Tuesday, May 18, 2010

What a suprise!

Doctors in Texas are rejecting Medicare and Medicaid in droves. It just doesn't cover the doctors' base costs, much less permit them to earn a living.

After mandatory Medicaid comes into full effect, I foresee a whole lot of doctors retiring, and many of the rest will accept cash only.


  1. This really means they won't bill Medicare--you can still see them as private patients and bill Medicare yourself.

    You will end up paying 100% of the bill.

    The bill is X
    Medicare pays Y
    The difference is Z---which you would pay (normally written off by the doctor.)

    ...and Emergency Room might just become over burdened...

  2. Yep. And a whole lot of people are like my family, and "can't afford" to pay cash.

    My mother and sister make more than I do, but "can't afford" to budget for self-pay. I plan to self-pay for my prenatal care, and my maternity care at the hospital I had my first baby in. There's a *significant* discount for self-pay both at the midwife's office ($1000 discount for total prenatal care) and at the hospital ($7000 difference between self-pay and insurance). Total that I'll be paying will be about $500 less than my deductible, because of those discounts, even if I had bought maternity coverage (for $6500 more per year than I'm currently paying).

    But somehow, people "can't afford" to self-pay, despite discounts, and the fact that not everything they take to the doctor is something they should be taking to the doctor. I think what people think they "can't afford" is the mental effort it takes to think about whether there's actually something a doctor can treat, or if it's something they'll have to get over on their own. And unfortunately, those that take everything to the doctor either have Cadillac plans (a small minority), or are on Medicaid, and think the doctors' visits that they "can't afford" to self-pay are somehow "free" if they don't have to pay for it.

    If I were a doctor, I'd have stopped taking any Medicaid patients long ago, and would probably limit Medicare patients, and charge them the difference between what Medicare pays, and what I charged.


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