6 ms·

As a sibling commenter notes, it's great that you recognize the real root of this is often not a lack of empathy by physicians, but instead constraints of the s

As a sibling commenter notes, it's great that you recognize the real root of this is often not a lack of empathy by physicians, but instead constraints of the system and especially the payors, who are not patients but insurers (or the federal government). Frankly, I'm surprised a small community-based primary care physician practice is even financially tractable in 2022. This bit from the article was also very interesting to me: Participants described both financial and time-related challenges of accommodating communication needs. One non-rural-practicing primary care physician stated: “I took it upon myself to actually hire an outside service to do [sign language interpretation]. They billed the office. …Their bill was higher than what we were making, so it was a losing venture. …It cost me $30 per visit for that patient, out of pocket.”

lotsofpulp 4y ago
> who are not patients but insurers (or the federal government). Or state government, in the case of Medicaid.
abracadaniel 4y ago
This issue is at least somewhat perceptual. If you have to charge everyone the same, but some patients cost more, then you raise the prices to account for the fluctuation and the other patients subsidize the more costly one. If, instead, the extra cost were covered by a tax rebate or something, then the cost is still subsidized to the other patients. Effectively, it isn't any different, it's just a matter of accounting. Making the disabled person pay extra for their services makes the flow of money more obvious, but at the expense of cruelty. I doubt many want to see that be the norm, but I think the result is then an argument of who sees the subsidy being paid on a bill. The doctor seeing a $30 loss on one patient and everyone pays $1 more, or 30 patients seeing a $1 interpreter fee.
- brian-bk 4y ago
  You can't just "raise prices" in billing the insurance company though, and copays are often fixed by the insurance company..

lotsofpulp 4y ago

> who are not patients but insurers (or the federal government). Or state government, in the case of Medicaid.

abracadaniel 4y ago

This issue is at least somewhat perceptual. If you have to charge everyone the same, but some patients cost more, then you raise the prices to account for the fluctuation and the other patients subsidize the more costly one. If, instead, the extra cost were covered by a tax rebate or something, then the cost is still subsidized to the other patients. Effectively, it isn't any different, it's just a matter of accounting. Making the disabled person pay extra for their services makes the flow of money more obvious, but at the expense of cruelty. I doubt many want to see that be the norm, but I think the result is then an argument of who sees the subsidy being paid on a bill. The doctor seeing a $30 loss on one patient and everyone pays $1 more, or 30 patients seeing a $1 interpreter fee.

brian-bk 4y ago
You can't just "raise prices" in billing the insurance company though, and copays are often fixed by the insurance company..