Insurers to pay doctors 30-40% less under exchange plans.

[BlueStreak]

114. New rules

We are giving them a guarantee that almost all of their customers will have good insurance, including coming in for regular check-ups. That makes a big difference in the cost of running a medical practice. Unless you are a specialist, the really sick patients are not the profitable ones. They take a lot of time that you may not be compensated for. Regular check-ups are better for the patient and more profitable for the provider.

My point is that there are several variables at play. We are reducing the non-collectables, and getting more patients into the office. Taxpayers have also subsidized the modernization of record-keeping. which also makes the practice more efficient. In return for these things, providers should be willing to give some. I want them to be well paid. I want the most capable people to want to pursue a career in medicine. But they don't all have to make a million bucks a year or more.

I know the education is expensive. I'd be all in favor of greatly increased grants for those going into medicine so that the don't emerge with $500,000 of debt before they take their first patient.

I have had a great deal of contact with the medical world in the past year. My parents have both had extensive issues requiring them to need a lot of care, and I've had to change my own PCP and Ophthalmologist. My little window on the world is hardly a scientific sample. But what I have seen is this: 24 months ago, every doctor I saw was grousing about "Obamacare". (And before "Obamacare", they were all grousing about the insurance companies, managed care, Medicare and everything else.) 18 months ago, they were still bitching about "Obamacare" in general, but mostly cranky about having to upgrade their records systems.

But the past 6 months, I haven't met with a single doc that expressed this kind of dissatisfaction. Some of them have mentioned the changes going on, but not really in a hostile way. And every one of the seems to have embraced the vastly improved records systems. It is letting them practice better medicine and spend more of their day with patients. And another thing these systems does is enable the Docs to delegate more tasks to NPs, confident that they can look into the complete customer record at any time.

I'm not saying every doctor is happy, or that any of them are happy being squeezed financially. But overall, I think they have a pretty good thing going right now.