Will Universal HealthCare Change Medical Care in the United States
I do not know of any absolute, fool-proof way of finding the best doctors in a given specialty.
To be honest, I do not know if the lay person would even be able to make that determination regardless of how much data is available.
We find that if the doctor doesn't kill us or make us sicker and has a nice personality, we think they are the best doctor in the world.
I hear this a lot about dentists.
A typical comment is "I love my dentist because he does not hurt me.
" Is he skilled? Who knows? With that said, there are physicians that have a reputation within the medical community as being a cut above the rest.
Often, you can find them through recommendations from other physicians with whom you have a good relationship.
Otherwise, they hand you a list of available specialists in the area and put an asterisk next to the ones that they have a financial interest in.
The idea that if you have to wait a month for an appointment is not a sound measure of a doctor's capabilities.
The physician might be one of the few specialists or primary care providers within a certain network.
Therefore, the difficulty of getting an appointment has nothing to do with their abilities.
It is all based on the limited number of providers in that particular plan.
What we have found after many years in the health insurance business and as a patient is that talent does not come cheap.
"But I have health insurance, who cares what they charge?" My family physician will not take United HealthCare nor will they accept Aetna.
These are two excellent companies.
My gastroenterologist will not accept United HealthCare.
Most of the "better known" specialists in my area will not be a part of an HMO network.
If you have a Medicare HMO, you might have to drive 50 miles for some specialties in many parts of the country.
This is not due to a shortage of specialists.
It is due to the fact that many have limited or discontinued Medicare patients.
Why is this happening? You must first stop and consider that a medical practice or a dental practice or any professional practice is first and foremost a business.
It is about getting paid properly for the type of care you are providing.
It is also about not having an insurance company downgrade a treatment code or preventing you from treating a patient in the manner that you feel they should be treated.
This brings us to the latest proposals in health care reform.
We have already seen seniors driving unheard of distances to find a specialist who will take Medicare.
If you are in New York or perhaps Los Angeles you are thinking that everyone takes Medicare.
There is the perception that Medicare is a cash cow for doctors and they love it.
That is just not so.
A proposed public plan will pay Medicare rates for services.
It might start out paying more, but over time, as they private health insurance companies fold up, the rates will change.
If a public plan becomes dominant, the physician will have to accept the rates or close their practice.
The physician who has a mix of Medicare and private insurance patients can make up for the low Medicare reimbursement with private insurance patients.
If everyone goes to a public plan, which will put private insurance out of business, then the practice of medicine becomes a grueling, expensive education without the ability to make any more than a good auto mechanic.
As a matter of fact, in the United Kingdom, they actively "import" physicians form third-world nations because medicine in no longer a popular pursuit.
In the United States, we have numerous Canadian physicians as clients who have moved their practices south to earn a better living.
The much touted Mayo Clinic operates in the red at an ever increasing loss.
I know it might destroy an idealized image you might have about your doctor, but a bright young college graduate is not going to spend $250,000 and eight more years in school so that they can earn $125,000 a year.
A good paralegal, auto mechanic, plumber and many other trades people already do that.
I doubt that many of you reading this have ever been on Medicaid.
But if you have, you probably realized that there virtually no physicians who would give you an appointment and that you needed to use the emergency room for any and all services.
This is an example of a public health insurance plan.
So, what would happen if there was a public plan? Those of you who could pay for private health insurance would continue to do so.
You want access to the best doctors and the best care.
Those who could not, would go to a public plan.
It is as simple as that.
But there is a slight problem.
The new healthcare reform calls for the insurance companies to take everyone regardless of their health and not charge more for the insurance.
That is already the case in New York.
The result was that sick people were able to obtain health insurance.
So, the 20% who could not get insurance now can.
But, the 80% who were relatively healthy saw their premiums double and triple.
Why you ask? Because someone has to pay for the sick people.
Now, health insurance in New York and New Jersey (another state that adopted this measure) is unbelievably expensive.
The bottom line is that you cannot please everyone without a cost.
If the federal government would pay a stipend to an insurance carrier that accepted sick people, then the cost would remain low.
If they went just one step further and said to the carriers "we will cover all expenses after they reach $20,000, then health insurance would be cheap and available to everyone.
"That's a great idea.
Why don't they do that?" Politicians are extremely well versed in politics.
Most have little knowledge of finance, international relations and of course healthcare.
It would leave the insurance business in the hands of private companies.
Since there is a much broader social welfare agenda at hand, it would not look good to have private enterprise at the core of the solution.
Achieving universal healthcare so simply would not yield a lot of political capital for the politicians.
It would not expand government and not give credit to a particular president or party.
It would also make us refocus on all the other problems facing us and make us wonder if there wasn't a similar, logical solution to the mess we are in.
To be honest, I do not know if the lay person would even be able to make that determination regardless of how much data is available.
We find that if the doctor doesn't kill us or make us sicker and has a nice personality, we think they are the best doctor in the world.
I hear this a lot about dentists.
A typical comment is "I love my dentist because he does not hurt me.
" Is he skilled? Who knows? With that said, there are physicians that have a reputation within the medical community as being a cut above the rest.
Often, you can find them through recommendations from other physicians with whom you have a good relationship.
Otherwise, they hand you a list of available specialists in the area and put an asterisk next to the ones that they have a financial interest in.
The idea that if you have to wait a month for an appointment is not a sound measure of a doctor's capabilities.
The physician might be one of the few specialists or primary care providers within a certain network.
Therefore, the difficulty of getting an appointment has nothing to do with their abilities.
It is all based on the limited number of providers in that particular plan.
What we have found after many years in the health insurance business and as a patient is that talent does not come cheap.
"But I have health insurance, who cares what they charge?" My family physician will not take United HealthCare nor will they accept Aetna.
These are two excellent companies.
My gastroenterologist will not accept United HealthCare.
Most of the "better known" specialists in my area will not be a part of an HMO network.
If you have a Medicare HMO, you might have to drive 50 miles for some specialties in many parts of the country.
This is not due to a shortage of specialists.
It is due to the fact that many have limited or discontinued Medicare patients.
Why is this happening? You must first stop and consider that a medical practice or a dental practice or any professional practice is first and foremost a business.
It is about getting paid properly for the type of care you are providing.
It is also about not having an insurance company downgrade a treatment code or preventing you from treating a patient in the manner that you feel they should be treated.
This brings us to the latest proposals in health care reform.
We have already seen seniors driving unheard of distances to find a specialist who will take Medicare.
If you are in New York or perhaps Los Angeles you are thinking that everyone takes Medicare.
There is the perception that Medicare is a cash cow for doctors and they love it.
That is just not so.
A proposed public plan will pay Medicare rates for services.
It might start out paying more, but over time, as they private health insurance companies fold up, the rates will change.
If a public plan becomes dominant, the physician will have to accept the rates or close their practice.
The physician who has a mix of Medicare and private insurance patients can make up for the low Medicare reimbursement with private insurance patients.
If everyone goes to a public plan, which will put private insurance out of business, then the practice of medicine becomes a grueling, expensive education without the ability to make any more than a good auto mechanic.
As a matter of fact, in the United Kingdom, they actively "import" physicians form third-world nations because medicine in no longer a popular pursuit.
In the United States, we have numerous Canadian physicians as clients who have moved their practices south to earn a better living.
The much touted Mayo Clinic operates in the red at an ever increasing loss.
I know it might destroy an idealized image you might have about your doctor, but a bright young college graduate is not going to spend $250,000 and eight more years in school so that they can earn $125,000 a year.
A good paralegal, auto mechanic, plumber and many other trades people already do that.
I doubt that many of you reading this have ever been on Medicaid.
But if you have, you probably realized that there virtually no physicians who would give you an appointment and that you needed to use the emergency room for any and all services.
This is an example of a public health insurance plan.
So, what would happen if there was a public plan? Those of you who could pay for private health insurance would continue to do so.
You want access to the best doctors and the best care.
Those who could not, would go to a public plan.
It is as simple as that.
But there is a slight problem.
The new healthcare reform calls for the insurance companies to take everyone regardless of their health and not charge more for the insurance.
That is already the case in New York.
The result was that sick people were able to obtain health insurance.
So, the 20% who could not get insurance now can.
But, the 80% who were relatively healthy saw their premiums double and triple.
Why you ask? Because someone has to pay for the sick people.
Now, health insurance in New York and New Jersey (another state that adopted this measure) is unbelievably expensive.
The bottom line is that you cannot please everyone without a cost.
If the federal government would pay a stipend to an insurance carrier that accepted sick people, then the cost would remain low.
If they went just one step further and said to the carriers "we will cover all expenses after they reach $20,000, then health insurance would be cheap and available to everyone.
"That's a great idea.
Why don't they do that?" Politicians are extremely well versed in politics.
Most have little knowledge of finance, international relations and of course healthcare.
It would leave the insurance business in the hands of private companies.
Since there is a much broader social welfare agenda at hand, it would not look good to have private enterprise at the core of the solution.
Achieving universal healthcare so simply would not yield a lot of political capital for the politicians.
It would not expand government and not give credit to a particular president or party.
It would also make us refocus on all the other problems facing us and make us wonder if there wasn't a similar, logical solution to the mess we are in.
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