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Stunning: Many Doctors Prefer Single-Payer Health Care Because Of Demands By Insurance Companies

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Stunning: Many Doctors Prefer Single-Payer Health Care Because Of Demands By Insurance Companies

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Reprinted with permission from Alternet.

After the House bill defunding Obamacare and Medicaid failed, progressives in Congress and activists have been pushing for what they’ve wanted all along—to open up Medicare enrollment as a step toward a single-payer health system.

A new poll of 500 physicians by the business networking website LinkedIn found that nearly half, 48 percent, were in favor of a single-payer system, with 32 percent opposed and 21 percent undecided. What’s stunning about LinkedIn’s survey was not just the show of support for single-payer, but the comments and explanations from physicians about their industry’s greed-driven codependent relationship to insurers.

“As a doctor, it’s really against my best interest to support single-payer healthcare,” said Sean Kivlehan, the associate director of the international emergency medicine fellowship at Boston’s Brigham and Women’s Hospital, in LinkedIn’s report about the poll by Beth Kutcher. “It reduces my earning potential. At the same time, it’s about human rights and taking care of people that need help—that is why I do this work.”

Anyone who’s been surprised by medical insurance bills, high deductibles or spoken to the non-medical specialists after seeing physicians to try to find less expensive ways to access new drugs has crossed paths with this often-hidden codependent relationship. What’s never discussed by caregivers or insurance companies is how insurers rely on physicians’ offices as collection agents—and then in turn, pay these providers more money than they might otherwise earn in a single-payer system.

Kutcher reported that many medical professionals said they would accept earning less if it meant fewer dealings with insurers (which averages four hours a week), less insurance bureaucracy, more time with patients, and a freer conscience as a result.

“Even though doctors acknowledged that they might take a financial hit under a single-payer system, many respondents said it would be more than mitigated by getting out of the collection business,” she writes. “In other words, even if they earned less, there would be more patient care and less of the aggravation that comes with negotiating with and tracking down payment from multiple insurance companies.”

What’s stopping more physicians from supporting single payer? Some cited the political arguments about free markets, saying that competition and financial rewards in medicine have driven new advances and that could be stymied. More telling, however, was a trap awaiting medical school graduates. Many owe $100,000 or more in student loans, and partnering with private insurers as collection agents helps them get out of debt.

“Unlike other countries with single payer healthcare, medical school in the United States is very expensive—79% of med students were graduating with more than $100,000 in debt, according to the Association of American Medical Colleges,” Kutcher writes. “U.S. doctors need to generate a substantial income to pay that off—something that doctors in other countries don’t need to worry about.”

The way this ends up working goes to the heart of why for-profit healthcare is bad for physicians, bad for their staffs and bad for patients—bad for everyone except insurers and others whose profits come from pressuring doctors to collect more in fees.

Incredibly, the poll’s interviews with doctors suggest this nasty cycle is getting worse.

“While commercial insurance providers may be the most lucrative payers, they’re increasingly moving toward plans that require doctors to collect more money from patients before they can even submit a claim for reimbursement,” Kutcher wrote. “As many as 29% of people with employer-sponsored health insurance are enrolled in a high-deductible plan, according to the Kaiser Family Foundation. And people with high-deductible plans are more likely to delay care for financial reasons.”

The way patients see this system is when they interact with the billing staff at doctor’s offices. A study in the peer-reviewed journal, BMC Health Services Research, found that billing and insurance expenses totaled $70 billion for medical practices in 2012. The poll found two-thirds of the 500 doctors surveyed “implemented measures” to collect from patients with high-deductible plans. A fifth said they had to hire financial counselors.

It’s not new to hear doctors complain about arguing with insurers after their treatments are rejected or health plans don’t cover certain drugs. It’s also not new to hear doctors complain that it’s hard to get to know patients after they change insurers and medical records get lost in that transition process.

But the reality is a stunning snapshot of healthcare in America: Private insurers are increasingly treating physicians’ offices as their collection agents, pushing medical office front desks to grab more money from patients, while doctors have little choice but to go along to pay off their student debts, or accept it as the way to earn a six-figure income.

No wonder the prescription from nearly half of the physicians surveyed by LinkedIn is to get private insurers out of the healthcare field. The for-profit system is sick and isn’t allowing too many doctors to practice medicine the best way they know how.

This article was made possible by the readers and supporters of AlterNet.

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21 Comments

  1. Thoughtopsy April 9, 2017

    As they say:
    Capitalism is the most amazing thing that humans have ever created, it has given rise to a vast increase in knowledge and wealth… but it’s a two-edged sword. Capitalism will also completely suck the the value out of anything it touches if it is not sufficiently controlled.

    At it’s heart, this is why the Republican religion to “free” Capitalism is destroying America. It’s not because Capitalism itself is bad… on the contrary, it’s extremely good. It’s because removing all the rules from Capitalism turns it into a voracious destructive force.

    Consider a fishery like the Anchovy fishery off the West coast of Argentina. Put regulations in place, and the fishermen can only take so much a year. They all make money… the fishery replenishes itself… the industry has a mutually beneficial relationship with Capitalism.
    What actually happened?
    The rules were removed. The “Free” market was finally “free”!
    Fishing companies began to take more and more fish to make ever more money. Soon they had to go from boats and nets, to GPS, fish finders and satellite imaging to find the last few schools of fish. The fastest companies with the best technology made the most money… and then?
    Then all the fish were gone. And the industry collapsed.
    And Capitalism? Oh.. the money just moved on to the next area of value to suck the life out of, leaving a permanently destroyed industry behind it.

    Capitalism requires rules. Something the GOP does not understand.

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    4. dpaano April 10, 2017

      So very true!!!! It’s just a very logical conclusion, but Republicans are not all that logical!

      1. Thoughtopsy April 11, 2017

        Actually it’s worse than that.
        It’s naked self-interest in most cases, not lack of logic.

        If you are the people controlling the money to invest, you don’t want rules getting in the way of stripping value out of everything you invest in.

        The GOP are either in that group, or pandering to that group (the 1%) for campaign money. And that group want no restrictions.
        E.g. If they want to bribe Financial Advisers to direct consumers into high fee/low return investments that make their investment company billions, but screw over the customer…. they don’t want any pesky rules getting in the way.

        This degree of rapacious greed has infected, to a greater or lesser extent, all levels of American business.
        From a certain point of view, this unethical greed at every level neatly explains the Global Financial Crisis. The industry had to be rotten from bottom (The shyster selling the mortgages to people with no assets and faking the paperwork)… to the top (the Wall Street Companies, especially Goldman, bundling up terrible mortgage securities and paying off S&P to rate them as AAA).

        Apparently there was no person, company or government agency at any level with enough ethics to see this and stop it, as opposed to joining in to rape the system for short term gains.

        1. dpaano April 13, 2017

          And, we see our illegitimate president getting rid of ALL the protections that were put in place by the previous administration (and administrations prior to that one) to allow these companies to go back to their old greedy, unethical, and unscrupulous ways! 45 and his billionaire cohorts are “raping” the government and I’m not sure there’s a way for us to stop it unless we get out and vote in the mid-terms and take some of the House seats back! I just hope that all the people that are marching against 45 will march to the polls in 2018 and get rid of some of these people!! This is the most we can do at this time.

    5. dbtheonly April 11, 2017

      The near extinction of the American Bison is another example.

      Capitalism also does not account for worker safety or retirement.

      One of my favorite posters shows a couple of turn of the century young children, standing in front of a machine three times their size. The caption reads, “Needless Government Regulation cost them their jobs!”.

      If not rules per-se, Capitalism requires vibrant Labour Unions to balance the negotiating power of Labour and Capital.

  2. Mama Bear April 10, 2017

    Everyone on the planet prefers a single payer system ….except Republicans who mostly own insurance and pharma companies.

    Reply
  3. dpaano April 10, 2017

    It would seem that it would end up being cheaper for doctors to go with a single payer system…..they would NOT have to pay for people to collect money from their patients, they would NOT have to pay for staff to put in insurance claim forms, etc. It would cut their staff down to basically nurses and front desk staff. Also, as the article said, they would be able to take more time to see patients and to do their jobs.
    As for the patient….we wouldn’t have to pay big bucks to purchase insurance…..even when we get employer-paid insurance, we still have to pay a large share of it. I would rather pay that large share directly to the state in exchange for single payer health insurance. In the long run, it would probably save me money because I also would not have to pay that small bit to Medicare.
    Since I’m not a big mathematician or insurance whiz, I don’t know if single payer would be good for the patient AND the doctor, but something HAS to be done with insurance companies who charge outrageous charges for simple procedures! The same goes for pharmaceutical companies who charge an arm and a leg for medications that cost a fraction of what they sell them for!

    Reply
    1. Mama Bear April 10, 2017

      Medicare is a perfect example to examine, d. For $108. (more or less) per month you get a basic 80/20 policy managed by Medicare. Your hospital bill is $1,000 your part of it is $200. If you choose (and most do) there are “supplements” that you can buy to cover additionally to one degree or another. I have a plan that I pay $157.00/month for and I never see a bill for anything (other than meds, which is another story). This is an efficient model and the insurance companies only get involved when you buy a supplemental plan. That is why they are so opposed to a single payer system.

      1. dbtheonly April 11, 2017

        You’re 80/20 works until you need an MRI, which, I’m told, bills at $10,000.

        Equally now the game is to bill the insurance and, only then, drop the remainder so as to be affordable to the patient. The recent billing for therapy on my knee is written proof.

        1. Mama Bear April 11, 2017

          Agree. That is why there are supplements and Medicare Advantage programs, to help with the cost. Years ago before the big healthcare explosion the best plans were 80/20. The best employer sponsored plan was an “indemnity” plan which was the 80/20 plan. At the ripe old age of 45 I contracted a superbug (the one that killed Jim Hensen). I was in intensive care for 3 weeks and hospitalized for 2 more. My bill was over $100,000 and I remember thinking not only was I lucky to be alive but lucky that my portion of the bill was “only” $10,000.

          1. dbtheonly April 11, 2017

            No, we’re the lucky ones to still have our Mama Bear around.

            I keep coming back to lasik. The price has dropped some 90% over the past ~15 years. I don’t know if the machines have dropped that significantly in price. But I do know it’s not covered by insurance. Thus all expenses are out-of-patient-pocket. Thus all patients have to feel the advantages of the surgery outweigh the cost. So the cost has dropped.

            The gaming of the insurance companies bothers me too. How much of the “high cost of health care” is bull, charges only if the insurance will pay?

            Any word on you move? Did you ever visit the Four Corners?

          2. Mama Bear April 11, 2017

            thank you for the kind words, db 🙂
            Having worked as a publisher of medical journals throughout my career I can tell you that yes…it became all about money and profit – and not in the pockets of the physicians. It cost the average doc $100,000. to set up systems and comply with mandated electronic record keeping. Not many of them had or were willing to invest in these systems so they had 2 choices – retire if they could or sell their practice to a hospital. The result is that now the docs are “employees” and literally owned by the hospitals who could afford to buy them out. Hospitals are for-profit and that is when everything changed. Capitalism. Money. Greed.
            You are always asked “do you have insurance?” and that is because yes, an added chunk of change is added to the “service” if you do.

          3. dbtheonly April 11, 2017

            So we have the very existence of insurance to cover the expenses driving up those expenses because insurance will cover it(?)

            Will even “single payer” get us out of that trap?

            I think it self evident that health care, the ultimate, bottom line, needs to be priced at the level where the average American can afford it. This sets one side of the equation and costs, equipment, education, office requirements, everything, needs to balance the other side.

          4. Mama Bear April 11, 2017

            from your lips to god’s ears.

          5. dbtheonly April 11, 2017

            But I don’t have an answer.

            I just have insolvable problems.

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  5. Gemma Clarke April 15, 2017

    ” You’re 80/20 works until you need an MRI, which, I’m told, bills at $10,000.

    Equally now the game is to bill the insurance and, only then, drop the remainder so as to be affordable to the patient. The recent billing for therapy on my knee is written proof.”

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