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

Other messages in this thread:

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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

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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