# Physician licensure only if MD accepts Medicare patients/payments. Good idea or not? **URL:** \ **Category:** Great Debates\ **Created:** [June 2, 2010, 7:11pm UTC](https://boards.straightdope.com/t/physician-licensure-only-if-md-accepts-medicare-patients-payments-good-idea-or-not/541685 "2010-06-02T19:11:48Z")\ **Posts on this page:** 20\ **Page:** 1
**Author:** ![pinkyvee](https://avatars.discourse-cdn.com/v4/letter/p/6de8d8/32.png) [@pinkyvee](https://boards.straightdope.com/u/pinkyvee)\ **Post date:** [June 2, 2010, 7:11pm UTC](https://boards.straightdope.com/t/physician-licensure-only-if-md-accepts-medicare-patients-payments-good-idea-or-not/541685/1 "2010-06-02T19:11:48Z")
```auto ``` > **[Doctors may be forced to accept Medicare rates to stay licensed](https://kevinmd.com/2010/05/doctors-forced-accept-medicare-rates-stay-licensed.html)** > > Medicare rates may be forced on doctors as a condition of their licensure. Massachusetts is considering a new law. > [@](#): > > [Senate bill 2170 and house bill 4452] would require physicians and all other health care providers to accept 110% of Medicare rates for health insurance for small businesses. For physicians, acceptance of set rates would be as a condition of licensure! Moreover, physicians would have to accept all such patients – and such rates – if they participate in any other plan offered by that insurer. What would happen if this sort of requirement to accept a government decided pay scale were to include other professions requiring licensure? If you are a hairdresser who is applying for a state license, should the government regulate your pay? What if you are an attorney? A veterinarian? Who thinks this proposed law is a good idea, and why? I am not a Massachusetts resident. However, I am a licensed health care provider. I would be against this law if I lived in Mass. I think it will devastate primary care even further. This law seems like fertile grounds for tons of unpleasant, unforeseen consequences. Tell me if you disagree, and why. ---
**Author:** ![Ruminator](https://avatars.discourse-cdn.com/v4/letter/r/b9bd4f/32.png) [@Ruminator](https://boards.straightdope.com/u/Ruminator)\ **Post date:** [June 2, 2010, 7:38pm UTC](https://boards.straightdope.com/t/physician-licensure-only-if-md-accepts-medicare-patients-payments-good-idea-or-not/541685/2 "2010-06-02T19:38:03Z")
> [@pinkyvee](#): > > ```auto > > ``` > > [Doctors may be forced to accept Medicare rates to stay licensed](http://www.kevinmd.com/blog/2010/05/doctors-forced-accept-medicare-rates-stay-licensed.html) > Who thinks this proposed law is a good idea, and why? This is a stupid proposal. I can’t see how any respected economist (even liberal ones) would endorse this. At minimum… if they were to pass it, the law should delay the effective date of enforcement by at least 11 years so that today’s high school graduates and their parents can properly weigh the ROI of spending $100,000+ on medical school. It would also allow citizens to plan on practicing in another state that does not artificially restrict their income. ---
**Author:** ![Qadgop\_the\_Mercotan](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/qadgop_the_mercotan/32/83_2.png) [@Qadgop\_the\_Mercotan](https://boards.straightdope.com/u/Qadgop_the_Mercotan)\ **Post date:** [June 2, 2010, 7:41pm UTC](https://boards.straightdope.com/t/physician-licensure-only-if-md-accepts-medicare-patients-payments-good-idea-or-not/541685/3 "2010-06-02T19:41:03Z")
I’m against it. It’ll discourage docs from seeking licensure in Massachusetts, especially young ones with huge debts to pay off, which they’ll never ever do on Medicare reimbursement. It forces professionals to participate in a poorly run, poorly regulated, poorly reimbursed program lest they be stripped of their professional credentials, it turns said professionals into public employees, obliging them to give care for the Medicare system while not even paying them enough to cover their costs of delivering the care in most cases. That’ll do for a start. ---
**Author:** ![pinkyvee](https://avatars.discourse-cdn.com/v4/letter/p/6de8d8/32.png) [@pinkyvee](https://boards.straightdope.com/u/pinkyvee)\ **Post date:** [June 2, 2010, 8:01pm UTC](https://boards.straightdope.com/t/physician-licensure-only-if-md-accepts-medicare-patients-payments-good-idea-or-not/541685/4 "2010-06-02T20:01:48Z")
> [@Qadgop\_the\_Mercotan](#): > > I’m against it. It’ll discourage docs from seeking licensure in Massachusetts Not just physicians, apparently. > [@](#): > > and all other health care providers ---
**Author:** ![Tastes\_of\_Chocolate](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/tastes_of_chocolate/32/3232_2.png) [@Tastes\_of\_Chocolate](https://boards.straightdope.com/u/Tastes_of_Chocolate)\ **Post date:** [June 2, 2010, 8:11pm UTC](https://boards.straightdope.com/t/physician-licensure-only-if-md-accepts-medicare-patients-payments-good-idea-or-not/541685/5 "2010-06-02T20:11:31Z")
Couldn’t this also lead to jacked up rates for those patients not covered by the conditions above? > [@](#): > > …health insurance for small businesses. > [@](#): > > … physicians would have to accept all such patients – and such rates – if they participate in any other plan offered by that insurer. So small businesses get 110% of Medicare rates. Does that leave large businesses making up the difference? TOC, “BIG COMPANY” is offering you a job in Mass., but our health insurance only allows you to visit doctors outside of the state. ---
**Author:** ![Kent\_Clark](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/kent_clark/32/105_2.png) [@Kent\_Clark](https://boards.straightdope.com/u/Kent_Clark)\ **Post date:** [June 2, 2010, 8:16pm UTC](https://boards.straightdope.com/t/physician-licensure-only-if-md-accepts-medicare-patients-payments-good-idea-or-not/541685/6 "2010-06-02T20:16:17Z")
As big a fan of UHC as I am, I have to say that if you’re going to regulate my income, at the very least, you’ll have to regulate my expenses. Either cap or rebate my medical school tuition so I don’t start out hopelessly in debt. Cap the cost of the equipment I need to set up my practice. Not just my medical equipment, but office supplies, furniture, rent, etc. Cap the salaries my staff can receive, since I can’t cover their overhead from my patient fees. Cap the prices my suppliers (my accountant, payroll service, IT consultants, utilities and so on) can charge me to remain in business. The only way this will work is to turn the entire healthcare system into a state-run bureaucracy – which is a different topic entirely. ---
**Author:** ![pinkyvee](https://avatars.discourse-cdn.com/v4/letter/p/6de8d8/32.png) [@pinkyvee](https://boards.straightdope.com/u/pinkyvee)\ **Post date:** [June 2, 2010, 8:25pm UTC](https://boards.straightdope.com/t/physician-licensure-only-if-md-accepts-medicare-patients-payments-good-idea-or-not/541685/7 "2010-06-02T20:25:44Z")
> [@kunilou](#): > > As big a fan of UHC as I am, I have to say that if you’re going to regulate my income, at the very least, you’ll have to regulate my expenses. > > Either cap or rebate my medical school tuition so I don’t start out hopelessly in debt. > > Cap the cost of the equipment I need to set up my practice. Not just my medical equipment, but office supplies, furniture, rent, etc. > > Cap the salaries my staff can receive, since I can’t cover their overhead from my patient fees. > > Cap the prices my suppliers (my accountant, payroll service, IT consultants, utilities and so on) can charge me to remain in business. > > The only way this will work is to turn the entire healthcare system into a state-run bureaucracy – which is a different topic entirely. ??? cap malpractice insurance / payouts ??? ---
**Author:** ![Kent\_Clark](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/kent_clark/32/105_2.png) [@Kent\_Clark](https://boards.straightdope.com/u/Kent_Clark)\ **Post date:** [June 2, 2010, 9:19pm UTC](https://boards.straightdope.com/t/physician-licensure-only-if-md-accepts-medicare-patients-payments-good-idea-or-not/541685/8 "2010-06-02T21:19:38Z")
> [@pinkyvee](#): > > ??? cap malpractice insurance / payouts ??? Once it shifts completely over to a state-run system, malpractice will be criminal offense. During the transition we’ll need malpractice suits more than ever because a lot of good doctors will be leaving the state. ---
**Author:** ![Bill\_Door](https://avatars.discourse-cdn.com/v4/letter/b/50afbb/32.png) [@Bill\_Door](https://boards.straightdope.com/u/Bill_Door)\ **Post date:** [June 2, 2010, 9:59pm UTC](https://boards.straightdope.com/t/physician-licensure-only-if-md-accepts-medicare-patients-payments-good-idea-or-not/541685/9 "2010-06-02T21:59:36Z")
I think it’s kind of amusing that for years physicians have suckled on the teat of licensure, benefiting from the lack of competition, but now all of a sudden the power of the state to grant and withold licenses doesn’t seem so sweet. I guess it all depends upon whose ox is being gored. ---
**Author:** ![Rumor\_Watkins](https://avatars.discourse-cdn.com/v4/letter/r/d9b06d/32.png) [@Rumor\_Watkins](https://boards.straightdope.com/u/Rumor_Watkins)\ **Post date:** [June 2, 2010, 10:03pm UTC](https://boards.straightdope.com/t/physician-licensure-only-if-md-accepts-medicare-patients-payments-good-idea-or-not/541685/10 "2010-06-02T22:03:34Z")
> [@Bill\_Door](#): > > I think it’s kind of amusing that for years physicians have suckled on the teat of licensure, benefiting from the lack of competition, but now all of a sudden the power of the state to grant and withold licenses doesn’t seem so sweet. I guess it all depends upon whose ox is being gored. 10 points out of 10, you’ve got. ---
**Author:** ![The\_Tao\_s\_Revenge](https://avatars.discourse-cdn.com/v4/letter/t/73ab20/32.png) [@The\_Tao\_s\_Revenge](https://boards.straightdope.com/u/The_Tao_s_Revenge)\ **Post date:** [June 2, 2010, 10:45pm UTC](https://boards.straightdope.com/t/physician-licensure-only-if-md-accepts-medicare-patients-payments-good-idea-or-not/541685/11 "2010-06-02T22:45:07Z")
> [@Bill\_Door](#): > > I think it’s kind of amusing that for years physicians have suckled on the teat of licensure, benefiting from the lack of competition, but now all of a sudden the power of the state to grant and withold licenses doesn’t seem so sweet. I guess it all depends upon whose ox is being gored. Well I always gathered the point of licensing was to ensure your doctor wasn’t dangerously incompetent. I don’t really want competition from idiots who don’t know the difference between a pancreas and a kidney because the times I most need a doctor are also the times I really don’t have time to shop around. That said this bill is a piece of garbage. If you want to make doctors public employees then fine, but do it in the right way. Pay for their education, supplies, equipment, insurance, and staff cost. Also make sure they have enough left over to attract the most medically smart people. Crippling their ability to make money then leaving them with huge costs isn’t fair to the doctors, and dangerous for the rest of us. ---
**Author:** ![Oakminster](https://avatars.discourse-cdn.com/v4/letter/o/77aa72/32.png) [@Oakminster](https://boards.straightdope.com/u/Oakminster)\ **Post date:** [June 2, 2010, 11:44pm UTC](https://boards.straightdope.com/t/physician-licensure-only-if-md-accepts-medicare-patients-payments-good-idea-or-not/541685/12 "2010-06-02T23:44:35Z")
> [@Bill\_Door](#): > > I think it’s kind of amusing that for years physicians have suckled on the teat of licensure, benefiting from the lack of competition, but now all of a sudden the power of the state to grant and withold licenses doesn’t seem so sweet. I guess it all depends upon whose ox is being gored. What lack of competition? Doctors are competing against other properly licensed doctors. The intent of the licensing requirement is obviously to protect the public from people claiming medical skill/knowledge they do not have. If I was a doctor and my state passed something like this, I’d be moving my practice to another state. When people have to start waiting three years to see a doctor, because damn few will tolerate this nonsense, maybe the government will figure out this was a bad idea. ---
**Author:** ![pinkyvee](https://avatars.discourse-cdn.com/v4/letter/p/6de8d8/32.png) [@pinkyvee](https://boards.straightdope.com/u/pinkyvee)\ **Post date:** [June 2, 2010, 11:55pm UTC](https://boards.straightdope.com/t/physician-licensure-only-if-md-accepts-medicare-patients-payments-good-idea-or-not/541685/13 "2010-06-02T23:55:08Z")
> [@Bill\_Door](#): > > I think it’s kind of amusing that for years physicians have suckled on the teat of licensure, benefiting from the lack of competition, but now all of a sudden the power of the state to grant and withold licenses doesn’t seem so sweet. I guess it all depends upon whose ox is being gored. WTH are you talking about? States have always had the “power” (I’d say responsibility) to grant licenses to the competent and suspend a license when a lack of competency compromises public safety. ---
**Author:** ![smiling\_bandit](https://avatars.discourse-cdn.com/v4/letter/s/e9a140/32.png) [@smiling\_bandit](https://boards.straightdope.com/u/smiling_bandit)\ **Post date:** [June 5, 2010, 12:46am UTC](https://boards.straightdope.com/t/physician-licensure-only-if-md-accepts-medicare-patients-payments-good-idea-or-not/541685/14 "2010-06-05T00:46:21Z")
This is really not a good idea, and it’s Massachusett’s desperate flailing to solve their own HC crisis. In fact, Mass’s UHC system is sort of a testbed for the national one Congress is trying to put into place. If so, we are in deep trouble, because their system is going badly out of control, and their efforts to “fix” it basically boiling down to trying to force people to do unproductive things. Amazingly, this isn’t working. ---
**Author:** ![Rand\_Rover](https://avatars.discourse-cdn.com/v4/letter/r/db5fbb/32.png) [@Rand\_Rover](https://boards.straightdope.com/u/Rand_Rover)\ **Post date:** [June 5, 2010, 1:28am UTC](https://boards.straightdope.com/t/physician-licensure-only-if-md-accepts-medicare-patients-payments-good-idea-or-not/541685/15 "2010-06-05T01:28:42Z")
> [@smiling\_bandit](#): > > This is really not a good idea, and it’s Massachusett’s desperate flailing to solve their own HC crisis. In fact, Mass’s UHC system is sort of a testbed for the national one Congress is trying to put into place. If so, we are in deep trouble, because their system is going badly out of control, and their efforts to “fix” it basically boiling down to trying to force people to do unproductive things. Amazingly, this isn’t working. Yep. Agreed entirely. This proposed law is just straight out of the looter’s playbook in Atlas Shrugged. ---
**Author:** ![Fuzzy\_Dunlop](https://avatars.discourse-cdn.com/v4/letter/f/848f3c/32.png) [@Fuzzy\_Dunlop](https://boards.straightdope.com/u/Fuzzy_Dunlop)\ **Post date:** [June 5, 2010, 2:15am UTC](https://boards.straightdope.com/t/physician-licensure-only-if-md-accepts-medicare-patients-payments-good-idea-or-not/541685/16 "2010-06-05T02:15:18Z")
> [@pinkyvee](#): > > WTH are you talking about? > States have always had the “power” (I’d say responsibility) to grant licenses to the competent and suspend a license when a lack of competency compromises public safety. Restrictions on the number of people entering the medical profession raises the return on investment of becoming a doctor, especially for people who are already licensed, to the extent that the constraint is designed to limit entrants, not ensure competence. **Bill Door** is saying that doctors were happy to accept the economic rent enjoyed from the artificial restriction on the supply of doctors and are now complaining about political constraints on licensure when they don’t benefit them. Medical licensure is a pretty classic example of rent-seeking behavior. ---
**Author:** ![athelas](https://avatars.discourse-cdn.com/v4/letter/a/5e9695/32.png) [@athelas](https://boards.straightdope.com/u/athelas)\ **Post date:** [June 5, 2010, 2:19am UTC](https://boards.straightdope.com/t/physician-licensure-only-if-md-accepts-medicare-patients-payments-good-idea-or-not/541685/17 "2010-06-05T02:19:49Z")
Bad idea. Underpay doctors, and they’ll leave the state or reduce their working hours, worsening the healthcare shortage. Only when the government is so heavily involved in the healthcare market would it think that the way to fix a physician shortage is to _lower_ their pay. Of course, if you think this is a stupid idea, you should think the same about UHC. Both will end up in the same place, with politicians trying to hold down physician wages and a healthcare shortage in response. Once this fails, the politicians’ next step would be to outlaw private medicine - forcing everyone to fall under the UHC umbrella - in a desperate attempt to hold up a fatally flawed system. As a med student, that will be the day when I leave for China. ---
**Author:** ![Der\_Trihs](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/der_trihs/32/233_2.png) [@Der\_Trihs](https://boards.straightdope.com/u/Der_Trihs)\ **Post date:** [June 5, 2010, 2:35am UTC](https://boards.straightdope.com/t/physician-licensure-only-if-md-accepts-medicare-patients-payments-good-idea-or-not/541685/18 "2010-06-05T02:35:24Z")
> [@athelas](#): > > Of course, if you think this is a stupid idea, you should think the same about UHC. Both will end up in the same place, with politicians trying to hold down physician wages and a healthcare shortage in response. Once this fails, the politicians’ next step would be to outlaw private medicine - forcing everyone to fall under the UHC umbrella - in a desperate attempt to hold up a fatally flawed system. As a med student, that will be the day when I leave for China. Um, what makes you think China doesn’t have some variation on UHC, like the rest of the civilized world? I believe this has been covered before; if you are trying to flee the terror of UHC, there pretty much isn’t any place besides America and presumably failed states like Somalia. ---
**Author:** ![Rand\_Rover](https://avatars.discourse-cdn.com/v4/letter/r/db5fbb/32.png) [@Rand\_Rover](https://boards.straightdope.com/u/Rand_Rover)\ **Post date:** [June 5, 2010, 2:38am UTC](https://boards.straightdope.com/t/physician-licensure-only-if-md-accepts-medicare-patients-payments-good-idea-or-not/541685/19 "2010-06-05T02:38:00Z")
Ah yes, let’s talk about “the rest of the civilized world.” How are they doing now? The EU is in shambles due to large social programs. Canada is discussing what they are going to do to get their health care spending under control. The UK is having similar problems. Doesn’t look like UHC is working out all that well for them. ---
**Author:** ![Der\_Trihs](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/der_trihs/32/233_2.png) [@Der\_Trihs](https://boards.straightdope.com/u/Der_Trihs)\ **Post date:** [June 5, 2010, 2:42am UTC](https://boards.straightdope.com/t/physician-licensure-only-if-md-accepts-medicare-patients-payments-good-idea-or-not/541685/20 "2010-06-05T02:42:23Z")
> [@Rand\_Rover](#): > > The EU is in shambles due to large social programs. They are in “shambles” because everyone is. > [@Rand\_Rover](#): > > Canada is discussing what they are going to do to get their health care spending under control. The UK is having similar problems. Doesn’t look like UHC is working out all that well for them. Again, we spend more than they do per person for less return. Whatever problems they may have, we have worse. [Next page](https://boards.straightdope.com/t/physician-licensure-only-if-md-accepts-medicare-patients-payments-good-idea-or-not/541685.md?page=2)