Very curious to see how the SCOTUS will rule on the subsidies and what the reaction will be from both parties if the justices vote to uphold how the law was written and not what dems say the laws intent was.
…..vote for the bill to see what’s in the bill…..
The sad commentary is now that the people have had a taste of free healthcare paid for by others who lost the plans they wanted to keep, will it really matter if the justices rule subsidies in states without an exchange set up are illegal?
Tucci78
June 10, 2015 10:58 am
Under the Federal Tort Claims Act, doctors are covered for professional liability (“malpractice insurance”) pertinent to work they do as unpaid volunteers rendering charitable care for patients in free clinics. Over the past several years in New Jersey, the Association of American Physicians and Surgeons (AAPS) have advocated a bill in New Jersey called the Volunteer Physicians Protection Act (VPPA), under which doctors will receive state-sponsored medical malpractice coverage for _all_ of their other professional work – not just the charitable work they render – in return for a minimum of four hours per week rendered in non-governmental (low-overhead, bureaucratically unburdened, cost-efficient) free clinics. (See https://tinyurl.com/7szlw8m and a brief video of a recent TEDx presentation at https://tinyurl.com/nshvzre )
Almost every doctor to whom this proposition has been put – charitable patient care in exchange for a *massive* reduction in the cost of practicing medicine – has enthusiastically embraced the idea. The principal reason that Medicaid (a big part of the Obamacare plan) is not accepted by most doctors in private practice is that the costs of engaging the Medicaid bureaucracy exceed the payments received.
When you see a Medicaid client in your office or in the hospital, you’re *losing* money. Better to treat the time and other expenses involved in rendering care as “caritas” – charity – and just write it off.
But we’re not even allowed to deduct such donations of our resources on our “income” taxes.
Malpractice lawsuits in association with medical care rendered in free clinics by doctors covered by the Federal Tort Claims Act (FTCA) are few and far between. That’s not because the care is qualitatively better, but because the average tort lawyer knows that engaging an arguably frivolous lawsuit against a state or federal government is kinda like shoving his hand in a blender while his ex-wife hits the “Frappé” button.
For that and other reasons, it’s unlikely that the taxpayers would suffer as much financial damage as what’s being inflicted by the Medicaid bureaucracy and the administrative costs that health care providers _must_ recoup in order to deal with the Centers for Medicare & Medicaid Services (CMS).
Relative to federally qualified health centers (FQHCs), non-governmental free clinics can (and do) render care at an average of about one-tenth the cost per patient encounter. This would (ceteris paribus) free up a bunchatonna government budget to handle the sorts of “catastrophic” care needed by the poor in genuine emergencies and hospitalizations.
Knowing the medical profession as I do, my personal take on the VPPA is that – not just in New Jersey but in every state where similar laws are enacted – the average American doctor will wind up donating _far_ more unpaid time and effort than just the minimum 4 hours a week, and he’ll do it quite happily. Not just for the “free” malpractice coverage, but because almost every one of us, once engaged in the care of a patient, finds emotional satisfaction in doing good for the sake of doing good.
And if that’s not enough, there’s that “guilt trip” thing.
You don’t get into med school – or through a residency, for that matter – if you aren’t consciously or subconsciously committed to the principle behind the canonical (Alan) Shepard’s Prayer.
“Dear Lord, please don’t let me fuck up.”
Bostonbob
June 10, 2015 2:41 pm
My primary care doctor dropped his Medicaid patients because he was losing money on everyone of them. He had a lot of them and he took it very personally as he really cared for them, even though as he said many did not take very good care of themselves. He said if he continued to take them on he would have gone out of business and his whole staff would have been out of work.
Interestingly both he and his wife do a lot of volunteer work both in this country and in Africa, that is how he often spends his vacations. He is very concerned that the whole system is going to implode as the fewer of us that have good/expensive insurance continue to subsidize the many that have no or cheap insurance. We did not have the time to get into the cost structure of the direct health costs themselves. Maybe next check up.
Very curious to see how the SCOTUS will rule on the subsidies and what the reaction will be from both parties if the justices vote to uphold how the law was written and not what dems say the laws intent was.
…..vote for the bill to see what’s in the bill…..
The sad commentary is now that the people have had a taste of free healthcare paid for by others who lost the plans they wanted to keep, will it really matter if the justices rule subsidies in states without an exchange set up are illegal?
Under the Federal Tort Claims Act, doctors are covered for professional liability (“malpractice insurance”) pertinent to work they do as unpaid volunteers rendering charitable care for patients in free clinics. Over the past several years in New Jersey, the Association of American Physicians and Surgeons (AAPS) have advocated a bill in New Jersey called the Volunteer Physicians Protection Act (VPPA), under which doctors will receive state-sponsored medical malpractice coverage for _all_ of their other professional work – not just the charitable work they render – in return for a minimum of four hours per week rendered in non-governmental (low-overhead, bureaucratically unburdened, cost-efficient) free clinics. (See https://tinyurl.com/7szlw8m and a brief video of a recent TEDx presentation at https://tinyurl.com/nshvzre )
Almost every doctor to whom this proposition has been put – charitable patient care in exchange for a *massive* reduction in the cost of practicing medicine – has enthusiastically embraced the idea. The principal reason that Medicaid (a big part of the Obamacare plan) is not accepted by most doctors in private practice is that the costs of engaging the Medicaid bureaucracy exceed the payments received.
When you see a Medicaid client in your office or in the hospital, you’re *losing* money. Better to treat the time and other expenses involved in rendering care as “caritas” – charity – and just write it off.
But we’re not even allowed to deduct such donations of our resources on our “income” taxes.
Malpractice lawsuits in association with medical care rendered in free clinics by doctors covered by the Federal Tort Claims Act (FTCA) are few and far between. That’s not because the care is qualitatively better, but because the average tort lawyer knows that engaging an arguably frivolous lawsuit against a state or federal government is kinda like shoving his hand in a blender while his ex-wife hits the “Frappé” button.
For that and other reasons, it’s unlikely that the taxpayers would suffer as much financial damage as what’s being inflicted by the Medicaid bureaucracy and the administrative costs that health care providers _must_ recoup in order to deal with the Centers for Medicare & Medicaid Services (CMS).
Relative to federally qualified health centers (FQHCs), non-governmental free clinics can (and do) render care at an average of about one-tenth the cost per patient encounter. This would (ceteris paribus) free up a bunchatonna government budget to handle the sorts of “catastrophic” care needed by the poor in genuine emergencies and hospitalizations.
Knowing the medical profession as I do, my personal take on the VPPA is that – not just in New Jersey but in every state where similar laws are enacted – the average American doctor will wind up donating _far_ more unpaid time and effort than just the minimum 4 hours a week, and he’ll do it quite happily. Not just for the “free” malpractice coverage, but because almost every one of us, once engaged in the care of a patient, finds emotional satisfaction in doing good for the sake of doing good.
And if that’s not enough, there’s that “guilt trip” thing.
You don’t get into med school – or through a residency, for that matter – if you aren’t consciously or subconsciously committed to the principle behind the canonical (Alan) Shepard’s Prayer.
“Dear Lord, please don’t let me fuck up.”
My primary care doctor dropped his Medicaid patients because he was losing money on everyone of them. He had a lot of them and he took it very personally as he really cared for them, even though as he said many did not take very good care of themselves. He said if he continued to take them on he would have gone out of business and his whole staff would have been out of work.
Interestingly both he and his wife do a lot of volunteer work both in this country and in Africa, that is how he often spends his vacations. He is very concerned that the whole system is going to implode as the fewer of us that have good/expensive insurance continue to subsidize the many that have no or cheap insurance. We did not have the time to get into the cost structure of the direct health costs themselves. Maybe next check up.
Bob.