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ObamaCare Clusterfuck: Doctors discovering they will be paid less from Exchange plans

Imagine that. Kaiser Health News:

Many doctors are disturbed they will be paid less -- often a lot less -- to care for the millions of patients projected to buy coverage through the health law’s new insurance marketplaces.

Some have complained to medical associations, including those in New York, California, Connecticut, Texas and Georgia, saying the discounted rates could lead to a two-tiered system in which fewer doctors participate, potentially making it harder for consumers to get the care they need.

If you're Walmart running a clinic, that's not a bug. It's a feature. Anyhow, what's wrong with a two-tiered system? The poor deserve to suffer!

And it also looks like doctors find the insurance industry just as opaque as the rest of us do (and how else to rent seekers extract their rent, anyhow? Except by creating artificial complexity in the dark).

The conflict sheds light on the often murky world of insurance contracts in which physicians don’t always know which plans they’re listed in or how much they’re being paid to treat patients in a particular plan. As a result, some doctors are just learning about the lower pay rates in some plans sold in the online markets, or exchanges

“If you’re a physician and you’ve negotiated a rate from insurance, shouldn’t it be the same on or off the exchange?” said Matthew Katz, executive vice president of the Connecticut State Medical Society. “You’re providing the same service.”

Well, apparently ObamaCare gave the health insurance companies more market power. Fancy that!

Insurance officials acknowledge they have reduced rates in some plans, saying they are under enormous pressure to keep premiums affordable. They say physicians will make up for the lower pay by seeing more patients, since the plans tend to have smaller networks of doctors.

The best way to keep "premiums" "affordable" would be to have zero premiums, and pay for health care on your 1040, like the Canadians do. (And then we can talk about progressive taxation.) Remind me what's wrong about putting the democratic process in charge of the market, instead of putting the market in charge of the democratic process?

No votes yet


Submitted by Dromaius on

I've been saying this all along. Obamacare and its narrow networks have given insurance the power to run the show. It's extortion.

And I've been saying that it's not that those evil hospitals and providers aren't cooperating. It's that insurers are paying less in reimbursements, sometimes a whole lot less than they do with traditional plans. They frequently pay less than Medicare which is already reimbursed pretty low. And unlike Medicare/Medicaid, the reimbursements are NOT regulated.

In my state, the only way insurance companies would agree to participate on the Exchange is if they could offer narrow network plans. I believe that when insurance says they are "under pressure," they are lying.

NWLuna's picture
Submitted by NWLuna on

"make up for the lower pay by seeing more patients"

Hey! It's a production line, hurry it up there.

As a clinician, I get enough pressure from administrators to Jiffy-Lube patients through their appointments faster and faster.

One of the management emailed all of us a few months back to read a New Yorker article by a surgeon on how the processes behind The Cheesecake Factory's success should be applied to healthcare. Now, surgical supply selection and procurement may certainly be streamlined. But primary care patients -- helping patients live with hypertension, diabetes, anxiety, depression, arthritis, who cannot be fixed by sterile carpentry with scalpels -- not so easy.

I was too wary or too cynical to email the management back asking "So, patients are like cheesecakes how?"

jo6pac's picture
Submitted by jo6pac on

This is great news on the Hurry UP & Die Health Care plan and if you were forced on to Medicaid so much for leaving a little for the kids. I should send this off to my Dr. he really believed this would be a great plan and he did sign up for this hmo.