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#11
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First of all, Medicare and Medicaid are not the same program and should not be lumped together, in the same way that Social Security is not funded the same way Medicare is, and should not be lumped in when discussing gov't debt (are you hearing me, mainstream media?). Medicare is a federal funded program for the elderly and certain long-term disabled people and Medicaid is shared between the federal and state gov'ts to provide care for the poor. Reimbursement for doctors is generally not great with Medicare, however, reimbursement rates for hospitals are generally pretty good. Most hospitals would have to close without Medicare patients. The breakdown of where Medicare money goes is: Acute care hospitals: 48% Physicians: 20% Home health: 9% Outpatient services: 8% Skilled nursing home care: 6% Hospice care: 1% Admin overhead: 0.7% Profit: 0% So, taking a dentist's opinion on Medicare as the complete truth is a rather limited sample size and I suspect would not get you a passing grade in a statistics class. And again, it's not the same thing as Medicaid and many doctors take Medicare and won't take Medicaid, of which only 6% of the money goes to doctors (25% goes to nursing homes and 19% to inpatient hospitals, 10% to home health care, to give you some frame of reference). Medicare also reimburses teaching hospitals at a higher rate, so in fact, many doctors have their education partly subsidized by Medicare. The big issue with Medicare reimbursement rates, if we're talking long-term reduction of costs, is that more specialized procedures get reimbursed at a better rate than basic services. So, if it's harder to find a GP who accepts Medicare, you're more likely to put off getting care until something that might have been minor, becomes major. And this is a very, very important point. Our current system essentially penalizes people for tending to water dripping through the ceiling, but pays up when the roof finally collapses from years of accumulated water damage. Requiring insurance companies to cover wellness visits will save them and us money in the long run. The shortage issue is not doctors entirely, it's GPs specifically. Lord knows it's not dentists. GPs are the ones who need to be recruited. In my perfect world, the gov't would subsidize tuition, in return for a certain number of years of work in underserved areas. I have a relative who got her midwife certification under a program like that- tuition paid for; in return she works in inner city facilities for 5 years. Make tuition affordable and you'll see people eager to become doctors.
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