A Workman Is Worthy of his Hire

Apparently doctors consider themselves workmen, too. Having paid for their own educations and insurance, they resent being dragooned into working below their rate.
Decker finds a positive correlation between Medicaid reimbursement rates and how many providers accept Medicare. In Wyoming and Alaska – largely rural states that pay Medicaid providers about 50 percent more than Medicare reimburses – the vast majority of providers accept Medicaid. In New Jersey – where reimbursement is the lowest – only about 30 percent say they’ll take new patients.
Why is this important? Part of the new health care law is expanding Medicaid. In states with lower reimbursement rates, however, more private doctors simply refuse to play along.

Which states would those be?
As Avik Roy pointed out a few weeks ago, states with Democratic governors actually tend to have lower reimbursement rates.
What? Why?
Faced with crunched budgets, some have chosen to cut provider payment rather than reduce services.
So, faced with crunched budgets, the states have chosen to cut the doctors' pay per Medicaid client. They are shocked to find that doctors are unwilling to accept such clients when they could work for people who pay the full rate.

This is what the death spiral looks like. Expand social welfare, and costs rise. Costs rising leads to budget cuts. Budget cuts lead to fewer doctors being willing to participate in the social welfare system. This results in political pressure on the politicians to force the doctors to participate...

...and that's surely the next step here. Expect it when you see it.

By the way, what does it mean for the health care law if the Republican states refuse to fund the exchanges, and the Democratic states can't afford to pay doctors for the Medicaid expansion?


Texan99 said...

I hear this argument all the time, that doctors should be forced to work at cut rates in exchange for the privilege of receiving their education and licenses. I always ask how the writer plans to force new young people to go into the medical profession?

MikeD said...

It will begin with incentives to get more doctors into the field. That will prove insufficient. Then there will be laws mandating that doctors take patients. That will drive many out of practice, heightening the shortages. Then? I'm not sure how it will look. Will they mandate kids go to medical school? I don't see how that would work. I'd bet it'd be more along the lines of certifying LPNs to do traditional MD roles (up to, and eventually including, surgery).

Basically, it will force critical shortages of caregivers which will cause increased wait times, people dying while awaiting treatment, and eventually reform. How many will die before we get that reform would be the real question.

Grim said...

I could see it getting as far as a French-type system that mandates examinations in High School to determine what kinds of additional schooling for which you are eligible. Those found to be qualified for medicine, in numbers thought to be adequate to maintain the system, will be required to go; then required to take patients; and required to work at the government's approved rate. In return, though (as in France) their education would be free, and they would enjoy protections from malpractice suits.

That's the road mapped out by those who have gone down it before us, at least.

Eric Blair said...

I've been warning people about this, as I see the issue from inside the health insurance industry.

Nobody wants to listen.

bthun said...

Speaking of maps and the logistical gyrations spawned by socialized medicine, take a peek behind the curtain of the Liverpool Care Pathway.

Our veterinarian is on our Christmas Card list. Just sayin'...

DdR said...

What's the term we've historically used for someone forced to work with only such remuneration as their owner....uh, excuse me....employer....chooses to provide?

Grim said...

"Unfree." There are several variant forms of this, but that's the unifying term.