The "right" to healthcare does not require a doctor to work for free | Hacker News Reader

The "right" to healthcare does not require a doctor to work for free

medcitynews.com

8 pointsharold5 comments

The author of this article seems to be very concerned about something, but I'm not entirely sure I understood.

He implies that, under Obamacare, doctors will be compelled to provide services to patients at rates far lower than is currently standard, similar to how the cardiac surgeon was trying to compel the author, as an anesthesiologist, to work at a rate he considered too low.

Under Obamacare, will doctors be compelled to do work at sub-standard rates, or will they merely have the option to do so? In Canada, the government pays doctors specific fees for each patient seen or each procedure performed. Doctors can therefore take on as much, or as little, work as they wish and are paid accordingly. This system does have its drawbacks, but nothing like what the author of this article is describing occurs.

If, under Obamacare, doctors had the option of taking as much work on as they want at government-set rates, supply and demand would soon force the government to offer competitive rates. If doctors are instead legally compelled to offer care at substandard rates, then there could be a problem as the author claims.

In Canada, the Provinces set the payment systems since health insurance is a provincial responsibility but they have to do so within certain requirements outlined by the Canadian Health Act (which is Federal legislation) and based on input from Health Canada which provides part of the funding, so the system varies from Province to Province.

The main system for payment is fee-for-service, in Ontario for example there are 8,000 different fee codes for everything from patient visits, writing a prescription, trauma care, and overtime hours.

The fee schedule for fee-for-service is negotiated between the Ontario Department of Health and the Ontario Medical Association which represents physicians.

Fee-for-service can create disincentives so Ontario and other provinces are working on different payment systems which mix fee-for-service with set base-salaries, plus incentives and special premiums, to encourage doctors to work in under-served areas.

The problem with what this doctor and other Obamacare opponents are saying is that it will not massively increase the number of people who get free healthcare. If someone simply cannot afford healthcare, they should he covered by the number of federal, state, and private programs already available.

The biggest increase will be from people who do not have insurance available to them through work and those who cannot get coverage due to pre-existing conditions. Yes there will be people in that group who also cannot afford the coverage but currently make too much to qualify for other programs such as medicaid, but that will be a minor segment.

As for me, I have been self-employed for 15 years and have several significant pre-existing conditions. I have been turned down numerous times when trying to purchase insurance. Even my wife has been turned down simply for having seen a doctor about headaches. The thing is I could afford even the outrageous non-group rates but no insurance company would have me.

Now they can't do that. I am able to purchase insurance coverage from a private company with my own money and pay my own co-pays and deductibles. To a doctor me and millions of other people are no different than any other patient with private insurance.

It is extremely misleading to say that Obamacare is all about giving out health care for free. It is mostly about giving us the right to purchase insurance with our own money. Even those who get payment assistance from the government will often still be purchasing their insurance from private companies so there won't be anyone other than the same insurance companies dictating how much a doctor gets paid.

In fact, one of the greatest (non-imaginary) shortcomings of Obamacare is that there is nothing in there to keep doctors from pushing fees higher, abusing the fact that everyone will now have insurance. When doctors already charge 2-3 times as much when a patient has insurance, this sounds like a major windfall for everyone in the medical profession.

This doctor clearly does not understand Obamacare and apparently this article is more about expressing political views than anything else.

> Whenever someone tells me about the "right" to healthcare, I ask, "From whom? From me?" This question exposes this "right" for the robbery and slavery that it is.

> If too many doctors quit, the government might try to make them work.

Well, what a load of rubbish. Numerous free countries do indeed have some sort of right to healthcare in their laws: in practical terms it translates to a promise by the government that it will pay the market rate to ensure that there are adequate doctors working for it.

(One could, of course, make some generalised argument against taxes, but that doesn't seem to be what this is.)

An overpaid libertarian doctor doesn't like the rates he gets for Medicare patients and shits on the entirety of healthcare reform because of it. What a unique and interesting perspective on this topic.

Who cares if people avoid urgent care to save money? The freeloading ingrates that do hobble into my emergency room are expecting that I actually honor my Hippocratic oath instead of being as money-grubbing as I possibly can! That won't stand.

All this demonstrates to me is that it should have been a proper single-payer solution instead of this additional band-aid so doctors more interested in lining their coffers over helping patients don't have this argument.

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