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Let's put it in even simpler terms.

Right now, you have the government and insurance companies paying (along with a lot of nonpayers and self pay) for the medical care they receive.

Obamacare passes.

Private insurances start to fall by the wayside.   Some of the bigger ones will probably do OK for a while (until Obamacare II passes the public option).

Who do you THINK is going to be writing the regulations for both the Doctors Offices/Hospitals and Insurance Companies.

Who do you think is going to be doing the checking on the books to make sure patients aren't overcharged at the Drs Office/Hospital or their insurance is in compliance.

The most likely source for these inspectors is the same source as they got their TSA employees.

Right now, that's the people that work for ACORN (hey, didn't ACORN fire a few recently)  and many of the people on the welfare roles.

THOSE are the people that are going to be making your insurance decisions and medical decisions for you.

AFARR

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Go for it, and post updates on your "shrugging"

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i'm still waiting for you to tell me why Singapore's system is fucking absolutely awesome and why we would be better off if we copied it.


LOL!

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This is true only if you participate in the public system.  You can charge the patient if you do not participate in the public option.

You can be arrested for this in the US too, but we call it "insurance fraud"

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Singapore's system would never fly politically here.  The best model for the US would be like Canada's system.  State-run public insurance for everyone, funded by the national government.

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So what?

Obama will just open the floodgates and import  thousands of more doctors from India, Pakistan and elsewhere.

They'll work for peanuts and give equivalent care to what they're paid, all with a diverse multicultural accent.

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If they bring their family over, think of all the new Indian restaurants that would open up.

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possibly the only pro for importing doctors - the diversity of food.

Also I just want to point out to people claiming that doctors will all stay home if there is UHC a couple basic facts:

1) Nobody has provided any evidence of any figures showing exactly how much takehome salary doctors will forgo (or even if they will see a reduction in takehome pay) under any of the plans under consideration

2) Doctors who don't want to work for a public system have the option of working privately in most any UHC system, and the plan under consideration is a plan to force people to buy health insurance anyways.

3) What people claim they will do in a push poll is usually much different than what they will do when it actually comes down to it

4) Doctors/hospitals complain about how much medicare/medicaid reimburse, but they take it anyways for various reasons related to maintaining their businesses, from customer relations to charity, to volume considerations.

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#1.   In our practice, we take Medicaid, Medicare and Private Insurance.   I'm the ONLY guy out of 4 that takes the medicaid patients.   For an office visit...Medicare pays $40, Medicaid Pays $20 (or less), and Privates pay $50-60.  Government controlled insurance pays the worst.   Nobody CAN show how badly it will drop...but if they add 20 to 45 MILLION people to any kind of coverage...their reimbursements will drop even more (considering that a LARGE number of those people don't pay taxes anyway).

#2.   Yes, it is possible...however, since the general public hasn't been privileged with ALL the details of the plan, we can't know one way or another what the final plans are.   Given our President's penchant for incremental legislation (from his time in IL), if he doesn't pass universal coverage now...he's going to keep working on it in the future.   And, how will they force someone to buy insurance that makes $10/hr and has a kid or two around?  

#3.   Usually...but not always.   And in this case, a lot of doctors can afford to quit (the ones in practice for 20 or 30 years)...they are the ones that train the new guys––so they WILL lose doctors...the question is how many?

#4.   Yes we do complain.   We were (long before I went into practice) told by the Government that Medicare wouldn't set prices...they would pay what was customary.   Once the goverment started to realize how expensive it was...they started to set prices and cut reimbursements more each year.  By then, Doctors had large numbers of their patients on Medicare...and they would have to cut them off or charge considerably more for the services.    It's a matter of a lot of things...ethics, business volume (break even on Medicare patients, but at least you can pay your staff).

AFARR

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Think of all the Chinese herbal medicine too!

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The thing is, how many of your physicians are near/at/past retirement age? How many would just say "Screw this - it's not worth the effort. I can retire." The only physicians that will stay in are those that are fresh out, those that want to recoup (some of) their investment, those that can charge what the market will bear (e.g. fee for service), and those that simply love to teach. Note this last group is generally your older physicians, and if they aren't allowed to actually practice medicine due to rationing, they might just say "fuck it" as well, as their conscience won't let them continue on under that philosophy.

FYI - here is the census data from 2000

Age
        25-34      35-44       45-54      55-64   (no data was given for those over 65, but they are likely dead or retired now)
        19.0%     35.4%      31.2%    14.3%

So today, 9 years later, how many are nearing retirement? Notice the drop off in the number of people entering the field? How much worse will this shortage be when applicants see they can't possibly justify the cost and time of schooling? The only choice our government will have is to ease restrictions on FMG's, and even then state licensing has to follow suit. Good luck seeing a doctor in the future, esp, if this crap passes.

For what it's worth, I'm 38, and finished my fellowship 5 years ago. I plan on continuing to work. However, if they cut my salary, they will get a decrease in productiviity. If they want to fire me because I'm not meeting "quota" - fine, try to find a replacement, and see what kind of quality you get. The old adage still applies "cheap, good, or fast - pick two." When I first started on this path 20 years ago (yes, I knew I wanted to be a physician since my last year in high school), I could not even conceive of how much our gov't could fuck up my career. I busted my ass to get to where I am, and I believe I should enjoy the fruits of my labor. For those who think that doctors are overpaid/too concerned about money - think about what it takes to become one and what the job actually entails. During the course of your work day, how many times do you have a chance to kill someone because of a mistake?

Economics/Finance major graduate popping in to say that undergraduate Economics is pretty much only harder than psychology and art as majors.

Good for you on the math though. I'm going to take some more math classes so I am prepared for graduate level finance coursework.

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I'm probably one of the few people who isn't in the medical profession who thinks doctors DESERVE a shitload of money for what they do. It's an incredibly complex, incredibly specialized profession that requires YEARS of study, practice, and diligent application to be mediocre at, much less to excel at. Being a doctor, especially a surgeon or ER doc, is like working at Mission Control in NASA while trying to put together a 3-D jigsaw puzzle made of incredibly delicate glass without breaking any of the pieces. Considering how much time and effort goes into being a doctor, and how amazingly valuable the profession is, I frankly think they deserve to earn so much cash they can't even spend all of it. Nurses and paramedics should be raking in decent cash for the hard work and shitty hours they get. Ditto for cops and fire fighters. Instead, they have the shittiest pay and shittiest hours on some of the most dangerous, stress-inducing jobs there are.

Meanwhile, we have people bitching about medical insurance and football players are getting tens of millions of dollars a year for getting sweaty, playing catch, slapping each other on the ass, and taking group showers with other men.

The world is fundamentally fucked up.

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Why not? This administration seems bent on removing from the economy as a whole about 50% of the jobs based on their present priorities, actions, and initiatives.

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Bear:

My Apologies...I found the link....looks like you actually have the Degree:



Link to thread....Bear's post is about half way down first page.


But you still don't know too much about Medicine in the US....Or Canada......or here......or here......or here......Or the UK.......

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We just need to realize that health care is a business.

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Yes it is a business...and unfortunately (as I think it was C-4 above pointed out) Doctors are often crappy businessmen because we are not trained at it.   Like most businesses, if you get too much government regulation involved (and, under Obamacare..it will be a HELL of a lot more) they have problems.  

Do ANY of the posters here NOT believe that if Obamacare passes...there will be a significant increase in the number of people employed BY THE GOVERNMENT?   Do you really think they'll just pass a 1000 page bill...and say "just make sure you follow the guidelines" without creating a new bureaucracy?

That's not even including the increased numbers of people who will be added to the insurance rolls (either Medicare/Medicaid type government or private insurance...or some kind of "umbrella corp" universal coverage)....many of them DON'T PAY TAXES...how are they going to pay for their health insurance?   They won't...we will (either by paying the same but getting a LOT less medical coverage to spread it around, or by paying more $$ for the same coverage.    

So, we'll be paying for increased government...and more for our health care.

AFARR

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That's why I don't envy doctors.  You guys work in an industry that is sooooo damn regulated and hampered on ALL levels of government.  You guys get sued left and right to the point where there is an entire insurance category devoted to you - and law school courses devoted to specifically teaching future leeches the best way to draw blood from your over-educated selves.

THEN you have people that take the roughly decades+ of school for granted by not paying for your services....ALL while being sanctioned by the government - the very one that is nickel and dime-ing you guys and gals to death.

Lastly, you guys are in school for so damn long that after you come out, you're left with nothing but a medical degree and no business sense.

Did I miss anything?

ETA:  Almost forgot - our politicians decide on a near annual basis to use you as target practice for political activism.

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our health care problems will not change without changing how we do business within the health care industry - from doctors to insurance companies to the government. More government is NOT the way to go, but making competition more transparent and taking health care off the pedestal that most of us put it on would be a step. It is almost as if we have not decided on what type of good/service medical care is, exactly. If we were to decide, we would at least be able to manage and create better efficiencies within it. I'm willing to bet that if I sat down with a doctor and created a value chain/process map, we could identify quite a few bottle-necks within a standard practice/hospital.

(this is coming from an outsider who hates going to the doctor's office and knows very little about what doctors think or what they say behind my back when I leave).

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Marvelous, just Marvelous.
Considering all the times that I've seen Indian docs dictating an H&P then going into the patient's room.

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With all the time and money it takes to become a DR.  Your probabaly better off becoming a vet, if this shit passes.

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FYI.
At Texas A&M, all the vet school wash outs goto med school since it is easier.

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Unless they band together, gather up their resources, and create private clinics abroad, or even aboard ships just inside National waters.  I'm betting on starting private, cash only clinics in medical friendly countries.

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Also I just want to point out to people claiming that doctors will all stay home if there is UHC a couple basic facts:

1) Nobody has provided any evidence of any figures showing exactly how much takehome salary doctors will forgo (or even if they will see a reduction in takehome pay) under any of the plans under consideration

2) Doctors who don't want to work for a public system have the option of working privately in most any UHC system, and the plan under consideration is a plan to force people to buy health insurance anyways.

3) What people claim they will do in a push poll is usually much different than what they will do when it actually comes down to it

4) Doctors/hospitals complain about how much medicare/medicaid reimburse, but they take it anyways for various reasons related to maintaining their businesses, from customer relations to charity, to volume considerations.

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No, Obamacare in a nutshell forces citizens to have health insurance, under threat of fines.  You will have to either have private insurance that meets certain standards or they are making a public insurance option.  If you cannot afford insurance (by the .gov's calculation), you will be given subsidies and a free choice of where to get insurance from.  The public option will be revenue neutral, so it will not have any subsidies that the private companies cannot get

It's basically a handout to health insurance companies

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Actually the Mayo Clinic in Scottsdale, AZ doesn't take either Medicaid or Medicare anymore simply due to the awful reimbursements.  I'll bet you 20 bucks that the other 2 centers (Rochester, MN and Jacksonville, FL) follow suit with this bill.  That is of course if they are allowed to.  If the fees go down, and you are forced to take these lower fees, what do you think will happen to the quality of care?  

If I were a doc, I'd just give proportionately less effort and time.

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<snip>

I get what you're saying, but that may be the problem.  We HAVE  to start treating medical care and treatment like a commodity.  

Doesn't mean we can't respect our doctors (which they DO deserve respect).  We just need to realize that health care is a business.

ETA: I realize it's already a business, but it needs to be more transparent and competitive.

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"You can have medical care that is fast, right or cheap... pick two" is entirely appropriate.    Obamacare only gets to pick two of these choices as well.   What we are discussing is which two choices will be made...

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Quit...and do what? Early retirement only works for older guys.

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About 10 years ago GPs demanded that they be paid more than the $27 per standard consultation that thy were getting. My doctor at the time said that every doctor in his clinic had to see a patient every 5 minutes to make ends meet. In response, the gov raised the fee to $33 per consultation. In response, doctors left the system in drove and started charging. My Doctor currently charges $60 per consultation, of which I can get $33 back from the government. In addition, unless your condition is truly life threatening, you can wait months for surgery in the public system. Fortunately we also have a private system that is very good, and private hospital insurance that covers most of the costs. Most medical people have private insurance, and even my liberal, pro-gov health care nurse sister just got private insurance.

Oh, and by the way, once you get a gov healthcare system, even though everyone knows the problems, its political death to suggest its abolition. Everyone's suggested solution (which is hardly ever carried out) is more money. Medicare costs the Australian population (all 21 million of us) in excess of $50 billion per year. What do we get for our money? Hospitals were staff use petty cash and even their own money to feed their patients. Months and years-long waiting lists. Cutting edge drugs denied to patients as they are deemed either unnecessary or too expensive. Emergency departments running at over 90% as normal, and are frequently at code red (no new patients). Earlier in the year, every hospital in the state of New South Wales was on code red. New South Wales is bigger than Texas.

ObamaCare- just say NO!

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I've read 4 pages of ranting and not a single mention of a definite sentinel point.  

When Obungo-Care takes a foothold, the doctor-patient relationship WILL change.  Period.  No discussion.  FACT.  Forget how many docs will quit or retire.  Maybe a lot maybe a few.......big deal.  There are plenty of Mexican, Indian, and Russian "doctors" to fill any voids.  However, the change in the doctor-patient relationship will rock the world of ALL patients.  When choice is eliminated from the marketplace, the effort for excellence is also removed.  When you HAVE to go to a assigned doctor, because your insurance(or .gov) dictates, the doctor has no incentive to provide excellent, comfortable, painless, polite, timely treatment.  I've been there.  When patients arrive at my office, I do EVERYTHING possible to provide a positive experience.  From scheduling, to staff, medical equipment, facility, etc.  I realize the patient has made a CHOICE to come to my office.   Why would the doctor spend money on a beautiful, comfortable, convenient, up to date, modern office when you are "assigned"  to his office, regardless.  Of course, the doctor does not want to get sued or loose accreditation, so he will provide the MINIMUM level of service.  

This minimum level of service will become the new benchmark.

BTW.......Forget about the "two-tiered" system.  No possibility of that.  Paying extra for better treatment is racist and the plans being floated about address this by prohibiting it.  EVERYBODY gets the same.  Except congressmen.

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Even under a single-payer system, they would be free to not accept the government insurance scheme and continue practicing privately.

However, most doctors would use the government "insurance" because few doctors have the kind of market power to attract people who are willing to pay a premium for healthcare (and can afford it).  This is the way it is in Canada, which allows doctors to practice privately, under the condition that they cannot accept public money at all for any services rendered.  It's not worth the hassle in most cases, as you shut out a large portion of the market.  There are also even private hospitals in Canada.

People posting these unrealistic "rebel healthcare" scenarios are really ignorant of the fact that the vast majority of healthcare tourism is to places where healthcare is dramatically cheaper.  India, Singapore, Thailand, etc.  Seniors in America even go to Canada to buy drugs (blame Congress for preventing drug re-importation on that one) at the government's negotiated prices

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I don't even know how to respond to that.

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So what?  What difference does it make?

It's not like government control of the healthcare system will ruin med schools (which are already heavily government subsidized/controlled).  Also, the cost isn't a big deal because a lot of the doctors trained in the US and working in other countries don't pay their student loans back ever.

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You're an idiot.  The depth of ignorance you showed in this post is astounding.

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About 10 years ago GPs demanded that they be paid more than the $27 per standard consultation that thy were getting. My doctor at the time said that every doctor in his clinic had to see a patient every 5 minutes to make ends meet. In response, the gov raised the fee to $33 per consultation. In response, doctors left the system in drove and started charging. My Doctor currently charges $60 per consultation, of which I can get $33 back from the government. In addition, unless your condition is truly life threatening, you can wait months for surgery in the public system. Fortunately we also have a private system that is very good, and private hospital insurance that covers most of the costs. Most medical people have private insurance, and even my liberal, pro-gov health care nurse sister just got private insurance.

Oh, and by the way, once you get a gov healthcare system, even though everyone knows the problems, its political death to suggest its abolition. Everyone's suggested solution (which is hardly ever carried out) is more money. Medicare costs the Australian population (all 21 million of us) in excess of $50 billion per year. What do we get for our money? Hospitals were staff use petty cash and even their own money to feed their patients. Months and years-long waiting lists. Cutting edge drugs denied to patients as they are deemed either unnecessary or too expensive. Emergency departments running at over 90% as normal, and are frequently at code red (no new patients). Earlier in the year, every hospital in the state of New South Wales was on code red. New South Wales is bigger than Texas.

ObamaCare- just say NO!

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Actually the Mayo Clinic in Scottsdale, AZ doesn't take either Medicaid or Medicare anymore simply due to the awful reimbursements.  I'll bet you 20 bucks that the other 2 centers (Rochester, MN and Jacksonville, FL) follow suit with this bill.  That is of course if they are allowed to.  If the fees go down, and you are forced to take these lower fees, what do you think will happen to the quality of care?  

If I were a doc, I'd just give proportionately less effort and time.

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not just this post.  Basically every single post that this guy has made is epic in its ignorance.

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Yeah, but I got sick of reading his posts a few pages back.  They read like a monkey beating on a See 'N Spell.


Plain and simple.  Doctors do not make enough money now to put up with the BS they have to put up with.  Most are not doing it for the money anyway, but if you drop pay enough, it becomes impractical to do it at all and they will leave.  We're already seeing American trained doctors moving out of the profession and foreign ones coming in, and the comparison is not good.  I'd much rather go to a vet than your average foreign-trained doctor.  I've never met a doctor who liked Medicaid or Medicare, and many of them do not accept the plans.  It won't be any different with ObamaCare.

No one, except the people here in the medical field, knows how much time, how much effort, how many hours doctors put in, and how many of them they are not paid for.  I've been to other countries, in fact, I spent part of my childhood living in them, and I would never choose any hospital or doctor over an American one.  Even one of my ex-girlfriends, who I hate.

This is just common sense, and anyone who has been in a doctor's office before knows most of it, but not many know how much effort and care most American doctors put into their career.  And don't buy the nonsense about other countries with good health care.  They suck.  Look at the raw numbers yourself and compare.

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I really doubt they would quit. They would suck it up and get paid.

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Go for it, and post updates on your "shrugging"