By: dr deuce

dr deuce — Thu, 03 Apr 2008 14:58:34 +0000

the categories of doctors who don’t support single payer are the groups you describe PLUS any proceduralist (who are making off quite well under current regime and see no reason to change- ie cardiologists, gastroenterologists, ENT, ophthalmologists, and many surgeons) Of note there has been considerable movement in two other groups – general surgeons -whose fees are being squeezed tremendously and who are being crushed with uncompensated care with trauma cases, and OB-GYNs, who (while still getting well reimbursed for many procedures) are under pressure to reduce lucrative but questionable repeat C-sections and absolutely astonishing med-mal premiums (well over 200k per year in many urban areas)..There is also a generational gap, with older , more financially secure physicians narrowing their practices to not take insurance, and younger physicians struggling, esp with their high level of educational debt (averaging $250k as they emerge from med school at age 27) – other will be considerable retirement among the 55-65 yo physicians because of the unattractive trends in practicing medicine (and reimbursement may only be the last of them) in the next five, so thees trends will only accelerate. Look for a much faster tipping point than these figures extrapolate to right now (ie at a 10% movement every five years we could expect 90% of physicians to support single payer no later than 2023- I think it will be much earlier than that – probably <<10 years, as long as we don’t do anything crazy like either party seems to be proposing right now that will imbed the insurance industry even deeper into health care making it that much more difficult/radical to extract them (ie dems plans to “insure” 47 million more people without any expanded primary care capacity or change in primary care reimbursement or increased funding for emergency care, clinics etc, or full-speed -ahead” consumerism without any widespread HIT installation in most physician practices, physician agreed upon standards for evidence based care/P4P etc. So in the long run, single payer is inevitable, not because its so great or solves all our problems (e.g., we still have to ration care somehow and switch may rice bowls esp in industry/health care insurers out of health care field into something else (where will they all find employment ? finance? manufacturing? McDonalds ?) but because alternatives are even more problematic. As employers bail on providing health care, physicians retire early and close practices a whole new paradigm must develop, which will include medicare for all, an inversion of relative reimbursement rates between primary care and proceduralist, and government based standards f care (inevitably a political decision so it should be handled in political arena) and a painful decline in health insurance , devic e and pharmaceutical industry that they will fight tooth and nail all the way- so short term, ugly, but long term 10-20 years, sinle payer inevitabvle

Comments on: What The Doctor Ordered

By: dr deuce