Comment by MayBee

With Medicare, they have an allowance and a payment. It was once possible to be non-participating and collect a deposit (some elderly patients will get a check that is for six providers and they can’t remember who gets what) and charge the regular fee but they would pay the same regardless of whether you were “participating” or not. They will also not let you do more than Medicare allows, as some geriatric specialists have found out the hard way.

Medicare now pays about 25% of billed charges for surgeons. They have cut the payments by close to 50% in the past 25 years. What is now happening is some surgeons dropping out of Medicare completely, giving up provider numbers. Then they are practicing for cash for Medicare patients. Many internists have limited their Medicare patients to 10 to 20% of their practice. The optimum, according to practice consultants, is 11%.

The only fellowship trained geriatric specialist in central Iowa dropped out of Medicare completely because she was being harassed and she is totally private now and totally for cash. She is making a living although not getting rich.

There will be more and more of this unless some sensible reform happens. In a way, it is the libertarian option. Going John Galt.

It isn’t just Medicare. I was at a vascular meeting a few years ago. At the time, the best place to be if you had an aortic arch aneurysm was the Ochsner Clinic at Tulane. They had the best results so everybody used to refer their cases unless they were too critical to move. At the meeting, the chief of vascular surgery got up and announced that the financial loss on these cases was so great they could no longer accept transfers. They hated to say it but they lost $250,000 on each case.

There is a war on technology going on. Cardiac and vascular surgery have taken the biggest hits and fewer people are going into those fields. The actual dollar payment for lower leg bypasses has dropped by two thirds in the past 20 years. Some of those cases take seven hours.

Translation: I might as well invent another strawman to attack.

**yawn**

I see NO substance in glibly stating that “we are not going to control the health care cost inflation.”

She didn’t glibly state it. She stated it as a conclusion based on the historical evidence, as part of an argument that those claiming it will happen now ought to explain why conditions have changed now.

And it appears that neither you nor Obama have said explanation.

steve also writes:

Megan McArdle might as well say we no longer possess the entrepreneurial vision and skills to develop the products that people want at a price they can afford.

The mistake in this analogy is that steve (shocka) seems to have no grasp of the distinction between the private sector and the public sector. The former has a track record of being entrepreneurial and innovative; the latter, not so much. What we are seeing now is Congress attempting to make a “product” (service) that people will want at a price they can afford. And they are failing, as they have in the past.

I see NO substance in glibly stating that “we are not going to control the health care cost inflation.”

“All of us must be assured of access to reasonably priced health insurance,” as Sen. Tom Coburn plaintively argues.

Megan McArdle might as well say we no longer possess the entrepreneurial vision and skills to develop the products that people want at a price they can afford.

Coburn and Paul Ryan propose a “Medi-Choice” tax rebate that will give individuals $2,200 and families $5,700 to spend on health insurance. Who’s buying?