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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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.

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.

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

FredFlintstone's picture

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

Argos's picture

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

Freddie's picture

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

RafterManFMJ's picture

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

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.


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!  ;)

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! ;-)


Greshams Law's picture

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

I guess I could live without hearing, boobwise.

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.

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.


rodocostarica's picture

Why does this surprise me? What a fiasco.

johnconnor's picture

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

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.

Calmyourself's picture

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

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?

Arbysauce's picture

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

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. :)

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. 


Freddie's picture

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

RaceToTheBottom's picture

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

starman's picture

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

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. 

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.

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! 


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.

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.

roadhazard's picture

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


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

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. 

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).






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

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.

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.


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.

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.

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

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.

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.

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. 

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.

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.

adr's picture

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


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 service...deal!  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.