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ACA Threatens Promise of Concierge Medicine
The American Interest ^ | 04/12/2014 | Walter Russell Mead

Posted on 04/13/2014 10:00:28 AM PDT by Rusty0604

Doctors in Texas are showing us what a medical system without comprehensive insurance might look like. The NYT profiles the rise of Texan “direct primary care” practices that don’t accept insurance. Instead, patients pay flat fees out-of-pocket. In return, doctors save both time and money that they can then pass on to patients.

But there’s a catch here, as the article points out. Concierge medicine isn’t a new trend—we’ve covered it here before. But now that Obamacare is swelling the ranks of the comprehensively insured, doctors who don’t take insurance are increasing the pressure on the system. There’s a hint in the NYT piece that other doctors think it’s irresponsible for their colleagues to stop taking insurance just as the Obamacare rollout promises to strain practices and hospitals past capacity. This bias against innovators is what happens when federal legislation cements a dysfunctional system in place.

(Excerpt) Read more at the-american-interest.com ...


TOPICS: Health/Medicine
KEYWORDS: healthcare

1 posted on 04/13/2014 10:00:28 AM PDT by Rusty0604
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To: Rusty0604

Haven’t you heard? The liberals are saying that Liberty is “un-American.”


2 posted on 04/13/2014 10:04:34 AM PDT by BenLurkin (This is not a statement of fact. It is either opinion or satire; or both.)
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To: Rusty0604

Besides, just because the doctor “doesn’t accept insurance” only means he won’t process the claim. Unless the plan is network-only, the patients can just file it themselves, just like it always was in the old days before insurance companies got too big for their britches.


3 posted on 04/13/2014 10:12:35 AM PDT by Still Thinking (Freedom is NOT a loophole!)
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To: Still Thinking

They will end up trying to strong-arm doctors into caring for Obamacare patients.

Doctors are a surly lot when anyone tries to monkey with their practice of medicine...and rightly so.

It won’t be easy to force MDs to do anything.

I predict hundreds of thousands of new doctors that can’t speak English.


4 posted on 04/13/2014 10:29:04 AM PDT by Bobalu (Four Cokes And A Fried Chicken)
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To: Still Thinking
filing the claim is mere paperwork, that they don't accept/participate means you will pay BIGTIME to be seen/operated on when the bill comes...
5 posted on 04/13/2014 10:29:12 AM PDT by Chode (Stand UP and Be Counted, or line up and be numbered - *DTOM* -vvv- NO Pity for the LAZY - 86-44)
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To: Rusty0604

Face it Lib-Docs!... your gravey train is approaching the station!


6 posted on 04/13/2014 10:32:03 AM PDT by Safrguns (PM me if you like to play Minecraft!)
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To: Rusty0604

I would guess that a huge portion of the cost of a medical office is the staff required to deal with insurance. Do away with that and the price distortion introduced as various companies decide what they’ll pay, thus requiring that costs be redistributed onto others, and the cost of operating will greatly reduce.

However, legislatures are already reacting, threatening to pull the licenses of doctors who do not accept insurance.


7 posted on 04/13/2014 10:35:51 AM PDT by Gen.Blather
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To: Rusty0604

Well doctors did support Obamacare didn’t they?


8 posted on 04/13/2014 10:40:29 AM PDT by Mike Darancette (Do The Math)
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To: Chode

I think the opposite is true, and I have seen examples of it in reports in the past. If doctors, labs, pharmacies, etc., operated on a free market prices for most things would be less expensive.


9 posted on 04/13/2014 10:45:16 AM PDT by Rusty0604
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To: Gen.Blather

One doctor told me 3/4 of his staff were there to handle insurance. That’s a huge amount of additional overhead!


10 posted on 04/13/2014 10:49:37 AM PDT by nodumbblonde ("I'm all for helping the helpless, but I don't give a rat's a** about the clueless." - Dennis Miller)
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To: Rusty0604
i'm not talking about "if's" or "free market pricing"...

(without going into high deductibles and co-payments in this example)lets say a procedure costs $1000, if the Doc par's with the ins, the procedure cost is negotiated with the ins-co at lets say $650-$700 and you owe nothing

if they do NOT par, and your ins only pays lets say $300-$400, YOU will be billed for the other $600-$700, and even if they do pay(which they won't) $650-$700 you will still be on the hook for the balance simply because they don't par with your ins-co

11 posted on 04/13/2014 10:58:08 AM PDT by Chode (Stand UP and Be Counted, or line up and be numbered - *DTOM* -vvv- NO Pity for the LAZY - 86-44)
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To: nodumbblonde
if 3/4 of his staff is required to do his billing, he should be using a billing house.
12 posted on 04/13/2014 11:00:04 AM PDT by Chode (Stand UP and Be Counted, or line up and be numbered - *DTOM* -vvv- NO Pity for the LAZY - 86-44)
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To: Rusty0604
#1) Doctors accepting fee for services are denied admitting privileges at hospitals. The hospitals load the board of directors with people who take payouts from the insurance companies to enrich themselves and grow the hospital.

#2) As in the proposed Hillarycare legislation of 1996, accepting fee for service would be illegal, subject to felony charges and license revocation.

13 posted on 04/13/2014 11:09:47 AM PDT by blackdog (There is no such thing as healing, only a balance between destructive and constructive forces.)
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To: Still Thinking
Besides, just because the doctor “doesn’t accept insurance” only means he won’t process the claim. Unless the plan is network-only, the patients can just file it themselves, just like it always was in the old days before insurance companies got too big for their britches.

In the old days, medical expenses were more deductible (you could deduct the amount over 3% of gross income -- now it will be 10%). So people would pay cash, save their bills, add them up at tax time, and that would be that.

If the feds really wanted to simplify things, people would be allowed to pay for routine medical bills with their credit/debit cards, the provider would transmit a code to the card company that this is a deductible medical expense, the card companies would summarize the total and transmit a yearly 1098-type form to the card holder and the IRS, and the individual would just deduct it. BANG, no insurance overhead for the doctor, lower costs to the individual, less paperwork all around.

People could then go back to just needing to have catastrophic hospitalization insurance.

14 posted on 04/13/2014 11:10:37 AM PDT by PapaBear3625 (You don't notice it's a police state until the police come for you.)
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To: Mike Darancette

No, the AMA and some academics did. The vast majority of physicians want nothing to do with it.


15 posted on 04/13/2014 11:16:37 AM PDT by Kozak ("It may be dangerous to be America's enemy, but to be America's friend is fatal" Henry Kissinger)
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To: Rusty0604

The moment health care becomes a “human right”, health care workers become slaves.


16 posted on 04/13/2014 11:19:52 AM PDT by Bratch
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To: PapaBear3625

That would be too simple! Next Doctors would go back to making home visits and accepting payment based on what folks could afford, like eggs or produce. Oh the humanity!


17 posted on 04/13/2014 11:23:48 AM PDT by Rusty0604
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To: Mike Darancette
Well doctors did support Obamacare didn’t they?

No.
18 posted on 04/13/2014 11:24:01 AM PDT by PA Engineer (Liberate America from the Occupation Media.)
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To: Rusty0604

“There’s a hint in the NYT piece that other doctors think it’s irresponsible for their colleagues to stop taking insurance just as the Obamacare rollout promises to strain practices and hospitals past capacity.”

Peer pressure by academic and socialist doctors will somehow convince independent and concierge doctors to do what? Go out of business? Work as a serf at a big hospital corporation? This is a NYT wet dream.

Soft or hard coercion will only accelerate the early retirement of physicians or the exodus of top physicians to offshore clinics, just like the brain drain that occurred in the UK in the 70s as well as with Canadian physicians.

For those that can afford it, concierge medicine is one way to maintain quality, especially for primary care. Some innovative group practices might be able to create hybrid practices that have some providers accepting insurance, with other providers only accepting direct payment. If a patient needs more time, a quicker appointment, or a certain procedure, they could be given the option of direct pay with the opted out/ non-contracted physician.


19 posted on 04/13/2014 11:41:35 AM PDT by grumpygresh (Democrats delenda est. New US economy: Fascism on top, Socialism on the bottom.)
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To: Chode

No, direct pay doctors are actually much cheaper. Insurance inflates costs unbelievably.


20 posted on 04/13/2014 11:52:06 AM PDT by Still Thinking (Freedom is NOT a loophole!)
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To: Rusty0604

exactly... you will have to go docs that Ocare declares to be ‘acceptable’


21 posted on 04/13/2014 12:01:34 PM PDT by Nifster
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To: Still Thinking
i'm talking about the VAST MAJORITY of what IS, not what should be... and if you have insurance, as most people do, but don't use it, well, then you are in effect paying twice
22 posted on 04/13/2014 12:08:44 PM PDT by Chode (Stand UP and Be Counted, or line up and be numbered - *DTOM* -vvv- NO Pity for the LAZY - 86-44)
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To: Rusty0604

I agree, the difference in cost for vet care and people care is amazing, yet essentially it is the same product. And my cat’s vet certainly drives a very nice care.


23 posted on 04/13/2014 12:13:24 PM PDT by erkelly
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To: erkelly
i bet your Vet malpractice insurance is prolly 5% of what a human Doc pays too...
24 posted on 04/13/2014 12:29:39 PM PDT by Chode (Stand UP and Be Counted, or line up and be numbered - *DTOM* -vvv- NO Pity for the LAZY - 86-44)
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To: erkelly

At my last job we had very good health insurance, and our copays were $5 for Dr. visit, $5 for any medication, and $0 for any tests. It was 100% paid for (dependents too) by our ER. Some people in my office were at the Dr. office almost everyday for any little thing. They would chide me because I only went if I felt I needed it. I bet if they had to actually pay (or at least pay more) for their healthcare they wouldn’t be running up the demand curve and policy price.


25 posted on 04/13/2014 12:41:05 PM PDT by Rusty0604
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To: Chode

You’re off the track.

I said — You can pay him cash and file for reimbursement yourself, so in effect, yes he does take insurance.

You said — the paperwork is nothing, the real cost is that without insurance, the cost is going to be high. (So even if you do the paperwork yourself you still end up paying more)

I said — No, these docs are cheaper. So, yes you can do the paperwork yourself without coming out paying more.

You said — something I don’t follow about paying for insurance but then not using it, which has nothing to do with the train of the conversation as far as I can see.


26 posted on 04/13/2014 1:23:08 PM PDT by Still Thinking (Freedom is NOT a loophole!)
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To: Still Thinking
after rereading you first post, i see missread it the first time through to mean if a doc doesn't accept YOUR ins, not doesn't accept ins at all... in which case you are right

my bad, there was another thread about people having ins but having a hard time finding doc's that take it

You said — something I don’t follow about paying for insurance but then not using it, which has nothing to do with the train of the conversation as far as I can see.

i guess my point there was i don't think i know anybody that doesn't have ins, so going to a doc that doesn't take ins seems like paying twice, once for ins that other docs will take to goto a doc that doesn't take ins/or your regular PCP goes to not taking ins, but if you think the doc is worth it, then he IS worth it... it's your health on the line and all

27 posted on 04/13/2014 1:50:14 PM PDT by Chode (Stand UP and Be Counted, or line up and be numbered - *DTOM* -vvv- NO Pity for the LAZY - 86-44)
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To: blackdog

How does the lack of admitting privileges by the doctor affect admission of a patient?


28 posted on 04/13/2014 2:00:42 PM PDT by tbw2
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To: tbw2
It's a big deal. A really big deal.

"Admitting privilege is the right of a doctor, by virtue of membership as a hospital's medical staff, to admit patients to a particular hospital or medical center for providing specific diagnostic or therapeutic services to such patient in that hospital. Each hospital maintains a list of health care providers who have admitting privileges in that hospital. Admitting privileges granted to a non physician is limited to treatment of patient independently, and admission of such a patient to hospital requires a physician’s order. Admitting privileges of some physicians are limited to consultative services only.

Access to diagnostic testing will not happen. MRI's, etc...

29 posted on 04/13/2014 2:28:03 PM PDT by blackdog (There is no such thing as healing, only a balance between destructive and constructive forces.)
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To: tbw2
A fee for service physician will not have access to CT scans, ultrasounds of organ function, most radiology services beyond an Xray, dialysis, lab testing, surgery, and so on. Also nobody will insure for malpractice liability if the doctor has no admitting priveleges.

It's like hiring a lawyer who is not allowed to practice law before the court, only instead of a civil matter of well being, it's your life.

30 posted on 04/13/2014 2:40:19 PM PDT by blackdog (There is no such thing as healing, only a balance between destructive and constructive forces.)
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To: Chode

Actually, let me rephrase my original post. I may not have been clear. Assuming that you have insurance, and that it is not network-only, then even if you go to a doctor who accepts no insurance at all, he will give you a receipt once you pay him and you can go through the hassle of collecting from your insurance to pay for some or all of his bill. That’s what I was trying to say. That the doctor policy, no matter what it is, doesn’t stop you from getting reimbursed by your insurance, supposing your plan covers doctors not pre-affiliated and that you’re willing to do the legwork. Ergo, there is no paying twice. There, hope that’s clear.


31 posted on 04/13/2014 6:38:58 PM PDT by Still Thinking (Freedom is NOT a loophole!)
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To: blackdog

You do realize you can walk into a test lab and get all that stuff, and FAR more inexpensively than if provided through whatever practice or hospital the doctor works at.


32 posted on 04/13/2014 6:40:12 PM PDT by Still Thinking (Freedom is NOT a loophole!)
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To: Rusty0604

And that’s EXACTLY why that isn’t “good” insurance. HSA’s for everybody!


33 posted on 04/13/2014 6:41:59 PM PDT by Still Thinking (Freedom is NOT a loophole!)
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To: Still Thinking
yes, you are right as i completely misread your original post... but i am happy my PCP, who i wouldn't trade for anybody, and local hospitals all except my ins
34 posted on 04/13/2014 6:51:34 PM PDT by Chode (Stand UP and Be Counted, or line up and be numbered - *DTOM* -vvv- NO Pity for the LAZY - 86-44)
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To: Mike Darancette

The AMA did, but most Medical Prof. Specialty Orgs. were must less enthusiastic.


35 posted on 04/13/2014 8:58:34 PM PDT by az wildkitten (8 years 'til I retire)
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