I can't help but weigh in here, although I know very little about the entire process.
The main reason we get screwed over is because we LET ourselves get screwed over. Do you think the lawyers we keep referencing would allow the government to make them go through 3rd party payers? And, yet, we have more leverage than any "business" in America. Our organizations such as the AMA, AAFP, AAP, etc. are already organized and could easily lobby on our behalf. But, they don't. My local medical society has four barbaques per year and sends out email invitations. That's helpful
And, before someone tells me that if we "went on strike" and didn't accept Medicaid, etc., it would be considered illegal, I would still before it. We are not public or civil employees. At least not most of us. I doubt it would take a week to force the insurance companies to sit down with physicians to negotiate reimbursement. What incentive do they have now? None, except as John says, it will collapse one day.
The other reason the situation is due to the fact that the law makers truly don't understand the problem. Which is why when they try to fix it they won't be able to. Yes, the lawmakers may not care, but I am willing to bet if they knew the reality, a lot more would try to actually help primary care. Let me give an example, and I apologize in advance if I am patting myself on the back. But, I think it is a powerful example.
In my state, beginning January 1, the state no longer covered vaccines for non VFC children. VFC = Vaccines For Children and to qualify you basically had to be Medicaid or unable to pay. Physician's offices were forced to purchase a second supply of vaccine to keep on stock to give to the privately insured patients. They then had to bill their insurers. Well, you can see the nightmare. I emailed every single representative and senator. Nothing happened. I then talked to someone about it who happened to know the governor. I got a call the next day from the governor. He talked to me for over 15 minutes, and the rest of my day was spent talking to DHHS and Medicaid and the immunization councils from my state. Two days later, he proposed $2,000,000 to allow universal coverage for all children in my state. It still needs to be approved. I am testifying before the house and senate committees this week. I was told by one of the higher ups in the immunization councils that all this happened because the governor had no idea this took place.
I am willing to bet that very few congressmen and women know the true plight of primary care physicians.
