Re post #75- yes it is very complex. One thing I have been thinking about in regards to this thread is just the overall change in the complexity of the practice of medicine. When did CT scans come into routine practice? 1970’s and 80’s or so? MRIs- maybe 80’s and 90’s? just think of the explosion of diagnostic tests that are available, genetic tests, antibody tests, all the various imaging studies. A doctor in the 50’s didn’t have all this at their disposal so that has added a lot to the cost. And then all the other things that have been discussed, it’s not just one thing there are a lot of factors. I do think there is a lot of money tied up in the insurance industry that could be streamlined and directed to actual health care.
The problem isn’t Obamacare, it’s the insurance companies
http://www.pressherald.com/2016/11/28/maine-voices-the-problem-isnt-obamacare-its-the-insurance-companies/
@audiophile Yes. Of course. But people like to have a scapegoat. ACA (Obamacare) is a convenient target.
@katliamom my experience mirrors yours. I spend a lot of time in the med school and with doctors and doctors in training because of my research area. Not one wants Obamacare repealed and many have taken to the streets or otherwise become politically active in order to keep Obamacare from being gutted.
Their biggest issue is the prospect of losing pre-existing condition protections. Much easier to maintain conditions than to treat them in the ER.
I had my whole body check with my dermatologist yesterday. She informed me that she will be leaving that practice and starting her own practice. She will not be concierge but will not take insurance. She will give you paperwork when you leave the appointment to file with your insurance. She feels she will take a pay cut but she will be able to practice medicine as she feels is appropriate. She wants to not feel rushed, to actually be able to sit down and talk with her patients. I’m not sure what I will do. I can see her partner but my only other choice is to go to a large medical group or continue to see her and pay.
My primary Dr doesn’t take my Anthem plan. She is a provider for other Anthem policies. I continue to see her because I like her. She is easily available through her portal. She doesn’t overbook her appointments. She schedules an entire hour for my annual physical exam. I can’t imagine she is making a whole lot of money.
So, for doctors like above who say they don’t take insurance, is it strictly a paperwork thing for the patient or is it also a case where the doctor is no longer part of the insurance network? I would have no problem handling the paperwork myself for a doctor I liked going to, but there is a huge difference between in network and out of network coverage on my insurance.
@doschicos - she would be out of network
The reason the ACA needs reform is because it’s an insurance driven policy. A competitive public option (what Hilary said, but not well) will bring insurance costs down. I left private practice before the ACA due to insurance regulations. I don’t practice defensive medicine because of the cost of lawsuits. What does it matter if I get sued for 5 million vs 50 million? I use the technology available as appropriate for the patient.
Out of network can be a significant price difference. With our insurance, insurer will reimburse patient up to 50% of the lower of the billed or their contracted price. There is no ceiling on how much you may be billed.
For a MD I like, if we can afford it, I’d be OK with paying out of network rates. I’m sad to see how poorly MDs are reimbursed by insurer in network for caring for complex cases. It really makes it difficult for providers to spend the time needed for patients.
A patient cannot “do the paperwork” for an in-network doctor. It has to be done by the doctor’s office. It’s all computerized.
A LOT of doctors in Manhattan do not participate with any insurance plans. I still go to my gyn whom I’ve been with since 1982. She uses paper charts. My file is about five inches thick, including four pregnancies and two births. I pay her $350 for my annual visit and have her send the pap smear sample to my in-network lab.
I recently, reluctantly, left my internist. She charges $900 for the annual exam. That’s soup-to-nuts—physical exam, blood labs, and EKG. Everything done in-house. She calls me back within an hour (“It’s much easier to fit in a call between patients than to bunch them up at the end of the day”), refills prescriptions as needed, prescribes meds for simple things (allergies, eczema, UTI, etc.) based on a phone conversation. I loved her and trusted her implicitly. But when the fee went to $900, I just couldn’t do it any more.
My primary went concierge last fall. He doesn’t participate in any plans, so I pay upfront and get reimbursed from my insurance. I wind up paying about 35% of the bill. I need someone who has the big picture of all my issues – but I worry that he will retire in a couple of years. My counselor is also out of network. Most of my other docs are in-network, but there have been times when they weren’t. Some have gone back to hospital-owned practices and that seems to get them into network panels again.
Because I’m so complicated medically, it’s more important to me to have continuity of coverage than to have a lower copay. I know I’m fortunate to have that choice. DH has basically committed to staying in his current job instead of going someplace more lucrative so that I am adequately insured. Our medical coverage is the biggest protection of our assets that we have.
Yes, H has great medical insurance because of his 45 years as a federal employee. I told him I married him for his medical insurance–I was only partly joking. 
In my area, it limits you to find a specialist who accepts a Medicare Advantage plan. Most psychiatrists accept Medicare, but not these plans. The clinics do, but then the people are dissatisfied. This has nothing to do with ACA.
I’m not having an issue with my MA. Maybe it’s the provider for that?
And this this is a big drain on our businesses and economy. Healthcare should not be tied to the employer. The ACA was a small step in this direction.
And federal/state/(and in some cases) municipal employees shouldn’t get better healthcare than everyone else. They are supported by taxpayers. We’ve heard over and over how (too!) generous these plans can be.Why do they have the apparent right to better healthcare?
My PCP has a hybrid concierge model. He accepts insurance (not all plans). We do have a monthly fee to get the concierge benefits.
Many federal and state employees have generous benefits in compensation for making less money than they would on the open market.
I don’t think that government employees have that much better health insurance than those who work for a large company that self insures. My H works for a large company that has union employees. They self insure and need to offer salaried employees somewhat similar health insurance to what the union negotiates for their workers.
^^^^^^^ yes, I work for a state uni and my pay as an NP is less than my peers, but my benies are better. so that is the trade off for me.
Government employees pay taxes, too. The premiums aren’t cheap. We have five-figure out-of-pocket medical expenses (above premiums) every year. Y’all get your money’s worth from my DH. 70 hrs/wk, every week, plus 2.5/day commute.
I could never do concierge medicine. It’s against what I see as the mission of medicine.
The ACA is not the problem. The insurance companies are the problem. And not to get political, but the ACA was quietly sabotaged in the budget vote in 2015 to allow what insurance companies have done.
Having Marcus Welby isn’t all that it seems. In that era, many ‘Marcus Welbys’ were never home, never really parented their kids, their marriages (ie wives) were often neglected. I went to medical school with many of their kids. They wanted a different kind of practicing life from the very start, no matter the modern culture of medical practice. It just happened that modern medical practice went there anyway.