Regarding the May 14 editorial “A near-universal health-care plan”:
The Urban Institute’s health-insurance plan is hardly new (it has been bruited by them in one form or another for most of the past decade) or insightful. It says we can provide expanded coverage and lower costs by lowering physician reimbursement.
However superficially compelling, a crude global reduction in reimbursement will only aggravate shortages of primary-care physicians and access to care in many communities. Sustainable reimbursement initiatives must be targeted at the highly reimbursed procedural specialties and over-bedded geographic areas, lest they erode real access (such as primary-care availability) and drive up emergency-department visits and costs for chronic and acute care. Moreover, any reform must be phased in to avoid major unintended consequences. Planning in health care has a very long lead cycle compared with in other economic sectors. (Consider capital expenditures, transactional research implementation, drug development, physician training, etc.) Whether one is touting reform a la Sen. Bernie Sanders (I-Vt.), Sen. Tim Kaine (D-Va.) or the Urban Institute, primary-care access must be expanded, and the cadence of implementation must acknowledge that the health-care “system” cannot be reshaped safely and humanely overnight.
J.D. White, Potomac
As a primary-care physician, I don’t charge Medicare anything. It tells me what it is going to pay me. Insurance companies base their payment rates on what Medicare pays. Medicare payments barely cover the overhead of running the office. Anyone without Medicare or insurance who pays cash gets an immediate 35 percent discount off the standard fee. That brings the payment down to about what Medicare and most insurance policies pay.
This payment model is why primary-care providers are flocking to an employment model. Almost no primary-care doctors set up private practice anymore. They go to work for a company, health-care system or large medical group.
This is also why many primary-care providers are very much in favor of a single-payer, universal health-care system. Everyone would have basic health-care coverage from birth. It would eliminate ridiculous, onerous employer-based insurance. Providers would have only one entity to deal with (instead of the more than 50 plans our office deals with every day, with different rules, pre-authorization criteria, formularies, contacts, etc.). Also, providers would be able to unionize so they could be represented in negotiations regarding benefits for patients, regulations and pay.
There are lots of good ideas and thinking out there. I’m not impressed by economists and academics. They don’t need to make payroll and deal with providing value with higher-quality care for less reimbursement.
Allen W. Ditto, Hagerstown, Md.