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70% Of Calfornia's Doctors Expected To Boycott Obamacare

Tyler Durden's picture


We need some recognition that we’re doing a service to the community. But we can’t do it for free. And we can’t do it at a loss. No other business would do that,” exclaims the president of the California Medical Association, as The Washington Examiner reports, independent insurance brokers estimate 70% of California's 104,000 licensed doctors are boycotting the exchange. “The Covered California board says we have plenty of doctors, and they allege they have 85 percent of doctors participating, but they’ve shown no numbers," and if a large number of doctors either balk at participating in the exchange or retire, the state’s medical system could be overwhelmed. “Enrollment doesn’t mean access, because there aren’t enough doctors to take the low rates of Medicaid,” warns one health director. “There aren’t enough primary care physicians, period.”


Via The Washington Examiner,

An estimated seven out of every 10 physicians in deep-blue California are rebelling against the state's Obamacare health insurance exchange and won't participate, the head of the state's largest medical association said.


“It doesn't surprise me that there's a high rate of nonparticipation,” said Dr. Richard Thorp, president of the California Medical Association.




California offers one of the lowest government reimbursement rates in the country -- 30 percent lower than federal Medicare payments. And reimbursement rates for some procedures are even lower.




“Some physicians have been put in the network and they were included basically without their permission,” Lisa Folberg said. She is a CMA’s vice president of medical and regulatory Policy.


“They may be listed as actually participating, but not of their own volition,”




This is a dirty little secret that is not really talked about as they promote Covered California,” Waters said. He called the exchange's doctors list a “shell game” because “the vast majority” of his doctors are not participating




“The Covered California board says we have plenty of doctors, and they allege they have 85 percent of doctors participating," notes Mazer. "But they’ve shown no numbers."




Enrollment doesn’t mean access, because there aren’t enough doctors to take the low rates of Medicaid,” he said. “There aren’t enough primary care physicians, period.”




Briscoe professed not to be surprised by the refusal of doctors to participate in Covered California. “It rings true. I’ve been kind of wondering in my head, ‘How are they offering such low premiums?’ ”


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Sat, 12/07/2013 - 17:52 | 4225183 Freddie
Freddie's picture

This is exactly what the Labour Party did in the UK.  These doctors also end up killing people.

They do not care who is running health care.  As long as they are their people that is all that matters.  You will be paying double to get post office like care.  Elections have consequences. F Democrats and RINOs.

Sun, 12/08/2013 - 05:06 | 4226322 Isotope
Isotope's picture

A little news for everyone: they have already done this. I know it by personal experience. Every day that I go work, I spend a lot of time patching up their mistakes.

Sat, 12/07/2013 - 18:27 | 4225277 RaceToTheBottom
RaceToTheBottom's picture

Worked when they applied it to engineers and other technical fields.  Salaries have remained stagnat for decades.

The AMA has shielded DRs from reality and removed the ability to punish incompetence. 

The DRs have brought this on themselves

Sat, 12/07/2013 - 19:14 | 4225382 FredFlintstone
FredFlintstone's picture

Maybe Obama has an uncle who is a doctor who can immigrate?

Sat, 12/07/2013 - 16:00 | 4224897 Argos
Argos's picture

If you need some surgery of any type, do not put it off.  Get it done now.

Sat, 12/07/2013 - 17:58 | 4225205 Freddie
Freddie's picture

Why would anyone junk you after that comment?   You are correct.

Sat, 12/07/2013 - 19:59 | 4225466 RafterManFMJ
RafterManFMJ's picture

Let 100,000 sets of new, augmented titties bloom across the fruited plain!

Sat, 12/07/2013 - 20:19 | 4225516 Miffed Microbio...
Miffed Microbiologist's picture

Real men don't like rubber boobs. Real women love their men as they are and show them how much they are appreciated. This eliminates the need for penis pumps and Viagra in the bedroom. Win for humanity and a loss for big Pharm and cosmetic surgeons.


Sat, 12/07/2013 - 22:26 | 4225775 Mike in GA
Mike in GA's picture

LOL...yeah, 100,000 sets of new  larger-than-a-mouthful rubber boobs are a waste of health care assets.

Penis pumps I don't have problem with, I was born with two manual pumps and a pair of visual augmentation devices connected through my optic nerve to my brain.  Need I bother to mention the olfactory response available from puberty and tactile stimuli all over.

Win for humanity, indeed!  ;)

Sat, 12/07/2013 - 22:47 | 4225814 Miffed Microbio...
Miffed Microbiologist's picture

Uniting all 5 senses is the key to peak sensual experience as well as sharing it with one you love so much. I can't imagine what life would be like without good sex. Keep your apparatus in peak condition and enjoy the rewards! ;-)


Sun, 12/08/2013 - 02:04 | 4226184 Greshams Law
Greshams Law's picture

You make a good point regarding the use of all 5 senses.

I guess I could live without hearing, boobwise.

Sun, 12/08/2013 - 00:22 | 4225994 RafterManFMJ
RafterManFMJ's picture

Check out fat transfer breast augmentation...fat lipoed from where you don't want it, right into where you do. Natural. Humane. No rubber, no silicone, all you, baby, all you.

Sun, 12/08/2013 - 00:53 | 4226070 Miffed Microbio...
Miffed Microbiologist's picture

Well, I am a natural 36D and my dearest has said he wishes no enhancement. The sad thing is the bigger they are the harder they fall and I certainly don't want to kick them as I walk. I may consider a lift when the time comes. In my case, I could use a tad off the hips and upper thigh but I guess it would either go in the garbage or into soap making a la Fight Club.


Sat, 12/07/2013 - 16:03 | 4224912 rodocostarica
rodocostarica's picture

Why does this surprise me? What a fiasco.

Sat, 12/07/2013 - 16:08 | 4224923 stant
stant's picture


Sat, 12/07/2013 - 16:09 | 4224928 johnconnor
johnconnor's picture

doctors just want to keep making over a quarter million a year in Cali on average

Sat, 12/07/2013 - 16:29 | 4224982 Wyatt Junker
Wyatt Junker's picture

And the people who see them value their service as well as their own lives.  If you don't value your life, then you can fucking choose to die when its your turn to have a blood transfusion after a head on collision, getting your body pried out of a car and medvac'd out be helo to a roomful of multi-million dollar machines.  

If you don't want full-service, life saving treatment, then enjoy your medicaid/Obamacare and learn to love the death that is coming.

Sat, 12/07/2013 - 16:40 | 4225003 Calmyourself
Calmyourself's picture

The good ones should make what the market will bear, just cut congressional and bureaucratic salaries in half, plenty of money..

Sat, 12/07/2013 - 17:32 | 4225129 Pure Evil
Pure Evil's picture

I'm sorry, but a quarter of a mil per year in Cali is like making peanuts in Mexico.

Between federal, state, local taxes, and the extremely high cost of living in Cali is there really any money left over to spend?

Sat, 12/07/2013 - 18:32 | 4225288 klockwerks
klockwerks's picture

So move!

Sat, 12/07/2013 - 16:14 | 4224942 Arbysauce
Arbysauce's picture

If this doesn't give rise to a viable small-government party nothing will.

Sat, 12/07/2013 - 17:55 | 4225200 Mike in GA
Mike in GA's picture

Key word viable.  Ain't gonna happen.  Too late, too much damage.  Obamacare will destroy the best health care delivery system on the planet AND THEN force us onto single payer. 

The only way .gov gets smaller is collapse.  How that comes about no one knows but we're workin on it. :)

Sat, 12/07/2013 - 20:11 | 4225488 Arbysauce
Arbysauce's picture

With you on that one.

Sat, 12/07/2013 - 16:16 | 4224946 MedicalQuack
MedicalQuack's picture

This is a big issue in California, and back in November of 2012 I told my readers that Blue Cross would be paying their doctors about 30% less.  MDs who currently were in network with Blue Cross had to send a registered letter to "opt out" otherwise they were opted in.  Just another one of these issues that was there now coming to light.

Blue Shield too had to up what they were paying as well.

Yes MediCal, California's Medicaid as it is called is the worst and lowest paying with on exception, pre natal care, they want healthy babies.  They pay wiell on that and I only stumbled on it finding an MD as client years ago that enlightened me so that's all he did:)  Once baby was born, go find another doctor is the story there.

Doctors struggle to find specialists who will see Medicaid patients here and spend hours and sometimes it's a long conversation on the phone to convince a specialist to make an exception and see the patient, sucks but that's what it is here.  Folks in Southern California are kind of stuck with Molina for one and they are an HMO.  Now the next battle, the hospital that takes Medicaid.  It's ugly out here but it's kind of like Medicare was for years in the fact that the commercial reimbursements made up for the low pay on Medicare but now with insurers and their armies of Quants they have figured out how to use complex contracts and with the formulas and algorithms that calculate, they net pay less than Medicare so go figure.  Medicaid used to ride on those shirt tails too with the commercial insurers paying more, but that math model broke years ago.

Now we have the SGR coming up with the stupid formula that's been broken for 10 years, since it was passed.  So let's now add on the 2% sequester cuts that have been in place since April 1st of this year, one more reduction that is there.  If they don't fix that there's another 20% cut out there, so who in the hell wants to be a doctor anymore you might ask.  I said bring in a couple quants and fix the model, included a screenshot, it's flat out algebra that is used for most business intelligence math models and again insurers are hiring armies of quants as this is beyond where the actuaries go and quant work is tired to profit directly, look at the classified.

But here's an interesting read as the Supreme court gave MDs a tiny bit of relief as they can now group to litigate...prior to this all insurers had contracts for MDs to sign that said they could not do that and United Healthcare ran this up to the Supreme court and you know how much money that cost. They are suing this now with the 2 doctor groups who got a judge to file an injunction against United in Connecticut where United is firing doctors right and left who see Medicare Advantage patients.  Pretty damn ugly.

Ok so let's tack on the possibility of a shut down, well guess what there's more sequester cuts scheduled for next year.  But don't fear United is doing their part here once you go broke and is doing just like the banks with creating low income housing so they can get some of that Social Security check in the form of "rent"..

I live in the OC, the United Healthcare Manifesto and you don't here a lot of kinds words here and they no longer sell individual policies and cater to business policies.  1/3 of their revenue comes from Health IT consulting if you looked at their last reporting.

Interesting in that area as now they want to be the outsourced integrator for 3 of the large medical records systems sold in the US to hospitals.  SEC listed 15 pages of subsidiaries, go look at them and they also have the tax haven in the Netherlands and Minnesota recently was complaining about missed tax revenue citing United and a few other big corporations like 3M shorting the tax bills.  The Netherlands (the Dutch sandwich) is a very popular place for tax havens for those with IP properties and this video, the Tax Free Ride does a good job explaining how it works.  Health insurance has become a pretty scummy business to say the least and it's all math business models.  Watch the 4 videos in the footer of my blog to get educated on a lot of this.

Sat, 12/07/2013 - 18:02 | 4225220 Freddie
Freddie's picture

Blue Cross and United Healthcare are among the most evil.  I loathe Blue.

Sat, 12/07/2013 - 16:36 | 4224994 RaceToTheBottom
RaceToTheBottom's picture

Insurance companies playing this quite nicely.  DRs don't even realize they are being mined.

Sat, 12/07/2013 - 16:36 | 4224996 starman
starman's picture

the Jews fled Egyipt when the Pharaos now  Egyipt flods the USA! were fucked! 

Sat, 12/07/2013 - 16:37 | 4225001 I am Jobe
I am Jobe's picture


Long on Casket Manufacturers

Sat, 12/07/2013 - 16:46 | 4225015 SmittyinLA
SmittyinLA's picture

All my doctors are elderly and quite wealthy, they have the ultimate leverage, they can quit and live off their assets, worst still CA will drive them to Nevada whom has ZERO income taxes too, not only can we NOT force them to work, we lose their tax revenue too.

The CA real estate crater is coming big time.  Nothing like chasing hundreds of thousands of wealthy investor/producer taxpayers out of your state for poor illiterate diabetic illegal aliens to annihilate the economy. 

Sat, 12/07/2013 - 16:46 | 4225019 Parth
Parth's picture

Its fixable, just open H-1 visas for Doctors, 100% it will happen. Manpower shortage has one solution- foreign labor. About time JAMA caved in and allows foreign doctors enmasse.

Sat, 12/07/2013 - 16:48 | 4225021 delivered
delivered's picture

I live in California (San Diego area), have been self employed for the past 20 years, and always had numerous insurance options available. Yes, I received the "FO" letter this year from my carrier so we've been cramming in all our health maintenance procedures before the end of the year and then will most likely go "naked" on the insurance front and pay the yearend penalty. It absolutely makes me sick having to purchase insurance through the exchange which will be more expensive, have higher deductibles, and less access to medical care/service providers.

The constant nightmare that keeps running through my mind is having to go to a medical clinic of some sort with an underqualified and overworked doctor attempting to fit me in their schedule, sitting with a group of people that have never had insurance, are unhealthy, unmotivated, and simply looking to fill their day and leverage the entitlement system even further. Hell, I can't think of a more unhealthy place on a given day.

I would rather take the premiums we're currently paying, set them aside, pay direct with health providers we actually want to use (cash at the point of service which I can usually secure a discount with the doctors), become a more aggressive consumer of health maintenance procedures, and then hopefully find some very high end catostrophic plan. So I'm willing to roll the dice to reinforce a simple concept in America - Freedom! I should have the right to choose my own plan, with specific coverages and not have some bullshit insurance program crammed down my throat. 

BTW, I can't blame the service providers from opting out as they are going to be creamed on so many fronts its scary. On top of having to absorb lower reimbursements, the risk they are going to take with having to provide services to previously uncovered and more than likely, poorer health consumers would really worry me. These are the people that constantly work, leverage, and abuse the system so I can't wait to see how twisted the healthcare system becomes a year or two into this mess. 

Finally, how does the government actually expect to get these newly covered consumers to pay for the premiums? Remember, 20% plus of the US population is non banked. I'm guessing that a good portion of the newly covered consumers are non banked so just exactly do the exchanges and the insurance companies expect to get paid? No credit, debit cards, or Paypal to ping. Forget direct ACH/EFT as they don't have bank accounts. Can you imagine the collection nightmare that will follow. Even if the consumers do pay, has anyone considered the impact on the economy as the premiums are effectively a tax?

The bottomline is that who cares about whether the website works or not as this is just a small pot hole on the road to hell. There are so many logistical, operational, risk, etc. issues coming down the road that nobody has any idea how badly this could implode. But why would we expect anything different from the government other than complete FUBAR as there's not a business mind to be found anywhere in Washington. Only politicians and a bloated government trying to figure out how to ensure their voter base for the next elections are secure (translation for the Democrats - Increase the junkies in the entitlement crowd along so they will never bite the hand that feeds them).

So my advice to all is very simple and comes down to three simple concepts. First, there has never been a more important time than now to get healthy (change diets, exercise, etc.). Second, vote with your choice and tell the government to FO by not buying this crappy insurance. Third - Don't Get Sick! 


Sat, 12/07/2013 - 18:34 | 4225292 RaceToTheBottom
RaceToTheBottom's picture

Smart words.   Own your own health.  Research on the web.  Take responsibility for yourself.

Regardless of the insurance plans or whether you go nakid, you will be better off.

Sat, 12/07/2013 - 19:05 | 4225363 FredFlintstone
FredFlintstone's picture

Right on, brother. I wish you well. I work for a large employer as a well-paid wage slave, but we may all be where you are soon with respect to insurance. Sitting in a waiting room with Walmart people? Give me a cyanide pill. 

I wonder if foreign insurers could get in the game with a catastrophic insurance product. The US really fucked itself with the ACA. Medicare/Medicaid may sink us soon anyhow.

Sat, 12/07/2013 - 21:25 | 4225657 roadhazard
roadhazard's picture

"..sitting in a room with wallmart people."


and how is that different than it's ever been.

Sun, 12/08/2013 - 03:12 | 4226266 delivered
delivered's picture

Thanks for all of the comments and up votes on my rant earlier today. After running some errands today and thinking about it a little more (over my two glasses a day of red wine which I believe is still considered good for you), I wanted to pass along two other thoughts to the ZH community. 

First, I'm a huge fan and supporter of small businesses in this country. Always have been and always will be but the ACA is just another deterent thrown in front of pursuing what use to be the American dream (of starting a business). The pressure to secure insurance will deter people from starting a business given how poor the choices are (from the exchanges). People will be "swayed" towards sticking with job opportunities in larger companies that offer much better insurance programs. Even if someone elects to start a business, they will experience a "brain drain" as on top of not being able to offer competitve wage, vacation, etc. packages to the employees, candidates will be more inclinded to drift towards larger companies with stronger health programs rather than take added risks in small businesses. Just add another nail in the coffin of small businesses as if they don't have enough challenges already, then this one will simply be the final straw that breaks the camel's back. 

Second, if you really want to address health insurance in this country it's simple. If you smoke - Stop! If you don't exercise - Start! If you are overweight - lose it! And if you have a poor diet - Change it! I know I'm preaching to the ZH choir on how easy this really is but I think we tend to forget about just how large the "entitlement" population anchor is on America. I believe America is about to see just how big this anchor is once the entitlement crowd is provided another method to, as the old saying goes, "Why buy the cow when you can get the milk for free".

Signing off now from California and what will surely become the ultimate proving ground for just how flawed the ACA really is. 

Sun, 12/08/2013 - 10:57 | 4226535 FredFlintstone
FredFlintstone's picture

I had similar thoughts about ACA really giving one more advantage to the industry giants in all sectors. Although I currently work for a company with 60,000 people, I have worked for a tiny firm before and have toyed around with heading to a small firm or even expanding my moonlighting gig to a full time venture. During the ACA debate (if you can call it that) and just after it became law I had heard the argument that it will encourage the inner entrepreneur in people by allowing them to go  out on their own without fear of finding insurance. At the time it seemed plausible, now it is laughable. You would need to be even more capitalized now to go out on your own if you needed to purchase a health plan. Add to that all of the uncertainty. That small venture trying to lure staff from the large company now has more to overcome in trying to sell the dream to them. 

Most families are dual income these days so as long as one earner has the job with the big organization, the other earner can still experiment with their employment for the time being. I sense that soon the field may be leveled though. My wife just got a job with a large (28,0000) healthcare organization so I switched our health plan over to hers. She was notified that the cost to insure spouses will start to climb. I can see large employers making it real expensive to keep spouses on the plan especially if they have access to a plan where they work.

We have all read where even employees of larger companies may see their plans cancelled. Not sure what to make of this, but my sense is that if a company is positioned at the top and wants the "A" players, it will need to invest in their health plans to retain the employees and their position. 

We may end up with almost a black market here in the USA before long. Pay cash for good, quick care vs. all of the Gov programs (medicare, medicaid, obamacare).






Sat, 12/07/2013 - 20:26 | 4225525 starfcker
starfcker's picture

i feel like a cheerleader today. all i keep doing is upvoting great posts. that's right on the money, delivered and RTTB

Sun, 12/08/2013 - 05:03 | 4226321 FreedomGuy
FreedomGuy's picture

Very well written and thought out, Delivered. You are seeing it from another side. The bottom line is that the Democrat-statists have no idea what they have bitten off. They wandered into something and like a Chinese finger trap they cannot pull out.

Here is one other part (of many) that will be pure hell. The cash market and working with your doctor will become illegal. Why? Because you MUST purchase government mandated insurance. That means all transactions must be conducted under that umbrella. You will pay a lot of cash but you will simultaneously have to pay for insurance meaning you actually pay to buy virtually no coverage. Look at the prices and huge deductibles.

The bottom line is that most all of productive America will become criminals as they opt out or ignore the whole program. That sets the stage for things we don't want to think about.

Sat, 12/07/2013 - 16:56 | 4225053 mjk0259
mjk0259's picture

Doctors have been saying this since Medicare started decades ago. Their average income rose throughtout the whole period and remains at 5 times median household income. Mine charges $140 for a visit which is usually two minutes with a nurse and two minutes with him. The insurance rate is $70. Still about $1,000/hour gross. In most other countries, doctors make about the median income.


Sat, 12/07/2013 - 17:27 | 4225117 Solarman
Solarman's picture

Totally misleading statistic.  Most primary care doctors make low $100,000 take home, and then they are paying off massive student loan obligations into their 50's for some.  I was charged 2,000 to be hooked up to a ekg and bp sleeve for 4 hours, and 5 minutes with a ER doc. Really?


Now that everyone is covered we must focus on Hospital costs, appropriate vs defensive care, and get the lawyers out at the same as we boot out insurers and the government.

Sat, 12/07/2013 - 21:28 | 4225659 roadhazard
roadhazard's picture

yeah, I feel so sorry for doctors. One stitch costs $500.00.

The COST of health care is not addressed because the repubican'ts and democraps are bought off.

Sat, 12/07/2013 - 22:14 | 4225747 Eugene9876
Eugene9876's picture

Again, hospital and physician costs are completely different schedules. These ridiculous prices are generated by hospitals and large health care systems. $500 is the hospital fee. Re-read the NYT article

Sat, 12/07/2013 - 20:15 | 4225502 johnconnor
johnconnor's picture

Healthcare in America is another big racquet, like education, Wall street, etc... surely the ones that make the big bucks are insurance companies and hospital managers but the doctors in America make like 2-5 times what they would make anywhere else on the first world. It was never a profession to get wealthy except here.

Sat, 12/07/2013 - 21:15 | 4225503 johnconnor
johnconnor's picture


Sat, 12/07/2013 - 17:17 | 4225096 Jack Burton
Jack Burton's picture

American health care is so complicated and lacking in sense that it is hard to know what to make of a story like this. I suspect that insurers are sqeezing providers on how much they will pay for care, like Medicare. The sqeeze on providers will only get worse. Care is getting more and more expensive, the private health insurance industry grows larger and more costly by the minute. Very profitable, every sick American pays a huge tax to the insurers. This fact nobody sane can deny, it is a provable fact.

The problem is each person can almost require an unlimited amount of care before death. Eaxh person who dies, meaning all of us, will cost a fortune to pass away. Nobody wants to confront this.

Sat, 12/07/2013 - 18:55 | 4225340 FredFlintstone
FredFlintstone's picture

I totally agree. I think many hospitals and certain doctors see the elderly as ATMs. I have heard it said that 80% of our HC dollars in the US go to end of life care. I know that hospitals play games in where they put patients to jack up their reimbursement rate. With Medicare and Medicaid we have a tradegy of the commons on a grand scale. 

A related story: My wife is a nurse and and got an 85 year old lady admitted that really had nothing wrong with her. Her son said she has been coming in to the hospital every thanksgiving weekend for a number of years. Basically looking for some attention. If she had to pay for more of the cost perhaps she would not be doing this. 

Sat, 12/07/2013 - 18:28 | 4225133 Hongcha
Hongcha's picture

Thank you ZH for providing More Chicken Soup for the Soul.

I am rarely occupied with the schadenfreude and odium I am feeling towards this bloated pig of a ginned-up tax scam.

I am thoroughly enjoying watching it crash and burn.  And we are just getting started.  The churn of the inevitable nationwide, catastrophic data clusterfux have not started yet.

It's like, just appetizers so far; but soooo good you know the following courses with be wonderful.

Carry on brethren.

Postscript: Gov. Brown is a handlicking career policitician, son of another one; who has known nothing in his life outside the bubble of privilege, entitlement, duplicity, word-magick and licking the hands of power when told to do so, on cue.  He is a miserable bootlicking mandarin.

Sat, 12/07/2013 - 17:49 | 4225175 ncdirtdigger
ncdirtdigger's picture

you have to be willing, and ready, to tell people to go fuck themselves. Do it your godamn self if you don't like what I charge.

Sat, 12/07/2013 - 18:10 | 4225231 adr
adr's picture

The point is there needs to be balance. Medical care used to be affordable, it isn't anymore.


Sat, 12/07/2013 - 22:55 | 4225829 realitybiter
realitybiter's picture

I'm so confused.

When I was born in 1960 my mother's hospital bill was less than $200 for a four day visit to the hospital (I came out strong, like bull) and yet, somehow, for that hundred and something bill, the doctor lived in one of the nicer homes....and he was a great citiizen, too.  A real friend.

Folk, need to pull their collective heads out of their collective asses.  Our healthcare system is corrupt to the core.  Regulations are merely opportunities to monopolize and gouge....take Obamacare.  Why would the insurance companies not cooperate?  Mine just got $500 more a month and provides no more!  And big pharma?  Oh,theys lovin' it!!  But price controls on doctors?  Good f-in luck.  

Wake up numb nuts!!  You are living in the soviet union of the 70's.  You will wait in line, overpay, and then break your teeth on that shitty loaf of bread that the baker makes no money on (hence stale)....

but hey.  you won.  your guy got you insurance.  Enjoy your shitty bread....or pull your head out.  Face facts.  

you messed up.  You trusted him.  Please attempt to learn.

Sun, 12/08/2013 - 00:14 | 4225976 PGR88
PGR88's picture

If health-care isn't the best example of big-government central-planning (and paying) it into oblivion, I don't know what is

It seems the American Left won't be satisfied until they turn the USA into Cuba or Zimbabwe.

Sat, 12/07/2013 - 17:55 | 4225194 AU5K
AU5K's picture

In the soviet union, doctors were nationalized and earned basically the same wages as everyone else.  They were expected to perform their services for the good of the country and not expect any extra pay for their skills, education or life saving talent.  Sadly it appears that is where we are going.

Sat, 12/07/2013 - 19:08 | 4225372 Mike in GA
Mike in GA's picture

It may appear that we are going but we will never get there.  Not in my lifetime or the lifetimes of all those alive today who have breathed as free men. 

The USSR, in your example, went from monarchial, feudalistic, slaveholding government of minimal subsistence level to the Bolshevik revolution to Stalin in less than 10 years.  The Great Butcher institutionalized the "Comply or Die" method of motivation and the rest is history.   In their case, I'd rather be a live doctor working for a menial wage than a dead doctor helping no one. 

Our doctors today enjoy a state of the art that is decades and generations beyond anything in 1920s Russia.  Our guys could not function without the many complex systems that have become the envy of the world. 

Should some .gov asshole, at any level, decide Soviet style care is what we must do, millions would die from its absence.  Included in those millions, I hope, would be the enlightened .gov assholes, at any level, who started it.

Sun, 12/08/2013 - 05:16 | 4226329 FreedomGuy
FreedomGuy's picture

You seriously want to use the Soviet Union as a model? In the old USSR doctors made less than an executive secretary for politburo members. You like that, too?

Sat, 12/07/2013 - 18:00 | 4225208 Reaper
Reaper's picture

Are Obama's and Gov.Brown's police going to make doctors treat these patients? In my State, the difference between Medicaid and Medicare is 20% and all the local doctors see Medicaid patients for only a part of one day per week. Most of the enrollees at Obamacare website are into Medicaid. More Medicaid patients + less doctors = longer waits and delayed or denied treatments. WTSHTF, even the Medicaid rabble will turn on Obama.

Sun, 12/08/2013 - 00:20 | 4225988 PGR88
PGR88's picture

Its too late for California.  They have millions of citizens whose political and economic reference points are life and politics in Oaxaca and Tegucigalpa.   They will choose the first guy who promises them free shit, and they will wind up with Hugo Chavez, Venezuela, and a Vice Ministry of Supreme Social Happiness.


Sat, 12/07/2013 - 18:01 | 4225211 adr
adr's picture

All I hear anymore is how doctors and hospitals can't make any money anymore. But all I see is new medical centers being built all over the place and breaking ground for new expansions everywhere else.

If a hospital can't make money, how can they keep building?

When it costs $1800 to stitch a finger, $5000 to put a cast on a fracture, $200 for a Tylenol, how can the hospital not make any money?

 Sure a doctor might only get $50 for the welfare queen going to the ER for a headache, but its not like it takes any work to diagnose the bitch. 

If I have to go to the doctor it is just to get some antibiotics for an infection. It takes about five minutes and the doctor gets reimbursed $110 for the appointment. $110 for ten minutes is a pretty good rate of return for something that took no effort. My wife is required to go to the doctor every six months to get her asthma medication renewed. There isn't even a medical evaluation done. Just a hello and an electronic renewal of her prescription.

A clinic near me charges $80 to administer a flu shot. That takes about fifteen seconds. 

Perhaps doctors shouldn't believe they deserve to get paid as much as they do. $350k to work an MRI machine. $125k for a nurse practitioner. Sure pay a surgeon $200k, but someone that amounts to nothing more than a paper pusher isn't worth $125k.

Sat, 12/07/2013 - 18:43 | 4225308 RaceToTheBottom
RaceToTheBottom's picture

Over 200000-400000 deaths a year are due to preventable medical mistakes performed by medical professionals.

I guess they get paid so much cause the do so much good work.....

/Fucking large SARC

Sun, 12/08/2013 - 00:57 | 4225783 Miffed Microbio...
Miffed Microbiologist's picture

May I suggest to you to do some research into the efficacy of flu shots. You may be astounded to find how ineffectual they are. Plus injecting your body with mercury, adjuvants and other chemicals you do not need for longterm health. Think about it. How do you catch a viral infection? By touching mucus membranes. This is how the bodies immune system is initiated. Injecting antigens intramuscularly causes a potential reaction to ALL substances present. Therefore unforeseen reactions can occur. I had a violent reaction to a flu vaccine that made having the flu look infinitely preferable. There I just saved you $80.

Now, address the need for your wife to have asthma medication in the first place. I was a severe asthmatic for 25 years. I had 2 puffs of albuterol every four hours 24 hrs a day for 25 years ( plus other preventative steroids to help prevent attacks) I had at least one severe pneumonia a year. I went on a crusade to cure myself. In the last 5 years I've had no asthma and am on no meds. You have a choice. I listened for years to what modern medicine told me was good for my health. All I got was sicker and with more prescriptions. I finally got the courage to tell them to fuck off and tried to find an alternative way. Take control of your own life and be amazed where it leads.


Sat, 12/07/2013 - 23:28 | 4225886 malek
malek's picture

So these new medical CENTERs are built and owned by the doctors?

You should get your preconceptions readjusted.

Sun, 12/08/2013 - 00:47 | 4226049 bunnyswanson
bunnyswanson's picture

Large hospitals in communities are consolidating - buying out small rural hospitals and closing them down, then building/adding to their own structure.  It's becoming a monopoly.  Hospitals are said to have begun hiring doctors to work within these medical institutions, so doctors are getting paid by hospital, closing their own offices.  There are articles about this on line.


Doctors spend a lot of time dictating reports, talking to other physicians about their patients, reading investigative studies (lab data, radiology studies), coordinating care.  It is more than just what you see when you visit him.

Sat, 12/07/2013 - 18:13 | 4225237 Randoom Thought
Randoom Thought's picture

Pretty sure there is plenty of money for doctors and that the doctor patient relationship would be better if they were able to get insurance companies, lawyers and big pharma out of their way so that they can do their jobs and take care of patients.

Sat, 12/07/2013 - 18:41 | 4225312 RaceToTheBottom
RaceToTheBottom's picture

Add the AMA to that statement.  The AMA has coddled the DRs for decades

Sat, 12/07/2013 - 22:16 | 4225756 Eugene9876
Eugene9876's picture

Very few doctors participate in the AMA. The AMA is an organization that makes the bulk of its money off shuffling and re-shuffling diagnosis ICD-9 and ICD-10 codes, which most doctors want nothing to do with.

Sun, 12/08/2013 - 22:42 | 4228152 Boiling Frogs
Boiling Frogs's picture

17%. 17% of physicians are members of the AMA. My guess is the vast majority if that 17% are in academia plus residents and medical students. I was a member when I was a student and resident because it was FREE and you got the monthly journal (worthless), some other schwag like a textbook and ink pens. Granted medical students aren't yet physicians but I imagine they're included in the head count anyway.

Sat, 12/07/2013 - 18:15 | 4225248 Son of Loki
Son of Loki's picture

What doctor would want to practice in Fuki-Saturated Kornifornia where the lifeguards and Tiny-Town Mayors are paid more then family practice doctors from what I've read.

Mon, 12/09/2013 - 01:22 | 4228465 Freddie
Freddie's picture

LOL!  So true.  Tiny-Town Mayors.  LOL!  The worst was that small town. Bell, CA or something.  They had a population of about 3,000 and city manager was making something like $540,000 a year.    Insanity.

Let's hope Nancy Pelosi's Nor Cal wine vineyards gets lots of Fuki-MOX love.

Mon, 12/09/2013 - 02:30 | 4228574 zebrasquid
zebrasquid's picture

Us San Diegoians are glad that the rest of the country, currently enduring sub-zero early winter, so misunderstand life here.

Sat, 12/07/2013 - 18:28 | 4225283 Duude
Duude's picture

The Federal government never thought to ask doctors what they felt about this. What government doesn't seem to understand is besides the high cost of malpractice insurance doctors have to pay perhaps another 1/3 of their revenue towards collecting from both insurance companies and the government. Now Obamacare is adding an additional dimension. If an individual stops paying his monthly premiums, he's still covered for 90 days after his last payment. The first 30 days the insurance company eats and the remaining 60 days is left to the doctors to collect from the individual. Besides having to deal with this it creates a new level of moral hazard because an individual can pay for the first 9 months of the year, get covered for all 12, and reapply to another insurance company the next year. This what happens when lawmakers are allowed to design 1/6th of the US economy with legislation.

Sun, 12/08/2013 - 00:44 | 4226042 bunnyswanson
bunnyswanson's picture

Malpractice insurance in California isn't what it used to be.  The law has changed.  The price is cheaper for malpractice insurance (affordable).  If I recall, to win a lawsuit, you must be dead and the reward will go to children and the amount of damage has been contained. 

Cancer patients will die sooner under ACA - If abnormality is found on a diagnostic test (x-ray), return for follow up of this finding is "in 1 year."  One year is a death warrant when tumor is high-grade cancer cells.  "Studies have found that early detection does not extend life." 

Sat, 12/07/2013 - 19:23 | 4225402 Advoc8tr
Advoc8tr's picture

Just an obseervation as I am not American but "it is the insurance companies stupid !  How it can cost so much for healthcare over there is beyond most of us. Your doctors aren't generally better than any from our or other western countries and from the comments above they aren't all rich either - where does all the money go then ?

We have had a single payer system here for more than my 40 yrs and it works great ?  A few grand a year rolled into your annual tax return (so it usually get's covered by a portion of your tax refund)  Our GPs are upper middle class, surgeons comfortably so but Doctors are not all millionaires. They are highly respected by most in society and most kids "wanna be a doctor when they grow up"

No one is ever refused any kind of medical care and you only pay full amount for elective stuff like cosmetic and the "top up" which is maybe $30 for a standard consultation. In fact until the insurance lobby finally got its way a decade a go medical care was completely free as most doctors would not charge above the amount proscribed by the gov even though they could.

It has worked for ages, been copied by the UK and others and has not caused any significant blowouts in deficit - we actually used run genuine surpluses not so long ago ?

Finding yourself bankrupt or dead because you have an accident and require medical help is worry you can do without.

Boils down to a single large non-profit insurance scheme run by the government and is evidenced to work long term if done right. It is regualry touched on for change by pollies who owe the insurance companies a favour but they quickly go to zero in the polls so is considered sacred turf generally.

PS.   As a very large buyer our gov gets medicines from companies in USA at a pittance to what they retail to you for .. so they must be charging massive markups to you ... they voluntarily submitt much lower prices to our PBS board who decide what pharmaceuticals gets covered etc ? Single large buyer has more pull.


Sun, 12/08/2013 - 01:49 | 4226168 rustymason
rustymason's picture

@Advoc8tr, Our health care was the best in the world by far and was very inexpensive before the government became involved in helping us pay for it. Our new "elites" forced on us the socialist system you advocate and this is the result.

Sun, 12/08/2013 - 02:14 | 4226194 DeliciousSteak
DeliciousSteak's picture

Socialist? America has fascist healthcare. It is run by the insurance companies and the racket is protected by the government.

Sun, 12/08/2013 - 05:38 | 4226340 FreedomGuy
FreedomGuy's picture

Your European healthcare is heavly subsidized by the USA. The reason is that when companies develop anything be it a new MRI machine or medicine they all have their eyes on America as the primary market. Historically they have a bigger market and can make enough money to play ball with the autocratic systems in Europe. Tell me where most of the innovations in medicines have come from for the last 50 or 60 years? Yup, America like most innovation. Your light socialist systems are actually the side game for most anyone who wants to innovate in medicine. All those horrible prices you mention you might note are from nice European pharmaceutical companies. Your nice countries will seize patents if they don't like the price. They also now mandate one price, lowest price or price match of other countries without regards to differences.  

I see many talking about $500 for a stitch and lots of other things in America. There is a listed price and there is the true reimbursement. The true payments are far lower. Plus, when you pay your doctor you are also paying his medical assistant, the receptionist and several admin people you don't see who do all that nasty billing and fighting with your insurance company or the government. when you go to a doctor (in the USA), get a blood draw and a simple prescription you involve a dozen people with various levels of training to get all those "free" things for you and then fight the lawsuits you will launch if you don't like the result. Is anyone besides me incredulous at 2000 page bill that has not a sentence on tort reform? Lawyers, as usual remain untouched. BTW, about 2/3 of Congress is lawyers. Your OBG pays thousands each month just for legal defense.

There is another nasty secret the U.S. government is about to learn, too. That expensive private market has been subsidizing the government for decades. What happens is that doctors, hospitals, nursing homes and others can make enough in the private market to take the lousy reimbursements of the government. Even before ACA doctors limited the amount of medicare they would take and many take zero Medicaid. You can tell a medicaid clinic immediately when you walk in.

For those of you who still think realize what I am positing. Your private American insurance has always subsidized the U.S. government market and even indirectly subsidizes Europe and other countries. America has set the pace in all areas of medical innovation and led the world. We pay Cadillac prices because of the free riders and because we want premium healthcare.

There are reforms that could have been done but they would have been in the opposite direction. They would have to be in the direction of freedom and free, not controlled markets. ACA has just blown those possibilities out of the water. Where I will agree with Advo on is that we could have simply copied some European models that are at least tested, but then Obama and the lefties would have to have been honest about their goals. That would not have passed.

Sun, 12/08/2013 - 07:50 | 4226388 Eugene9876
Eugene9876's picture

Exactly. Prior to ACA the insurance companies received direct subsidies (via Medicare) that presumably offset the cost of the private insurance plans. ACA stripped that subsidy, so regardless of the new insurance features, this should drive the cost of private insurance up

Sun, 12/08/2013 - 11:13 | 4226563 scaleindependent
scaleindependent's picture

I'm curious.

What country are you from.

Sat, 12/07/2013 - 20:22 | 4225521 kchrisc
kchrisc's picture

Government control of doctors and their careers in 3, 2, 1...

"Sorry doc, you can't retire/stop/quit. You are required to keep doctoring until we say so or you die--for the good of the nation."


"Is it time for the guillotines yet?!"

Sun, 12/08/2013 - 22:53 | 4228185 Boiling Frogs
Boiling Frogs's picture

No it will more likely be...
"Dearest Dr.,
Going forward in order renew your state license you must accept all Medicare and Medicaid patients."

Mon, 12/09/2013 - 00:42 | 4228400 kchrisc
kchrisc's picture

"Winner, winner, chicken dinner!"

Sat, 12/07/2013 - 22:32 | 4225789 NihilistZero
NihilistZero's picture


So with everyone either unemployed or losing their insurance and moving to Medicaid, where do these doctors expect to find patients? They better get used to less compensation because their aren't enough 1%ers to keep them in business.  Demand for medical services is high, but demand for those services at the rates these doctors want to charge is quite low.  Welcome to the multi decade deflation Doc...

Mon, 12/09/2013 - 12:30 | 4229295 VinnyTheBlade
VinnyTheBlade's picture

They don't need 1%ers.....right now when a doctor that accepts insurance charges $150 for an office visit....they might actually collect $90...and out of that, they have to pay for 2 or 3 full time people who shuffle insurance paperwork back and forth. If the doc goes to no only, and eliminates these employees, they can just charge $50 cash for a visit, and have fewer headaches. This is what is going to happen. People unwilling to pay the $50 cash for an appointment, will simply wait 6 months or more for a routine appointment(if they can even fnd a doctor willing to take their crappy medicaid), or sit 8 hours in the ER waiting to be seen. The majority of doctors that stay in the system and participate in these dubious insurance exchanges will be the crappiest of crappy doctors. The smart ones will go to cash only, or retire.

Sat, 12/07/2013 - 22:52 | 4225821 jpc578
jpc578's picture

How will the California legislature respond if these doctors go on strike and boycott the exchange? They will pass legislation that will require doctors to accept Medicaid and Obamacare exchange insurance plans. If the doctors retire as a result, the legislature will make a law that requires doctors to stay on the job. California will respond with their version of Directive 10-289. It’s the only way to make healthcare a “right”.

Sun, 12/08/2013 - 01:40 | 4226157 honestann
honestann's picture

Yes, and when everyone, including braindead liberals realize the consequences of their actions?

They will demand the most predatory authoritarianism the world has ever seen.

Humans WILL NOT admit their corruption.  They would rather die, and they will.

Except, of course, the top-level predators-that-be, who always win no matter what, because the cops work directly for them, and will round up any doctor they want who still resides in their fictitious nation.

Sun, 12/08/2013 - 00:09 | 4225967 PGR88
PGR88's picture

Let's hope the whole fucking thing collapses.


The USA needs a major re-set like an Enema on an overweight drug-addict.

Sun, 12/08/2013 - 01:30 | 4226138 rustymason
rustymason's picture

Most of the doctors I have met, save the two I have now, are complete liberal dipshits -- selfish to the max. They know exactly zero about economics and have always advocated more government interventions to solve any problem, especially medical issues. I wonder if they are beginning to sense something.

Sun, 12/08/2013 - 01:36 | 4226148 honestann
honestann's picture

DOCTORS:  Quit.  Retire.  Go on strike!

Mon, 12/09/2013 - 06:43 | 4228729 aicohn
aicohn's picture

Going on strike ain't an option.  Government will use RICO, etc. to bust it.

And it wouldn't surprise me at all to see the government require doctors to accept obamacare as a condition of licensure.  I think MA does that for their state insurance already.

Early retirement is the route many will take, given the aging of the medical professional population.

Then america will be in a world of hurt with no doctors.

Sun, 12/08/2013 - 01:51 | 4226167 slightlyskeptical
slightlyskeptical's picture

How can this not be total bullshit? Obamacare is run by private insurance companies. Obamacare does not dictate what these insurers pay the doctors.

I hate Obamacare but this is just plain bullshit.


Sun, 12/08/2013 - 05:36 | 4226233 honestann
honestann's picture

EXACTLY...  Medical care will be run by predators-DBA-insurers AND predators-DBA-government.  And you think doctors don't know insurers intend to take 80% of every dollar paid, load doctors down with unlimited paperwork (as they already have, in cooperation with government), refuse to pay many claims, and refuse to allow doctors to deliver appropriate care?

Nah.  Doctors know what is coming.

Sun, 12/08/2013 - 06:33 | 4226357 pupdog1
pupdog1's picture

Obamacare was engineered and written by the useless middlemen insurance whores, and it is doing exactly what they designed it to do. They greased the palms of our congresswhores, who haven't even read the thing.

What Big Insurance didn't calculate is the massive national revolt that will arise against them when this thing really implodes--it hasn't even started to implode yet.

Americans are going to start dying from Obamacare due to cancelled policies replaced by policies that are four times more expensive, jammed up their ass at gunpoint by Obama and congress, when they could barely afford their old basic policy. Hundreds of Americans will die, and then thousands, because they simply can't afford the Stasi's demand. If you're in the middle of cancer treatment when you're dropped, tough luck.

And any greased congresswhore who supported this fascist crap--and they are all on the record--will soon realize that there is no longer a future in politics for them. This is an extraordinary national disaster.

A guy I know once said "Five bucks is a lot of money of you don't have it."

Sun, 12/08/2013 - 12:01 | 4226655 DosZap
DosZap's picture

If you're in the middle of cancer treatment when you're dropped, tough luck.


Yep, AND if you go to the press with it, the D.C machine sicks the IRS on your ass,sad as hell,but just happened.


Sun, 12/08/2013 - 03:01 | 4226254 GumbyMe
GumbyMe's picture

Nah, all the doctors need is a good incentive to comply.

Get onboard or lose your license.

Mon, 12/09/2013 - 10:36 | 4228989 jkjacksonhole
jkjacksonhole's picture

They could just demand cash for services up front.

Sun, 12/08/2013 - 09:32 | 4226447 lindaamick
lindaamick's picture

This article does not specify by what means California doctors will boycott Obamacare. 

The most likely boycott seems to be that doctors will refuse Medicaid patients but this is not stated.

For non-medicaid patients that have signed up via Obamacare, the doctors will have no way of identifying them as these people will be using the same carriers as non-Obamacare people and institutions.

Tue, 12/10/2013 - 10:18 | 4232185 VinnyTheBlade
VinnyTheBlade's picture

The plans in the exchanges have much higher deductibles than people are used to now. People are in for a rude awakening...especially if they need to schedule a surgery or some other expensive procedure. Doctors have people that usually review the insurance people have before they will schedule procedures. If it isn't an emergency, once they see that the insurance isn't up to snuff...they will not be willing to provide the service without significant up front payment.

Sun, 12/08/2013 - 20:50 | 4227857 SeattleBruce
SeattleBruce's picture

"But we can’t do it for free. And we can’t do it at a loss. No other business would do that,”
Terrorists, right? Or so deemed by the obammunists.

"Enrollment doesn't mean access."

Mon, 12/09/2013 - 06:36 | 4228725 aicohn
aicohn's picture

Obama has a great deal for doctors.  Twice the work, half the fee.  Make up for it on volume.

"If you like your patients, or even if you don't, you get twice as many.  Period.".

Now, that's the only promise he's made that I do believe.

Mon, 12/09/2013 - 06:37 | 4228726 aicohn
aicohn's picture

Next Obama will declare doctors to be enemy combatants and he'll be targeting them with drones.

Mon, 12/09/2013 - 10:34 | 4228984 jkjacksonhole
jkjacksonhole's picture

The only good thing coming from Ca these days maybe a medical boycot of Obamacare by Ca Drs.

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