California Mandatory Health Ins Law

[LdiJ]

This whole thread reminds me of what things were like before health insurance (other than hospitalization) was totally necessary in order to get good care.

When I was a child the schools offered group hospitalization coverage for all students. Doctor's offices had the doctor and a nurse/receptionist and that was it. Doctor's office visits were very affordable for pretty much everyone, and your doctor would let you run a tab and make payments. My pediatrician would often just call in prescriptions for ordinary illnesses without requiring us to be seen. When he retired they did a write up in the newspaper and he talked about the fact that mothers were really excellent diagnosticians.

When I was in college, for 25.00 a semester we received excellent health care from the college health care center. It was a mini hospital and it covered literally everything except major surgery AND included whatever medications we needed.

Health care in the 1960s and 1970s and for most of the 1980s was much more accessible than it is now. It was the advent of the HMO that started the decline in accessibility in my opinion.

 

[ajkroy]

Then why is it that several doctors I know are perfectly happy to accept BCBC and most other insurance but flatly refuse to accept Medicare and Medicaid.

Medicaid is a completely different program managed by individual states. It has terrible reimbursement and many doctors don't take it.

I have never heard of any doctor anywhere not accepting Medicare, nor can I think of a reason for not taking it. The next time you talk to those doctors, you should ask them why.

 

[LdiJ]

Medicaid is a completely different program managed by individual states. It has terrible reimbursement and many doctors don't take it.

While I agree with you, all doctors are able to accept it if they want to. They don't even have to jump through hoops other than filling out the correct paperwork to make the claims.

I have never heard of any doctor anywhere not accepting Medicare, nor can I think of a reason for not taking it. The next time you talk to those doctors, you should ask them why.

I have seen some doctors limit the number of medicare patients that they will accept.

 

[cbg]

Health care in the 1960s and 1970s and for most of the 1980s was much more accessible than it is now. It was the advent of the HMO that started the decline in accessibility in my opinion.

IMO it was not the HMO per se, but the decision to allow HMO's and other managed care plans to be for-profit and not non-profit.

 

[LdiJ]

IMO it was not the HMO per se, but the decision to allow HMO's and other managed care plans to be for-profit and not non-profit.

I cannot disagree with that. I am not sure that I was informed enough back then to substantially agree with that, but I certainly cannot disagree with it now.

 

[PayrollHRGuy]

Medicaid is a completely different program managed by individual states. It has terrible reimbursement and many doctors don't take it.

I have never heard of any doctor anywhere not accepting Medicare, nor can I think of a reason for not taking it. The next time you talk to those doctors, you should ask them why.

This link is a little dated (2015) but it certainly shows it. https://www.kff.org/medicare/issue-brief/primary-care-physicians-accepting-medicare-a-snapshot/

Here's another. https://www.fool.com/retirement/2016/11/06/200000-doctors-turning-away-new-medicare-patients.aspx

In fact, a Google search for "doctors not accepting medicare" has about 24,300,000 results.

 

[ajkroy]

This link is a little dated (2015) but it certainly shows it. https://www.kff.org/medicare/issue-brief/primary-care-physicians-accepting-medicare-a-snapshot/

Here's another. https://www.fool.com/retirement/2016/11/06/200000-doctors-turning-away-new-medicare-patients.aspx

In fact, a Google search for "doctors not accepting medicare" has about 24,300,000 results.

Both of those articles are dated, and point toward a demographic reasoning rather than an insurance-reimbursement one. Since Medicare patients are, by definition, either elderly or disabled, it makes for a difficult and time-consuming demographic to manage clinically.

A major reason for cutting costs is that the private insurers are driving the costs to deliver care higher each year. The need for the almighty shareholder of ABCInsuranceCo to see a 20% return on his investment is making everything cost more for the rest of us. The only ones making any money in healthcare these days are insurers and pharmaceutical companies -- and the occasional concierge practice with a robust, well-off roster of loyal patients.

 

[Taxing Matters]

The only ones making any money in healthcare these days are insurers and pharmaceutical companies -- and the occasional concierge practice with a robust, well-off roster of loyal patients.

Hospitals and doctors (other than those in rural areas) do quite well, too. The IRS statistics of income (SOI), which annually reports aggregate income tax data in various ways, including by profession/occupation, have consistently reported doctors as the highest earning profession/occupation in the U.S.

 

[PayrollHRGuy]

Both of those articles are dated, and point toward a demographic reasoning rather than an insurance-reimbursement one. Since Medicare patients are, by definition, either elderly or disabled, it makes for a difficult and time-consuming demographic to manage clinically.

65 isn't elderly. And while I sade they are a little dated we are talking 3 and 4 years not a decade ago.

 

[ajkroy]

65 isn't elderly. And while I sade they are a little dated we are talking 3 and 4 years not a decade ago.

Now you are just being argumentative. 65 is the *beginning* age for Medicare, which means that would be the youngest age eligible. The entire aggregate of the Medicare populace is considerably older.

The common definition for elderly is "past middle-age". By that definition, I am approaching elderly status at 48.