Let's see... for every $100K of gross income, if you eliminate maybe 0.5 FTE for dealing with the morass of insurance companies and their policies and forms, that's about $17K per year of decreased expenses.
If you give me back at least $.50 on a dollar of charges for all the free care I give (uninsured, etc.) that probably another $5-10k per year recaptured. Next, I regain an hour or two a week in handling referrals and preauthorizations required by carriers and various HMOs. Believe it or not, in many areas MC pays fees far faster than private carriers, so that's a few bucks in my favor.
Yup, I'd probably make a little less under an all-Medicare system, but not that much. Then there's always that opt-in private carriage trade practice you could tap into if that was your style. I figure I'd get by.
Now, if I were an opthalmologic surgeon or invasive radiologist, or other high-paying procedure specialist, I would probably have to figure out a way to get by on $400-$500K instead of 50% more than that, but we all have to sacrifice
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In fairness, you have a point. Reimbursement needs to be set fairly or the whole system will eventually bog down from lack of providers -- it's a big deal. But I figure the market would eventually square itself up, perhaps a bit less lucratively than now, and not without some trauma.
Like the VA system, MC is far from perfect, but there are aspects of it that work very well.