We are a commune of inquiring, skeptical, politically centrist, capitalist, anglophile, traditionalist New England Yankee humans, humanoids, and animals with many interests beyond and above politics. Each of us has had a high-school education (or GED), but all had ADD so didn't pay attention very well, especially the dogs. Each one of us does "try my best to be just like I am," and none of us enjoys working for others, including for Maggie, from whom we receive neither a nickel nor a dime. Freedom from nags, cranks, government, do-gooders, control-freaks and idiots is all that we ask for.
I opted out of being a Medicare "provider" several years ago. It saddened me, because I like working with seasoned citizens. However, they are now so accustomed to Medicare that the expectation that they should personally pay me for my time is anathema to many. Not to all, however. I have never refused to help a patient because of financial limits.
However, entitlements turn otherwise proud grey-haired adults into... what?
The last time I was accepting Medicare, they paid me around $70 for a lengthy office visit, less than my plumber charges me for the same thing. No disrespect for plumbers at all: I respect their skills very much.
But what really put me over the top was their paperwork. Being a sole practioner who donates 1/3 of her time to teaching and a charity clinic, I could never afford a trained "Coder" to do insurance forms for me for $65,000/year (or more).
This gastroenterologist in NH would dearly love to drop Medicare. My coder's bookshelf is almost as large as my professional bookshelf. All that NOT in order to know how todo my work, but whow to get paid for it!
The post office is the same. They have a manual about four inches thick of regulations for mail. If the government gets involved in health care you'll probably have to fill out about nineteen forms to get a tetanus shot.
Heck of it is, the patient may not only need to fill out many forms for a tetanus shot, the patient may be compelled both to fill out the forms and to get the shot. Or at least harrassed seriously to do so.
A few months ago one of my teeth fractured around a twenty-year-old filling -- these things happen. About a third was left. Options: $190 to remove it, $1,000 to crown it, $3,000 for an implant. Based on location, I had the tooth removed. I felt that I had other uses for both $1,000 and the time for three or four appointments before the job was done. Under a dental version of Obamacare, I might have been pressed by the dental practice to have one of the othe procedures so they could document "best practice", whether or not best practice suited the client. Same kind of thing with preventive or screening care. I haven't had some of the 50+ procedures and I probably won't. My medical history puts me at low risk for the usual screenable problems and I have no symptoms of anything but mild arthritis and GERD (which I've had since my early 20's anyway). A couple of thousand dollars for inconvenient and unpleasant procedures that are probably not going to find anything? But under a national plan, my assigned provider wouldn't want a chart audit to show that I'd slipped through the cracks.
You describe another aspect of the hidden cost's in the medical model. How many medicaid/medicare patients can a doctor see and still make a competitive salary? They are unfunded mandates.
The insured patient has been asked to carry the load for illegal immigrants, Medicaid and Medicare patients. So when the hospital charges a insane amount for aspirin it should be noted WHY they must charge that much. Utopia costs more than we can afford.
I'd feel a lot better about Medicare if it were clear that I could bypass it once I hit 65, but I can't quite figure out if that's possible. I believe I won't be able to buy insurance (except for Medicare supplemental insurance) -- can anyone on this board tip me off if I'm wrong about that? I also understand that a doctor who accepts Medicare patients can't see me other than through Medicare once I'm 65. Is that right? But if I can find a doctor who's boycotting Medicare, I can pay him in cash, presumably. So then my only problem will be that I have to manage all medical emergencies with cash and no possibility of risk-shifting through insurance. Dr. Bliss, can you enlighten us?
Update -- the best I can figure is that it works like this. Your current insurer won't drop you just because you reach 65, but it will drop you (not sure if this is just its choice or if it's mandated by law) if you're enrolled in Medicare. You aren't automatically enrolled in Medicare at 65, but -- nice Catch 22 coming up! -- the only way you can avoid enrolling in it is to forfeit the Social Security monthly check you might otherwise have been expecting to get after paying into the system for decades. Nice trick, yes?
On the other hand, if, like me, you're pretty sure the SS system will be broke by then, or that you'll be means-tested out of your so-called benefits, that might be an option that would permit you to keep your existing insurance. That would mean that you could actually see the doctor of your choice, including a doctor who believes he should be entitled to payment at a market rate at which he doesn't lose money. That might mean you could expect better health care. Maybe even such better health care that it would make up for the confiscation of your monthly SS benefits.
All this assumes, naturally, that Medicare hasn't been expanded to the entire population and made even more openly mandatory than at present.
There is a pending lawsuit, Hall v. Sebelius, challenging the government's right to strip away your SS benefits just because you want to opt out of the floundering Medicare disaster. There also is a legislator who forlornly files a bill every year to change this ridiculous law. The bill gets buried and ignored every year. Maybe the new lawsuit and the current atmosphere of outrage over ObamaCare will make a difference in this situation at last.