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January 09, 2006



There is some fancy name for the strategy the physicians are using. My understanding is that there are many situations where a group that is benefiting from a situation that is bankrupting society will refuse to change its behavior beyond the point of bankruptcy. If that is indeed the case, then it seems like it would be difficult to convince doctors to voluntarily give up substantial salaries in the here and now to prevent an uncertain crash in their income.


Here's one doctor in favor of some sort of universal healthcare. My motivation stems from frustration with the administrative hassles which stem from working with a few hundred insurance companies, but moreso from the fact that our ER serves about 120,000 patients a year, of the whom I guesstimate 20-25,000 are uninsured and a comparable number are on medicaid. I'm frustrated because a) I don't get compensated for the services I provide and b) these folks have effectively no access to primary/follow-up/non-urgent care once they leave my ED.

I've crunched the numbers for our practice. If you took all the well-heeled insured patients and reduced the compensation to Medicare's level, and took all the no-pay/medicaid patients and increased the payment to medicare levels, it's be close to a wash. I think our bottom line would suffer, but it would be close.

Of course, ERs with a better payor mix would be really hurt -- so don't expect all ER docs to just jump on the bandwagon. In the end, I just want a solution which gets everybody covered. I would hope one could be at least revenue-neutral for us (we don't really make *that* much money), but it's a train wreck in slow-motion and soemthing's got to be done.

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