The Question

Bart Hinkle asks what I think is a pretty good question:

If insurance companies can’t turn people away, then why should physicians be allowed to?

4.4% of physicians accept no new private patients. 14% accept no new Medicare patients. Almost 30% accept no new Medicaid patients.

40% of physicians provide no care free or at reduced rates, generally considered an ethical obligation.

The answer that physicians generally give to the question is that they must turn away some patients to be able to provide adequate care to the rest. That the patients turned away are those for whom they receive less compensation is just one of life’s mysteries.

I don’t think that the answer to the question resides in something as abstract as self-determination or speculative as the ability to provide adequate care. I think that it was easier to persuade insurance companies that they would benefit from a larger pool of subscribers than it was to persuade physicians that they should do more work for lower pay.

7 comments… add one
  • PD Shaw

    The difference between insurance products and physician’s service is one of them is rivalrous. I think slightly different questions need to be asked, how many hours a day does the physician work, how man patients does he/see a day, and how many minutes are reccommended for patient, etc.

  • However, the risk against which the insurance companies are insuring is rivalrous and, since 80-85% of insurance costs are based on the underlying rivalrous goods, the cost is necessarily in lock-step with the cost of the underlying good.

    My point is that if insurance companies are required to insure everybody and are restricted in price differences among different insureds we should expect insurance prices to rise.

    Additionally, assuming that the objective of the PPACA is care rather than insurance it cannot be assumed that insurance will lead to care. The only way you can guarantee care is by mandating it.

  • Guarneri

    Slavery was outlawed a while back.

  • When is slavery not slavery? When it’s a prerequisite for licensing.

  • Andy

    “That the patients turned away are those for whom they receive less compensation is just one of life’s mysteries.”


  • steve

    The beginning premise is incorrect. Insurance companies can turn patients away. They have been and will continue to do so. If you cannot afford to buy insurance, you don’t get to have it. As we know, some people are not eligible for subsidies. Some may not be able to afford it even with subsidies.

    What is really happening is that insurance companies are being forced to take patients who are sick. How many doctors refuse to take patients who are sick? The answer is not zero, but it is too complex to get into in a comment. Next, the insurance company must charge that sick person the same rate as everyone else in their plan. The sick person causes rates to go up for everyone in the plan. Physicians, OTOH, charge more for more complex procedures. If you think that is problematic, then docs could charge the same for every procedure, but that means the costs of simple care would increase. Not sure that is a great idea. Also, since many docs are now on salary and employed, from their POV that is pretty much already the case anyway. They are going to get their X number of dollars from the hospital whether they do difficult care or easy stuff. (Not completely true but adequate for a discussion of medical economics.)

    On the broader topic, I think physicians have an obligation to care for those who need care and cannot afford it. We do. That said, the whole issue of physicians not seeing knew patients has been used extensively for political purposes and the truth is actually a bit more complex. Just as a quick example, many people like to go on about docs not seeing Medicaid patients. However, Medicaid patients fall mostly into a few groups who need specific kinds of care, meaning especially pediatricians and OB/GYNs. Interestingly, in those sub-groups of physicians, the rates of seeing new patients is much higher.


  • We do.

    Some do. As the link documents 40% do not.

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