Another Day, Another Temporary Extension of Doctors' Medicare Reimbursements

Once again, Congress kicks the can down the road.

The top Democrat and Republican on the Senate Finance Committee shepherded through a one-month "doc fix" Thursday paid for by cuts to payments for certain therapy services.

The goal is to have the House pick up the bill after the Thanksgiving recess, on Nov. 29 or 30. Doctors would see a 23 percent cut in their Medicare payments under the Sustainable Growth Rate (SGR) formula on Dec. 1 if the House doesn't act before then.

…The patch retains a 2.2 percent update in physician payments through the end of the year. Baucus and Grassley also agreed they would work together to pursue a year-long fix to the formula that could be enacted before the month-long patch expires.

There are no good options here. Making the current higher payment rates permanent will cost a couple hundred billion dollars and there's no consensus whatsoever on where that money will come from. Letting the cuts go into effect and you jeopardize seniors' access to care. Fixing the system is going to be difficult and unpleasant for a lot of people, but then, that's what happens when you build health systems around dysfunctional government programs.

More on the doc fix and Medicare's sustainable growth rate payment formula here and here. 

Comments

[Fluffy]

That's also what happens when you set up pricing schemes to make it look like you've cut a program you have no real intention to cut.

[John Thacker]

Or even if you do have "good intentions," it's what happens when you decide to push off all the pain until "later."

[R C Dean]

This is exactly what you can expect from government penetration of the healthcare market. And the deeper they penetrate, the worse it will get.

[sage]

Are you talking about the TSA?

[Rob McMillin]

Only if you have prosthetic boobs.

[American Medical Association]

The Senate's bipartisan action to stop the Medicare cut for one month will help avert an immediate health care access crisis for seniors this December 1. This, however, is a short-term reprieve, and more work must be done to prevent a Medicare meltdown. A new AMA poll found that four out of five people want Congress to act immediately to stop the Medicare physician payment cut. The AMA urges Congress to pass legislation to stabilize payments for 2011 as soon as they return from the Thanksgiving holiday to add security to the program for patients and physicians, and allow time to develop a long-term solution to the broken physician payment system.

[Xenocles]

Holy shit, the AMA supports the government paying doctors more. This is my shocked face.

[shrike]

This is the only realistic place to whack FY 2010-11 spending.

Looks like that brand new GOP House will be busy with empty social conservative gestures and partisan investigations.

[R C Dean]

Oh, horseshit, shriek. They haven't passed a single budget bill for this fiscal year. The whole budget remains to be written. I suspect there are one or two things other than slamming the doors on Medicare that they could do.

[Some Guy]

I suspect there are one or two things other than slamming the doors on Medicare that they could do.

They could do a lot of things. But the point is that they won't. Because they don't actually want to cut spending. It's sad, but it's true.

[shrike]

Please elaborate!

LMSAO. You know as well as I do they won't cut a fucking thing of substance in the budget. I'm talking the House too and not the final signed budget.

Oh yeah - that piddling little $16 billion in earmarks will get a lot of ink and grandstanding...

[John Thacker]

shrike, you did notice from the article that the one-month "doc fix" cost is $1 billion, right? Which implies that a 12 month fix would be $12 billion?

In shrike's world, $16 billion is "piddling" but $12 billion is "the only realistic place to whack spending."

The "permanent" doc fix cost over 10 years is $200 billion, because that includes some inflation including expected beyond normal inflation medical inflation.

[shrike]

Bartlett says the Medicare trustees claim all is fixed by those lower reimbursements.

Now we turn to Medicare's 2010 report. It shows enormous improvement in the program's long-term costs as a result of the Affordable Health Care Act. Starting with Part A, we see that Medicare's actuaries are projecting no long-term deficit whatsoever.

http://www.thefiscaltimes.com/.....efits.aspx

[shrike]

See this.

http://www.thefiscaltimes.com/.....efits.aspx

[shrike]

see this -

http://www.thefiscaltimes.com/.....efits.aspx

[shrike]

Now we turn to Medicare's 2010 report. It shows enormous improvement in the program's long-term costs as a result of the Affordable Health Care Act. Starting with Part A, we see that Medicare's actuaries are projecting no long-term deficit whatsoever. Last year's projected deficit of $36 trillion has literally fallen to zero (p. 85). Part B's finances also show significant improvement, with the long-term deficit falling from $37 trillion to just $12.9 trillion or 1.5 percent of GDP. Medicare Part D's finances are unchanged. The long-term deficit is estimated to be $15.8 trillion or 1.1 percent of GDP.

Putting these numbers together, we see that Medicare's unfunded liability fell from almost $90 trillion in 2009 to less than $30 trillion, a two-thirds improvement in one year. As a percent of GDP, the taxpayers' obligation has fallen from 6.8 percent to 2.6 percent. Throw in Social Security's unfunded liability, estimated by its actuaries (p. 65) this year at $16.1 trillion, or 1.2 percent of GDP in perpetuity, we see that the potential tax increase from entitlement programs has fallen in half, from 8 percent of GDP to 3.8 percent. That still means a possible income tax increase of 38 percent, but that's a lot better than 80 percent.

Bruce Bartlett

(couldn't link - got robo spammed)

[John Thacker]

Yes, that's the excess cost for all of Medicare's unfunded liability for the actuarial life of the plan, not the doc fix. The doc fix is $200 billion over ten years.

So when you said "this is the only realistic place" you weren't referring to the doc fix, the subject of the article, but to the entire Medicare unfunded liability?

That doesn't really make sense in the context of "whack[ing] FY 2010-11 spending," though, which is the term you used. Most of Medicare's unfunded liability, like Social Security, is forward-looking and judging what's promised in the future.

It cannot possibly be part of FY 2010-11 spending. Congress could pass a law promising to cut the future spending that's "owed", yes, but it would still be subject to suspension when the cuts actually bit-- just like what happened with the sustainable growth rate formula.

If you think that the House GOP would somehow be responsible by passing a law promising to cut Medicare spending in the future, then you have to think that they were responsible in 1997 when they passed the SGR provisions in the first place.

[shrike]

Well how is the unfunded liability reduced so much if not by the elimination of the doc fix?

[John Thacker]

You're shifting the debate from FY2010-11 spending to the actuarial deficit for Medicare and Social Security in general. After what happened with the SGR, I wouldn't be too impressed with the new Congress if all they did was pass a law promising cuts in the future that didn't implement any now.

Just like the Fannie and Freddie bill, when you erroneously focused on the letter from the President and then claimed it was a pocket veto. In truth, what happened was that the House amended (including such idiots like Bachus) the Senate bill to the point where it was actually worse than doing nothing to Fannie and Freddie. Threatening that veto was the right thing to do if you were concerned about Fannie and Freddie. Not that you'll trust anyone else on the issue.

[John Thacker]

And you're quoting the numbers that assume that the same thing won't happen to the recently passed law that happen to the SGR.

And of course if Bruce Bartlett wants to view the numbers this way and say that Medicare's deficit has been reduced, then he has to agree that Obamacare increased the deficit otherwise. You can't double count. If the overall effect was deficit neutral, then any reduction in Medicare's deficit was offset by spending elsewhere. But the Medicare reductions take place in the farther future, and they're not really different from the SGR in effect. I fully expect a future "doc fix" type solution for them, but I don't expect the extra spending to go away.

[John Thacker]

So perhaps you're arguing that what the Republicans need to do is repeal all the extra Obamacare spending, while not repealing any of the Medicare cuts?

[John Thacker]

Bruce Bartlett is a tool. He elsewhere claims that Obamacare was "almost fully paid for." It's either almost fully paid for, or it reduced the Medicare deficit. You can't call it both. That's double-counting. If it reduced the Medicare deficit, then it wasn't paid for at all and has its own deficit.

[TrickyVic]

If there's one thing our government is good at, it's kick the can.

[TrickyVic]

A large number of people want health care reform. They want reform that benefits them, not reform that benefits the fiscal condition.

[SIV]

Letting the cuts go into effect and you jeopardize seniors' access to care.

I'd like to see that tested.

[SIV]

Perhaps an open borders policy for docs who will treat the patients "American doctors won't do" is in order.

[MNG]

"Perhaps an open borders policy for docs who will treat the patients "American doctors won't do" is in order."

Hmm, like that African witchdoctor that gave Palin the witch preventative treatment?

[Cunctator]

A little off topic but, SIV, what happened to your most excellent link???

[BladeDoc]

There already is one. About 56% of family practice residents are foreign grads, and 50% of internal medicine grads are FMGs (see http://www.nrmp.org/data/index.html). We can't import 'em fast enough. There is a growing shortage of doctors and because the feds don't want to pay for more residencies this is not projected to improve. And in light of this you want MORE price controls whereas it's pretty universally accepted that price controls lead to shortages. Good luck with that.

[BladeDoc]

More than 50% of family medicine residents are foreign med grads already and ~50% of internal medicine grads are FMGs (I can't insert the link but if you google "NRMP data and reports" you can see the pdfs. The feds aren't willing to pay for expanding residency programs even though there is a growing doctor shortage. Furthermore as we all (should) know price controls lead to shortages and this would essentially advocate more price controls. Good luck with that.

[MNG]

Heh, me too, but I'm sure I mean this differently. Even if the government offered a low price there are going to be plenty of docs lining up to get that contract (look at how entities line up to get contracts with Wal-Mart's low paying ass [I mean for their wares not their workers]).

[John Thacker]

Strange, you note the willingness of people to accept a free market wage, and from that reason that enough supply would be available at a government fixed price cap?

[MNG]

The reason they line up for Wal-mart is that it can provide such a large volume of steady business. Ditto for the government with medicare.

[MNG]

Companies regularly pay below "usual" market prices for large volume or long term contracts.

[John Thacker]

And doctors regularly refuse to take Medicaid patients too, so there's that.

And again, you're comparing a freely accepted contract to a price ceiling set by government. The AMA is indicating that it doesn't want to freely accept the government's offer. While naturally they have every incentive to bluff, by its nature this is not a contract and cannot be compared to one.

[John Thacker]

Ah yes, the First CityWide Change Bank business plan.

You can't lose money on every sale and make it up in volume.

You're still comparing a freely accepted offer in a market to a government imposed price ceiling. They're not the same. You can't pretend that because freely negotiated discounts exist that government imposed by law prices are the same thing.

[Some Guy]

You're still comparing a freely accepted offer in a market to a government imposed price ceiling.

No he's not. He's saying that the government should lower its offer, and that he believes that there will be a sufficient supply at the new price to meet demand.

I agree with lowering the offer, but I would want that regardless of whether supply was sufficient to meet demand at that price.

This may be news to you, but doctors are not required by law to accept medicare rates for anyone. They choose to do so because they want that business. In fact, many choose not to right now.

[John Thacker]

He's saying that the government should lower its offer, and that he believes that there will be a sufficient supply at the new price to meet demand.

He's arguing that there would be sufficient supply regardless because of volume.

This may be news to you, but doctors are not required by law to accept medicare rates for anyone. In fact, many choose not to right now.

News to me? It's practically my point. He's the one saying that they'd accept the rates anyway. I'm arguing that many doctors already refuse Medicare and even more refuse Medicaid, so reducing the rates by 28% probably would cause problems with supply.

[Some Guy]

He's arguing that there would be sufficient supply regardless because of volume.

How do you believe that differs from my statement?

News to me? It's practically my point. He's the one saying that they'd accept the rates anyway. I'm arguing that many doctors already refuse Medicare and even more refuse Medicaid, so reducing the rates by 28% probably would cause problems with supply.

Well if you understand it, stop using the term "price ceiling."

[Rob McMillin]

Not entirely true; the exception (one at least) is if you have a high-capital cost business where those costs dominate. If you only have two passengers on you 150-seat jet, you're gonna lose money.

[John Thacker]

Yes, and if that happens over the long run, you go out of business and/or reduce flights, etc. You can't lose money on *every* flight and make it up on volume, which is what I said. You can afford to do so on some flights if the advantage of having a regularly announced schedule helps you make money on other flights.

[cynical]

I don't know about "line up". I know a lot of people that sell in Walmart that absolutely hate it, but don't feel like they have much choice. But I guess that makes your analogy more valid, not less.

[Logic]

So doctors can lose money on every case, but make it up with enough volume, right?

[MNG]

No, they can't lose money and make it up with volume, but a contract that makes less money per purchase but has a huge volume is often more attractive than one with more per purchase but much less volume. The government, like Wal-mart, cannot bargain to nothing with their volume, but it is a huge factor in pushing the price down.

[R C Dean]

Even if the government offered a low price there are going to be plenty of docs lining up to get that contract

Reality begs to differ. There are already lots of docs who don't take Medicare at current rates, and lots of places where finding a doc who hasn't closed his practice to new Medicare isn't easy.

[Hazel Meade]

Anyone have any ideas on how to phase out medicare?

Most of the time we just talk about social security.

What would you do? Convert it to a real insurance system gradually?

Right now, the system is really headed for collapse. And much sooner than social security. AFAIK, it doesn't even have much of a "trust fund".
It's just going to start becoming a huge money hog, with no way of curtailing it.

Can we means test medicare, maybe?

[MNG]

Hazel
I don't want to phase out the program, but I would means test the hell out of it...

[celtigirl]

I don't want to phase out the program, but I would means test the hell out of it...

Isn't there a similar sounding program that is means tested called medicaid? Why not just switch indigent old ppl over and be done with medicare?

[shrike]

Indigent old people are already on Medicaid (yes, one can be on both).

What is being phased out is the monster known as Medicare Advantage (more accurately the federal subsidies for it). This is a privately managed system that distributed tax money for Medicare reimbursements.

Thank Obamacare for that.

[Marshall Gill]

Even though I am completely opposed to welfare instead of charity, a means tested medicare would be much more palpable to me as well. Surely, when we are as far in debt as we are, we can have Warren Buffet provide for his own medical expenses.

[MNG]

It boggles my mind when liberals object to means testing. We like programs to help the needy. The programs in place are going insolvent in part because the benefits are going to the non-needy. So wtf is up with objecting to strict means testing? Why would any liberal want to see these supposedly cherished programs go under because we simply must pay benefits to folks who don't need them?

[John Thacker]

Because they sincerely believe that Republicans hate the poor, and that Republican suggestions for means testing are simply preludes for cutting the hell out of the program once it becomes a welfare program, and they're afraid that would be a vote getter and it would inevitably happen. That a means tested Medicare would become Medicaid, and Medicaid sucks and no one cares.

That's the objection.

[MNG]

Well, they are not exactly crazy on this. Look how many people here advocate means testing who would also vote to kill medicare in a heartbeat...

[John Thacker]

I'm not saying that they're crazy. I'm trying to sincerely answer your question. I like to think that I generally try to understand the best arguments of those with whom I disagree.

I think that the tremendous efficiencies offered by not shuffling money around the middle class and the lower deadweight tax loss would more than make it easy to afford at least as good if not better treatment for the poor. But I do feel bound to understand the other side, and not just call them (all) hypocrites. (Some are, but I don't really like arguing on the basis of assuming hidden motives.)

[John Thacker]

Though I do find it kind of silly that I have to be the one to un-boggle your mind and help your understand the arguments of "your side."

[cynical]

"It boggles my mind when liberals object to means testing."

It increases buy-in. And they really don't want people to perceive two of the largest items on the federal budget as "welfare programs", or there will be some slashing to come.

[R C Dean]

Phase out Medicare by replacing it with a voucher program. The vouchers would be sufficient to cover a catastrophic care policy with real copays. The feds can set the minimum benefit levels.

You want better, you can buy up out of your own pocket.

You can even means-test the vouchers, if you want.

As a cost-saving bonus, you can fire thousands of Medicare bureaucrats.

[shrike]

Or a $5000 annual deductible.

Yes, Rand Paul said it too.

[Janice]

Catastrophic care does not help anyone with chronic illness.

[R C Dean]

Sure it does, if the chronic illness is expensive to manage. Catastrophic care insurance doesn't cover only medical catastrophes, it covers high medical expenses. It has high deductibles, no first-dollar coverage, that sort of thing.

[Red Rocks Rockin]

Reform both programs to make them actual public options rather than transfer-payment programs.

In other words, if don't you want Social Security and Medicare, the government won't force you to have to pay for it (same thing with your employer--they'd contribute payments to the retirement fund or healthcare system you're attached to, not the government programs). That was the whole red herring behind the progressives' arguments for a public option last year--the idea that the government would offer a program that you supposedly wouldn't have to sign up for if you didn't want it, but would still have to pay for it through taxes.

Change the programs and make them purely optional, with nobody in the program forced to contribute, and we'd find out real quick just how popular both SS and Medicare really are.

[Red Rocks Rockin]

Correction: nobody outside the program forced to contribute.

[Marshall Gill]

Can we means test medicare, maybe?

Nope. My step-mother is supposedly a conservative Republican. Even though I am pretty sure that she and my father could get by with out it, any suggestion that there is a reduction in medicare or SS will result in actual screaming of "I paid in". Like the teapartiers, they want the government reduced, just not their cut.

[cynical]

We could start by means testing people after they receive whatever they paid in. I don't really know how much of an impact that would have, though.

[Marshall Gill]

We could start by means testing people after they receive whatever they paid in.

Bullshit. Every fucking penny, every single mother fucking cent "paid in" was immediately spent. Not on those who are young today, but on those who actually "paid in". So they don't deserve shit. Except a kick in the nuts when they think they can make demands upon me based upon their previous actions.

Just because the politicians promised not to come in your mouth is no reason I should have to supply you with toothpaste.

[Michael S. Langston]

You mean the government will not be doing what it said it would do when the projections for lowering the deficit were announced?

Surely ye jest!

/sarcasm

[Don't Touch My Junk]

"Like the teapartiers, they want the government reduced, just not their cut."

DIAF, cunt.

[Don't Touch My Junk]

@ Marshall Gill|11.19.10 @ 5:23PM|#, BTW.

[shrike]

He is absolutely correct. Teabaggers are just a Medicare lobby.

How do you explain their "Keep your filthy government hands off my Medicare!" stance and the fact the average age of the crowd is mid-60's?

Call me a cunt too. Like I give a fuck.

[Marshall Gill]

Don't be retarded. You see the sign that said "Keep your government off my medicare"? Some of the Tea Party movement my be serious, but tons of them are on the government tit and simply don't want to share. Since it is medicare and SS that will bury us, I can't remember, was a reduction of these programs a big part of the Tea party agenda?

[John Thacker]

You see the sign that said "Keep your government off my medicare"?

You're also one of those people that insisted that all the antiwar protestors were crazy socialists and friends of the Westboro Baptist Church based on one sign, right?

[Marshall Gill]

Was a reduction in medicare and SS a part of the Tea Party...agenda? They aren't particularly centralized, are they? Is there a Platform? Does it call for serious reductions in the two "entitlements" that will economically crush us, SS and medicare? I don't claim there isn't, I just have not heard that there is. Unless these two are addressed, you ain't serious.

You aren't over 65 by any chance, are you?

[Marshall Gill]

@ Don't Touch My Junk

Fuck you.

[Marshall Gill]

Really, he wasn't worth a response. Thanks for having my back, I guess.

[[e-mail]]

I have posted this already here before You guys should stop complaining because, one the health care we have now isnt as good as it was supposed to be. also the law has just been signed so give it some time. so if u want to say u have the right to choose tell that to ur congress men or state official. If you do not have insurance and need one You can find full medical coverage at the lowest price check http://ow.ly/3akSX .If you have health insurance and do not care about cost just be happy about it and believe me you are not going to loose anything!

[heller]

Fuck off.

[cariqunyil]

Nothing is for free...that is the basis of capitalism.

Either adequately pay for Medicare or get rid of it. Anything else is a false choice.

[Jersey Patriot]

Will means testing actually save that much money? Someone has to write the means test, someone has to score the means test, someone has to administer the means test, someone has to hear the appeal of the result of the means test. And then, you've got every 65+ American having to submit to the time, money, frustration, and aggravation of a means test. Sure, you can cut benefits to the rich and save some cash, but if you need bureaucrats to handle all these steps, are you just spending the money on overhead instead?

[Jonathan]

I'm a physician and I hope that the Medicare cuts take place. Why? Because this will encourage more physicians to opt out of being a Medicare provider. The reimbursement is terrible, the patients have complex medical issues and the growth of the number of Medicare patients is set to explode as the Baby Boomers retire. The only good thing about Medicare is that they pay claims faster than any private insurance company.

What really is needed to address the cost issue with Medicare, and medical care in general, is this. There is no free lunch. We can't provide unlimited care to everyone. Right now, whatever a Medicare patient or their family wants, they generally get. Particularly with end of life issues.

Do we need to pay for kidney dialysis for your demented 86 yo mother who hasn't walked in 6 months. Does she get a feeding tube when she can't swallow anymore? How often to we hospitalize her for the decubitus ulcers on her buttocks and heels from laying in bed?

Or how about the obese Medicare smoker who has diabetes, heart disease and peripheral vascular disease who continues to smoke and we spend $100,000's to fix their heart and legs again and again. When do we say enough is enough? Unless you pay for it yourself.

Or how about the new, very expensive anti-cancer drugs like Provenge. Are we really going to pay $93,000 per patient to treat his advanced prostate cancer that only give 4 extra months of life?
http://online.wsj.com/article/.....12374.html

Let's face it. Americans want it all, but they don't want to pay for it.

Don't look for help from politicians from any party. The Democrats will say you can't discriminate against the disabled and aged. While the Repubs will say you can't have death panels and are "pro life". Remember the Terri Schiavo case. More proof in that case that the Repubs don't care about a small, limited and nonintrusive government or living within their means.

[Neu Mejican]

Not arguing against your main point, but I can't help but notice that you put this two ideas together in the same post.

1) The reimbursement is terrible.
2) We pay $100,000 to fix someone's heart and legs.

The juxtaposition is interesting.

[Rrabbit]

You are asking the important questions, but neither then Dems nor the Reps will dare touch that topic with a stickpole.

[Neu Mejican]

http://www.cejkasearch.com/com.....survey.htm

[prolefeed]

There are no good options here.

Sure there is. Make Medicare a voluntary program that people can opt out of.

Oh, wait, you mean no politically feasible good ideas. Then, sure.

[prolefeed]

The alternative is to let the cuts take place, and let people find out that Medicare is a voluntary program for doctors that they can and will opt out of if they are getting paid so poorly that they are losing money on each patient.

[sevo]

They don't have to be losing money on each patient to opt out.
MNG made the false equivalence to Walmart above: Walmart can increase floor area/stores and number of employees to make thin margins work; a doctor can't clone herself into multiple docs. Each doc has X hours per day to see patients; the ones that pay better get the time.
It simply becomes a question of carrying costs for the delayed pay of private insurance balanced against the low payment of Medicare. With interest near zero, carrying costs aren't all that high.

[R C Dean]

It simply becomes a question of carrying costs for the delayed pay of private insurance balanced against the low payment of Medicare.

Medicare is low and increasingly slow, with huge categories of claims getting sucked into months and years long appeals processes by third-party auditors who get a percentage of every claim they deny.

So that ain't it. When Medicare doesn't cover your actual, out of pocket costs, it doesn't matter how fast they pay.

[sevo]

"So that ain't it. When Medicare doesn't cover your actual, out of pocket costs, it doesn't matter how fast they pay."

Can't argue with that; the earlier comment said it paid fast but low. If it is now low and slow, you couldn't ask for worse.

[Jonathan]

Neu, so your point is....

you don't believe well educated, hardworking professionals should make a living?

Oh, I see. Since we work hard and do pretty good, we should give our services away to those enrolled in Medicare. Excellent idea!

Now, since Exxon, Costco, Apple, Microsoft... make so much money -- they can afford to heavily discount their products to customers over 65 years old. Let's make that a federal law. And when you sell your home, you must give a discount to buyers over 65.

I see you are not a free market thinker.

In my field of anesthesiology, Medicare pays me $17 (Seattle) per anesthesia billing unit while private insurance carriers pay me $50-55 per anesthesia billing unit.

Do you work for that kind of discount?

If I could choose my patients (I can't), why would I take care of Medicare patients at all? Especially at 2am with a ruptured aortic aneurysm, diabetes, renal failure...

I typically work 50-60 and sometimes 80 hrs a week. I'm on night call every 3rd night, and I take care of all patients regardless of their ability to pay. And with little or no appreciation from the public at large.

But me, like many are getting tired of working harder and harder and making less and less. I won't even get into how reimbursement hasn't even kept up with inflation over the last 20 years.

Then there is the looming physician shortage. Women make up 50-60% of medical students today. But they tend to work part-time. Very few are "old school" hard workers. They are smart and excellent physicians, but they want to have a family, work regular hours and have their nights and weekend free. And these are the exact things most physicians have to give up to keep a busy practice.

Most physicians now tell their children not to go into medicine. And most children of physicians see what a terrible home life they have and don't want to do the same.

So in the future, when you can't find a physician who takes Medicare or the hospital doesn't have the specialist on call at night, you now know why.

[sevo]

Jonathan|11.21.10 @ 1:08PM|#
"Neu, so your point is....
you don't believe well educated, hardworking professionals should make a living?"

First, I don't care what you make; it's not my business. But, on average, to claim it's 'a living' won't win you many friends:
http://www.cejkasearch.com/com.....survey.htm
I didn't bother with the arthmetic, but it looks like ~$300K is an average.
I'll also agree I won't (and didn't) go through the training required, but there is evidence that the training and the exclusion of those who might give some of that care without all the training is, well, other than 'free market'.
And while I don't like 80-hour weeks, I've certainly delivered them for far less than what looks like that average.
AMA's efforts (and results) get no more support from me than does Obamacare.

[Wall Murals]

I can't blame doctor's for cutting back on medicare patients that they see. They're losing out on revenue when the government can't reimburse them on time. I also feel bad for those patients that are being left out. There has to be a better way.

[Wallpaper Murals]

can we keep it clean please?

[Matrix]

Cutting doctors' payment is not a good way to solve the problem. They don't get much from Medicare as it is. Many of them will drop Medicare patients if they drop doctors' reimbursements. They should, however, target cutting out reimbursements on procedures that even insurance companies would not cover.