Patterico's Pontifications

7/11/2010

Texas Physicians are Opting Out of Medicaid

Filed under: Health Care — DRJ @ 1:25 pm

[Guest post by DRJ]

The Dallas Morning News reports Texas physicians are opting out of Medicaid:

“Just 32 percent of primary-care doctors are accepting Medicaid, according to a survey by the Texas Medical Association. And fee cuts threaten existing doctor-patient relationships, especially in North Texas.”

The head of Texas Health and Human Services Commission explains why more Medicaid cuts are inevitable:

“[Tom] Suehs, head of the Health and Human Services Commission, has said he’s sensitive to doctors’ gripes about low Medicaid payments, even as state GOP leaders order him to scrub programs for savings.

“No one ever wants to cut Medicaid,” said commission spokeswoman Stephanie Goodman. “It’s 75 percent of [the commission’s] budget. So when you start to identify places to reduce our budget, it gets very hard to skip Medicaid.”

But things will only get worse when ObamaCare makes deeper cuts and adds more patients. Texas physicians see government health care in their future and are opting out. As Mike K explains, even physicians who opt-out won’t be able to escape the government regulations and oversight that will compromise their professional independence and the integrity of the medical profession.

— DRJ

50 Responses to “Texas Physicians are Opting Out of Medicaid”

  1. Along with the dollar cost of Medicaid patients, there’s the type of patient that Medicaid brings in — often swollen with a sense of entitlement, with health compromised by drugs, drink, smoking and — above all — idleness.

    Unfortunately there is no way to distinguish between the many who use welfare as a bridge to a better life, and the other many who see it as the best life of all and won’t ever budge.

    Kevin R.C. O'Brien (188cc7)

  2. The same is happening here in Northern VA as well. My mother-in-law who turned 65 this year was looking for a new Dr., the first question 4 out 5 asked her is if she had medicaid which she signed up for because she HAD TO but she has insurance through her work. They advised her if she did they were NOT taking any new medicaid patients. I don’t blame em.

    There will be two tiers of medical service the one you pay with cash and the government option. I will stop paying for insurance IF obamacare continues on and just bank the cash for Dr.’s visits as needed.

    I await the new Conservative House of Representatives to DEFUND obamacare until they get the Presidency back in 2012!

    JadedByPolitics (1f19fe)

  3. The Big Zero strikes again.

    Icy Texan (3221ee)

  4. Its the patriotic thing to do – stop allowing the feds to set their prices

    next we need to stop education in its tracks

    EricPWJohnson (cedf1d)

  5. Eventually, someone is going to have the bright idea of making it illegal for doctors to refuse to see Medicare and Medicaid patients, even if they take a financial loss in doing so.

    Steven Den Beste (99cfa1)

  6. Like #5 said they will just make it so doctors are required to accept it.

    Dopey (adee9d)

  7. Eventually, the only way to make ObamaCare to work will be that all medical personnel will work for the Federal Government – an American Health Service – and like in Canada, it will be unlawful for Doctors to accept private payment for medical care. Unlike in Canada, American’s won’t have somewhere convenient to go for alternative care – unless Canada completely scraps their system, which is slightly unravelling, particularly the prohibition on private care.

    AD - RtR/OS! (f4b0b9)

  8. Any idea that Obama does not intend a radical restructuring of how doctors practice medicine should have been debunked by his recess appointment of Berwick.

    So too should any idea that Obama intends to actually air in front of the American public his ideas for restructuring – hence the recess appointment avoiding any hearings.

    SPQR (26be8b)

  9. Eventually, someone is going to have the bright idea of making it illegal for doctors to refuse to see Medicare and Medicaid patients, even if they take a financial loss in doing so.

    I bet they’re trying to think of a way to sue Texas and its physicians, or selectively change administrative rules, i.e., if providers fall below a certain percentage then the government can step in a require physicians accept Medicaid patients.

    Why penalize blue states when you can make an example of a red state?

    DRJ (d43dcd)

  10. unless Canada completely scraps their system, which is slightly unravelling

    I have to snicker when I think of the various fans of ObamaCare who’ve pointed to Canada as a shining example of why we Americans should be more cynical about our current system and instead very happy-face enthusiastic about the idea of instituting socialized medicine. That we should be cheering on a variation of a system that in Canada’s case really has been shaped by a very leftwing/socialistic-influenced philosophy and policies.

    If Obama, Pelosi, Reid, etc, really had their way, I’m sure they’d love to make the American system about as rigid (“open a private practice, you’ve broken the law!!”) and extreme (“take money from a patient, you’ve broken the law!!”) as the Canadian system.

    Canadian Medical Association Journal, August 2005:

    The [Canadian] Supreme Court’s decision to strike down Quebec’s laws prohibiting commerce in private health insurance should not be narrowly interpreted. By logical (and perhaps legal) extension, provincial laws that effectively prohibit physicians from practising in the private sector (through opt-out legislation, for example) are likely to be ruled invalid also.

    There is no use permitting private medical insurance but forbidding physicians to provide private care…..

    The Supreme Court ruling on what it judged a waiting time that was unreasonable and potentially harmful to a single patient is in fact a broad condemnation of medicare, a system that is failing to deliver despite recent federal injections of Can $41 billion. Canada also ranks among the highest-spending nations on health care per capita. Is the problem simply insufficient resources, or is it, as Romanow, Kirby and others have reported, also, and perhaps mainly, inefficiency, mismanagement and professional self-interest?

    Mark (411533)

  11. I thought conservatives hated entitlements. And spending. Wasn’t cost one of the GOP objections?

    JEA (9c99ca)

  12. Like we do you, we keep them around for comic effect.

    AD - RtR/OS! (f4b0b9)

  13. JEA, incoherency makes that strawman all the more intimidating to you.

    SPQR (26be8b)

  14. “I thought conservatives hated entitlements.”

    JEA – You should have stopped at “I thought.”

    daleyrocks (1d0d98)

  15. Daley, I think the trolls are really, really scared about November. And angry, because they voted for something different in 2008 than they intended.

    It must sting.

    Eric Blair (c8876d)

  16. Since Mike K seems to be otherwise occupied today (ggod for him), I’ll say it for him:

    I told you so!

    AD - RtR/OS! (f4b0b9)

  17. All kidding aside, I don’t “get” these folks who dislike Republicans telling them what to do, thinking that Democrats telling them what to do would be so much better?

    Market forces have their own set of problems. But it is the best of our choices. Government control doesn’t do many good things, it seems.

    We also don’t teach much history. That is a big part of this.

    Eric Blair (c8876d)

  18. Before you go lambasting Canada’s medical care (and also the UK)–consider the following.
    When I see Canadian and British people commenting on the US health care system, it’s generally the same sort of comment US conservatives reserve for the Canadian and British systems (ie, Horrible system! It kills people! How can they live with such a monstrous way of doing things!) I think most of these people are politically left, but not all of them–and the comments are not usually in a political context–usually they are more in the nature of conversational asides–and most seem to think favorably of their own medical system in comparison to ours, particularly the Canadians. The Brits are less inclined to praise, and more inclined to complain about, their own system, but still will defend it as better than the US’s system.

    I think part of it comes from the fact that they hear mostly horror stories about our system (the 50 year widow denied lifesaving treatment by her insurance company sort of thing) and we generally hear their horror stories (the people who feel forced to come to the US for medical treatment,etc.) but the stories about things that go as they ought to go don’t make it to anyone’s ears, whether it happens in the USA, the UK, or Canada. What comes to our notice may in fact be a one sided picture.

    I should also note from what I’ve been told by the Canadians is that, while the details vary from province to province, they can generally get treatment outside the government system, as long as they are willing to pay for it themselves, or have insurance to cover it (and apparently health insurance is a thriving business there). I would have to assume that the Quebec laws mentioned in the comment above were much more restrictive than normal. And I know of one specific instance (which took place about two weeks ago) in which surgery took place immediately in Quebec, to repair a fractured arm.

    And also, I’ve been told several times by several different people that the business of waiting times is over-dramatized. There are waits for surgery, but only if the surgery is truly optional. You may have to wait a few months for a knee replacement operation; you may have to wait a month or so for an intestinal resection if you have Crohn’s (I know of one specific instance, which is why I refer to it so specifically)–if the surgery is not needed as an emergency measure. But if the surgery is needed as an emergency measure, or the problem severe enough (for instance, a heart bypass after a heart attack), wait times are roughly the same as in the US–in other words, none at all.

    kishnevi (bb4d18)

  19. “most seem to think favorably of their own medical system in comparison to ours, particularly the Canadians”

    kishnevi – A company I worked for sold medical insurance to Canadians for use when they traveled outside the country, in this case the U.S., since their government insurance provides no coverage. All I can tell you is the Canadians fought tooth and nail against being repatriated to receive treatment in Canada versus the U.S.

    daleyrocks (1d0d98)

  20. “…And also, I’ve been told several times by several different people that the business of waiting times is over-dramatized. …”

    Um. Seems to me that you can dig up some fair minded statistics other than what people have told you? No disrespect intended.

    I understand you are being what you consider to be fairminded, but if we are going to start comparing stories we have heard from people, it is no longer factually based, and it quickly descends into internet name calling.

    Eric Blair (c8876d)

  21. Some of the crucial details in understanding the death of Natasha Richardson have not been available in the public record. Most of the second guessing has been focused on the initial delay in getting medical attention beacause at first “she felt fine”. I find that a very inadequate explanation.
    From Wikipedia:

    Refusing medical attention, she returned to her hotel room and about three hours later was taken to a local hospital in Sainte-Agathe-des-Monts after complaining of a headache. She was transferred from there by ambulance to Hôpital du Sacré-Cœur, Montreal, in critical condition and was admitted about seven hours after the fall.[19][20] The following day she was flown to Lenox Hill Hospital in New York City, where she died on 18 March.[1] An autopsy conducted by the New York City Medical Examiners Office on 19 March revealed the cause of death was an “epidural hematoma due to blunt impact to the head”, and her death was ruled an accident.[18]

    So, within 7 hours after the accident she had been through 2 Canadian Hospitals. The following day she was transferred to NYC, where she later died, the second day after her accident.

    I’m guessing she never had a CT scan while in Canada. If she had it would have been clear she needed surgery immediately. The only explanation for not getting a CT scan would have been that there were none. The abscence of a neurosurgeon would not have been a critical factor, as often emergency room docs or a general surgeon (at least in the developed world) would have been able to drill a burr hole to relieve pressure until more definitive treatment was available (the Egyptians knew how to make burr holes thousands of years ago, for crying out loud!!)

    I will defer to Mike K. or others who know more about surgery or about the incident to correct me. In the meantime, I doubt that the standard of emergency care in Canada approaches that of the US. If things played out like I describe and it happened in the US, two hospitals might as well shut down, hold a garage sale, and hand over all the money to the estate.

    MD in Philly (3d3f72)

  22. kishnevi, while anecdote is not the singular of data, I have a personal friend in Manitoba who had a first-hand experience in waiting times for a torn ACL repair. Nine months waiting for a diagnostic MRI, and ten months subsequent awaiting surgery, together with recovery time she spent two years on crutches from first injury.

    SPQR (26be8b)

  23. I would have to assume that the Quebec laws mentioned in the comment above were much more restrictive than normal.

    No. Canada’s ultra-leftist policies apparently extend from the country’s east coast to the west (ie, Vancouver, British Columbia):


    Medicalnewstoday.com, Dec 2006:

    A healthcare showdown could be looming in Canada after a private emergency care centre, the False Creek Urgent Care Centre, opened in Vancouver yesterday. Why has this attracted the attention of reporters, politicians and even some demonstrators?

    For a start, Gordon Campbell, Premier of British Columbia (B.C.), has threatened prosecution, add to this a new bill which authorizes auditors to monitor the clinic’s activities, plus the fact that it is against the law to make patients pay for treatment which is deemed as medically necessary.

    Yesterday, George Abbott, B.C Health Minister, has asked that auditors inspect the centre. It looks as though the audit will happen and Abbott says he expects the centre to ‘comply fully with all requests made of it by the commission.’

    The centre charges $199 for an evaluation, $20 for a jab, and $75 for an X-ray. If a patient requires intensive care, the centre will stabilize him/her and send him/her to another hospital. The centre, which is open seven days a week, from 8 am till 11 pm, will initially operate with 24 ER doctors.

    Mark (411533)

  24. First, BC is the most radical of all the provinces, even more radical than Saskatchewan which started the Canadian system.

    Second, the Richardson case resembles that of Princess Grace who also died because the Monaco hospital had no CT scan. They had a better excuse as it was 1982. The Wikipedia entry has obviously been altered to shelter Stephanie who is widely believed to have been driving.

    Three, if anyone is interested, I have a number of posts on what I consider to be a model system for reform of our health care. It is that of France. Search Health Reform and France to see the posts.

    The basic problem we have, and which Obama care makes worse, is first dollar coverage of routine care. No country can afford that and France has a good system of handling that problem.

    I am in the process of moving so am absent for most of the time this weekend.

    Mike K (82f374)

  25. JEA truly puts the “stu” into “pid”.

    Icy Texan (74c331)

  26. ONE PERCENT? That’s where they draw the line? What a bunch of crybabies.

    Chris Hooten (c34512)

  27. My GP here in Plano just went to 100% “concierge” aka become a “member” for an extra fee. Hard to blame him.

    SDN (b3e3b7)

  28. #

    ONE PERCENT? That’s where they draw the line? What a bunch of crybabies.

    Comment by Chris Hooten — 7/12/2010 @ 6:57 am

    I’m sorry Chris, but you shouldn’t discuss health care if you do not under understand the problems with Medicaid. It’s a completely different universe than Medicare.

    It’s tremendously harder to turn a profit these days because of the extra hassle, wait, and constantly lowered payments. At some point, you reach your breaking point. I know medical professionals who reached it ages ago, but for these, it was this 1 percent.

    The idea, your idea, that this is about solely one percent, is completely mistaken.

    I think DRJ made that clear in discussing the ‘inevitable’ aspect, but it’s something I would just assume anyone interested in this topic to know. It’s a huge problem and it’s scary to consider how our best and brightest doctors will deal with the coming arbitrary world of the bureaucrats. I suppose you can say they should be happy to heal people for low wages. They aren’t.

    Dustin (b54cdc)

  29. Dustin – Being a ‘tard of thunder and aggressively ignorant are the only topics that Hooten is qualified to hold forth on.

    JD (0f9c01)

  30. JD, I’m certain Mr. Hooten is out collecting all of his nonpartisan (that is, no DU, DK, HP sourcing) proof that Republicans are responsible for “most” voter fraud.

    It’s a BradBlog kind of thing, I guess.

    Eric Blair (02a138)

  31. Just in case you missed it, here is the trollage, from over an hour ago.

    http://patterico.com/2010/07/11/green-room-posts/#comment-678140

    This is why I think they guy is just a troll.

    Eric Blair (02a138)

  32. Eric, you have to admit, that’s a very effective troll comment you linked.

    Everyone cares about democracy and voter fraud. Everyone knows the democrats love that stuff. Guaranteed reactions when someone says it never happens.

    Dustin (b54cdc)

  33. You bet, Dustin. And from a person who insists that we should take him seriously. That says it all.

    But then, I was never fooled. Remember when he carried on about how uncivil people were to him…and then daleyrocks presented us with a Hall of Fame of his own posts on BradBlog that showed, um, he had little room to talk.

    Getting back to the topic, I am still amazed at people singing the praises of the NHS in the UK.

    Eric Blair (02a138)

  34. Eric,

    It’s just crazy, but there will be millions of Americans who demand we never undo the damage of Obamacare, if we allow it to be fully implemented.

    More than a third of the Colonial citizens wished to remain under the thumb of King George III. It’s interesting to consider.

    I’m a fan of different experiments with policies. It’s a shame these people didn’t just move to Massachusetts and leave Texan medicine alone. That is the obvious solution to most of these policy differences. The Chris Hootens and Rev Wrights and Michelle Obamas can be just as happy as you and I. The only problem is that a federal system provides much less wealth and power for politicians to steal from.

    Dustin (b54cdc)

  35. Well, Dustin, these folks know better than everyone else, and want to make rules for everyone.

    I like the idea of letting different states try different solutions to various problems.

    Eric Blair (02a138)

  36. #35

    Simple, get the Feds out of the medical care field. Completely out, regulation included, the states can handle that.

    Arguably the biggest driver of medical costs is federal paperwork.

    LarryD (f22286)

  37. Plus, let’s not forget the question of whether or not the FDA creates more problems than they prevent?

    AD - RtR/OS! (809c7f)

  38. As I’ve noted before, Medicaid was not designed to actually pay doctors to see patients, it was designed so that when a doctor saw a patient for free (which most doctors did at the time), the government would pay for the non-physician overhead costs, so the doctor would “not lose money”. As usual, unforeseen and unintended consequences took over and the rest, as they say, “is history”.

    The 1% drop is more of a slap in the face than an economic issue for many, I think. In most states you cannot give the kind of care you want to medicaid patients unless they are few or the doc is independently wealthy. When I was a resident eons ago, the cardiologist we usually refferred patient too did our medicaid patients for free. He said it would cost him more money for his billing person to go through the hassle of submitting the bill than he would get back.

    In so many issues people totally ignore the original plan and how things developed. it should not be hard, for example, to know that Social Security was not going to work forever when it was set up essentially to cover the relatively few people who reached retirement age at the time before they died, and when retirement was usually about necessary because the peron could no longer physically do their job.

    MD in Philly (3d3f72)

  39. Also, remember that as originally constituted, SocSec covered far less people as a percentage of the population that it does now – it has continually been broadened to bring more into the system.

    AD - RtR/OS! (809c7f)

  40. Comment by AD – RtR/OS

    And even if it hadn’t been broadened, the percentage covered would have gone up as the avg life expectancy has risen.

    One way it has been broadened significantly is to cover End-Stage-Renal-Failure/ Dialysis.

    Also, a high percentage of Medicaid funds goes to nursing home care for those who can’t afford it themselves.

    I think it would be interesting to look at medical costs as a percentage of income above what’s needed for basic expenditures. I wonder what expectation and cost for a car has done over the last 60 years compared to medicine. You pay more for a basic car now than before, even more for a car that can park itself!!

    Of course, medicine is different because I don’t care if someone can’t afford a new car, we do care if someone can’t afford their cardiac surgery.

    MD in Philly (3d3f72)

  41. Doc, as to cars, even the most basic of cars today come “standard equipped” with features that 50-years ago would only be found on top-dollar luxury makes, and sometimes not even there as the technology did not exist.
    I’m sure that a lot of medical care is similar in that we expect, as a matter of course, treatments today that fifty-sixty-seventy years ago would only have been available to a Rockefeller, or Mellon, or Kennedy.

    AD - RtR/OS! (809c7f)

  42. Do you want to reduce Medicaid? Well, payment cuts are going to have to be part of that.

    libarbarian (90bd00)

  43. In my opinion such article should be written and published so that people will know that how much racial discrimination is bad and should not be done so that people will know this destroy any one’s life. Very informative article.

    cheap computer (8c0658)

  44. It’s unfortunate that things like this are happening. Hopefully it won’t be as bad as it sounds.

    Medical Medicaid CareSource (759d15)

  45. In prior years, the second open sign up period made possible plan holders to change plans around Jan. 1 as well as March thirty-one. That open enrollment period has long been eliminated. subsequent to Jan. 1, plan slots can solely drop the particular Medicare benefit coverage plus switch oh no – original medicare insurance. The switch will have to be made previous to Feb. 15….Elimination of your second application period is one of the many changes medicare health insurance users will probably notice after that year.

    Jarrod Taegel (a3a516)

  46. I know my brother would agree with you here, but I’m not sure that’s accurate in all cases

    Dwayne Aungst (e0a85a)

  47. So true. It really does matter, whether you like to think so or not.

    Maryln Baldelli (3ab2aa)

  48. I’m not so sure I agree. Most pros will be able to spot the problem before it gets that severe.

    Pearlie Curley (850f89)

  49. Well who’s to say they’re wrong? Seems like a matter of opinion to me.

    Damian Soliz (850f89)

  50. lots of spam ending up on this thread.

    SPQR (26be8b)


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