerage fees don't get tacked on to the price tag. These things won't happen under a government run system for reasons people have commented about government run entities above.

Mogul kind of hit on this earlier in regards to underwriting. The ACA will cripple our ability to underwrite. Actuaries have gotten good at determining an appropriate cost to underwrite a company. Under the ACA we can only base fees on Age, gender, tobacco abuse. There may be a couple more, but the point is that good, efficient companies may go out of business because they can't properly underwrite under the constraints of the ACA. Most insurance companies won't even get into the exchange business because the risk isn't worth it.

In saying all that, I do think that changes needed to be made, but not in the form of the ACA. I agree with legislation on pre-existing conditions. I think that requiring insurance companies to pay for evidence based screening is good. Both of these didn't need bloated legislation to get it done. Currently physicians get paid on volume. I think pay structures need to be based on value(i.e. quality, efficiency), and volume in the future. Don't need the ACA for that. By the way, where was Tort reform in the ACA? If a doctor tells you he has never ordered a test to save his ass than he is a liar. That would help costs considerably.

I am not an economist, but I have often thought that the government should only provide catastrophic coverage. Catastrophic care places a high burden on the health system. The sickest 10% cost upwards of 40% of healthcare dollars spent. You would need to regulate that private insurance plans cover important preventative care measures then they can compete among themselves for the other bells and whistles. Throwing Medicare in there or not would have to be made by someone smarter than me.  Not sure if this would work, but I am not one to criticise without trying to think of some solutions.
Fortunately and Unfortunately the solutions aren't up to us here.

After I posted, I realized how long this post was. If it helped put some light on the issue great, if not sorry for wasting 10 minutes of your life.

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