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> what if doctors just stop... negotiating with public insurers? is there some legislation I don't know about that prevents that? Doctors aren't negotiating at

> what if doctors just stop... negotiating with public insurers? is there some legislation I don't know about that prevents that? Doctors aren't negotiating at all with public insurers. Medicare doesn't negotiate, for any meaningful definition of 'negotiate'. They set the rates they are willing to pay, and you can either accept it or.... accept it. As a provider, it's very, very difficult to refuse to treat Medicare/Medicaid patients in practice, for all sorts of legal reasons. (Also, it's usually the hospital that's in this position now, not doctors. Private practice is a dying breed; most doctors in the US are now salaried.)

hardwaresofton 11y ago
OK got it - so there is some law that prevents/makes it prohibitively expensive for hospitals to not serve medicare/medicaid patients?
- lloyd-christmas 11y ago
  Not specifically law, but the number of patients on Medicare. You're essentially eliminating at least 15% of potential patients(and growing as the population ages) That doesn't even factor in the age of patients. Only 15% of that 15% are under the age of 65. That leaves you with 40m+ people on medicare who are over 65. Who tends to go to the doctor more frequently, a 25 year old or a 70 year old? Dependent upon specialty, you could have 90% of your patients on medicare. If I dropped 90% of my clients, I don't think "comfortable" would be an accurate description of my workload. It's a tough position to be in. Many doctors ARE dropping medicare due to the large amount of paperwork, costs of auditing, deep price discounts, etc. This means that the doctors who DO accept medicare end up getting swamped with patients which increases the patient wait times. So, as a medicare recipient, you either end up paying more out of pocket to see the doctors who dropped medicare or you wait longer to see your doctor. As a doctor, you either lose your patients or gain an unmanageable amount of patients along with drastically more paperwork. Lose-lose. All that being said, it's clearly a lot easier to criticize than contribute meaningful suggestions. The only thing I could suggest is to put much more effort into preventative medicine. Preventing disease is drastically cheaper than managing symptoms. While it comes up a lot, it doesn't seem to be a focal point.

hardwaresofton 11y ago

OK got it - so there is some law that prevents/makes it prohibitively expensive for hospitals to not serve medicare/medicaid patients?

lloyd-christmas 11y ago
Not specifically law, but the number of patients on Medicare. You're essentially eliminating at least 15% of potential patients(and growing as the population ages) That doesn't even factor in the age of patients. Only 15% of that 15% are under the age of 65. That leaves you with 40m+ people on medicare who are over 65. Who tends to go to the doctor more frequently, a 25 year old or a 70 year old? Dependent upon specialty, you could have 90% of your patients on medicare. If I dropped 90% of my clients, I don't think "comfortable" would be an accurate description of my workload. It's a tough position to be in. Many doctors ARE dropping medicare due to the large amount of paperwork, costs of auditing, deep price discounts, etc. This means that the doctors who DO accept medicare end up getting swamped with patients which increases the patient wait times. So, as a medicare recipient, you either end up paying more out of pocket to see the doctors who dropped medicare or you wait longer to see your doctor. As a doctor, you either lose your patients or gain an unmanageable amount of patients along with drastically more paperwork. Lose-lose. All that being said, it's clearly a lot easier to criticize than contribute meaningful suggestions. The only thing I could suggest is to put much more effort into preventative medicine. Preventing disease is drastically cheaper than managing symptoms. While it comes up a lot, it doesn't seem to be a focal point.