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06/10/2014 Jim Shipley, DPM
Are You in Favor of a Single Payer System?
I'm somewhat shocked and amazed at the current percentage given at this week's poll on having a single payor system. While I can understand the frustration that we are all going through when dealing with insurance companies, I feel my experience can lend some insight into this insurance dilemma and what possibly a single payor insurance scenario would bring.
Even though born in the U.S., I grew up in Canada until adulthood, after which I moved to London, England for two years before moving back to the States. I feel well rehearsed in all three countries' healthcare systems. Canada and England both have single payor systems, and Canada's healthcare system is consistently touted as being one of the best in the world. However, I wouldn't trade our healthcare system for theirs in a million years. Capitalism and competition still continue to be the only safeguard against corruption it seems. Competition between insurance plans is what allows decisions to be kept between doctors and the general populous. It's what gives research companies and pharmaceutical companies hope that their new and advanced product will get paid for.
For example, MRI technology has existed for decades now, but when I last looked, Alberta Canada, (floating on oil, and arguably the wealthiest province in Canada) had nine MRI's for the entire province of approximately 4.1 million people, spanning an area the size of Texas. (By contrast Winston-Salem, NC has over 20 MRI's and around 400k people). Why is this? Because years ago politicians decided it was too expensive and voted against paying for it. 5 of the 9 MRIs in Alberta are owned by Universities for med school training and research and non-accessible to patients, the other 4 are for non-Canadian healthcare insurance patients or those paying cash.
I fully understand that the American healthcare system is flawed. My point is that if you want politicians to vote and decide every aspect on how you get paid and what your patients have access to, then a single payor system is exactly what you want. I'm for choices, options, and the continuation of new and advanced medical research.
Jim Shipley, DPM, Mt. Airy, NC, jimshipley@gmail.com
Other messages in this thread:
06/18/2014 Joshua Kaye, DPM
RE: Are You in Favor of a Single Payer System? (John Moglia, DPM)
I was initially surprised to see the results of the PM News survey that showed that those who voted were about evenly split on this subject. Subsequently, there were only responses from those who were opposed to a single payer system. I am strongly in favor of a single payer system. For the past 15 years or so, we had had a multi- payer system and during that time our surgical reimbursement rates have dropped in excess of 50%. There is no question that the various private insurance companies are continually trying to determine methods of increasing insurance premiums, decreasing benefits and decreasing reimbursements. Their primary concern is big business with perhaps a side benefit of providing health care coverage and their least concern is providing appropriate provider reimbursement.
Functionally, multiple insurance companies are redundant and can justify their expenses and then reduce their provider payments. So called corporate “signing bonuses” are just one small example. The diagnosis and treatment CPTs of a bunion, for example, are exactly the same throughout the country. So why support the need for a thinly veiled justification for multiple insurance companies? The process of the reduction of internal operating expenses is common throughout the business world. That would occur with a single payer system. Unfortunately, this issue is highly politically polarized. We need a viable solution to the current healthcare crisis. Simply not liking a simple payer system is not a solution. As increasing numbers of insurance companies are dropping out of the health care market, we will essentially evolve through attrition to a modified single payer system. Rather than be concerned about the supposed dangers of single payer, we would be better served in determining specifically how we our involvement in such a system would be advantageous to our profession.
Joshua Kaye, DPM, Los Angeles, CA, jk@joshuakaye.com
06/16/2014 George Jacobson, DPM
Are You in Favor of a Single Payer System?
Be careful what you wish for! After having a decline in the practice volume the first three months, we all of a sudden see a small increase in patient volume. What happened was people and plans were in limbo in the first quarter and through the enrollment period. We lost some patients to new plans, but now out of the 50+ marketplace plans we some how we are on one of them. That has generated some new patients. But here is the but, there are limitations that we have no control over. We will see limitations to everyone in a single payer system. The limitations will no longer be limited to a one of many plans, but to everyone. I refer all my surgical cases to my colleagues. I recently referred out a patient with a 4th and 5th displaced metatarsal fracture for surgical consultation. I was advised by my colleague that none of the hospitals or surgery centers that he is on staff (for past 30 years) take the new insurance. I guess one can send them to the ER, defeating the purpose of "insuring everyone." The patients are now limited to the county hospitals, period. We have already heard of this problem affecting cancer patients who can't get continuance of care and have to travel into the new unknown because their hospital was not included. The hospital list is limited. The specialist list is limited. The podiatry list is limited. Any one of us can end up being on the outside looking in. By the way those who think Medicare is great, a commercial for an HMO in our area states that Medicare only pays 48% of costs. Look at the therapy limitations as one example. You better not get a stoke if you got PT for your ankle in the same year. Centralized power creates a omnipotent dictator. We already have many medical dictators, just imagine what it will be like with a single payer dictator.
George Jacobson, DPM, Hollywood, FL FL1SUN@MSN.COM
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