If patients don't improve under "proper protocols and standards" then the doctors are practicing incorrectly and need to make changes to the protocols and standards.

Successful outcomes from updated and corrected protocols and standards ought to be rewarded. Not getting a bonus or more pay is not punishment. I don't see Blueprint penalizing anyone.

If a doctor turns down the challenges of healing and avoids sick people in order to get bonuses, then his motivation is not for people but for his own wallet. It is for this type of doctor and attitude toward medical practice that insurance companies are designed - benefit everyone more and more except the patient.

It's time we get past that

I don't see how doctors would be punished. If so, that would open the door to controlling our very lives and lifestyles, removing our free will, so they could force good outcomes. No more soft drinks, no more living it up with that scotch on Friday nights. We have to take responsibility for our own health, use moderations, and not get punished for our lifestyles.

Doctors are already being punished. You should see what they have to go through with the billing and appealing claims to the insurance companies. Patients are punished by not being able to get the care they need because there's an insurance guy between them and their doctors.

I was in healthcare when managed care and utilization review started. To be honest, I never saw care being "managed" for the benefit of the patient. It did make it harder for people to get certain procedures, too. I'm not sure what good that did.

Then it sounds like doctors ought to be in there pitching heavily against insurance companies and should welcome results-oriented care.

I've been hearing about that. Some seniors have trouble when switching doctors, because docs only need to accept a certain amount of medicare patients. So, it is hard to switch. But they have to accept medicare if they haven't met their quota of medicare patients. It must be the low reimburesement rates that are making them reluctant to accept more than their quota. We need to fix Medicare Part D (a good example of poor legislation that now has to be fixed) and we need to fix Medicare so that it pays proper rates.

"we need to fix Medicare so that it pays proper rates"

Well, the amounts being paid by Medicare exceed those for the same services in the EU - an economy larger than ours. It's just as likely that the reimburement is higher than what we can afford as it is too low for doctors' desire for compensation.

Resources are limited but desires are not. Pricing has to respond to available resources if health care is to be made available to everyone.

Part D is a disgrace. We need to find a tested model for controlling pharma costs on a national level, for all patients.

Good point, Harold. We should not increase rates before reforming how care is delivered. Funny thing is, my healthcare buddies aren't returning my calls.

I'm guessing it's a problem with equipment purchasing and just streamlining business practices, besides the obvious over-testing thing. It's a conundrum.

It would be so easy to just model after a working system and just reform everyting, than to do it bit by bit. Sigh, do we need an "agency" to analyse, review and recommend? I hate to recommend another government agency, but what else can be done? The doctors won't reform their own practices unless pushed to do so.

I think there are progressive doctors being silenced. They want change and are willing to change but are shackled by compensation restrictions and muscled out of the media.

It's like independent politics. You can sit in a room full of good ideas, contact the press, and then see, in the next days paper, an opinion piece under a reporter's byline that was written by a Republican or Democrat press agent.

Congress has been given their marching orders and working parameters. There, too, I think there are many who know that reform isn't what it needs to be. I wish there was a way to encourage them.

I agree that another agency wasting time to investigate what every other industrialized nation already has is really frustrating. The insurers and providers emulate each other, you'd think the people would want their government to take that cue.

I understand Harold.  My concern is the increase in the gap size between the haves and have not's with elimination of the insured middle class.  If government health care  proceeds as medicare, we need guarantees that the insurance will be taken by doctors.  I don't believe the issue is addressed.

Check out http://healthcare.change.org/blog/view/whats_next_five_moves_to_watch_in_healthcare_reform for the Medicare SGR repeal and Medicare +5% proposals. While no guarantee doctors would accept public plan patients (right now some doctors refuse to take any insurance at all), these proposals do sweeten the deal for doctors treating both Medicare and public plan patients.

M.

As I noted "the bills do not propose any such thing and organized physicians will likely seek to squash a robust public option by refusing to participate." There is no requirement in any of the bills that doctors accept any insurance, public or otherwise. Nor is there a provision that insurers compensate the physician of the patients choosing - "a mandate for every individual to buy but not one for every provider to sell."

Physician income will decline if enough peoples' coverage is excluded. If insured "haves" become insured "have nots" by selecting a public insurance plan, it will not be because they selected a public plan but because the rules which govern compensation and participation remain unchanged. To that extent, the elitism you question is already in place.

All plans do not open up all physician possibilities to all people and nothing trumps cold cash in our system.

Congress is not protecting us in this regard. However, if private insurance is to be protected (as with all the bills on the table) scuttling the negotiated networks and provider restrictions is not possible. This is still the going theory for insurance-based cost containment and a basis for competition among insurers. Our division is their strength and Congress is not even offering to address this on our behalf.

I'm still curious about the $8-$10 reimbursement and would like examples.

Harold,

I understand that the reimbursement rate seems low, but that is what I was told when I tried to use  my care plan. I've heard that reimbursement would go up 5% for medicare, but what is that to a doctor?

I don't want to be bumped or demeaned because of the new health bare bill and enrollment in the new system. I would hate to see us all pay more for worse care.

Someone that has their union supported nice health care package will be ahead of the line.  I will get the left overs!

Right now I only pay part of a premium for an extra package through work.  With this gone, and it will be, where will I turn?

The government will just screw things up unless they do it right.  They've done it before!

The congress has to address an issue that widens the chasm and will create a horror story for more of it's people!

PS.  Through the Internet, I've discovered medicare reimbursement is different depending on the area where people live.  There are several articles available with a search, just watch who writes them:)  Maybe you live in a good area, maybe not.  I wish you the best!

The bills in Congress do nothing to protect any person, regardless of the source of their insurance, from losing a physician or being kicked from one network to another.

It may even exacerbate the situation by adding another, lower-paying insurer, the public plan, into the mix.

However, since our expenditures on health care are not based on utilization (other OECD coutries pay about half per capita and receive more services), it calls into question whether we have a problem covering costs and providing health care workers/ providers with a living and enought to sustain facility operation or whether we're simply failing to meet their desired price.

Given the weight of evidence in other industrialized nations, I'd say it's a question of desired price and profit, not Medicare paying too little for the services.

If Congress is going to mandate that everyone buy coverage, as the insurers want, then it would be only right that all insurers reimburse all providers and providers be mandated to accept whatever insurance their patients have.

Managed care is such a hodge podge of backroom agreements. Thanks for explaining, and I actually worked for a Utilization Review doctor, and I'm still confused. I think it's clear it never benefited the patient, just the doctors and insurance companies.

Love those docs! Wish Obama would meet w/them.

Been blogging with them for months. They're great!

hi betty, you are a member if you are able to post on this site. It sets a cookie so you don't have to log in everytime you visit, which I really like, personally. There is no charge and it's a great way to make an impact.

Betty--the issue may be that you aren't signed in when you want to post a comment. As CherokeeGirl said, if you can post you are a member. Just make sure your browser is set to allow Change.org to use cookies.

Betty,

Ideas are free. We'd never charge to inflict them on each other. Welcome aboard!