Thursday, September 10, 2009

The healthcare debate

I listened with interest to the President's speech last night.  I am in agreement that every person in this country has the right to healthcare coverage.  The costs of caring for the uninsured through the ER is increasing costs for everyone.

I just don't know how it should be administered.  Medicare and Medicade are huge government buearacracies which are difficult to navigate and sometimes extremely difficult to get compensation out of.  Like any government entity, the only thing they know how to do is make rules and create paperwork.  And in our state Medicare pays one of the lowest rates of reimbursement.  Medicade only pays 45 cents on the dollar so for people with multiple medical problems and complex psychological and social problems, I can't afford to care for them.

But the insurance companies have providers in a bind as well.  They decide how much they will pay as well and you are locked into their rates.  Very few insurance companies reimburse at 100%.  Most of them are at 65%.  So as a provider, I could raise my prices but I wouldn't be compensated more.  A price increase will only hurt those people who have no coverage.  Insurace companies are in the business of making money for themselves.

I am in solo practice.  My overhead runs 65%.  Rent, payroll, supplies and malpractice insurance keeps rising, but the amount I earn per patient visit is static.  Today I filled out five patient forms which I can not be reimbused from.  I have patients who work for Boeing and Microsoft who make more than I do, but because I am "a rich doctor" I am viewed as the source of the increases in medical costs.  I have not raised my fees in four years.  So where do I cut costs.  I cut them in the amount that I pay myself.

I will be steadfast.  I don't believe that bigger medicine makes better medicine.  I don't believe that more paperwork and buearacracy do anything to enhance my relationships with my patients.  I don't believe that big government can improve access to care.  But what I do know, is that if I had a million dollars, I would keep doctoring until it is all gone.

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