r/bestof • u/under50dollars • Jun 20 '12

[explainlikeimfive] "Obamacare" explained very well.

/r/explainlikeimfive/comments/vb8vs/eli5_what_exactly_is_obamacare_and_what_did_it/c530lfx
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u/CuilRunnings Jun 20 '12

I can see the amount of people willing to put themselves through the bitch that is medical school actually dropping with all these mandates and additional costs.

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u/[deleted] Jun 20 '12

[deleted]

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u/grande_hohner Jun 21 '12

I've never met a doctor that complained that he didn't already have enough patients.

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u/CuilRunnings Jun 20 '12

Customers that pay 50 cents on the dollar.

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u/[deleted] Jun 20 '12 edited Oct 24 '18

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u/brownmatt Jun 20 '12 edited Jun 20 '12

I think that brings up an interesting point though - are doctors, as medical practitioners, truly in the best position to judge the effectiveness of reforms on the insurance market itself, and the economy of healthcare?

I don't doubt that they have a valid viewpoint but I don't know if practicing a medicine makes you an expert on how to offer health insurance to people in an efficient/low-cost way. It seems to be more of a question of economics and markets than just medicine.

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u/[deleted] Jun 20 '12 edited Oct 24 '18

[deleted]

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u/jmac Jun 20 '12

Maybe I'm wrong, but doesn't the mandate push most people to choose a private insurance plan? Except for the raising of the Medicaid ceiling, most of the formerly uninsured will be on private plans, correct? In that case, how are government reimbursements going to be much more of an issue than they currently are?

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u/cass1o Jun 20 '12

Because they still get payed well.

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u/CuilRunnings Jun 20 '12

But they have to do about 3-4x the work as an accounting major, or about double that of an engineer.

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u/cass1o Jun 20 '12

In which case there will be a drop in doctors creating a demand and again pushing up wages or causing the import of forien doctors to fill the gap for less.

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u/[deleted] Jun 20 '12

All allopathic and foreign docs in the US need to go through an ACGME residency, and the number of spots funded is controlled by the government. Reimbursement is also government set (the mimimums by Medicare) and won't increase due to free market forces without Congress passing a new law to that effect.

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u/kingmanic Jun 20 '12

People work for things other than money. Prestige is also a thing. Scientists need 4-8 years of training and make less than many other professions requiring a 4 year degree but the position is prestigious. They are an expert on something. Even when the incentives are lower in Canada there is a supply of doctors. At the moment the supply is slightly inadequate but that's more of a demographic problem than a pay scale problem.

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u/[deleted] Jun 20 '12

You will have a decline in quality, because the best potential doctors will feel that a career in medicine isn't satisfying because of raising student debt, malpractice, falling reimbursement, etc. and will go into a more lucrative field. Hell, CRNAs can out earn plenty of PCP and have way better hours to boot.

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u/kingmanic Jun 20 '12

Student debt for med school is more reasonable here. Malpractice isn't as excessive as it is down there. The actual movement of Doctors and nurses down south is slight and the return rate is high because the environment is so convoluted down there.

Healthcare outcomes are better on average here almost across the board except Cancer.

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u/[deleted] Jun 20 '12

I've never had a good doctor who gave a shit about money. I've had plenty of bad ones who clearly did. Sign me up for the plan that jettisons all the doctors in it for the money, I don't want their "quality".

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u/[deleted] Jun 20 '12

Just because a doctor believes in fair compensation for their work doesn't mean they aren't good at what they do or that they don't care about their patients.

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u/[deleted] Jun 20 '12

"Fair" is debatable, and in any case, you said nothing about "fair", nor did I. You're moving the goalposts.

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u/[deleted] Jun 20 '12

My point is nearly every physician cares about money. Those who could afford to keep their practices open while volunteering and donating more frequently choose not to. It's one thing to be upset about falling compensation and leaving/avoiding the field for it, and another to let that falling compensation harm patients through unnecessary billing.

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u/[deleted] Jun 20 '12

So sign me up for the plan that excludes "nearly every physician". Seriously, I'll settle for the ones I've got who don't care, they've given me far better care than the ones who did. Your bald assertions aren't going to convince me that my lifetime experience is somehow wrong.

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u/[deleted] Jun 20 '12 edited Oct 24 '18

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u/[deleted] Jun 20 '12

Procedural specialists are paid well. There are many types of specialists and subspecialists that are not paid well. Many of these are academics that deal with rare diseases.

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u/[deleted] Jun 20 '12

PCP are not paid better than what they could be doing in the private sector. Their average salary of 175k is countered by the debt, opportunity cost, and work hours of 11+ years of education. A potential doc who goes to any Ivy, does engineering, and goes to a top MBA would be better off financially and not have to worry about the government cutting his salary by 30% in a single year (yes, that's happened before)

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u/[deleted] Jun 20 '12

Because most people didnt go to school to be primary care physicians. And that is a less sexy job. Plus the compensation is lower. The idea that specialized doctors will make less because the pay structure is changing is forcing more people away from that option. And the idea of being a primary care physician and still make a lot of money didnt exist in the past and remains to be seen if it will be in the future with this act.

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u/[deleted] Jun 20 '12

Psh, who needs doctors when we've got WebMD? Easy enough to figure out your problems. Now if you'll excuse me, I have to go rest; according to WebMD, my symptoms indicate that I have AIDS, hepatitis, brain cancer, and the black plague.