When Doctors Opt Out

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Last week, I published an oped in the Wall Street Journal where I pointed out that extending health insurance (especially with a government option) to the entire population would be problematic unless the problem of doctors opting out of insurance under the current system is addressed.

In other words, health insurance doesn't automatically mean health care, especially if you lack the caretakers to accept it.

This oped produced a firestorm of responses, from letters to the Journal to hundreds of responses to the WSJ blog which published an abbreviated version, to hundreds of emails to my personal account. I discussed my oped on Fox News and Fox Business. Most of the responses were positive, and Rush Limbaugh read my oped on his radio show and praised it. The NY State Commissioner of Health is going to meet with me to discuss ideas.

Among my critics, some people lost sight of the point that I have not dropped Medicare myself, in fact I pointed out in the article that I take care of many Medicare patients who have left other doctors they were happy with because they dropped out.

Another criticism was that I don't provide solutions. That is a fair comment, though my father always taught me that a person's first responsibility is to identify a problem before considering solutions. In any case, here are some preliminary ideas that could help primary care doctors and keep them from opting out of an expanding system:

* Subsidize education and provide incentives for choosing primary care medicine as a career. * Provide tax incentives for seeing Medicaid and perhaps Medicare patients. * Do NOT take Medicaid funding away from hospitals to increase reimbursement to private physicians because this will have little impact and because taking care of Medicaid patients - who are often the sickest due to poverty - requires the kind of network you only find at the hospital and associated out-patient clinics. * Increase physician reimbursement and decrease paperwork. * Consider a system where insurance is less pervasive and is focused more on prevention and emergencies, with high deductibles to discourage overuse. The middle ground between prevention and emergency intervention can involve negotiated prices between doctor and patient, the way it used to be. Health Savings Accounts should also be considered.

Dr. Marc Siegel is an internist and associate professor of medicine at the NYU School of Medicine. He is a FOX News medical contributor and writes a health column for LA Times, where he examines TV and movies for medical accuracy. Dr. Siegel is the author of "False Alarm: The Truth About the Epidemic of Fear"and "Bird Flu: Everything You Need to Know About the Next Pandemic." Read more at www.doctorsiegel.com