Must-read on health care

[hudebnik]

If you care about the U.S. government's budget deficit...
If you care about the competitiveness of U.S. businesses...
If you care about economic fairness...
If you care about preventing individual bankruptcies...
If you care about health care for all...

you must read Steven Brill's detailed exploration of the costs of the U.S. health care system.

If you already know how incredibly inefficient and corrupt the system is, read the article anyway: it's even more inefficient and corrupt than you thought.

Comments

[siderea]

but they're different chapters of the Medicare law (right?)

No idea. If opportunity presents to interrogate one of our (or really any) psychiatrist or other party in the know, I will.

I suspect that "providers billing Medicare seem to be doing fine" is true as long as they don't have too large a proportion of Medicare patients.

Or you can otherwise make the books balance. I've been thinking about making this a post in my journal, but the summary: there is an emergent phenomenon, here in MA at least, resulting from details of medical licensure law intersecting with Medicare and Medicaid regulations and their low compensation rates. The practical upshot is we are winding up with two tiers of mental health care: poor people treatment and rich people treatment. Poor people treatment is conducted by the most junior possible clinicians (basically grad student and post-grad therapists, who have to do residencies to get licensed, and can be coerced into working for what amounts to ~$10-$20/hr), in ever larger institutions/agencies (impersonal and with awful bureaucratic impingements on care). Rich people treatment is conducted by senior clinicians in private practice.

Apparently, it's not just mental health? I have a patient on disability, who told me that she's had to get a new PCP three times in a decade, because each one quit after three years, and the clinic she was at assigned her someone else; apparently she is getting residents, and when they complete their residencies, they're off to jobs that pay actual MD money. So much for developing a long-term ongoing relationship with a treater. But she's on Medicaid; when she looks around for alternatives, they're all clinics like the one she's been at.

For that matter, I have a Medicare patient I've been seeing for about three years. She's been at this clinic for 9 years; I'm her fourth therapist. About 2 months after her third anniversary with me, she, out of the blue, asked me if I was going to be leaving, too. I assured her that I intended to continue working at the clinic and seeing her and my other present patients, but that I wasn't taking new ones.

What I did not trouble her by explaining was that, if a patient over 65 presents at my private practice, I will be forced to file my Medicare optout to accept that patient... which may make me ineligible to be her therapist at the clinic. Not sure, and it would probably involve lawyers, and maybe they wouldn't even be able to tell. Medicare rules about optout are very all-or-nothing, and if I decline to accept Medicare in my private practice, it may make me ineligible to be employed at any facility that accepts Medicare. (Well, or to see Medicare patients if I am so employed; but who would employ a clinician who was blackballed from a major insurer?) You see the sorting effect. But I digress.

Poor-people care is profitable solely because it's made up in volume on the backs of indentured labor paid vastly less than market rates, and who flee as soon as their indenture is up.

There's more sorting pressures, but I'll leave it there or I'll wind up writing the whole post as a comment in your journal. :)

[continued]

[hudebnik.livejournal.com]

if I decline to accept Medicare in my private practice, it may make me ineligible to be employed at any facility that accepts Medicare.

In the comments section of some article or blog I read today was a doctor who says he doesn't take Medicare at his private practice, but does see Medicare patients at the hospital. Or maybe it was Medicaid. I don't know what state he lived in, IANAL, etc. etc.

[siderea]

If it is Medicare, maybe he just hasn't been caught yet. :(

I don't think Medicaid cares.

It is strange how different the two are.