I met with our local congressman (Wally Herger R-CA2) this morning with some other physicians at our hospital conference center. He seemed receptive to the need for insurance company reform. I had to educate him that his opinion that private insurers pay more than Medicare is at least in the area factually incorrect. Two large insurers, Blue Shield CA and Anthem Blue Cross dominate insurance here with 80% of the adult commercial market and can dictate rates. I would dump them and go out of network if it wasn't for the recession and may well do so if / when this recession ends. They are intransigent on reimbursement rates and will not negotiate seriously. The predictable result is a provider shortage. Also here in CA we heard from a pediatrician that all the peds in town are cancelling acceptance of Healthy Families, since Blue Cross the contractor is passing on cuts from the State budget by ..... cutting provider reimbursement to below Medi-Cal rates. So now no Pediatrician in Chico CA will take Healthy Families and the kids will end up in an overloaded safety net subsidized clinic at higher cost or the ER - great savings !
What we need are cost reductions in our overhead and fair remibursement, otherwise cash only and or micropractice is the only viable future, other than joining a large healthcare system, which doesn;'t exist in this town so it looks like the 100,000 residents will learn to go without healthcare unless they travel 80 miles to a city.
In the interview on Fox News (from your link, above), Orszag also says: "The bill prevents that cut in payments, but no one ever thought that you'd have a 20 percent reduction in Medicare in reimbursement rates for doctors. That was going to happen regardless. It so happens they added that to this piece of legislation, but that's sort of already baked in to our fiscal trajectory." I don't see how you can read that & claim that SGR won't be killed. SGR was a profoundly stupid approach to containing costs. The only thing it has accomplished is to further reduce physician's trust in Congress & Medicare. It has never been applied & has never saved any $$ & has never cost doctors anything other than hearburn.
You speak the truth with clarity and insight. Every practicing physician knows that absent meaningful tort reform there can be no healthcare reform worthy the name.
Best wishes.
SGR has been applied every year since its inception. While if has numerous short-sighted problems that lead it to mandate unrealistic reductions in physician payments, it did not have an obvious negative effect until the economy began to shrink in the last economic downturn. SGR caused the -5% payment update in 2002. Medicare patient access problems arose in many states immediately (a 5% reduction in gross reimbursement resulted in 12-25% reductions in net -after overhead- physician income from medicare patients). Congressmen heard the fallout about access, and they've seen to it that the full SGR has not been applied since. But, the SGR has produced negative payment updates annually, which has served to keep Medicare physician payments low. And fighting SGR has consumed nearly all of the physician and AMA lobbying resources and goodwill ever since.
I agree with you, Daniel--keep up the good fight (for and with ALL of us!)...without issues such as tort reform, insurance industry reform, 'patient responsibility', and prudent, physician-driven assessments of costly new technologies through the lens of solid outcomes studies, simply reducing physician salaries even further will only drive this country's healthcare system toward a significant reduction in quality. American physicians, collectively, can neither work much harder or longer, nor withstand more financial hardships...
Thank you Daniel for your continued insight. It is absolutely true that our own worst enemy is each other. Turf battles amongst physicians have prevented a solidarity that could bring about real change. As cut after cut is made to physician reimbursements, docs seek out any revenue stream to keep their head above water. Primary care docs should be paid enough per visit (still much less than any plumber or mechanic would charge for similar time) so they don't fell compelled to self-refer to inhouse xrays, path slides, etc. to supplement income (which drives up costs). Defensive medicine accounts for 30-35% of costs, not the absurd 1% the dems like to quote. At least 2/3 of the scans ordered in most ER's are not indicated. I can't fault the ER docs, though, because if they miss anything they'll be sued, even if they followed appropriateness criteria. I love how life expectancy is always quoted as a failure of the US medical system, even though it includes accidents and military deaths which are much higher in the US. Never mind our obesity epidemic. I've heard physician payments account for 5% of the total health care costs. Any one else heard similar? You can cut that to zero and still not acheive significant savings. Why they don't target tort reform, adminstrative costs and huge insurance profits is beyond me? Oh that's right, it has nothing to do with saving money and is about acheiving government control over healthcare, at least that's my take. Call me cynical, but it's the only thing that makes sense to the proposals being made.
Yes, but other than 2002, it hasn't cost us $$, per se, has it (& I really don't know since I haven't dealt w/ insurance until recently)? It has kept us from more reasonable payment adjustments & caused us to fall behind inflation, but have rates actually decreased any other year? Kind of insidious: we can't really complain @ them cutting off our fingers when we keep them from cutting off our arms. I would ascribe it to malign intent, but they're not smart enough to have thought of it. I don't think we should invest further energy in continuing to fight SGR: just say "thank-you, now, how about paying E/M more than plumbers or auto mechanics"
Here's a question: where does this idea that Medicare pays worse than private insurance come from? From my experience, Medicare is the best of a very bad lot, but one of the main arguments against the public insurance option was that it would pay like Medicare.
The Centers for Medicare and Medicaid Services (CMS) has released for review the 2010 Medicare Program Fee Schedule (MPFS) Proposed Rule on July 1, 2009. Some highlights of the fee schedule are as follows.
• Effective January 1, 2010 the conversion factor for MPFS will be $28.3208. This is a 21.5% decrease from the current 2009 conversion factor of $36.0666. Medicare must implement this cut unless Congress overrides this mandate. • The overall impact in reimbursement is approximately an 11% reduction in the aggregate for diagnostic imaging as a result of changes to the practice expense and malpractice values. Some imaging services will be reduced even further. • There is a Mandatory accreditation program for CT, MR, and Nuclear Medicine (including PET) that is mandated to be implemented by January 1, 2012. • CMS proposes to change the equipment utilization rate from current 50% to 90% for equipment price over $1 million. This would cut the technical component of ET and MR by as much as 40% for 2010 (Note legislative proposals on Capital Hill would establish a 70% utilization assumption rate spread across all imaging modalities).
Totally agree with your assessment, Dan. However, I feel strongly that private insurers must be somehow forced to engage in real negotiations with doctors, as well as be transparent with their members. I just got a letter from Aetna - they are increasing my premium cost and my copay amounts - first time I have seen this - and there is no way for me to ask them for a specific reason. If this type of highway robbery continues, a public option begins to look more attractive (I never thought I would say such a thing, but I feel this way now!).
Captitation was so "Successful" the last time, I can't believe that we're headed that way again. Realistically, we are going to add 40-50 million people to the mix, at the same time that we are cutting Physician reimbursement. Unless there is an indentured servitude amendment buried deep in this bill, I wonder where the Primary Care Doctors to take care of this population is magically going to come from. To the extent that we, like everyone else in this country, are now going to be on salary or straight cap--watch what happens to the Average Doc's productivity when we try to beat the 5 oclock traffic home like every other government employee!!!
Response to Sermo Doc 6: my understanding is that physician payments make up about 20% of medical spending (2nd to hospitals, I think), which brings up an interesting point: we only get 20% but we control 100% (not much happens w/out a doctor's order). It seems to me that we could greatly reduce medical spending w/out anything coming out of our hides.
At great risk of being hung in effigy, I'd like to ask a question. Why not adopt a single-payer system and let that phase out over time, as the economy as a whole recovers, and allow the insurance industry to evolve again as it retools/reinvents itself according to the new market?
Great posting, and thanks for carrying the torch - I recently discovered this site and appreciate the opportunity to discuss this important issue with my fellow physicians.
I've been in enough discussions to know that the public is woefully ignorant of the trouble physicians have with compensation. The "awww, poor rich doctor" comments get old, quick...
Thanks Daniel. You are doing a great job. Keep up the good work. I agree with all your observations. Any health care reform which does not address malpractice reform, insurance reform, patient responsibility, will not be worthy to be called as reform. It is such a simple straight forward fact. Even a person with IQ in 60s can understand these concerns. But these great democrats don't. Such a shame.
Thank you Dr. Palestrant. It is indeed disturbing that the repeal of the SGR has been taken out of the initial bill, and that capping physician payments may be considered. Why not cap the insurance company profits?
I do not understand why even one lawmaker has not criticized the Health Insurance Industry for making so much money in a time when so many people are suffering because they cannot afford health care? And, doing it by shortchanging physicians and patients is unconscionable, immoral and should be illegal. I suspect it is because most of our officials have taken money ("campaign contributions") or are shareholders in these companies, and because they never have to worry about not having decent insurance coverage.
The lawmakers COULD take charge and: Cap executive salaries/bonuses/all other goodies for those in the insurance industry. And, not allow them to make such ridiculously high profits, perhaps requiring that they become non-profit.
The people COULD demand that the legislators lose their health insurance and have to buy it just like the rest of us. After all, aren't they working for us?
Finally, we need to insist on tort reform. Isn't there a way for us all to take action in a big way? What would happen if we all took the same wkend to show up in Washington? Or, if we all agreed to write Obama and our representatives/senators a letter outlining OUR IDEAS for a plan during the same week? Instead of Obama talking to the AMA, why can't we talk to him? Whatever happened to the suggestion that you meet with him for us? Perhaps I missed something?
I do not know how to measure how much the above ideas would save but it seems like a lot. The CEO of United Healthcare made 124 or 127 million dollars in salary and 2.6 billion in stock options in 2006. How about if he made $500,000 instead? Couldn't anyone live on that? And that was only one executive. If we did not allow them to profit so much, insurance wouldn't cost as much, more could afford it, and physicians could be paid more, not less.
If we could control the insurance industry's profits, get rid of the lawmaker's free health insurance, repeal the SGR, and get tort reform, would that be enough to make meaningful change?
Dear Colleagues, Most of the above commentary avoid one major problem. Greed and avarice is not the sole province of insurance execs, hospital administrators, etc. It includes many of the medical community. When ophthalmologists were able to charge $2500 for a fifteen minute cataract removal and lens implant, I don't recall a hue and cry of "unfair" going up amongst our minions. When "standard fees" are reduced by 2/3 by insurance companies and accepted by physicians but are still charged at the full rate for poor, uninsured patients, is there ever a sense that there is something wrong with the practice of charging the most to those who can afford it least. When our procedure oriented medically brethren have annual incomes that are 3 to 10 times greater than those of physicians providing cognitive services such as primary care docs, pediatricians, psychiatrists, etc. has there ever been a serious discussion of the inequity or a realistic attempt to reduce the cost of procedures and increase the reimbursement for taking time to talk to patients and to think? Studies have shown that tort reform has done nothing to lower the frequency of ordering needless tests (notwithstanding my conviction that tort reform is long overdue). Rather, the problem is that people don't take the time to think and worse yet, were never taught how to think. Folks, we have met the enemy and he is us. There is a lot of reforming to be done. Why don't clean up our own house first? Then maybe someone might take our suggestions seriously when we address other areas of weakness in the health care delivery system.
In Houston, medicare pays 5 to 25% less than commercial and medicaid pays 19 to 30 cents on the dollar. I am shocked that doctors in other parts of the country are willing to work for medicare rates and have a higher cost of living and pay higher malpractice premiums. Although I love our cap, real tort reform requires the abolition of torts in medical malpractice completely. A no-fault system, coupled with better reporting and vigilant, authoritative state medical boards, would provide fairer compensation than our capricious, inconsistent, adversarial litigation.
Physicians have no hope for reform, especially malpractice, unless we withhold our services. This is the only way we have of getting the politicians and the public to take notice and the only hope of getting what we deserve.
I agree with Sermo Doc 16. Militancy is the only thing that they will understand. Shut the system down and present our demands. All it takes is some UNITY and we can have it anyway we want it. We cannot be replaced.
We have tried the "nice guy" approach for too long. It does not work. The politicians, lawyers and insurance companies laugh at us for being so nice. We need to take a lesson from them...
Daniel, of course i agree with you. Despite struggling to pay the office bills and taking no money home , I stil have some semblance of sanity left
And it is so true that the public is unaware of our plight.
I try to bring it up as often as I can with my patients. Most of them just smile and don't understand. They think I am misinterpreting the health care reform and that things will continue with my husband and I as their doctors.
But there are a few lights here and there, people who are surprised and "with us."
I just don't know what to do. Wish we were in a financial position to go cash only.
Oh, an yes, this has been mentioned so often. But people bring up the fact that the AMA is "with" Obama. They are shocked to find out that we have never been members and that the AMA was never really formed to represent doctors. And they do not represent most of us.
Dan, you are one terrific and insightful person. Thank you, again.
I find it fascinating that this is supposed to be about making for a better healthcare system. Someone should tell BO that when you cut reimbursements, doctors have to see more patients. Less time with a patient=poorer care.
At least more people will be getting worse care. Hey-that means that we will all be in the same boat! And isn't that what it is supposed to be about?
Good work, Dr.Palestrant, keep it up, can anyone tell this community what is the actual percentage of healthcare dollar is paid to physicians for the services provided, when i researched about this i couldn't find any information, only thing i came up was administrative costs are range from 15-40%
Health Care Reform Has Already Passed; It's buried in February 09 Stimulus Bill - google it.
This physician law website had the following: the link is below.
Stimulus Bill and Health Care Reform
Posted on February 18, 2009 by Todd Rodriguez
Yesterday President Obama signed the much touted s
timulus bill into law. Although not much is publicly being said about health care reform yet, sweeping changes to the health care system are quietly taking place. In fact, over $150 billion of the stimulus bill funds are earmarked for health care related projects. In no particular order, these include:
• Comparative Effectiveness Research to compare treatment effectiveness ($1.1 billion)
• Support for State Medicaid and Children's Health Insurance Program Programs ($87 billion)
• Investment in Health Information Technology ($19 billion)
• Medical Research Funding through the U.S. National Institutes of Health ($10 billion)
• Federal Support for COBRA ($25 billion)
Many of these change can be expected to have an impact on the way physicians practice medicine (and in particular the information technology provisions since they include incentives for physician compliance). Accordingly Physicians need to keep a sharp eye on the changes that are taking place and should begin retooling to best take advantage of what will undoubtedly be a very different playing field in just a few short years.
They no longer need physicians to carry out their agendas. They have nurse practitioners and PAs. We are obsolete, in my opinion; have been pillaged and abused by the system of health care which swallowed the system of medical care sometime ago.
Insurance company reform, not health care reform, should be the focus of this plan to get any real result in health care savings. These companies and their CEOs are crooks. They charge the patients hugh premiums, don't cover many important services for their clients (Blue Cross does not cover for smoking cessation counseling!), drop coverage when they feel like it and don't pay doctors fairly for the work done (if they pay at all .) We have got to educate the public and politicians about this scam called health insurance we are all paying for.
Second, reducing malpractice claims and moving cases to a medical panel (to abitrate and assign compensation for loss based on true malpractice) instead of through the inefficient legal system that does not adequately compensate patients who actually have losses - the med-malpractice lawyers are the crooks here! I have stopped providing OB care in the prime of my career (based on age and experience) due to the high costs of malpractice in Cook County, IL. Unless this is reformed, moe and more physicians will continue to reduce their risk by not taking on the most difficult or high risk patients. Their will be a shortage of the most trained and experienced so that many of these patients who need the most experienced provider will be taken care of by NPs or midwives.
Once these reforms above are met, then as doctors we can contribute and add to the savings by not having to order unecessary tests (as a result of the practice of defensive medicine or in trying to boost compensation through overcharged office procedures.) As doctors, we can't help in this health care saving process until our compensation from the insurers is reasonable (and not costing more in overhead as our billers spend hours to get payments in ) and until we are not in constant fear of a lawsuit that could ruin our careers. The bottom line is we are the orderers of the tests and procedures (not the legistatures who are trying to dictate what reimbursement we deserve for our work), so until our interests are brought into this debate on Capitol Hill, costs will just continue to go up and up and up...and the CEOs of Blue Cross, United, Unicare, Aetna and all the rest will just continue to laugh at all of this as they take their millions to the bank.
I am still laughing at this: "Why not adopt a single-payer system and let that phase out over time, as the economy as a whole recovers, and allow the insurance industry to evolve again as it retools/reinvents itself according to the new market?"
So, tell me--what government program are you aware of that has been put in place and then revoked? And once you entitle a population (of voters, no less), how do you rip that entitlement away? Have you any idea what Sarkozy is going through right now with the health care system in France?
The past several weeks of townhall meetings, and careful analysis of HR 3200 by the "grass roots" has exposed the detailed content of HR 3200. Real democracy in action. For more detailed analysis I have posted on my blog a careful anallysis by John Lewis of Duke University. The link is healthtrain.blogspot.com
If I mention BO or Congress and their health care bill in my office I find patients spitting nails with anger over the issue. Many people are getting the message and much prefer the status quo, as mixed up as it is, over new legislation moving us toward a government option only. Many patients can see on their EOBs that doctors are getting ripped off and wonder how we stay in business. The strength we have is our relationship with our patients and the general public sympathy for doctors and nurses.
If we are militant and strike or withhold care, I feel we will violate that trust and bond we have with our patients. If we walk away from Medicare and insurance contracts, patients will not like the change but will be more understanding of the unacceptable situation driving many out of practice. Our country needs their physicians and more of them as our population ages.
Thank you. The real issues at stake, the SGR and the future of reimbursement, along with tort reform have mysteriously been invisible as all the self appointed experts join the debate. One need only tune into any pundit, any politician, any radio talk show, any town hall meeting, and within 30 seconds it becomes obvious the furious debate has now devolved to meaningless horseshit. We are the only ones left who can elevate the debate and salvage a sustainable solution. But does anyone care?
when, not if health reform is passed(dems have the votes) it will create a real access issue. Who will be able to cover overhead and make a living on the fees proposed? Then in about 4-8 years a doctors shortage of huge scale will start. Who will want to be a doctor when they will never have the funds to pay for school? We have the power why do we not organize and use it? Who really speaks for us and our patients?
Private insurers have no incentive to increase reimbursement to physicians. It cuts into their profits and that is all they care about. BC/BS and CIGNA as well as local private plans have all ratcheted down their reimbursements year after year. After each reduction, they also slow reimbursement times by a day or two thus keeping interest on their money for that day or two and that adds up to a lot of money for them. My own costs for employee health insurance, however, rises at 6-9% annually so who is getting that money? Not me that's for sure. I am all for a single payer system if it covers medical school costs for upcoming physicians and includes a no fault tort system. Can't do much worse financially.
"If we are militant and strike or withhold care, I feel we will violate that trust and bond we have with our patients."
Sermo Doc 26, while I agree with you, I see no other choice but revolt. If we do not act quickly, it won't matter whether or not we walk away from Medicare, Medicaid or any other contract, because we won't be in existence any more, or we'll be federal employees forbidden to walk away. We are the only ones who can provide real healthcare. We hold the power in our hands to reform the system, but are afraid to do it because we're afraid of public opinion. Hell, most of the public thinks we're rich and greedy docs, so what's the difference? While we are also concerned about our ethical and moral obligations to patients when we talk about striking or shutting down, do we not have a moral and ethical obligation to our patients to remain in viable practices in order to provide needed healthcare? Why are we afraid to use that power that we hold? Why are we unable to unify and use that power to effect change, to get Congress and the President to listen to those grunt docs on the frontline, not the ivory tower docs, who know how to lower costs?
Lord, I'm so angry and pissed off at all those outside forces looking to enslave us, but I'm more angry at us. We are our own worst enemies.
I feel like we are all sitting in the living room and acting like a dysfunctional family that will not talk about Uncle Sam's "addiction" to special interests. It's the white elephant in the middle of the room. Health insurance provides no service, no product, no health care, etc., yet, is the most profitable scam in U.S. history. Malpractice attorneys are winning major awards on skimpy cases that often do not even make it to court due to the fears of malpractice insurance carriers. All this money is being spent without any patient actually getting care.
dodge and redirect: as they hone in on insurance companies profits the insurance companies say we the physician are the cause of escalating costs. We physicians joined this endeavor many many years ago and agreed to discount our fees. They have been continually discounted while health care costs rise and many many CEO's of the healh insurance industry make millions of dollars in salary each and every year. With the discount of fees as does happen with anything discounted, it loses (and we) lose respect. We have done that to ourselves and have allowed it to continue. I was recently reviewing a contract I signed back in 2001 (as I cancelled my participation). There is a paragraph that says if health reform happens and it is detrimental in a financial way, the health insurance carrier has the right to cancel my contract with 90 days notice. They do not give one squat for health care (yet another example). I may be naive but without health insurance I am still a physician - I have many patients who pay cash. BUT without the practicing physicians, the health insurance industry has no industry. It seems fairly straight forward and simple; we need to cancel all our participating contracts with each and every health insurance company. That effectively takes them out of the conversation. Then perhaps the rest will value what we have to say, allowing us to share the reality of medicine in the "ditches" of practice and speak for our patients. Making health reform real and not just another avenue for a lot of business men to become richer.
addendum to my prior post: I suggest we call or fax our respresentative/senators every time we have to call or fax an insurance/managed care company. Let's let them understand the time (= dollars) that are being wasted meeting the demands of these scam artists.
Glad I can provide you with some comic relief, Sermo Doc 24. Here's a little alphabet soup of cancelled programs and agencies from the New Deal era that sets president for timely disposition of federal programs in times of crisis. Feel free to choke on it, along with your insipid arrogance: WPA, PWA, NRA, FSA, CWA, and probably a half dozen more that escape memory.
Point being, health care reform is only one small part of a much greater collapse of infrastructure within the nation. This concept of infrastructure includes both the physical plant of roads and utilities, as well as the intellectual plant of destructive economics and outsourcing innovation and education. In a time of crisis like this, my experience as a sailor serves me better than that as a physician: it is much better and safer to shut down the system and provide basic services until the plant can be brought back on line rather than try to hold it together with duc tape and bailing wire. To address just the health care aspect of this problem in a similar vein, the system is so fractured now that the discussion over reform is pulling us in a dozen different directions. Insurance reform, EMTALA, tort reform, patient responsibility, the list goes on and on. Meanwhile, the system continues to crumble. So take the plant off line. Go single payer, physicians have to stand up and get put in the driver seat of an interim system of health care, let the public get a feel for what the really need from health care based on a single payer system, and when the insurance industry comes back on line those who want to bail from the public option can truly exercise that option, those who realize that the federal system suits there needs fine can stick with it, and physicians can play a role with the start up and transition phases to ensure real reform occurs vice slap and stick window dressing.
Why would a "government doctor" purchase "malpractice insurance"? What would happen to the lawyers IF every doctor in America CANCELLED their "medical liability" insurance? Why do they always sue for "policy limits"? After all, if we are not going to be paid a living wage for our work, why work? Why worry about bankruptcy and losing it all if there is no incentive to work or be competent? (The only way to "get rich" in medicine today is to work for the government or be an out and out crook. You could marry into money but it won't be another physician.) Every doctor who hired a PA or a LNP to "make more money" and "see more patients" has taken a viper to his breast. Note that Obama clearly touted the support of the AMA, AARP and THE NURSES. The nurses and PA's are FOR Obamacare because they now have the clout and credibility that WE GAVE THEM. Lyndon Baines Johnson's "Great Society" has created a Pavlov-like response in three generations who BELIEVE that "ready access to FREE and competent health care is a RIGHT" for anyone who can be born or get into the borders of the United States. You cannot GIVE anything to anyone without TAKING it from someone else. Medicine is a "zero-sum" equation. Someone has to pay and someone has to provide. You cannot eradicate poverty by stealing from the prosperous, despite what Congress believes. Since when has the government EVER been able to run anything efficiently? Medicine changed for the worse when insurance companies issued stocks and went on the New York Stock Exchange. Their loyalties changed from patients/providers to their STOCKHOLDERS. Profit alone became their motive to please their STOCKHOLDERS. Co-ops are NOT the ANSWER. BLUE CROSS/BLUE SHIELD IS A CO-OP. You will never be able to see the books of BC/BS. BC/BS is the 800-pound gorilla in the china shop and they control Congress with OUR MONEY that they stole from poor re-imbursements to doctors and hospitals. I made more money and had better retirement when I sold tires and batteries for Sears. What will they do when all the doctors quit when they get sued? If I am smart enough to finish college, medical school and three training programs, I am smart enough to do something else. I have a choice: quit or work for the government. Oh, I forget, we already work for the insurance companies and the government. WE already have "socialized medicine". The problem is that the insurance companies are NOW in control and they are worried that the government wants some of THEIR money and power. It is going to be an interesting Fall. I stay in practice solely to provide quality care to my family and friends but, I don't know how long I can last. Any doctor who accepts Medicare is a fool for the government. Doctors have financed health care in America for the past 50 years with decreasing pay and increasing "discounts" orchestrated by the government and the insurance companies. I jokingly say that, when I retire "I'm going to rape nuns and kill babies UNTIL I get back my self-respect ." I'm tired of being blamed for everything from poor care to higher costs. Yes, I have to purchase health care JUST like the rest of the public. Doctors are consumers, too. The public thinks that doctors get FREE health care and DRUGS. We have done a poor job of public relations and now we are reaping the whirlwind. So much for the "good news". Next time they are "sick", let them call an attorney or an insurance company. Lawyers will not work for free nor will insurance company executives so, why should doctors?
There are many questions left unanswered! or asked, as far as I can tell. What ABOUT THE DEBT that newly minted doctors and those still in the residency system? Are they expected to absorb it while "funding" the healthcare reforms? since doctors seem to be the problem, taking out tonsils unnecessarily and amputating legs in stead of trying to salvage them! No emphasis is placed on the patient and their compliance... IF a doctor wants his debt repaid, will they have to work for the "state" for 10 years? Will they have freewill to take care of their patients, or will they be forced to perform "necessary" procedures, like euthanasia, abortions, denial of care... WHAT ABOUT TORT REFORM? is that off the table? WHY ARE DOCTORS SEEMINGLY BEING LEFT OUT? Besides the misguided attempts of the AMA to give their input, have doctors, other than Rahm Emanuel's brother been asked their opinions? Seems to me, the best way to reduce cost is to work with the people who can prescribe the treatments. OR, is the where paraprofessionals come in? I guess we will just have to wait to find out what SEIU and ACORN will put in the final bill, since they are helping to write HR 3200! This is sooo bad!
Sermo Doc 6 above is right about the need for physician solidarity but that is in very short supply. A recent mailing from the Ob-Gyns for Women's Health PAC demonstrates the point nicely. In this letter, it explained how Congress is trying to cut $3 billion dollars for MRI and CT reimbursements as part of the health care reform proposal. It goes on to explain how radiologists (and their PAC) are responding by asking/lobbying congress to shift $1 Billion of those cuts to ultrasound reimbursement so Radiologists will not have to shoulder the entire $3 Billion cut alone. The letter goes on to explain the need for Ob/Gyns to contribute to their PAC so we can lobby hard against this change.
So, basically, the lobby and PAC groups (politicians) are once again getting us to fight amongst ourselves to distract us from fighting against the cuts in the first place.
And we are aparently still fallling for the same old tricks. We really need to stop all this nonsense. We really need to pick a date upon which we will no longer provide services to anyone until A) tort reform is done and B) there is an end to the insurance company's lock on price setting. Call it a strike, call it what you will but until the country is faced with absolutely no care they will not stop hammering away at us. If we actually all worked together and followed through with this, I predict it wouldn't take more than 48 hours to get the gov' t to respond to our concerns. And for all you tree huggers who say we can't abandon our patients, what do you think we are doing now by letting business men and lawyers steal billions out of healthcare now? It's just a slow death. By withholding care, we would actually be serving our patients by guaranteeing them quality care down the road.
Want to have enough money in health care to cover the uninsured and raise physician pay? It's quite simple. Eliminate the 35% of every health care dollar going to administrative costs at insurance companies (really for bloated CEO salaries). Can anyone say mandatory non-profit corporations only in health care? And second eliminate the billions being stolen by lawyers through tort claims. Wow suddenly there is plenty to go around for healthcare. The real trick is actually using every health care dollar for healthcare and not politically protected grift.
The AMA revels the validity of "organizing docs is like herding cats". In our area, and other Metropolitan areas, docs are refusing to take Medicare and Medicaid. As others have observed, medicare fees hardly pay overhead, leaving the doc less than a plumber. Fees for docs were frozen for a year longer than all else by the Nixon administration, and we have never been allowed to catch up with inflation or student loans. How does one create something comparable to the Mayo Clinic, or Cleveland Clinic, or similar groups in regions with few docs, no specialists? Technology helps some, but how does one do a physical on the net? When a PA does a physical, who is responsible for the result? Murphy is alive and well. Can any of us, or legislators, or insurance companies, or economists, or ... come up with a system that is tolerable to ALL?
Obama has brought everyone to the table and played an enormous high stakes shell game. AMA sold us out and signed on to get SGR out, but its not really out. AARP sort of says they are on board but $500,000,000 comes out of Medicare and a rationing board is established in the plan. Big Pharma makes multi-billion concessions and then gets stabbed in the back. AHA signs on but then finds out congress is playing rural facilities against teaching hospitals for the same $. Both are set up as the enemy of reform even while running ads supportive of Obama and the Dems. The only folks protected are the core of democrat power base - lawyers and unions. Dan has been right all along . . . and the AMA, AHA, Pharma, AARP, and big insurance have all played appeasing Neville's to . . . oh wait can't say that Nancy will call me a Nazi and someone is sure to call me a racist . . .
If only new doctors had the option of starting their career by declaring bankruptcy like the big wallstreet power houses..that would be nice. ..but student loans are not covered by bankruptcy protection! We have the most corrupt government.
The corruption of our government is exceeded only by the silence of its citizenry. There's a whole generation of lawmakers on both sides of the aisle that need to be retired.
Agree with above. Each time I read a section of this house bill I try to see how it will effect my practice. I keep getting screwed at every turn. I fear for the result of this cluster-f.
We will see what happens. I am as always with you Dan. Thanks for trying to keep us up to date.
Addressing the suggestion of single-payor as a temporary solution - why have a payor at all? We should just stop accepting health insurance entirely, let folks pay out of pocket and with credit plans so they can be in control of purchasing the healthcare they actually need an want (ie why do men and women over 60 need maternity coverage?). Everyone would be self-pay. No tax issues, no employer mandates. Employers could still give health benefits as a perk by putting cash into a medical savings account for the employee, if they wanted to go that way. Let the government deal with the poor with state or federal free clinics with financial checks for eligibility. Then we go back to the personal responsibility, doctors as self-managers, and let the lawyers try to make a buck off of the medical profession if they can.
2] adopt a retainer model "operating system" for primary care, which will greatly decrease physicians' billing overhead, thereby allowing them to absorb a decreased revenue stream with no effect on profits and vastly improve the physician-patient relationship
3] for non-primary care, encourage private insurers to offer high-deductible plans with sufficiently high out-of-pocket levels that patients are discouraged from irrational consumption
I agree that health insurance is a massive scam, with CEOs profiting at our expense. BUT, the government is not the solution either. All one needs to do is look at what we write off on Medicaid to see that. All the efforts at "reducing the 'spiraling cost' of health care" in the past few decades have come at our expense...I have little hope that this will change *unless and until* we advocate for ourselves.
To Neal, and others. SHUT IT DOWN! Close our offices for 2 weeks-announce it in advance. Go to Walmart, buy a table, chairs, a big umbrella and get your stethoscope and blood pressure cuff; then set up in a Public Park and provide care for free during those 2 weeks. That way we don't look like bad guys and girls. Educate our patients. Keep the ER's open-provide free care there, too. If the assholes in Washington still don't get it, we do it again. ENOUGH, ENOUGH, ENOUGH!
A united voice is what we need. The hell we AMA!!!!!!!!!!!!!!!
What I propose is that we set up a point person in every community/academic hospital in the nation through whom, Sermo's messages are communicated to the entire affiliated medical staff. In the age of e-mail and Twitter, this may be quite possible. Please contact me if you need someone in Tarzana, California. Best regards.
There is a way to revolt against terrible government contracts without withholding services and without tearing up contracts. Send in the signed contract, but first strike out the clause whereby you agree to accept their fee schedule as payment in full. This turns the tables regarding who is willing to participate with whom. If thousands of doctors do this, the government would become the ones refusing to participate if they failed to acknowledge the altered contract.
A lot of complaining. A broken system. Lack of plausible plans to create the health care net that is needed. I envision a system where MOST patients have a high deductible policy and pay for the first $2000 health care out of pocket with HSA monies. Those not able to do that would have government option, like VA and Indian Health currently offer. The incentive to do the first one would be to not have to be in VA and Indian Health system. It is a 2 tier system, but would work to cover all. Patients would have a pony in the race re: costs. Doctors could charge what the system would bear and eliminate HUGE overhead. Tort reform would be included. What do you all think? Why is this not being floated? It would eliminate the power and profit of the insurance companies, remove half of their staff and overhead, provide doctors with freedom of practice, and insure everyone. Thoughts?
for 30 years i worked to promote improved health care on both the left and the right!! i gave up on the Left.. they donot care for any intelligence or truth.. only their stuck agenda.. which they can not even think thru.. sorry.. i come from generations of Democrats..
what i am most excited about it that finally the people and docs are waking up.. This is how progress occurs.
My Senator Chuck Schumer just sent out an email as another diversion strategy.. He , of course is NOT dealing with the TWO LEADING COST DRIVERS of PRIVATE INSURANCe:
the FAILURE of GOVERNMENT MEDICINE TO PAY (medicaid, medicare , va and Indian Reservations) shifting the costs to private pay.. AND the
LEGAL COSTS built into every step.. this, of course now deals with how you deal with your Insurance co
the funniest and SADDEST part of the new OBAAMA plan is that he has the DRUG COMPANIES on BOARD
Does anyone NOT recall that THESE are ALL FOREIGN DRUG CO?? the last american drug co WAS SCHERING PLOUGH
they all started leaving the old usa because of NO TORT REFORM .. So NOW OB feels FOREIGN COMPANIES should force us into the same European mess called Socialized Medicine. which IS NOT WORKING THERE... WE HAVE international Medical Insuranc and KNOW!! the drug co are only negotiating as OUTSIDE the USA BUSINESS interests .... amazing
I am thankful for the opposition to current health care reform models. If you ask patients directly what is important to them, the vast majority will say affordable healthcare and continuing to see their doctor. United we stand? We cannot. We cannot unionize or set fees. We are forced to accept fees determined by third parties. Those fees are in large part determined already by the government, as most insurers base their fees on MCR reimbursement and rates. Imagine having to tell your attorney that or your plumber? We need: Tort reform and reimbursement reform. Insurance reform is absolutely essential as I am spending more and more time filling out forms from clearing houses such as Care Core to determine if the test I ordered is necessary. Often the form is longer than the note generated. And too often I am told that it has been denied. Are they serious? I then send them to the specialist to get the test ordered and voila! It is obtained. These issues are not being addressed by any legislator. They simply do not have the knowledge/competencies to delve into the matter. You might as well have the congress and president perform brain surgery- the results would in fact be the same. History should be our guide- less government is essential.
Dan, you did a great job on that spot. It was interesting to see that Lou did not realize that the AMA made money off the CPT codes themselves. I think that may help many lay people realize that their interests are really in their wallets and not with the patients we all care for each day.
I was watching CNN at lunch time yesterday and caught a fragment of a talking head discussing the reform debate. Sermo was mentioned as showing that many doctors do not agree with the AMA. She also said that although some try to blow off Sermo as a small player, if you go there and read what's being said you understand how significant the resistance is. Only caught that part of it so I can't provide any more context.
BTW, Dan lose the pink tie and white shirt. On TV you should wear a blue shirt. Otherwise when the camera tries to white balance it will darken the shadows in your face. The classic instance of this was the Nixon-Kennedy debates. Nixon wore a white shirt and ended up looking like a Sharpei. Kennedy's folks had him wear a blue shirt.
John Cowl says it so well. Atul Gawande's piece comparing cost of care between El Paso and McAllen, Texas was an eye opener. I practiced like Vance harris, MD (Thoughts of a Fading Primary Care Physician) and although I was salaried, was rewarded with less ancillary staff over time and more patients per hour. We have to decide among ourselves a fair pay scale that takes into account hours at the office, on call and on the phone and email as well as outcomes for the patient. We should be rewarded for keeping our people out of the ER and hospital as well as for our patients meeting improvement goals.
I agree with trapper, he should be hung in effigy. So what if half a dozen government programs have been phased out in the last century? THOUSANDS more have been implemented, including entirely new cabinet departments. The government is growing far faster than is healthy, and the rules are choking us. The Federal Register has 132,000 pages of medicare regs alone; we also have to comply with OSHA, CLIA, IRS, state medical boards, local taxes & regulatory agencies. Ayn Rand wrote that if you make enough rules, no one can comply with all of them. So when the government wants somebody, all they have to do is cash in on the guilt: Everyone is guilty of something. When I am in an exam room with a patient, I want that patient to be my overridding concern - not a government agent OR an insurance company clerk OR a malpractice attorney. That day will only come when we deal directly with our patients. You can safely regard the government takeover of medicine as permanent, trapper; if you want to work in that world, fine, but please excuse me from your nightmare.
Dan is the anti-AMA man.
So what does that mean to the primary care physician?
My answer: nothing or less than nothing because the anti-AMA message is obfuscating the messages that need to be otherwise sent.
Agree with Sermo Doc 45. We need even more organization for Sermo to make itself well known as an entity and I would guess that Dan would not mind help and possibly a larger team. The threads on this site are educational and very helpful. But I think that "shutting down" for 2 weeks but still seeing patients might indicate that we are always willing to work for free or for less, which is sort of the impression the government has of physicians already and they like to take advantage of it. They have center stage and would still find a way to call us the "greedy docs."
" As the ones who are on the front-lines of healthcare every day, physicians know what needs to be done to reform healthcare, perhaps more than anyone else. We also know that issues like malpractice reform, patient responsibility, and reduction in overhead are tough and often politically challenging. " How do we get our patients and the general public to believe this? We need to teach them that we understand the complexities of healthcare better than politician attorneys, because we actually do it everyday. They will also make their voice heard (townhall meetings are examples).
"If we are militant and strike or withhold care, I feel we will violate that trust and bond we have with our patients." True. But who out there knows we have thought about this? Let's make it known that we are so concerned about the reform, more potential regulations, and our patients that many docs have considered leaving medicine or striking, but because we are the ones who really care so much about being there for sick grandmothers, we are trying to avoid this at the moment (but it could be an option). Will need to start making it known that from day 1, we have been in it for our patients' best interests, not our own. We are definitely worried about our reimbursements, but our focus should be on how decreasing payments will decrease access to a PHYSICIAN'S care, not just access to any provider.
We need to find a way to educate the public on how tort reform helps everyone and reduces costs. Teach that we do not get rewards or lavish gifts from drug companies these days like people seem to think. Teach that PAs and NPs are actually not doctors - patients dont know this and need to learn to ask about it. Seems that only docs really understand what would happen if ALL healthcare were delivered by mid-level providers. Make it known that we go out of business quickly if all we see is Medicaid / Medicare patients. Surgeons dont make $50K for amputations, tonsillectomies are sometimes indicated, we are not cars (Obama compared us to cars when discussing penalizing hospitals and docs for bounce-backs within 30 days of discharge, stating "they did not do the job right"). Could go on. There are other points and they all seem very basic to us at this point but a lot of people do not know about such things. Most people I talk to do not even know what tort reform means.
Let's be careful to not succomb to the victim mentality and start playing more of the political game. It also seems that while we debate the reform bill, we could also educate and possibly reshape our image in some ways (not that it is bad now - but look at this link to get an idea of what I mean: forums.sulekha.com It would help to have more patients on our side. The people are doing a better job of speaking out against the bill. We could help arm them with more facts. Link to the bill - thomas.loc.gov
much improved camera presence Dan. You kept on point and were preise. The after discussion was on your turf, not the AMA's, which means you won the skirmish.
A lie, a disgraceful group of "leaders", and pure nonsense.
A governmental entity....by definition alone....simply CANNOT provide real market place "competition" for private industry. It's IMPOSSIBLE....or, should I say, WRONG.
A private business has to make it work.....of they go under. Bankrupt!
A government run entity has to only ask for more government revenue (taxes) if their plans and ideas fail. It is just not at all the same.
One has a real market place business to run and make work.....and the other has no real market place, but only the ability to slaughter more tax payers and take more of their hard earned wages when things get tough.
The Obama "plan" is disgraceful, un-American, and a lie.
Sounds like the AMA is in bed with the government....the insurance companies....and who knows who else! Sounds like the pharmaceutical companies are also playing both sides of the fence. Who can you trust????
We get screwed when private carriers like Highmark reimburse us at medicare par. There is no reason for them to follow medicare par. Private carriers sit on high reserves, bonus their do nothing executives millions, and throw us the crumbs. They are allowed to engage in government sanctioned organized crime (then again, government is nothing more than organized crime with the law on their side). Look closely, the private carriers violate every statute of the RICO law- racketeering and corrupt organizations. How do they do it? They pay off our elected officials to look the other way!
I was not aware that AMA receives these copyright payments for coding/codes- but not surprised. It fits entirely with my perception of them- working for the good of their administration, not for the good of their members. Although never a member, I am still entitled to their daily junk mail so they can get a kickback if I buy a credit card or life insurance through them. Thank you, Dan, for bringing this to everyone's attention.
Let's consider another wrinkle....PhARMA and the drug companies just cut a deal with the administration!!! Where does that leave the physician??? I have just contacted my reps and told them if this is true, our business is concluded and they are no longer welcome in the office at any time --- no appointments, education, nothing!!! Seems like this profession is on its own. So what else is new??
It's disappointing that Sermo has sunk to the level of consorting with Lou Dobbs, father of the "birther" movement. That CNN spot did very little to make the average person or patient care about the plight of doctors, which from the public's perspective is just a tiny part of the problem of health care reform, one that doesn't really concern them.
The message that needs to be conveyed is that with the current system, docs are being forced to close up shop because we are being squeezed out of business - this means no access to health care for patients, long lines/waits to see the doctor and inevitably rationing - all the things that the fearmongers are saying will come with reform. This will be the only way the public will come to understand this issue. Otherwise physicians are seen as whiny, money-hungry elitists who don't care about patients.
I watched this clip, and Dan did a great job. Lou Dobbs generally supports free-enterprise and a capitalist system, but the slant wasn't too blatant and the AMA sure came off looking pretty bad. I'd like to see Dan build on this exposure with a planned excursion to the Million Med March October 1st to really show the faces of practicing community physicians who do not support the AMA or the House bill, but are for tort reform as the foundation of cost reduction to allow more patients to be cared for.
"Sermo Doc 58 Internal Medicine Posted Aug 14, 2009 at 2:35 PM Dan is the anti-AMA man.
So what does that mean to the primary care physician?
My answer: nothing or less than nothing because the anti-AMA message is obfuscating the messages that need to be otherwise sent. "
Not really a fair criticism. After all, the more the AMA tries to paint itself as an organization that represents physicians, the more Dan or someone like him needs to refute that point of view so that meaningful representation of the physician community can take place.
I did not read all the comments but the more I understand about healthcare reform the scarier it gets. At least in Europe doctors are unionized, and they strike, plus they can negotiate contracts as a group. They also get paid for overtime. Nobody carries malpractice insurance with the obscene premiums required here, esp for surgical specialties: there hardly anyone gets sued!( then again they do not have trial lawyers lobbies either)
It has been always obvious to me that public option was code for phasing out private insurance all together and force everyone into the federal insurance to come in the future... I guess that will happen sooner or later and it is too late now to rewind the clock. I think however we sould start thinking about growing our collective spines and start letting politicians and the media that without MD's there is NO reform possible, and that the AMA represents but a small percentage of US physicians. If we do not act now we will onlt have ourselves to blame very soon.
Dan, you are doing a great job! But what makes me happy these days? My postcard that there are jobs for doctors in New Zealand. I used to throw them out, but this time I saved it. Also, I believe on Aug 12th, the head of the California Medical Association came out with a dressing down of the reform bill and of the President's insullts of doctors and of his lack of understanding of how medicine is practiced. Unfortunately, my computer skills aren't up to figuring out how to put in the link, perhaps another one of us can.
The problem is that nobody wants to sacrifice. There is simply no way to give everyone "affordable" health care unless there is a reduction in both costs and benefits.
This includes withholding futile treatment at the end of life, which is opposed by too many on "moral" grounds (too many people want their last breath, but expect someone else to pay for it).
This includes lopping benefits to seniors, such as their Medicare D funded Viagra (it makes me furious that retired people expect me to pay for their sexual "well-being" while I am working so much to pay taxes that I cannot have a decent sex life of my own). The AARP has become too powerful, and they do not care about bankrupting the country.
This includes raising tax on ALL Americans to fund the system. Why should only the "rich" contribute more, other than they are a minority to be taken advantage of?
This includes us, the physicians, having to accept a cut in reimbursement in order to balance the budget. Maybe we should not feel entitled to quite as much wealth, which came to physicians only after Work War II when the system was flush with cash.
This includes patients to lower their expectations with what can be done for them. Maybe not everyone can get what they want or need. Health care was not a right that was recognized by our "founding fathers". I reread the constitution and there is no mention of it.
We are all like an irresponsible person with a credit card, making purchases with no hope of ever paying the balance. This debate, if taken to it's conclusion, should re-evaluate the worth of everything we expect of the government. What a shame that it has come to this.
My suggestion is that either the government get out of the business of health care entirely and let the free market allow the disadvantaged to suffer (unlikely), or accept a single-payer system that will at least give everyone a mimimum standard of care (more likely to be the direction this will go, but with just about everyone screaming and kicking along the way).
Has Sermo been invited to this? If not, is it too late to get in this debate or at least speak with Chris Wallace's team before hand to suggest relevant questions?
Recent AMA announcement:
AMA President J. James Rohack, MD, will participate in a panel discussion on Fox News Sunday regarding the myths and mischaracterization in the health system reform debate. The program, which will air at 9 a.m. EST Aug. 16, will include a panel discussion hosted by Chris Wallace that includes Sen. Richard Shelby, R-Ala., ranking member of the Senate Budget Committee, and John Rother, executive vice president for policy and strategy at AARP.
A strike to withhold services would be a disservice to our patients and would be incredibly bad press for the medical profession. How we should strike is by refusing to accept ANY third party arrangement or payments. Opt out of Medicare, resign from insurance contracts, HMO's, etc., quit filling out their forms, set reasonable fees, lower overhead by not dealing with all the extra paperwork, and deal directly with our patients again. Provide charitable care where needed. It was like that when I started practice 45 years ago. Patients did not have such an entitlement mentality, I felt I was appreciated, and medicine was fun then. Sequester your assets, cancel your malpractice insurance and buy medical defense insurance instead. Trial lawyers sue only deep pockets, and knowing that there will be a vigorous defense, no pot of gold and possibly a counter-suit will discourage them no end.
Reply to Sermo Doc 6 Radiology, Pediatric Posted Aug 12, 2009 at 9:20 PM
"I've heard physician payments account for 5% of the total health care costs. Any one else heard similar? You can cut that to zero and still not achieve significant savings."
The percentage of healthcare spending received by doctors varies according to the identity of the third party payer.
Overall, according to the 2009 Edition of Health Care Costs 101, only 21% of the total of $2.2 trillion in U.S. health care spending in 2007 was spent on "Physician and Clinical Services" as compared to 31% spent on hospital care.
However, looking at the $454 FY 2008 CMS budget for the Medicare and Medicaid entitlements tells a different story. Only 12.9% of the $454 billion in total Medicare spending represented net outlays for physicians, compared to the 34.3% spent on hospital care (inpatient and outpatient).
This maldistributed spending reflects the absolute power the Medicare and Medicaid monopsonies (i.e. "buyer monopolies") and the private insurance seller monopolies and oligopolies enjoy to dictate the reimbursement levels of each of their different suppliers of services and products.
This publicly available information makes the support of HR 3200 and its "public plan option" by the AMA, the ACP and the physician advocates of government single payer NHI look even more economically and historically illiterate than the "leaders" in Congress and the White House.
If public option passes in some form ( as it will). Here ae some scenarios:
1) HSA will be abolished.
2) Employers will end up shelling around $400/employee for Medicaid type of coverage. No one has clarified who is going topay for dependents!
3) BCBS and other private insurers will price themselves out of the market or rebrand themselves as conveyors of government healthcare
4) Whether you like it or not doctors will have no option but to participate.
5) Most doctor's will downsize considerably. Those over 55 will seek out retirement, move to Costa Rica, Mars etc or switch part time working hours and terminate more than half of their employees. They will all aim to earn less than 150K/year to get benefits. Who wants to work when there is a handout?
6) The cooperatives will work like most Public Schools with Admin heavy, nurse managed operations with rare physician involvement.
7) Drug companies will drop prices as most people will not be able to afford any brand name drugs.
8) If enough educated people with debt but no jobs accumulate, we may become like France or Italy wheere the retirees live like kings(relatively speaking) and youngsters slog in low paying jobs.
It is not looking good!
Politicians and people keep talking about " physician patient must make decisions" who are they fooling? Physicians make decisions to avoid getting sued.Patients google and ask doctors what they want. if they don't get it they will sue. People don't want to change this but they also don't want to pay for this type of medical care. it is like smoking but suing the tobacco company or eating what you want , becoming fat and suing mcdonalds! All the people that shout so loudly in thesed town hallmeetings, don't talk about how they abuse the system, which has contributed to the rising cost of care Everyone wants to cut physician payment but no one talks about cutting hospital and insurance company CEO pay. how can we direct this health care reform debate towards what is need rather than all this nonsense
The only "reform" that will be tolerated by the health insurance industry and their purchased politicians will be more guarantees of insurance profits. Can anyone tell me one thing that the insurance industry contributes to patients, providers or any other part of the health care system?
I think health insurance needs to go the way of bustles and buggy whips. Eliminate insurance companies and their unearned profits and we'd have the dollars to convert to a single-payer system with truly universal coverage. With guaranteed universal coverage, the incentive to file malpractice suits just to be able to pay for necessary medical treatment would be eliminated.
60% of providers AND the public support single-payer, but it''s going to take a huge rising of public anger to defeat the lobbying pressure of the insurance companies.
What we need is a "Care-In" similar to a sit it. A broad based coalition who at a pre determined date refuse to see patients. each patient that calls and asks for service will be referred to a fee for service physician only or to the ER. It will require tremendous unity on our part but it will serve to make our patients aware that we are the only ones who can provide them with medical service. It is possible for us to get a seat at the table when it comes to health care reform. But only when the public and the politicians finally realize that it is because without us there is no health care.
We have always had a single payer system, probably as far back as we have had healers. That payer is, was, and always will be, the patient. What we are questioning now is, who should be the intermediary between the patient and the provider, be it Dr, hospital, or whatever entity one chooses to fit in. The real question that should be asked is being deflected or outright ignored, and that question is "why do we need an intermediary at all?" Quite simply, we would not be in our present state had we not started down that path, and by now we have so many individuals with a vested interest in the current situation that no one wants to let go, especially the federal government, which seeks unchecked expansion. This conceptual ideology of abrogation of individual responsibility by the individual and accretion of such by a central entity, be it insurance or government, is precisely what our forefathers rebelled against and tried to eliminate from our nation and our culture back in 1776. It works just fine for an ant colony, where individual identity is not of importance (except for the queen), but not too well for human beings.
As many of you may recall, Hallary's attemt to socialize medicine in 1993 included a provision making it illegal for doctor's to see patients for cash. She wanted to force all doctors into the system. Is anything like this in the house bill.? I have not seen any information regarding this. However, the liberals in congress who are pushing 'reform" must realize that their new plan with far lower reimbursement to physicians will result in many wanting to opt out. I doubt they will allow this.
EVERYONE IS ASKING "WHERE WILL FUNDS TO PAY FOR THIS COME FROM"
NO ONE IS ASKING WHAT SERVICES WILL BE CUT OR WHAT INCREASE CHARGES TO PATIENTS WILL BE INVOKED TO HELP REDUCE COST!! SUCH AS MAKING RETIRED MILITARY VETS PAY A LARGE DEDUCTABLE,WHICH IS A PART OF SUCH CHANGES BEING PROPOSED
How come no one has mentioned the expenses associated with Medicare fraud? For instance the Government Accountability Office reports that Medicare makes about $17 billion in improper payments each year. This seems to an understimate if we are to believe Harvard University's Malcolm Sparrow, a specialist in health-care fraud, recently testified to Congress that official estimates are "lacking in rigor," are "comfortingly low and quite misleading," and exclude many kinds of fraud and abuse. He thinks that as much as 20 percent of the federal health-care budget is consumed by fraud, which would be $85 billion a year for Medicare (http://invisible-hand.net/?p=3)
As a system, this option (is it an option?) is expansion of entitlement burden on tax money pool. As happens to all such programs, there will be a lot of waste, fraud, abuse and inefficient use of money. Result will be ever increasing money pit, leading to ever increasing tax burden on those who produce, leading to dis-incentive to produce.
This loss-leader could balloon big enough to bankrupt the US (Yes, in the eyes of natural laws, no one is too big to fail).
If they pass something like the current proposal, probability of US going bankrupt in my life time will go up significantly and I will not be keeping any spare asset in dollar denominated form.
**************** I disagree, though, that drug prices will be down. Pharma has got a deal with the mafia (aka politicians) that controls the DC that Govt will not allow generics. And remember drugs will be covered by the govt money, so basically, they are paying the lawmakers to have assurance that they will be allowed to loot from the tax money pool...... so there is no one to control the price, except the congress or NHB ......... and they can be "influenced".
*********************** What we need to cut costs is to open the suppliers of health care (Doctors, Hospitals, Pharma) to competition.
Let the consumer (patient) be in-charge of his/her money. Then every patient will work as price negotiator and quality controller.
Let there be skin in the game.
****************** In current form, this bill is just opposite of what we need as a nation. This encourages entitlementiasis, discourages employment, reduces responsibility, reduces control, freedom and right to choose from among the options.
In phases & steps, natural flow of the system will be towards complete socialization of health care......... and we know, no matter how Utopian and altruistic one's intentions are, in the end, laws of nature can not be violated.
One basic law is that there is no free lunch. If you dont produce a dollar, you can not consume a dollar without having unintended consequences. Sooner or later, you will run out of OP(iu)M (other people's money).
If a system, be it socialist or otherwise fails to respect this law, it **SHALL** collapse one day.
US has been on this path since early 1970s when we decided to ignore this natural law by removing dollar from gold peg ........ and this bill will accelerate the process.
call me Socrates, ... give me a bowl of poison to drink..... but please dont ignore the laws of nature, or .... "The Empire" will collapse.
Insurance and Torts
Break up the insurance companies and add tort reform!
We don't need another massive bill that denies liberty to all Americans!
Break up the insurance companies, break up the trial lawers, and forget new health bills. Break up the insurance companies by simply enforcing existing anti-trust law and let innovation take place for the rest of us. Think of it this way — If we break the five biggest companies in each of the insurance, pharma, and hospital industries into five or ten companies each — by simply stopping the anti-trust law exemption that these industries get, then we'd instantly have competition throughout the industry and we'd have 25-50 new companies in each industry innovating and trying to provide "better" service, creating new jobs...what's to lose?! That's why we have anti-trust laws. Any bill from any Repub/Democrat has lost site of what the whole idea of health care is. Break up the insurance companies by simply enforcing existing anti-trust law and let innovation take place for the rest of us. No new bills except for tort reform! Kill the Obama bills instead.
By the way, where are my fellow pathologists in all of this? I only see one other posting above from a pathologist. I guess their heads are stuck in the sand somewhere!
In the room filled with those responsible for spiraling health care costs in the US, the 1000 pound gorillas are health insurance companies and pharma -- the baby gorilla asleep in the corner is defensive medicine -- the point of health care reform is to redirect those health care dollars we spend to those who actually provide care to patients -- without change, the gorillas will continue to grow and the space occupied by physicians, hospitals, and ASCs will become even smaller in that crowded room -- I doubt there will be any meaningful tort reform (physicians are loved individually and "less loved" collectively) -- pharma has made some strategic concessions -- the only thing that will redirect some of those dollars is competition in the health insurance industry -- I support the president's plan for health insurance reform
If you guys think that Warren Buffet's decisions have some meaning, you could believe that Insurance companies are being taken to slaughter house.
He sold UNH and WLP again in Q2 after selling significant bunch in Q1. From Bloomberg: Berkshire reduced holdings of WellPoint Inc. 27 percent to 3.5 million shares and sold 24 percent of its shares in UnitedHealth Group Inc., lowering its total to 3.4 million shares.
And, many people believe he is close to BO (and of course many other "insiders")
Dan, Great job. You have my support. I believe that because of you and Sermo doctors are at least, finally, getting heard in this debate. We docs have lots of opinions but those of us not intoxicated with the Kool-Aide appear to have a voice through you. Thank you.
Medcare pays hospitals a fixed fee under the DRG codes based on diagnosis. Just wait...physicians, under the Obamacare plan, will also be paid under a DRG type plan...one fixed, all inclusive fee for hospital care and no individual pricing for services rendered. The cost savings will come from decreased physician payments. Does the public care? Hell no...afterall aren't all doctors are rich?
Fake doctors are at the Obama healthcare town hall meetings and he is receiving planned questions from Obama supporters. He already has his answers prepared. And why are the taxpayers paying huge dollars for him and his family to travel on sightseeing trips to the national parks? What a waste of taxpayer money.
Lastly, read the articles by Stanley Feld, M.D., FACP, on "Repairing the Healthcare System." They are very good (I am not Dr. Feld). See stanleyfeldmdmace.typepad.com
Physicians can bill what the market will bear. Those who think most physicians are greedy should go to the mission field where their self-righteousness will be rewarded. Government and insurers can decide what they are going to reimburse patients.
Can't believe this is passing around amongst AMA staffers.....
For those of you in love with Pharma I don't mean to upset or alarm ya' But Danny Palestrant's "Public options ain't good!" rants Aren't good for your afterlife karma
truga: you ae correct. The doctors who fail to negotiate a payment for services from hospitals will be left helpless when the Shi* hit the fan in the next few months
Sermo Doc 22: very perspicacious observation. You are right!
Obamacare (aka the destruction of healthcare in America and then America) secret plan: No tort reform. Doctors , hospitals and other providers will still have to see everything that walks in the door, whether covered or not. No treatment = potential liability. Therefore, uncompensated care provided under liability fear will shift cost of care from third party=government to providers. Neat if he can get away with it.
The statement that private health insurances would be "essentially phased out by 2013" is a flat-out lie. The number of lies, distortions and delusional statements made by opponents of health care reform is astounding. It's a real shame that Sermo has either joined forces with these groups, or like so many others, has been remarkably careless with their fact checking.
Go Dan Go! You are our only representative voice in this debate. The AMA does not represent us. Viewing all the commentary, I see that we are ready to fight--to fight for the truth and our patients. I think you have outlined it well that if we do not have tort reform, insurance reform, and overhead costs contained to deal with AMA and government bureaucracy, there will be no cost containment. The public thinks that docs are overpaid. Obama thinks Sermo Doc 69s get paid $50,000 to perform a leg amputation. We would be lucky to get paid 2% of that. Somehow the government thinks that physician reimbursement is the problem and we need to be clear what the real problems are: insurance companies, lawyers, and the AMA--their interests and incentives are not on the side of the patients or the doctors. Until this is made clear, Congress will try to pass "healthcare reform" with no reform at all.
Great interview... I agree with the previous and even current differences with the AMA, but I would try to avoid the "we hate the AMA" mantra as the crux of what your saying publicly. This is a prime opportunity to let the physician voice be heard on what we want changed, so let's use it to the best of our ability and we can fight with the AMA in private or in places like this. I think everyone understands that the AMA is out of step with the majority of physicians in this country, now let's tell them what's missing from the current healthcare reform... Thanks for all of your work!
The "public option" presents a perfect opportunity for physicians to establish a Physicians' Healthcare Delivery System that is funded by the government. It is a meaningful opportunity for us to gain a significant measure of control over healthcare decision-making. Please re-visit prior posts on this issue. See md.sermo.com
Let us have a vigorous debate on Sermo on this subject, and advance the outcome as a suitable "co-operative" to fill the public option vacuum.
Even if 100% of the doctors ALL agreeded we would still be in the minority with the numbers. The Deaf Democrates are not listening. You can post until eternity and the only ones that sees this are a small number. I heard Lou Dobbs comment that out of 900,000 physicians about 275,000 support the AMA. Then there were the 4,000 doctors of SERMO. Although 94% of that 4,000 agree, we are a few. We are like David up against Goliath. We need a good rock to throw since we at least have another modern day David (Daniel Palestrant, MD).
Obama has recently spoken about his health plan and has revealed his lack of understanding about aspects of medical practice and the reasons for rising health-care costs.
One theme the president has focused on is doctors' motives. During a prime-time press conference on July 22, the president referred to a doctor who muses that she makes "a lot more money if I take this kid's tonsils out", even if the child might not need surgery. Responding to a woman whose spry 100-year-old mother was given a needed pacemaker despite her age, the president said a few weeks earlier (at an ABC News town-hall event at the White House) that doctors should let patients know that sometimes "you're better off not having the surgery, but taking the painkiller."
Obama's clinical scenarios represent an excessive, erronious view on how doctors are influenced by financial incentives.
This view on medical decision-making may explain why programs Obama is proposing to lower health-care costs rely on the direct regulation of medical decisions. If Obama is serious about lowering costs, he'll drastically reform the economic structures in medicine, especially programs like Medicare.
Obama's policies will directly regulate doctors and their decisions.
Let's face it, most doctors haven't weighed in on the financial aspects of health care delivery because we "are above that discussion". Now we all see where it has gotten us. Some of you are correct, forcing doctors to accept less by legislation will be part of the solution. We need to reduce incentive to do more by paying less and reducing access. We will see if the public prefers this approach. I doubt it, but they will have no choice. Don't fall for the trap in vilifying a specialty Sermo Doc 69 to make yourself feel better. $600 for restoring vision is hardly overcompensation. Someone needs to educate our "smart" President that Sermo Doc 69s don't get paid $30,000 for a leg amputation". It is a purposeful attempt at misinformation.
a SIMPLE and cost effective solution to the mess is to open Medicaid CLINICs in each county for those on medicaid and those who refuse to buy insurance... You can staff it with medical aides. lpns etc... there is NO progress unlesss the Legal Reform occurs.. It is amazing to me when they toute that we have higher costs in america and poorer quality that NOONE points out the LEGAL COST In American is why most Pharmaceutical co have gone Abroad!! Schering Plough was our last one we lost this year! also I guess infarcting in Canada is cheaper than preventing scar damage and CHF.. amazing how that is "bettter care"
EVERYONE get active NOW and FIGHT THIS government GARBAGE .. IT is the GOVERNMENT PROGRAMS that are cost shifing to Private plans and destroying them.. along with Legal Mafia.. for 30 years i worked on the left and right to improve health care.... the Dems never used common sense.. only power control and cut back on the Providors (US) to solve every cost overun... They never cut their salaries or benefits
Since I was raised in a moral democrat family, I was shocked at the meanness to us>
After seeing Obama's Physician say he never had the gov interfer with his practice of medicine I can see WHY OB is still smoking!.. I am pleased that I prevented Meningitis in adults who i gave Hib and PCV to and ran the rath of Idiots at Medicare.. who could have cared less that i prevented life threatening illness.. Eventually I made the patients BUY their own vials and only charged them for the shot.. so i would not activate the Stupidity in the ranks! (whoops, maybe i should NOT have used That word!)
FOr us to GO to the MISSION Field, we must have NO DEBT...!!!
we need to start a campaign to prevent med students from going into debt for TRAINING.
that will lower our ranks and maybe someone on the left might wake up.. but dont count on it..
Dan and Sermo have made some huge strides in just the last 3 weeks in getting our voices heard - the best and most democratic voice of practicing physicians. One month ago it seemed like HR3200 was a speeding train that was unstoppable
Americans, meanwhile, have clearly shown that they have a great deal of common sense (generally) as borne out in their ability to tell HR3200 would be medically and financially destructive. Americans want the health care reform process to slow down, be well thought out, not destroy the high quality aspects of our health care system, and not financially burden the country. Talk of tort reform is even out there a little more.
3 weeks ago, it seemed like HR3200 was a speeding train and unstoppable. The Blue Dog pause on the legislation and force of the American people may have derailed this destructive piece of legislation.
HR3200 - may be derailed. Daniel is getting on CNN and other news channels, and he's been down to Washington.
We have a window and a little more momentum to truly have ourselves heard.
Each of us has to do our own practical things to help the cause. I'm doing the following, and would encourage everyone to do the same:
1) Voting as much as possible on Sermo
2) Telling/contacting as many colleagues as possible about joining Sermo to be heard
3) Discussing my thoughts with my patients about health care reform - including putting postings in my office (Our opinions hold a great deal of weight with most of our patients. I like to tell them how bad reform may harm the care I try to provide them.)
5) Directly contacting my House and Senate members with snail mail and email about health care reform
6) Contacting as many friends and family members as possible to contact their House and Senate members to do the same
7) Emailing friends/family on important health care issues that are being debated
8) Talking to my patients about what practicing MD
We have to keep up the fight. We're making some headway. I know there are some huge obstacles to some things we want (tort reform), but if enough of us hammer away at it endlessly, we can make a difference in many ways.
Sermo Doc 100,
How about also organizing as CORPORATE entities of physicians locally, then coalesce regionally into entities that form a "public option'?
It seems that opinion coalesces into two camps, specialists and primary care- FP/internal medicine/GYN/hospitalists vs. specialties that are more aligned to the piecework model (id more is better). I personally think this is the issue with the AMA as well- it represents numbers and there are more primary than specialty physicians in the US. I almost wonder if medicine will rearrange itself into two or three entities- a large primary mechanism that practices and is paid by different mechanisms than fee for service (capitation or number of covered lives) and a secondary specialist group that paid fee for service with a quality modifier for outcomes. Maybe even a third group- hospital based which are paid by hospital compensation mechanisms- RAP/EM (aptly named, unfortunately)- ie salaried. This will end up reducing or eliminating doctor owned hospitals, ASC's and imaging centers, which the large insurers are trying to do. The real need is doctors to form larger groups as primary care and specialists and "corporate" themselves as real providers of care, including insuring and risk taking for coverage contracts.
As a PCP, cut my reimbursement and I am out of business. If something pornographic is known as such when seen, then a CEO with a salary in the tens of millions is pornographic -- our cultural pornography. As for the pharmaceutical industry . . . The insurance industry has won its battle against PCM. The field has been so ruined that only one or two percent of students choose this specialty as a career path. They must be independently wealthy.
You do not pay the provider less. We are the front line. The hundreds of unreimbursed hours spent laboring on someone's behalf. The incessant interruptions throughout the day that must have the information contained in each be placed into some coherency. Always feeling rushed, always worrying about what might have been missed. It's time for fairness in this system of exploitation and servitude. The public says it's all about "me, me, me". Just do this for me. I don't care if you can't make ends meet -- heh, it's not my problem.
I need my airline bag . . .
Dr. Palestrant did a great job. The AMA is listening. Maybe there is hope.
We need to serve our patients and get paid by the patients for doing so. If our patients have more control over their insurance money, they get to decide whether the doctor has earned his fee. People need doctors: they need educated, dedicated, experienced, sophisticated, caring doctors who answer their phones and run their offices for their patients: not for CPT codes and fluffed up bills.
Insurance/Health care reform that restores payment for service, not for cpt code, is the only thing that will give our patients what they want and give us and our colleagues a great way to care for the well/sick and earn a good honest living.
So long as we complete with each other for CPT money, then we will be increasingly overwhelmed by NPs and PA-Cs and we will see our professional satisfaction decompose as we try to bill more bone densities, profit share in CT scans, and dream of self centered concierge practice.
Tort reform is the second leg: we are forced to treat everyone the same because of standard of care paranoia. Tort reform will enliven our care as we try to meet the needs of our well and sick, and not try to fill in the check list for bogus standard of care.
Physicians need to be able to bargain collectively. As long as this is prohibited, we will be powerless in the marketplace as well as in the political arena.
I generally agree with most of the AMA concerns and with Dan, however the argument that MDs will be out of work only works for as long as ot takes to reset the entire system to that of a Euro system, where MDs, darn good ones give care darn good care, to patients, and they make lilttle money delivering this care. You and I may leave the biz, but others with dfferent ideals will appear. Food for thought.
The administration wants to decrease reimbursement to discourage physicians from providing services!!! Then they can turn around and say to their constituents "it is the physicians who are denying you..., we are happy to pay"... (very little). In the end, it reduces the governments cost and they can state they have a universal plan to the people. Its not about what is right or wrong, its about pure politics.
The public should know that physician payments are only a small percentage of the total healthcare costs. For long physicians have taken care of poor populations for free, have accapted embaressingly low fee scheduales from the insurance companies and the public still thinks: rich doctors!
President Obamma at his meeting with AMA said that doctors should get their priorities straight. If someone suffers from a malpractice act deserves awards and we can not take that away from them. A simple question for our president: Why doesn't your bill contain a clause saying that there should be a maxium cap of 10% commision on lawyers fees? (instead of the current 40%-45%) so that the victims of malpractice can get all that they deserve?
Daniel, I just watched both posts, and really I could not agree with you any more ! Thank you for pushing this forward. I think that we should, as Physicians, organize further. Sermo is a great tool for this. I think this who concept needs to go to the next step, create an organization that truly has the patient's and Doctor's interest at heart. Count me in if we can create a new voice- we can organize locally, fund raise, lobby, be true advocates for what the health care system should be- WE NEED TO DO THIS- or we will be run over and left for dead-
Keep up the good work of confronting the real issues with and in the proposed bills. AMA's vested interest does not help rank and file physicians or patients. What a pity the "doctor's house" is warped by business desires and not noble goals. Tort reform is an absoult requirement. The AMA plays with the devil by courting the federal governement.
HHS Secretary said this weekend that they may forego the Public Option and push for Co-Ops! Co-ops never worked before so here we go again.
Obama said he'd accept a Bill without the Public Option so it appears he'll back the Co-Op Plan now. Sen. Conrad (D),ND, said Obama never game them any plan and they don't have the votes in the Senate for a Public Option. What? Obama never had a Plan?! So, he'll take whatever gets him reelected in 2012!
Obama likes "Death Panels" though and was quoted in the WSJ OPINION page on Friday, 8/14/09:
"Well, I think that there is going to have to be a conversation that is guided by doctors, scientists, ethicists. And then there is going to have to be a very difficult democratic conversation that takes place. It is very difficult to imagine the country making those decisions just through the normal political channels. And that's part of why you have to have some independent group that can give you guidance. It's not determinative, but I think has to be able to give you some guidance. And that's part of what I suspect you'll see emerging out of the various health care conversations that are taking place on the Hill right now."
I'd suggest Congress scrap all these Bills and, instead, draft a TORT REFORM bill and save $30 Billion in malpractice costs. Vote Sen. Specter and the other Trial Lawyers out of office in 2010.
Lastly, maybe Sermo and Dr. Daniel can look into having the Justice Dept. investigate the 5 big insurance companies, big PHARMA, and the big Hospital companies as a monopoly. Break up the insurance companies by simply enforcing existing anti-trust law and let innovation take place for the rest of us. Think of it this way — If we break the five biggest companies in each of the insurance, pharma, and hospital industries into five or ten companies each — by simply removing the anti-trust law exemption that these industries get, then we'd instantly have competition throughout the industry and we'd have 25-50 new companies in each industry innovating and trying to provide "better" service, creating new jobs, removing their control of doctors...what's to lose?! That's why we have anti-trust laws. Yes, these companies do have an "anti-trust law exemption" thanks to Government lawyers! Remove their "EXEMPTION".
Thanks for providing this forum. Dr. P. did a great job on CNN! As a side note, we just got our newest increases in premiums from BC/BS - going up 28.6%. Aetna is going up 41.6%! We called to ask if our fee schedule was also being adjusted up; once the insurance companies stopped laughing, we were told that an individual doctor will not be negotiated with. For those of us in solo practices, we are seeing our numbers shrinking in leaps and bounds. So, it is terrific that we can be a part of something as dynamic as Sermo to get our collective voices heard.
You are right on target: no insurance reform + no tort reform = no healthcare reform. If this bill goes through as is, we are done. We have to keep up the good fight...
This may be the most idiotic posting ever and if so I'm sorry. I say if they won't allow us to participate in the discussion for health care reform we make our own plan for reform. We are the only ones in the mix who can actually provide care. When doctors were being ripped off by malpractice insurance companies this spawned the creation of a malpractice insurance company run by physicians for physicians with better malpractice rates and better protection. Why not have physicians create create their own version of a not for profit BCBS run by physicians to compete with the vultures who are sucking our life force? A pro-physician company providing insurance to patients at better rates and offering better compensation to physicians where profits are funneled back to participating physicians like a credit union. If we could make this work BCBS could take a hike. I would politely decline to serve as staff to provide E.R. call and hospital consults for any hospital that did not accept the physician plan. As for being replaced by NP's and PA's don't make me laugh. If my experience with the care these "providers" deliver is typical the mortality rate in the U.S. will soar.
Lets unite. Yes we do not have the time because all we are doing is trying to catch up with the paper work. It is time to revolt, we should all drop off Medicare and Medicaid to let them know that they need to listen to common sense from physicians. We all have felt the the same way but we dont act.
I don't have time to read all the comments, but i echo Sermo Doc 116's question: Will you be there on Oct 1 in DC Dan? Why are you so silent on the MMM?
RADICAL IDEA: INCREASE PAYMENT FOR COGNITIVE TIME!
Do not penalize doctors for thinking through treatment plans.
Unfortunately, the problems are more complicated than the thoughtful, excellent post that begins this discussion.
We DO need to proceed incrementally BECAUSE no one can be sure how to disentangle the knot.
Something getting lost in all of this is the MAIN point of the IOM study of a decade ago: All the systm problems are so big, those in the system cannot see them.
That is also why no one practice style is THE ANSWER, one size doesn't fit all, and the supposed inefficiency is also a strength because it allows for options, experimentation, adaptability.
We have to face thereality that all the proposed answers squeeze air out of the system at one time, then the escalator begins to go up again.
We have to blame doctors for promoting the idea that practice of medicine is a bunch of algorithms! I have yet to see a profession that denigrates itself like medicine.
Former Gov. Dean calls public option indispensable
AP - 43 mins ago
WASHINGTON - Former Democratic Party Chairman Howard Dean, a leading figure in the liberal wing of his party, said Monday he doubts there can be meaningful health care reform without a direct government role.
Sermo Doc 39,there are those who believe that the public option will provide an alternative,hence introduce competition and eventually ensure coverage for 'all'.'Coverage for all' has been pushed as an indirect way of achieving tort reform since BO has neither the spheres nor disposition to go after his colleagues and mentors.The theory imagines that IF everyone has or is guaranteed coverage,there would be no reason for juries to award millions of dollars in cases involving unfortunate outcome from birth,disease or surgery.I do not agree with that theory.From where I stand,all the ills of medmal is driven by pure greed within the legal industrial complex and patients/citizenry.Just my personal opinion.
Ak, Cbeau: Isn't the problem jury trial itself for so called medical malpractice,which in 99% of the cases is mal-occurrence or poor outcomes? What better time than now to demand vociferously a different way of handling these issues through no-fault insurance system( like the auto insurance). Indictment of individual physicians should be banned by law, barring overt criminal acts when it should be handled in criminal courts. Of course the trial lawyers will go ballistic. So be it. Why can't the doctors tie this common sense measure to any reform bill? If we don't try, we get nothing. I'm tired of being mowed down every day.
JohnCowl views on cataract surgery costs are self serving and biased in his favor. The Government run Medicare & Medicaid and big insurance companies are monopolies that strangulate the health care delivery in the country. The health insurance reform along with tort reform can resuscitate the health care system.
The first causality of divide and rule tactics of government price fixation was Cataract surgery the gold standard of any surgery. In a simple cataract the cutting edge microsurgery IOL restores the sight back for good, rehabilitates the visually disabled with economic independence, lifts up the spirit and confidence to purse productive and happy life.
The cataract surgery being the most common surgery performed in USA at $1573 in 1989 became the object of unabated series of pay cuts thanks to irrational irresponsible people comments... The 2007 payment was $608. The gold and oil command the more price than sand unless it is a computer chip. The market forces of demand and supply determine the price of a service or commodity. People attach high importance to eye care all over the world pay well as it is a good value for high quality of visual function.
The two eye together account for 80% of total body function. The surgery demands micro surgical skills, dexterous operation of technologically advanced tools besides mere cognitive skills to achieve the precise visual function. All specialties and primary care are important for the health care delivery. The coronary by pass surgery is valued higher than surgery for intestinal obstruction, though both relieve obstruction. That is effect of market forces of demand supply of skills and the value public attach to a given surgery. The cataract surgery fee includes initial evaluation and 90 days post op care.
The couch care implanting ideas and prescribing the expensive psychiatric drugs on long time basis and charging for every second of every visit with no permanent cure is a lot more expensive than cataract surgery and less value for the money. There is day and night difference between cataract surgery and couch care in the complexity of care and quality of out comes and value given by public. The time is not the only factor paid for as in psychiatry listening to clients. Why should the president be paid $400,000 for administration and Wall street CEO paid millions? If one practices communism no one should be paid better than Psychiatrist. This class war fare fuels the Obama health care reform pitting cognitive versus Sermo Doc 69s, divides the physicians unity and in the end every one losses the deserved pay scale. When you have cataract if you go to psychiatrist he can listen and talk for ever and prescribe medications in vain to restore your sight. The cataract surgery is the most under valued surgery in the modern age for all the benefits bestowed upon the IOL recipients.
Government monopoly simply reduces physician pay every year under some pretext or SGR or using socialist principles. The RBRVS of 1992 assigned RVU s based upon intensity, time, overheads, professional liability and geographic practice index. This further modified on budget neutrality and SGR adversely effect surgical payments. As the seniors increase in numbers the cataract surgery demand increases especially with good visual results yet the fee is cut every year. IT is not group psycho therapy each surgery is performed individually.
JohnCowl views on cataract surgery costs are self serving and biased in his favor. The Government run Medicare & Medicaid and big insurance companies are monopolies that strangulate the health care delivery in the country. The health insurance reform along with tort reform will resuscitate the health care system.
The first causality of divide and rule tactics of government price fixation was Cataract surgery the gold standard of any surgery. In a simple cataract the cutting edge microsurgery IOL restores the sight back for good, rehabilitates the visually disabled with economic independence, lifts up the spirit and confidence to purse productive and happy life.
The cataract surgery being the most common surgery performed in USA at $1573 in 1989 became the object of unabated series of pay cuts thanks to irrational irresponsible people comments... The 2007 payment was $608. The gold and oil command the more price than sand unless it is a computer chip. The market forces of demand and supply determine the price of a service or commodity. People attach high importance to eye care all over the world pay well as it is a good value for high quality of visual function.
The two eye together account for 80% of total body function. The surgery demands micro surgical skills, dexterous operation of technologically advanced tools besides mere cognitive skills to achieve the precise visual function. All specialties and primary care are important for the health care delivery. The coronary by pass surgery is valued higher than surgery for intestinal obstruction, though both relieve obstruction. That is effect of market forces of demand supply of skills and the value public attach to a given surgery. The cataract surgery fee includes initial evaluation and 90 days post op care.
The couch care implanting ideas and prescribing the expensive psychiatric drugs on long time basis and charging for every second of every visit with no permanent cure is a lot more expensive than cataract surgery and less value for the money. There is day and night difference between cataract surgery and couch care in the complexity of care and quality of out comes and value given by public. The time is not the only factor paid for as in psychiatry listening to clients. Why should the president be paid $400,000 for administration and Wall street CEO paid millions? If one practices communism no one should be paid better than Psychiatrist. This class war fare fuels the Obama health care reform pitting cognitive versus Sermo Doc 69s, divides the physicians unity and in the end every one losses the deserved pay scale. When you have cataract if you go to psychiatrist he can listen and talk for ever and prescribe medications in vain to restore your sight. The cataract surgery is the most under valued surgery in the modern age for all the benefits bestowed upon the IOL recipients.
Government monopoly simply reduces every year under some pretext or SGR using socialist principles. The RBRVS of 1992 assigned RVU s based upon intensity, time, overheads, professional liability and geographic practice index. This further modified on budget neutrality and SGR adversely effect surgical payments. As the seniors increase in numbers the cataract surgery demand increases especially with good visual results, yet the pay is cut annually. IT is not group psycho therapy each surgery is performed individually.
... dazed, vertiginous, hit by a baseball bat, burnt out....... but still clinging on your coattails DAN, excellent voice for all of the above... and everyone including me!!!
All of this is insane. Why are we linked to insurance at all? We should push for "reform" making it illegal to include our professional fees in any insurance plan that includes in-patient and non-physician care. There should be separate "professional fee insurance." If that were the case, people would IMMEDIATELY recognize what a bargain we are (we account for 7-10% of the total cost of medicine) and we could gracefully step aside as the 1000-lb gorillas fight over the real cost drivers-- themselves.
I saw a need to help women and thus chose women's health. I have an enormous amount of debt. I'm only 3 years out and am already planning my escape from what I used to think would be the greatest profession ever. I no longer feel sorry for the American public when I realize they will lose many of their docs this way. I just can't practice when I look at every patient as if they will sue me (oh, I know that's only a matter of time- I'm OB for crying out loud), I have a huge sigh of relief when "difficult" or "high risk" patients get referred out or go somewhere else, even though much of that is what I'm more interested in. I simply don't have the time to treat everyone the way they deserve to be treated. I've decided I'm no longer coming in on my time off, no longer staying late to fill out paperwork, and I need to actually take a non-working lunch some time because I really can't remember the last time I did that. And it hit me this morning that this is what I was sold while being trained in a very fine Medical school- that I should be able to see a patient every 8 minutes and that to not do so was inefficient and wasteful. I've spent the last two years beating myself up to see more and more people and FOR WHAT? A constant headache, stress and now patient complaints that I'm TOO busy, too hurried and unavailable as I strive to see 40 patients a day for a large corporation. I would love to see tort reform, insurance reform and patients taking responsibility for themselves. I would love to have 20 min patient visits, HA! Then maybe I wouldn't dream of doing something else. Keep getting our voices out there!
Agree with arguing for the complete removal of the tort system and all participation by lawyers in the health care injury claims adjudication process. I believe that this should be ONE of a NUMBER of "demands" by physicians for participation in a Public Option.
Arguing from a position of stating "there must be tort reform for health care reform" is not going to get us anywhere in the health care debate. We must be clear what we will contribute to health care reform in return. Participation in a Public Option could be coupled with an expression of support to: 1) participate in an objective means of adjudicating health care injury claims, 2) use a free, well designed, physician-friendly EMR that contains agreed upon outcome of care measures that can be objectively defined with data collected in an unbiased manner, 3) provision of a physician-driven, continuous quality improvement mentality and work ethic, 4) do CME based on identified practice issues, 5) participate with other health care personnel to improve coordination and cooperation across the spectrum and continuity of care, 6) participate in comparative effectiveness studies when feasible in our practices, 7) continuous guard against interference with the Dr-patient relationship by outsiders except where that interference is explicitly agreed upon by physicians, patients and the government, *) self-critique our performance to ourselves, patients and to the government. In return we could "demand": 1) a no-fault, lawyerless adjudication process for health care injury claims 2) fair, negotiated payment at the time of visit 3) loan and expense "forgiveness" 4) the ability to apply behavioral economics to encourage better self care 5) only one review agency involved in practice reviews 6) guarantees that physician reimbursement could not be manipulated for political or government bureaucrat gain 7) a continuous quality improvement mentality and action by the government
We should be prepared to underwrite the above with an assured 30% decline in cost of care over next 2 years. Also add simplified billing through a single clearing house for medical claims. This the extent we should have a "single payer.." Remove restrictions that would lead to rational behavior based on market place demands..Example: if a doctor wants to treat a poor person for less than Medicare contracted rate that should not be a crime. It all distills down to "get the goons off our back"....There is no such thing as managed competition( even Hilary has given up talking about it)
Great dialogue! My anger with the system is soothed when I read docs all over the USA and of all specialties feel similarly (misery loves company!) We have a fight on our hands, but with the patient at our side and as our greatest concern, we must be rigid in our stance against these politicians and non-medical people who are trying to overturn the sacred doctor-patient relationship. Keep remembering that "they" can't have health care without us docs and our patients! Don't underestimate your value despite what "they" say. Don't knuckle under to government, insurance companies, lawyers, AMA, etc. Provide superb care in a caring manner and hand the patient the bill so they can get reimbursed by their choice of insurer. Voila, done deal! This should be the reality.......
1. Tort Reform - cap damages for pain and suffering nationwide 2. Tax Reform - given individuals tax deductions for having at least one physical a year, keeping their lipids, HbA1c, weight and waist circumference in normal range and having their age appropriate cancer screenings. Eliminate all other personal income tax deductions. See how everybody gets on a health kick, rather than a healthcare kick. 3. Health Insurance Reform - Mandate nationwide common forms. Mandate everyone to have catastrophic health insurance only for claims > $ 50,000. The rest people can pay out of pocket or HSA 4. HSA reform - Eliminate 'use it or lose it' provisions. Allow accumulating as much money as a person wants in an HSA. Allow using any money in the account for > 5 years to be used for any other purpose besides buying healthcare. Allow heirs to inherit HSA, though without any deductions or step-up in basis.
HSA should be the backbone of any decent healthcare system. The very fact BO finds it so abhorrent shows where we are headed. We, the physicians can control costs if there is no interference in our work. If the policy of the government is to insult us with crappy programs like the ones suggested by both Democrats and republicans who are so corrupted with lobby money, trying all these crazy mechanizations behind our back, there is no reason for us to even try to help, expect no cooperation. Physicians today are in a unique position to be brazenly confrontational when insulted and tell politicians off. We do not need to grease their palms. If it is a bare-knuckles fight, let us go for it. This is our last chance.
TOP TEN INDICATORS THAT YOUR EMPLOYER HAS CHANGED TO OBAMA'S PLAN:
(10) Your annual breast exam is done at Hooters.
(9) Directions to your doctor's office include "Take a left when you enter the trailer park.."
(8) The tongue depressors taste faintly of Fudgesicles.
(7) The only proctologist in the plan is "Gus" from Roto-Rooter.
(6) The only item listed under Preventative Care Coverage is "an apple a day."
(5) Your primary care physician is wearing the pants you gave to Goodwill last month!
(4) "The patient is responsible for 200% of out-of-network charges," is not a typographical error.
(3) The only expense covered 100% is.. "Embalming."
(2) Your Prozac comes in different colors with little M's on them.
AND THE NUMBER ONE SIGN YOU'VE JOINED
OBAMA'S HEALTH CARE PLAN:
(1) You ask for Viagra, and they give you a Popsicle stick and duct tape!
The practice of medicine in the USA is simply:
1. PROSTITUTED by 3rd PARTY intruders (non-medical, government, pharmaceuticals, insurers private or govenment, trial lawyers, paramedical NPs, PA's, chiroquactors, acupunctrists, soothsayers, etc, etc, in the NAME of the ALMIGHTY DOLLAR!!!!
2. PHYSICIAN outcry is LEAVE US ALONE we can manage health care!
AMA has orphaned us and had been in bed adulterous since the wedded gown is now despicably outworn in smithereens!
BUT the proverbial PHYSICIAN KNOW THYSELF is the only panacea in bringing back the TRUST and CONFIDENCE of the patient (3rd party and all!). The loss of confidence carries a hallmark of GREED, loss of compassion, crowned with a $$$ilver lined halo on our head!
The most touted EBM (evidence based medicine) is a cane crouch just like a drunk straddle over a night post in the middle of the street while the sober medical doctor races home for a late dinner as wife in tears mulling for a divorce and children already snoring in bed!
3. PATIENT INDULGENCE, irresponsibility, dependence because of health care AVAILABILITY magnified by the ALMIGHTY $$$ doleouts, social insurance security, cultural drug propagation without motivation, character and discipline.
Our ZEAL as adulterous but impervious as we are, NEEDS an SOS resuscitative cleansing among ourselves!
At the SERMO table, pray as need each other shoulder to lean on and cheer on Dan our SERMO President to go on!!! WE thank SERMO for representation just like David faces the G"O"liath in Washington, Congress Ataliah, AMA Aholibamah, the legal pundits of Ahab and the villous Deborah of Big Pharma, Cigna and Medicare!
On the heights of heaven, God stood and looked at our despondent hearts, as the glimmer of smile, courage and wisdom unite us all in prayer and praise that we still don the white coat of purity and victory!
1. Tort Reform
Remove trial lawyers like Specter (PA) from Congress in 2010 and stop Trial lawyers PAC and lobbyists. Pass a Tort (Malpractice) Reform Bill.
2. Insurance Reform
Break up 5 largest Health Insurersinto 25 smaller competitors using Justice Dept. and ant-trust investigation. Remove Ant-Trust Exemption from these large insurance companies which prevents free maket competition!
3. Implement Employer HSA's adding tax credits/deduction for Employers and/or patients who use them.
4. Kill all Obama bills.
Inform your patients, the media could care less as they love B.O.
Sermo Doc 47 is right. No one is talking about the three biggest things that need to be "Reformed."
1) Nothing is free in life. If a patient requires medical treatment then the patient should be responsible for paying for that service. Medical Insurance should be no different than homeowners or car insurance. If I have a plumbing problem in my house i call the plumber and pay his fee. If a tree falls on my house (a catastrophe which actually did happen to me) I call the insurance company. That is how health insurance needs to be approached. The predominant mindset that patients are entitled to all care for minimal cost is absurd and leads to disaster. Yes we have indigent patients and they should be cared for, but all of America is not indigent. 2) Tort reform. How can we practice medicine when some lawyer is capable of ruining us for doing our best and getting a bad result? 3) Why are physicians the only profession that is banned from unionizing?
And who says we are spending too much on health care? We are a rich country and our health is a priority as it should be. The best is not cheap. Congress is trying to engineer a scarcity.
WSJ OPINION
AUGUST 18, 2009, 7:16 P.M. ET
"Overspending is far preferable to artificially limiting the availability of new procedures and technologies."
By MARTIN FELDSTEIN
"Although administration officials are eager to deny it, rationing health care is central to President Barack Obama's health plan. The Obama strategy is to reduce health costs by rationing the services that we and future generations of patients will receive.
The White House Council of Economic Advisers issued a report in June explaining the Obama administration's goal of reducing projected health spending by 30% over the next two decades. That reduction would be achieved by eliminating "high cost, low-value treatments," by "implementing a set of performance measures that all providers would adopt," and by "directly targeting individual providers . . . (and other) high-end outliers."
"In the British national health service, a government agency approves only those expensive treatments that add at least one Quality Adjusted Life Year (QALY) per £30,000 (about $49,685) of additional health-care spending. If a treatment costs more per QALY, the health service will not pay for it. The existence of such a program in the United States would not only deny lifesaving care but would also cast a pall over medical researchers who would fear that government experts might reject their discoveries as "too expensive." '
Wonder how many QALY's we'll each have as we age. The Obamamorons will turn us all into "SOYLENT GREEN" if they have their way.
Town Halls have accomplished a lot. We haven't accomplished much at all with all our "Postings" and "Comments". Kill Obama's bills, break up the big Health Insurers, and add a Tort Reform bill by taking action.
Time is running out for us. We can educate every patient who comes to our office...they vote, they go to town halls, they talk to their Reps. and Senators, and they like us as "their doctor". Do it now or we all go down together!
Everybody from the Republican and Democrat Regime seems to agree that more competition in health care in general and in health insurance specifically is a good thing. Some say that a public option is good for competition, others say that a public option is bad for competition. If we want competition in health insurance, why don't we simply enforce anti-trust laws that are supposed to be the laws of the land in this country. The 50% market share enjoyed by BCBS and WellPoint, for example, in the Northeast US underscores that we should just enforce anti-trust laws against these insurance companies if the government wants competition.
But no - the insurance lobby industry makes sure that nobody even talks about simply enforcing anti-trust laws as a method of creating competition and trying to cut costs in the industry. Breaking these giant roll-up companies like United Health would certainly cut down on the lobbying powers of these companies. As it sits now, the health insurance industry actually has a full-on exemption from the anti-trust laws of this country.
That anarchic lawless exception to our country's laws stems from a 1945 bill that was supposed to enable the federal government to "regulate" health insurance.
The McCarran-Ferguson Act, 15 U.S.C. § 1011, is a United States federal law. The McCarran-Ferguson Act was passed by Congress in 1945 after the Supreme Court ruled in U.S. v. South-Eastern Underwriters that insurance could be regulated by the federal government via the Commerce Clause. The Act also provides that federal anti-trust laws will not apply to the "business of insurance" as long as the state regulates that area, but federal anti-trust laws will apply in cases of boycott, coercion, and intimidation.
Companies like United Health in particular took advantage of this loophole in US anti-trust law and gobbled up the competition to become ever more powerful. And now they might be too big to fight. United Health hasn't just been illegally consolidating their industry horizontally by rolling up competitors to their health insurance business. They also have been illegally consolidating their industry by rolling up their suppliers and customers.
We need to press our friendly lawyers and Reps. in Congress, our lawyer patients, our friends in the Justice Dept., and the AMA to press Congress to remove the "Anti-trust Exemption" from the large Health insurers, break them up like AT&T, create 25 smaller companies who will compete in a free market, lower costs, and give Docs a better deal on reimbursement and other issues.
A recommendation for improvement from Cody Willard, 8/12/09.
Why the hell Baucus and others in Congress would propose the little-studied "health care coop" as any sort of meaningful option is totally beyond me (unless AHIP is a huge donor to these guys, which would surprise me....not)
Keynote speakers urge AHIP to press Congress on healthcare IT.
At AHIP Institute 2008, Thompson especially promoted the use of healthcare IT and innovation, and called on AHIP members to play a role. "It's an exciting time today," he said. "I can't think of a better opportunity for AHIP."
He said AHIP and its members need to lobby Congress to pass healthcare IT legislation. "IT is the way to go. We can save a tremendous amount of money," he said.
Breaux agreed, saying that healthcare IT is "part of the answer," and Congressional influence by AHIP should be exerted.
Thompson said that as payers, health plans need to force providers to use healthcare IT such as e-prescribing. He cited 98,000 deaths last year attributed to medical mistakes, with 50 percent attributed to the wrong medication having been given.
While William Frist, former Senator (R-Tenn.) was less optimistic about the scope and shape of reform, he and former Sen. John Breaux (D-La.) and former Health and Human Services Secretary Tommy Thompson said healthcare IT is part of the solution for healthcare reform.
The great god Obama has two connections to people who will profit handily from the government push for IT. One has already cashed out and sold Allscripts on the prospect of mandatory EMR.
The other has a Chacago based IT business that will be at the center of EMR junk.
See my previous posts with all the links on this.
Also, the majority of the country doesn't want what is being forced upon us by the radicals in the democratic party. Baucus, Conrad et al represent centrist populations.
Run the plan past Maxine Waters. If she disapproves, then it is likely 75% of the country will like it.
"Thompson said that as payers, health plans need to force providers to use healthcare IT such as e-prescribing. He cited 98,000 deaths last year attributed to medical mistakes, with 50 percent attributed to the wrong medication having been given. "
Becasue we have elevated nurses to professional status when many of them are simply morons. Go into the specifics of the IOM report that is the basis of all of this.
You know what you find?
Malpractice is usually system errors, not doctor error.
Nurses are generally morons and the basis of most malpractice.
Hospital administrators are self important jerks who are the source of the bulk f the rest.
Too bad no one wants to address that reality.
Remember, while nurses tend to be morons, they tend to be unionized morons with great clout in the democratic party, and the spend more time talking to patients.
Hospital administrators are represented by a trade organization that doesn't pretend to be a humanitarian enterprise, it just represents the intersts of it s members. We, on the other hand, have organized medicine.
AHIP has corrupted the politicians. Just follow the money....It makes no sense for the government to collect money from the public and subsidize the insurers (that is what they want..).
we all need a reality check. there is no way everyone can be covered without raising taxes by at least 20% for every one in some form or the other.( direct taxes, VAT/Sales tax etc). This will toss US into the grabage bag in the world marketplace.
Rationing care is NOT wrong so long as the patient who is willing to pay for those services is not denied extra services( that is capitalism).
Catastrophic care with well defined and limited benefits is appropriate under our current bankrupt system and may reduce costs overall. Example: This may mean No screening colonosocpy,mammography after 75 years or no dialysis over 70. No politician has the gall to mouth these hard facts.Pres. Obama has laudible points, but has been drowned out by hatemongers. Unfortunately he is uneducated about complex issues related t healthcare and has failed to solicit physicians and practicing MDs to help him formulate policy. For this he will pay with failure.
High deductible insurance and HSA must be encouraged. This should be the model for all other plans. It imposes restraint, pain, thought and appropriate use of services and actually empowers patient.
Doctors who provide free care should be given tax breaks. Arlen Spector and Lindsey Graham want to give a tax break for trial attorneys who work on contingency basis! I wonder what planet these senators came from.
Docs or their business who do "pro-bono" work or install EMR's should be given "Credits", not lesser deductions.
On the AHIP, the 50% market share enjoyed by BCBS and WellPoint, for example, in the Northeast US underscores that we should just enforce anti-trust laws against these insurance companies if the government wants competition.
Like Anthony Hopkins and Brad Pitt said (Legends of the Fall), "screw the politicians" or something similar! Specter is a the number one disgrace to Humanity among Trial Lawyers!
..... "mission field where their self-righteousness will be rewarded."
WHAT AN INSULT to colleagues who had SELFLESS efforts in the name of helping, sacrificial sharing their love, compassion and talents to those who are in need for GOD's righteousness ...
REID WILL RAM Health-Care Bill THRU SENATE AUTOCRACY
GOP Should Shut Down Senate If Dems Use Procedural Tactic to Ram Health-Care Bill Through, says Conservative Leader(CNSNews.com) Gary Bauer who warned Wednesday that Democratic leaders in Congress will try to ram through their unpopular health-care reform plan later this fall, employing a little-used tactic first conceived as a way to maneuver around the budget deficit battles of the 1980s. The tactic, known as "reconciliation," is designed to get around the filibuster. "It's a little esoteric, but the bottom line is that they will be able to ram this through with just 51 votes," Bauer said.
Do 51 corrupt votes represent 65% of Americans who oppose this Bill or are not sure? Do we still live in a Democracy or is it now an Autocracy?
WHERE'S THE AMA AND ALL OUR MEDICAL SOCIETIES NOW WHEN NEEDED??
I sense your pain / frustration, but it doesn't help the dialog to declare that nurses are morons. Most of them aren't morons. A really good nurse can save a hospitalized patient's life. The problem on the inpatient side is that they spend too much time entering data (a la CPT and medmal) and don't have enough time to provide care.
We cannot run medicine without nurses who nurse.
Further, for every "the NP killed the patient" story we share, believe you me there is an equivalent story of an MD who killed the patient, through laziness instead of ignorance.
what is the problem with "quality" of healthcare in the us. why do i keep hearing this. look at recent data released comparing mortality rate for diseases between the us, uk and france. i dont understnd this line of thought. yes the major source of reform needs to the insurance companies and our reimbursements. as a 30 something year old physician and i deeply disappointed and worried about the next genration of physicians who will come out and take care of me!
Can we stop criticising each other? Look at how we could use our energy to accomplish something.
We need urgent Tort Reform. Investigate the Trial Lawyers PAC Lobby and how much they pay Congress to support them. Indict the crooks and remove Sen. Specter (PA) in 2010, the worst of the bunch.
Have the Justice Dept. investigate the largest Health Insurance Cos., remove their ANTI-TRUST EXEMPTION, and break them up like AT&T. Many smaller cos. can compete effectively in a free market and work with us fairly.
The HSA is one solution that could solve many of our health-care problems. For example, Whole Foods Market pays 100% of the premiums for all team members who work 30 hours or more per week (about 89% of all team members) for a high-deductible health-insurance plan. They also provide up to $1,800 per year in additional health-care dollars through deposits into employees' Personal Wellness Accounts to spend as they choose on their own health and wellness.
We can place short handouts re the above in our offices, in the doc's lounge, and in our bills; post a notice on our office door, talk briefly to our patients who like us in the exam room and lab about health reform, write a letter/fax to a local paper and to our Congressmen, speak on local talk radio or Rotary, go to a town hall, and talk to colleagues who may be complacent about reform. Together we are a vital force! Look at what you've accomplished over years of hard work and what you can do now.
Sorry for the preaching but if a Food Co. can do something, can't we?
Agree wghartmd. The American public (and most docs on this site) can accept regulation of unfair practices of credit card companies much faster than regulation of similar practices in the health insurance industry. It's time to admit that this is not working for anyone.
People have strong opnions about the issues but I would guess not even 5% of those on this site have actually have done anything this legislative season to make their lawmakers aware of their concerns. I commend those of you that have. The reality is that healthcare reform is coming -something WILL eventually be passed even if it does not get through this season- no matter how much you stamp your feet. Stop suggesting unrealistic fantasies (let's go back to the days of everyone paying out of pocket) and actually make sure that we are included in the process.
Agree Sermo Doc 87 that there are SPECIFIC issues that we can all agree need to be addresses no matter where we fall on the healthcare spectrum. Perhaps some strategic campaigning for those issues since all can't get accomplished at once.
What is most important to me is for doctors and patients to be able to contract as individuals. It is my understanding that all proposals will eventually prevent patients and doctors from opting out of whatever plan is finally used as the single payor program. patients will not Medicare already works this way. Choice of doctor may be an option, but choice of treatment will not!
The McCarran-Ferguson Act was passed by Congress in 1945 after the Supreme Court ruled in U.S. v. South-Eastern Underwriters that insurance could be regulated by the federal government via the Commerce Clause. The Act also provides that federal anti-trust laws will not apply to the "business of insurance" as long as the state regulates that area, but federal anti-trust laws will apply in cases of boycott, coercion, and intimidation.
Companies like United Health in particular took advantage of this loophole in US anti-trust law and gobbled up the competition to become ever more powerful. And now they might be too big to fight. United Health hasn't just been illegally consolidating their industry horizontally by rolling up competitors to their health insurance business. They also have been illegally consolidating their industry by rolling up their suppliers and customers.
We need to press our friendly lawyers and Reps. in Congress, our lawyer patients, our friends in the Justice Dept., and the AMA to press Congress to remove the "Anti-trust Exemption" from the large Health insurers, break them up like AT&T along with Big Pharma and Hospital CO's, create 25 smaller companies who will compete in a free market, lower costs, and give Docsand patients a better deal on reimbursement and other issues.
Dan, thank you again for this very coherent presentation and your continued efforts to bring the real issues forward. I have been out of touch for a month with my family at our lake cabin. I guess that the good news is that the administration's plan is not progressing smoothly and we are in for a battle when congress returns to Washington.
This gives working physicians a fighting chance to be heard. Sermo is picking up momentum. Physicians who have not understood the complexities of this issue are beginning to take time, read and wake up to the reality of the grievous threat that is posed to our profession.
Thank you again for playing a major role in our education and voice!
Competition lacking among private health insurers
By RICARDO ALONSO-ZALDIVAR (Associated Press Writer)
From Associated Press,August 22, 2009 11:45 PM EDT
WASHINGTON - One of the most widely accepted arguments against a government medical plan for the middle class is that it would quash competition - just what private insurers seem to be doing themselves in many parts of the U.S.
Several studies show that in lots of places, one or two companies dominate the market. Critics say monopolistic conditions drive up premiums paid by employers and individuals.
For Democrats, the answer is a public plan that would compete with private insurers. Republicans see that as a government power grab. President Barack Obama looks to be trapped in the middle of an argument that could sink his effort to overhaul the health care system.
Even lawmakers opposed to a government plan have problems with the growing clout of the big private companies.
"There is a serious problem with the lack of competition among insurers," said Republican Sen. Olympia Snowe of Maine, one of the highest-cost states. "The impact on the consumer is significant."
Wellpoint Inc. accounted for 71 percent of the Maine market, while runner-up Aetna had a 12 percent share, according to a 2008 report by the American Medical Association.
www.google.com
Justice Dept. must remove TRUST EXEMPTION and break up large insurers into many small companies who can compete fairly and give us all a better deal.
Isledoc, now you are talking about the substance of real reform...the kind of discussions that need to occur and have been glowingly absent from those inside the beltway. I believe that our hope in this is only with complete paralysis in Washington when congress reconvenes. Then, maybe, reason will begin to be heard and a serious discussion can begin. Up to now it's all fluff and posturing. We need to speak and expose the truth.
Part of the problem is that Medicare reimburses physicians differently depending on their specialty. For example, Medicare reimbursement for anesthesiologists is 33% of what private insurers pay. Whereas Medicare reimbursement to some specialties such as internal medicine and gastroenterology is on average 90% of what private insurance companies pay. The national average for Medicare is 81% of what private insurance companies reimburse. As long as your coding and paperwork are filled out properly, Medicare reimburses within 30 days no questions asked. It usually takes atleast 90 days to get paid by the private insurers. This is one of the reasons that their is such divisiveness among physicians regarding HR 3200. I personally am vehemently opposed to a public option particularly any option based on current Medicare rates.
1. Tort Reform
Remove trial lawyers like Specter (PA) from Congress in 2010 and stop Trial lawyers PAC and lobbyists. Indict corrupt lawyers, Lobbyists and politicians. Pass a Tort (Malpractice) Reform Bill.
2. Insurance Reform
Break up 5 largest Health Insurersinto 25 smaller competitors using Justice Dept. and ant-trust investigation. Remove Ant-Trust Exemption from these large insurance companies which prevents free maket competition! Allow interstate sale of health insurance with more competition, lower premiums, portable policies, and better deals for docs. No Government regulation of Reimbursement to Docs.
3. HSA's: Implement Employer HSA's adding tax credits/deduction for Employers and/or patients who use them. Allow docs to negotiate with HSA's. Checkout Wholesale Foods Plan.
4. Defeat all Obama bills.
5. Tax defer Medicare/Social Security taxes paid by employees and self-employed.
Inform your patients who vote, the media could care less as they love B.O.
I knew we were in trouble immediately with the "new" reform efforts when Time magazine did cover with "Dr. Obama" on the cover but had nothing of substance in the actual articles on the topic. I really could not understand how more taxes and growing entitlements change anything. But the sheer amount of negative developments continue to build: a) Growing un-insured aggravated by the annual growth of thousands of new American citizens every year from the deliveries of foreigners who are illegally in our country. b) Malpractice Reform: Golden Calf of the Democratic Party. How much money goes into 6 figured premiums along with the less tangible brain drain on the specialty. c) Un-investigated monopolies of insurers like United Health Care who also now can cross into other industries by owning prescription databases to sell back to the pharmas. d) Something like 30 to 40% of academic "thought leaders" in Medicine make significant revenue from pharmas and biotechs that they "investigate" e) How can a country force you to "buy" billing codes that are mandatory? How can that company claim to represent doctors? d) Loss of the Campaign Promise to make cooperative or individual prescription purchases by patients via established mail order processes "from whatever country gives the best prices." Why do Americans pay more than Canadians for the same drug still under patent? e) How can the World Health Organization dictate to American medical software vendors and billing systems that we must switch to ICD-10 or more recently (and quietly they hope) something called "SNOMED-CT" that we have to put into our patient encounters like data clerks to be paid?
Two things I would do I had the funding: a) Do five to ten 30 minute "day with the doctor" stories that cover a range of geographies and specialties. I don't think most people know what it is like to be in an independent medical practice. They don't know that when you see a new patient for 30 minutes, you are responsible for her or him 24/7 for emergencies at no additional cost. BUT PATIENTS KNOW THEY WANT TO CHOOSE THEIR OWN DOCTOR--too bad that under current trends you will be fortunate if you get to see an MD after a long wait in the "que"
b) Do a careful and independent financial analysis of the real income trends and debts between i) doctors of various specialties ii) insurance senior management iii) pharmaceutical senior management iv) trial lawyers. What it would show is that no matter what is said about healthcare inflation, there is an unprecedented deflation in physician incomes which will eliminate the best and brightest from all but the bariatric Sermo Doc 69s, dermatology, and the few surgical specialties left that can make ends meet.
You can't keep lowering physician reimbursement without causing a shift toward abandonment of current practices--sudden or incremental depending on the geography. I know that most of the Sermo doctors will go out on the weekends and do what we can for the poor, but our real jobs will be in some other related field: working on computer models for robotic care of various chronic diseases.
Recent quote from Dr. Sermo Doc 69 who listened to Obama Telephone Conference:
"Sermo Doc 69 Surgery, General Posted Aug 26, 2009 at 11:27 AM
Listened to the one hour conference call last night led by Kavita Patel a formerly practicing internal medicine specialist and David Semus(sp?) of the White House Communications office, with more than 2000 docs on line. I took voluminous notes. From my point of view, the priorities of the White House were clearly deliniated;
Insurance Reform consisting of
No exclusion for pre-existing conditions
Limitations on out-of-pocket expenses
No lifetime or annual caps on benefits
Eliminate Co-pays for preventative care
No loss of insured status due to occurence of a disease.
They stated a clear and specific desire to eliminate the fee for service model and pursue a Global Payment system nationally."
I wonder if "eliminate the fee for service model and pursue a Global Payment system nationally" means establish a Medicare type of physician reimbursement for services to patients with private health care insurance. I wonder if B.O. will then fix premiums globally for said insurance, and later add Bill for Death Panel Rationing?
Sounds like this could be a slick, modified new "Public Option" plan?!
Why doesn't anyone consider HSA plans? Our medical group switched to one several years back and it is a way more rational way to go. You spend your own money, in a tax free manner, for required services. But believe me, it makes you much more aware of what things cost. Before we all tried to spend our use it or lose it plan money every year. Now you get to keep what you don't spend for a rainy day. That fact has changed behavior even among highly compensated physicians, even more so among our staff. And we are all much more aware of prescription costs than we were when there was only the $10 co-pay. In fact, this particular plan also provides much better insurance. There is a maximum out of pocket for a given year, making medical bankruptcy impossible. Two years ago my wife was treated for breast cancer. After several years of savings, the HSA INSURANCE paid for this far better than our prior PPO. After the annual contribution was exhausted we were on the hook for about $2K, beyond which coverage was 100% rather than 80%. What people now refer to as insurance is really pre-paid medical care. As such, it is rational to spend lavishly to get the maximum bang for your contract bucks. HSA's change that incentive overnight.
Sermo Doc 137, John Mackey from Whole Foods does this for his employees and it works. What works is the reality of the health care consumer being connected with what they are purchasing...truly connected. This is the path to savings, one patient's decision at a time. This is based on reality and cannot be subverted by a middleman who adds virtually nothing of value to the patient's care.
We need urgent Tort Reform. Investigate the Trial Lawyers PAC Lobby and how much they pay Congress to support them. Indict the crooks and remove Sen. Specter (PA) in 2010, the worst of the bunch.
Have the Justice Dept. investigate the largest Health Insurance Cos., remove their ANTI-TRUST EXEMPTION, and break them up like AT&T. Many smaller cos. can compete effectively in a free market and work with us fairly.
The HSA is probably the one solution that could solve many of our health-care problems. For example, Whole Foods Market pays 100% of the premiums for all team members who work 30 hours or more per week (about 89% of all team members) for a high-deductible health-insurance plan. They also provide up to $1,800 per year in additional health-care dollars through deposits into employees' Personal Wellness Accounts to spend as they choose on their own health and wellness. The employees love their plan and have voted the Union out!
We can place short handouts re the above in our offices, in the doc's lounge, and in our bills; post a notice on our office door, talk briefly to our patients who like us in the exam room and lab about health reform, write a letter/fax to a local paper and to our Congressmen, speak on local talk radio or Rotary, go to a town hall, and talk to colleagues who may be complacent about reform. Together we are a vital force! Look at what you've accomplished over years of hard work and what you can do now.
Sorry for the preaching but if a Food Co. can have a good HSA, can't our great Government and magnificant one do something, can't they, please!?
The message on the Teleconference was that a Uniform Global Reimbursement Plan will be forced on the private Insurance Co's! This is nothing but blaming the Insurance Co's. for this mess and disguising another Public Option in its' place.
B.O. is getting pretty slick like his cronies!
Will Doctors Opt Out Of A Public Option?
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Date: 2009-08-26, 7:10PM PDT Craiglist
Reply to: comm-ucahn-1344356949@craigslist.org [Errors when replying to ads?]
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It appears at least some plan too. Dr. Alfred Bonati, who heads the American Society of Medical Doctors, says he plans to say "no" to accepting patients under a government run plan and, according to a poll he cites, so do an awful lot of other physicians:
Perhaps this is why a nationwide, nonpartisan poll of physicians this month found that a full 70 percent oppose the health care reform proposals under consideration by Congress. Sixty-six percent feel that a government-run health insurance plan would restrict doctors' ability to give the best advice and offer the best care possible to their patients. Perhaps most importantly, 60 percent said they would not accept new patients covered by a government insurance plan.
Nearly all the doctors polled have worked with Medicare. Most have likely been denied Medicare reimbursement, or given minimal reimbursement, for a course of treatment that they prescribed that best fits the needs of a patient and that patient's family.
I share the view of the 60 percent in the August poll -- those doctors who are planning to "just say no" if government-run health coverage is implemented. Many of us already do not accept patients who are on Medicare or Medicaid because of restrictions those programs put on our decisions as doctors. It pains us to turn away a patient in need, but the narrow rules of government reimbursement programs stymie our ability to follow our oath, so we simply opt out and work with patients who are also in need but have more flexible, private coverage.
If a government option gains the popularity that is expected -- after all, who would not choose the most affordable option available, and how could any option compete with one that is subsidized by taxpayers -- millions of Americans will face severely limited options in choosing a doctor. As physicians reject working with a system that does not honor our oath, patients will be left opening their own checkbooks, or going into credit card debt, to get the treatment they need and deserve.
The law of unintended consequences again raises its head. The government may indeed put a public option in place - whether or not the citizens of the nation want it or not. And they may, through legislation, force insurance companies to take everyone without exception, but -at least not at this point- they can't force doctors to accept patients under plans that don't feel reimburses at a rate commensurate with the care given or doesn't allow them to treat a patient in accordance with the oath they took.
Of course that then leaves that system with a problem and the government with a dilemma - does it then force MDs to take anyone who applies (as it will insurance companies) regardless of insurance plan? And if so, how do you suppose doctors and other health care providers will react?
It is these sorts of problems, dilemmas and unintended consequences that few are talking about in this great "debate". What if it is doctors who become the Atlas that shrugs when all is said and done? What options would the government then have - in this land of the "free" and home of the brave?
What we need are cost reductions in our overhead and fair remibursement, otherwise cash only and or micropractice is the only viable future, other than joining a large healthcare system, which doesn;'t exist in this town so it looks like the 100,000 residents will learn to go without healthcare unless they travel 80 miles to a city.
Best wishes.
SGR has been applied every year since its inception. While if has numerous short-sighted problems that lead it to mandate unrealistic reductions in physician payments, it did not have an obvious negative effect until the economy began to shrink in the last economic downturn. SGR caused the -5% payment update in 2002. Medicare patient access problems arose in many states immediately (a 5% reduction in gross reimbursement resulted in 12-25% reductions in net -after overhead- physician income from medicare patients). Congressmen heard the fallout about access, and they've seen to it that the full SGR has not been applied since. But, the SGR has produced negative payment updates annually, which has served to keep Medicare physician payments low. And fighting SGR has consumed nearly all of the physician and AMA lobbying resources and goodwill ever since.
Here's a question: where does this idea that Medicare pays worse than private insurance come from? From my experience, Medicare is the best of a very bad lot, but one of the main arguments against the public insurance option was that it would pay like Medicare.
released for review the 2010 Medicare Program Fee
Schedule (MPFS) Proposed Rule on July 1, 2009. Some
highlights of the fee schedule are as follows.
• Effective January 1, 2010 the conversion factor for MPFS
will be $28.3208. This is a 21.5% decrease from the
current 2009 conversion factor of $36.0666. Medicare
must implement this cut unless Congress overrides this
mandate.
• The overall impact in reimbursement is approximately
an 11% reduction in the aggregate for diagnostic
imaging as a result of changes to the practice expense
and malpractice values. Some imaging services will be
reduced even further.
• There is a Mandatory accreditation program for CT, MR,
and Nuclear Medicine (including PET) that is mandated
to be implemented by January 1, 2012.
• CMS proposes to change the equipment utilization rate
from current 50% to 90% for equipment price over $1
million. This would cut the technical component of ET
and MR by as much as 40% for 2010 (Note legislative
proposals on Capital Hill would establish a 70%
utilization assumption rate spread across all imaging
modalities).
I've been in enough discussions to know that the public is woefully ignorant of the trouble physicians have with compensation. The "awww, poor rich doctor" comments get old, quick...
I do not understand why even one lawmaker has not criticized the Health Insurance Industry for making so much money in a time when so many people are suffering because they cannot afford health care? And, doing it by shortchanging physicians and patients is unconscionable, immoral and should be illegal. I suspect it is because most of our officials have taken money ("campaign contributions") or are shareholders in these companies, and because they never have to worry about not having decent insurance coverage.
The lawmakers COULD take charge and: Cap executive salaries/bonuses/all other goodies for those in the insurance industry. And, not allow them to make such ridiculously high profits, perhaps requiring that they become non-profit.
The people COULD demand that the legislators lose their health insurance and have to buy it just like the rest of us. After all, aren't they working for us?
Finally, we need to insist on tort reform. Isn't there a way for us all to take action in a big way? What would happen if we all took the same wkend to show up in Washington? Or, if we all agreed to write Obama and our representatives/senators a letter outlining OUR IDEAS for a plan during the same week? Instead of Obama talking to the AMA, why can't we talk to him? Whatever happened to the suggestion that you meet with him for us? Perhaps I missed something?
I do not know how to measure how much the above ideas would save but it seems like a lot. The CEO of United Healthcare made 124 or 127 million dollars in salary and 2.6 billion in stock options in 2006. How about if he made $500,000 instead? Couldn't anyone live on that? And that was only one executive. If we did not allow them to profit so much, insurance wouldn't cost as much, more could afford it, and physicians could be paid more, not less.
If we could control the insurance industry's profits, get rid of the lawmaker's free health insurance, repeal the SGR, and get tort reform, would that be enough to make meaningful change?
Sermo Doc 13
We have tried the "nice guy" approach for too long. It does not work. The politicians, lawyers and insurance companies laugh at us for being so nice. We need to take a lesson from them...
And it is so true that the public is unaware of our plight.
I try to bring it up as often as I can with my patients. Most of them just smile and don't understand. They think I am misinterpreting the health care reform and that things will continue with my husband and I as their doctors.
But there are a few lights here and there, people who are surprised and "with us."
I just don't know what to do. Wish we were in a financial position to go cash only.
Dan, you are one terrific and insightful person. Thank you, again.
At least more people will be getting worse care. Hey-that means that we will all be in the same boat! And isn't that what it is supposed to be about?
thank you
This physician law website had the following: the link is below.
Stimulus Bill and Health Care Reform
Posted on February 18, 2009 by Todd Rodriguez
Yesterday President Obama signed the much touted s
timulus bill into law. Although not much is publicly being said about health care reform yet, sweeping changes to the health care system are quietly taking place. In fact, over $150 billion of the stimulus bill funds are earmarked for health care related projects. In no particular order, these include:
• Comparative Effectiveness Research to compare treatment effectiveness ($1.1 billion)
• Support for State Medicaid and Children's Health Insurance Program Programs ($87 billion)
• Investment in Health Information Technology ($19 billion)
• Medical Research Funding through the U.S. National Institutes of Health ($10 billion)
• Federal Support for COBRA ($25 billion)
Many of these change can be expected to have an impact on the way physicians practice medicine (and in particular the information technology provisions since they include incentives for physician compliance). Accordingly Physicians need to keep a sharp eye on the changes that are taking place and should begin retooling to best take advantage of what will undoubtedly be a very different playing field in just a few short years.
physicianlaw.foxrothschild.com
we need to focus on where and why we spend money and find waste and reduce that.
then we can have a lot better quality with much less money
BTW, politicians do not want to improve system ..... all they want is to increase control
Second, reducing malpractice claims and moving cases to a medical panel (to abitrate and assign compensation for loss based on true malpractice) instead of through the inefficient legal system that does not adequately compensate patients who actually have losses - the med-malpractice lawyers are the crooks here! I have stopped providing OB care in the prime of my career (based on age and experience) due to the high costs of malpractice in Cook County, IL. Unless this is reformed, moe and more physicians will continue to reduce their risk by not taking on the most difficult or high risk patients. Their will be a shortage of the most trained and experienced so that many of these patients who need the most experienced provider will be taken care of by NPs or midwives.
Once these reforms above are met, then as doctors we can contribute and add to the savings by not having to order unecessary tests (as a result of the practice of defensive medicine or in trying to boost compensation through overcharged office procedures.) As doctors, we can't help in this health care saving process until our compensation from the insurers is reasonable (and not costing more in overhead as our billers spend hours to get payments in ) and until we are not in constant fear of a lawsuit that could ruin our careers. The bottom line is we are the orderers of the tests and procedures (not the legistatures who are trying to dictate what reimbursement we deserve for our work), so until our interests are brought into this debate on Capitol Hill, costs will just continue to go up and up and up...and the CEOs of Blue Cross, United, Unicare, Aetna and all the rest will just continue to laugh at all of this as they take their millions to the bank.
So, tell me--what government program are you aware of that has been put in place and then revoked? And once you entitle a population (of voters, no less), how do you rip that entitlement away? Have you any idea what Sarkozy is going through right now with the health care system in France?
If we are militant and strike or withhold care, I feel we will violate that trust and bond we have with our patients. If we walk away from Medicare and insurance contracts, patients will not like the change but will be more understanding of the unacceptable situation driving many out of practice. Our country needs their physicians and more of them as our population ages.
The real issues at stake, the SGR and the future of reimbursement, along with tort reform have mysteriously been invisible as all the self appointed experts join the debate. One need only tune into any pundit, any politician, any radio talk show, any town hall meeting, and within 30 seconds it becomes obvious the furious debate has now devolved to meaningless horseshit. We are the only ones left who can elevate the debate and salvage a sustainable solution. But does anyone care?
Sermo Doc 26, while I agree with you, I see no other choice but revolt. If we do not act quickly, it won't matter whether or not we walk away from Medicare, Medicaid or any other contract, because we won't be in existence any more, or we'll be federal employees forbidden to walk away. We are the only ones who can provide real healthcare. We hold the power in our hands to reform the system, but are afraid to do it because we're afraid of public opinion. Hell, most of the public thinks we're rich and greedy docs, so what's the difference? While we are also concerned about our ethical and moral obligations to patients when we talk about striking or shutting down, do we not have a moral and ethical obligation to our patients to remain in viable practices in order to provide needed healthcare? Why are we afraid to use that power that we hold? Why are we unable to unify and use that power to effect change, to get Congress and the President to listen to those grunt docs on the frontline, not the ivory tower docs, who know how to lower costs?
Lord, I'm so angry and pissed off at all those outside forces looking to enslave us, but I'm more angry at us. We are our own worst enemies.
Point being, health care reform is only one small part of a much greater collapse of infrastructure within the nation. This concept of infrastructure includes both the physical plant of roads and utilities, as well as the intellectual plant of destructive economics and outsourcing innovation and education. In a time of crisis like this, my experience as a sailor serves me better than that as a physician: it is much better and safer to shut down the system and provide basic services until the plant can be brought back on line rather than try to hold it together with duc tape and bailing wire. To address just the health care aspect of this problem in a similar vein, the system is so fractured now that the discussion over reform is pulling us in a dozen different directions. Insurance reform, EMTALA, tort reform, patient responsibility, the list goes on and on. Meanwhile, the system continues to crumble. So take the plant off line. Go single payer, physicians have to stand up and get put in the driver seat of an interim system of health care, let the public get a feel for what the really need from health care based on a single payer system, and when the insurance industry comes back on line those who want to bail from the public option can truly exercise that option, those who realize that the federal system suits there needs fine can stick with it, and physicians can play a role with the start up and transition phases to ensure real reform occurs vice slap and stick window dressing.
What ABOUT THE DEBT that newly minted doctors and those still in the residency system? Are they expected to absorb it while "funding" the healthcare reforms? since doctors seem to be the problem, taking out tonsils unnecessarily and amputating legs in stead of trying to salvage them! No emphasis is placed on the patient and their compliance...
IF a doctor wants his debt repaid, will they have to work for the "state" for 10 years? Will they have freewill to take care of their patients, or will they be forced to perform "necessary" procedures, like euthanasia, abortions, denial of care...
WHAT ABOUT TORT REFORM? is that off the table?
WHY ARE DOCTORS SEEMINGLY BEING LEFT OUT? Besides the misguided attempts of the AMA to give their input, have doctors, other than Rahm Emanuel's brother been asked their opinions? Seems to me, the best way to reduce cost is to work with the people who can prescribe the treatments. OR, is the where paraprofessionals come in? I guess we will just have to wait to find out what SEIU and ACORN will put in the final bill, since they are helping to write HR 3200!
This is sooo bad!
So, basically, the lobby and PAC groups (politicians) are once again getting us to fight amongst ourselves to distract us from fighting against the cuts in the first place.
And we are aparently still fallling for the same old tricks. We really need to stop all this nonsense. We really need to pick a date upon which we will no longer provide services to anyone until A) tort reform is done and B) there is an end to the insurance company's lock on price setting. Call it a strike, call it what you will but until the country is faced with absolutely no care they will not stop hammering away at us. If we actually all worked together and followed through with this, I predict it wouldn't take more than 48 hours to get the gov' t to respond to our concerns. And for all you tree huggers who say we can't abandon our patients, what do you think we are doing now by letting business men and lawyers steal billions out of healthcare now? It's just a slow death. By withholding care, we would actually be serving our patients by guaranteeing them quality care down the road.
Want to have enough money in health care to cover the uninsured and raise physician pay? It's quite simple. Eliminate the 35% of every health care dollar going to administrative costs at insurance companies (really for bloated CEO salaries). Can anyone say mandatory non-profit corporations only in health care? And second eliminate the billions being stolen by lawyers through tort claims. Wow suddenly there is plenty to go around for healthcare. The real trick is actually using every health care dollar for healthcare and not politically protected grift.
Fees for docs were frozen for a year longer than all else by the Nixon administration, and we have never been allowed to catch up with inflation or student loans.
How does one create something comparable to the Mayo Clinic, or Cleveland Clinic, or similar groups in regions with few docs, no specialists? Technology helps some, but how does one do a physical on the net? When a PA does a physical, who is responsible for the result?
Murphy is alive and well. Can any of us, or legislators, or insurance companies, or economists, or ... come up with a system that is tolerable to ALL?
We have the most corrupt government.
We will see what happens. I am as always with you Dan. Thanks for trying to keep us up to date.
1] reduce office encounter documentation burden to increase provider efficiency (ditch E+M, RAC audits)
2] adopt a retainer model "operating system" for primary care, which will greatly decrease physicians' billing overhead, thereby allowing them to absorb a decreased revenue stream with no effect on profits and vastly improve the physician-patient relationship
3] for non-primary care, encourage private insurers to offer high-deductible plans with sufficiently high out-of-pocket levels that patients are discouraged from irrational consumption
What I propose is that we set up a point person in every community/academic hospital in the nation through whom, Sermo's messages are communicated to the entire affiliated medical staff. In the age of e-mail and Twitter, this may be quite possible. Please contact me if you need someone in Tarzana, California. Best regards.
I envision a system where MOST patients have a high deductible policy and pay for the first $2000 health care out of pocket with HSA monies. Those not able to do that would have government option, like VA and Indian Health currently offer. The incentive to do the first one would be to not have to be in VA and Indian Health system. It is a 2 tier system, but would work to cover all. Patients would have a pony in the race re: costs. Doctors could charge what the system would bear and eliminate HUGE overhead. Tort reform would be included. What do you all think? Why is this not being floated? It would eliminate the power and profit of the insurance companies, remove half of their staff and overhead, provide doctors with freedom of practice, and insure everyone. Thoughts?
for 30 years i worked to promote improved health care on both the left and the right!! i gave up on the Left.. they donot care for any intelligence or truth.. only their stuck agenda.. which they can not even think thru.. sorry.. i come from generations of Democrats..
what i am most excited about it that finally the people and docs are waking up.. This is how progress occurs.
My Senator Chuck Schumer just sent out an email as another diversion strategy.. He , of course is NOT dealing with the TWO LEADING COST DRIVERS of PRIVATE INSURANCe:
the FAILURE of GOVERNMENT MEDICINE TO PAY (medicaid, medicare , va and Indian Reservations) shifting the costs to private pay.. AND the
LEGAL COSTS built into every step.. this, of course now deals with how you deal with your Insurance co
the funniest and SADDEST part of the new OBAAMA plan is that he has the DRUG COMPANIES on BOARD
Does anyone NOT recall that THESE are ALL FOREIGN DRUG CO?? the last american drug co WAS SCHERING PLOUGH
they all started leaving the old usa because of NO TORT REFORM .. So NOW OB feels FOREIGN COMPANIES should force us into the same European mess called Socialized Medicine. which IS NOT WORKING THERE... WE HAVE international Medical Insuranc and KNOW!! the drug co are only negotiating as OUTSIDE the USA BUSINESS interests .... amazing
We are forced to accept fees determined by third parties. Those fees are in large part determined already by the government, as most insurers base their fees on MCR reimbursement and rates. Imagine having to tell your attorney that or your plumber?
We need: Tort reform and reimbursement reform.
Insurance reform is absolutely essential as I am spending more and more time filling out forms from clearing houses such as Care Core to determine if the test I ordered is necessary. Often the form is longer than the note generated. And too often I am told that it has been denied. Are they serious? I then send them to the specialist to get the test ordered and voila! It is obtained.
These issues are not being addressed by any legislator. They simply do not have the knowledge/competencies to delve into the matter. You might as well have the congress and president perform brain surgery- the results would in fact be the same.
History should be our guide- less government is essential.
Red tie = power tie.
I left california years ago because of the physician UNFRIENDLY environment.
I am now in florida and blue cross blue shield WON'T PAY me. So now I am
very reluctant on taking blue cross.
Everything is medically unnecessary with blue cross!
Your previous remarks helps me to realize that I am not alone.
JC
So what does that mean to the primary care physician?
My answer: nothing or less than nothing because the anti-AMA message is obfuscating the messages that need to be otherwise sent.
" As the ones who are on the front-lines of healthcare every day, physicians know what needs to be done to reform healthcare, perhaps more than anyone else. We also know that issues like malpractice reform, patient responsibility, and reduction in overhead are tough and often politically challenging. " How do we get our patients and the general public to believe this? We need to teach them that we understand the complexities of healthcare better than politician attorneys, because we actually do it everyday. They will also make their voice heard (townhall meetings are examples).
"If we are militant and strike or withhold care, I feel we will violate that trust and bond we have with our patients." True. But who out there knows we have thought about this? Let's make it known that we are so concerned about the reform, more potential regulations, and our patients that many docs have considered leaving medicine or striking, but because we are the ones who really care so much about being there for sick grandmothers, we are trying to avoid this at the moment (but it could be an option). Will need to start making it known that from day 1, we have been in it for our patients' best interests, not our own. We are definitely worried about our reimbursements, but our focus should be on how decreasing payments will decrease access to a PHYSICIAN'S care, not just access to any provider.
We need to find a way to educate the public on how tort reform helps everyone and reduces costs. Teach that we do not get rewards or lavish gifts from drug companies these days like people seem to think. Teach that PAs and NPs are actually not doctors - patients dont know this and need to learn to ask about it. Seems that only docs really understand what would happen if ALL healthcare were delivered by mid-level providers. Make it known that we go out of business quickly if all we see is Medicaid / Medicare patients. Surgeons dont make $50K for amputations, tonsillectomies are sometimes indicated, we are not cars (Obama compared us to cars when discussing penalizing hospitals and docs for bounce-backs within 30 days of discharge, stating "they did not do the job right"). Could go on. There are other points and they all seem very basic to us at this point but a lot of people do not know about such things. Most people I talk to do not even know what tort reform means.
Let's be careful to not succomb to the victim mentality and start playing more of the political game. It also seems that while we debate the reform bill, we could also educate and possibly reshape our image in some ways (not that it is bad now - but look at this link to get an idea of what I mean: forums.sulekha.com It would help to have more patients on our side. The people are doing a better job of speaking out against the bill. We could help arm them with more facts. Link to the bill - thomas.loc.gov
A governmental entity....by definition alone....simply CANNOT provide real market place "competition" for private industry. It's IMPOSSIBLE....or, should I say, WRONG.
A private business has to make it work.....of they go under. Bankrupt!
A government run entity has to only ask for more government revenue (taxes) if their plans and ideas fail. It is just not at all the same.
One has a real market place business to run and make work.....and the other has no real market place, but only the ability to slaughter more tax payers and take more of their hard earned wages when things get tough.
The Obama "plan" is disgraceful, un-American, and a lie.
Sounds like the AMA is in bed with the government....the insurance companies....and who knows who else! Sounds like the pharmaceutical companies are also playing both sides of the fence. Who can you trust????
The message that needs to be conveyed is that with the current system, docs are being forced to close up shop because we are being squeezed out of business - this means no access to health care for patients, long lines/waits to see the doctor and inevitably rationing - all the things that the fearmongers are saying will come with reform. This will be the only way the public will come to understand this issue. Otherwise physicians are seen as whiny, money-hungry elitists who don't care about patients.
So what does that mean to the primary care physician?
My answer: nothing or less than nothing because the anti-AMA message is obfuscating the messages that need to be otherwise sent. "
Not really a fair criticism. After all, the more the AMA tries to paint itself as an organization that represents physicians, the more Dan or someone like him needs to refute that point of view so that meaningful representation of the physician community can take place.
It has been always obvious to me that public option was code for phasing out private insurance all together and force everyone into the federal insurance to come in the future... I guess that will happen sooner or later and it is too late now to rewind the clock. I think however we sould start thinking about growing our collective spines and start letting politicians and the media that without MD's there is NO reform possible, and that the AMA represents but a small percentage of US physicians. If we do not act now we will onlt have ourselves to blame very soon.
This includes withholding futile treatment at the end of life, which is opposed by too many on "moral" grounds (too many people want their last breath, but expect someone else to pay for it).
This includes lopping benefits to seniors, such as their Medicare D funded Viagra (it makes me furious that retired people expect me to pay for their sexual "well-being" while I am working so much to pay taxes that I cannot have a decent sex life of my own). The AARP has become too powerful, and they do not care about bankrupting the country.
This includes raising tax on ALL Americans to fund the system. Why should only the "rich" contribute more, other than they are a minority to be taken advantage of?
This includes us, the physicians, having to accept a cut in reimbursement in order to balance the budget. Maybe we should not feel entitled to quite as much wealth, which came to physicians only after Work War II when the system was flush with cash.
This includes patients to lower their expectations with what can be done for them. Maybe not everyone can get what they want or need. Health care was not a right that was recognized by our "founding fathers". I reread the constitution and there is no mention of it.
We are all like an irresponsible person with a credit card, making purchases with no hope of ever paying the balance. This debate, if taken to it's conclusion, should re-evaluate the worth of everything we expect of the government. What a shame that it has come to this.
My suggestion is that either the government get out of the business of health care entirely and let the free market allow the disadvantaged to suffer (unlikely), or accept a single-payer system that will at least give everyone a mimimum standard of care (more likely to be the direction this will go, but with just about everyone screaming and kicking along the way).
Recent AMA announcement:
AMA President J. James Rohack, MD, will participate in a panel discussion on Fox News Sunday regarding the myths and mischaracterization in the health system reform debate. The program, which will air at 9 a.m. EST Aug. 16, will include a panel discussion hosted by Chris Wallace that includes Sen. Richard Shelby, R-Ala., ranking member of the Senate Budget Committee, and John Rother, executive vice president for policy and strategy at AARP.
"I've heard physician payments account for 5% of the total health care costs. Any one else heard similar? You can cut that to zero and still not achieve significant savings."
The percentage of healthcare spending received by doctors varies according to the identity of the third party payer.
Overall, according to the 2009 Edition of Health Care Costs 101, only 21% of the total of $2.2 trillion in U.S. health care spending in 2007 was spent on "Physician and Clinical Services" as compared to 31% spent on hospital care.
See: www.chcf.org
However, looking at the $454 FY 2008 CMS budget for the Medicare and Medicaid entitlements tells a different story. Only 12.9% of the $454 billion in total Medicare spending represented net outlays for physicians, compared to the 34.3% spent on hospital care (inpatient and outpatient).
See: www.hhs.gov
This maldistributed spending reflects the absolute power the Medicare and Medicaid monopsonies (i.e. "buyer monopolies") and the private insurance seller monopolies and oligopolies enjoy to dictate the reimbursement levels of each of their different suppliers of services and products.
This publicly available information makes the support of HR 3200 and its "public plan option" by the AMA, the ACP and the physician advocates of government single payer NHI look even more economically and historically illiterate than the "leaders" in Congress and the White House.
1) HSA will be abolished.
2) Employers will end up shelling around $400/employee for Medicaid type of coverage. No one has clarified who is going topay for dependents!
3) BCBS and other private insurers will price themselves out of the market or rebrand themselves as conveyors of government healthcare
4) Whether you like it or not doctors will have no option but to participate.
5) Most doctor's will downsize considerably. Those over 55 will seek out retirement, move to Costa Rica, Mars etc or switch part time working hours and terminate more than half of their employees. They will all aim to earn less than 150K/year to get benefits. Who wants to work when there is a handout?
6) The cooperatives will work like most Public Schools with Admin heavy, nurse managed operations with rare physician involvement.
7) Drug companies will drop prices as most people will not be able to afford any brand name drugs.
8) If enough educated people with debt but no jobs accumulate, we may become like France or Italy wheere the retirees live like kings(relatively speaking) and youngsters slog in low paying jobs.
It is not looking good!
Everyone wants to cut physician payment but no one talks about cutting hospital and insurance company CEO pay. how can we direct this health care reform debate towards what is need rather than all this nonsense
I think health insurance needs to go the way of bustles and buggy whips. Eliminate insurance companies and their unearned profits and we'd have the dollars to convert to a single-payer system with truly universal coverage. With guaranteed universal coverage, the incentive to file malpractice suits just to be able to pay for necessary medical treatment would be eliminated.
60% of providers AND the public support single-payer, but it''s going to take a huge rising of public anger to defeat the lobbying pressure of the insurance companies.
NO ONE IS ASKING WHAT SERVICES WILL BE CUT OR WHAT INCREASE CHARGES TO PATIENTS WILL BE INVOKED TO HELP REDUCE COST!! SUCH AS MAKING RETIRED MILITARY VETS PAY A LARGE DEDUCTABLE,WHICH IS A PART OF SUCH CHANGES BEING PROPOSED
As a system, this option (is it an option?) is expansion of entitlement burden on tax money pool. As happens to all such programs, there will be a lot of waste, fraud, abuse and inefficient use of money. Result will be ever increasing money pit, leading to ever increasing tax burden on those who produce, leading to dis-incentive to produce.
This loss-leader could balloon big enough to bankrupt the US (Yes, in the eyes of natural laws, no one is too big to fail).
If they pass something like the current proposal, probability of US going bankrupt in my life time will go up significantly and I will not be keeping any spare asset in dollar denominated form.
****************
I disagree, though, that drug prices will be down. Pharma has got a deal with the mafia (aka politicians) that controls the DC that Govt will not allow generics. And remember drugs will be covered by the govt money, so basically, they are paying the lawmakers to have assurance that they will be allowed to loot from the tax money pool...... so there is no one to control the price, except the congress or NHB ......... and they can be "influenced".
***********************
What we need to cut costs is to open the suppliers of health care (Doctors, Hospitals, Pharma) to competition.
Let the consumer (patient) be in-charge of his/her money. Then every patient will work as price negotiator and quality controller.
Let there be skin in the game.
******************
In current form, this bill is just opposite of what we need as a nation. This encourages entitlementiasis, discourages employment, reduces responsibility, reduces control, freedom and right to choose from among the options.
In phases & steps, natural flow of the system will be towards complete socialization of health care......... and we know, no matter how Utopian and altruistic one's intentions are, in the end, laws of nature can not be violated.
One basic law is that there is no free lunch. If you dont produce a dollar, you can not consume a dollar without having unintended consequences. Sooner or later, you will run out of OP(iu)M (other people's money).
If a system, be it socialist or otherwise fails to respect this law, it **SHALL** collapse one day.
US has been on this path since early 1970s when we decided to ignore this natural law by removing dollar from gold peg ........ and this bill will accelerate the process.
call me Socrates, ... give me a bowl of poison to drink..... but please dont ignore the laws of nature, or .... "The Empire" will collapse.
Break up the insurance companies and add tort reform!
We don't need another massive bill that denies liberty to all Americans!
Break up the insurance companies, break up the trial lawers, and forget new health bills. Break up the insurance companies by simply enforcing existing anti-trust law and let innovation take place for the rest of us. Think of it this way — If we break the five biggest companies in each of the insurance, pharma, and hospital industries into five or ten companies each — by simply stopping the anti-trust law exemption that these industries get, then we'd instantly have competition throughout the industry and we'd have 25-50 new companies in each industry innovating and trying to provide "better" service, creating new jobs...what's to lose?! That's why we have anti-trust laws. Any bill from any Repub/Democrat has lost site of what the whole idea of health care is. Break up the insurance companies by simply enforcing existing anti-trust law and let innovation take place for the rest of us. No new bills except for tort reform! Kill the Obama bills instead.
By the way, where are my fellow pathologists in all of this? I only see one other posting above from a pathologist. I guess their heads are stuck in the sand somewhere!
He sold UNH and WLP again in Q2 after selling significant bunch in Q1.
From Bloomberg:
Berkshire reduced holdings of WellPoint Inc. 27 percent to 3.5 million shares and sold 24 percent of its shares in UnitedHealth Group Inc., lowering its total to 3.4 million shares.
And, many people believe he is close to BO (and of course many other "insiders")
Great job. You have my support. I believe that because of you and Sermo doctors are at least, finally, getting heard in this debate. We docs have lots of opinions but those of us not intoxicated with the Kool-Aide appear to have a voice through you. Thank you.
Fake doctors are at the Obama healthcare town hall meetings and he is receiving planned questions from Obama supporters. He already has his answers prepared. And why are the taxpayers paying huge dollars for him and his family to travel on sightseeing trips to the national parks? What a waste of taxpayer money.
Lastly, read the articles by Stanley Feld, M.D., FACP, on "Repairing the Healthcare System." They are very good (I am not Dr. Feld). See stanleyfeldmdmace.typepad.com
www.gurufocus.com
Thanks for all of your efforts, tort reform has to be an essental part of any meaningful plan
You get what you pay for as a society.
Physicians can bill what the market will bear. Those who think most physicians are greedy should go to the mission field where their self-righteousness will be rewarded. Government and insurers can decide what they are going to reimburse patients.
People must shepherd their own resources.
For those of you in love with Pharma
I don't mean to upset or alarm ya'
But Danny Palestrant's
"Public options ain't good!" rants
Aren't good for your afterlife karma
Sermo Doc 22: very perspicacious observation. You are right!
Have installed the plugings....aaarrrggghhh
Great interview... I agree with the previous and even current differences with the AMA, but I would try to avoid the "we hate the AMA" mantra as the crux of what your saying publicly. This is a prime opportunity to let the physician voice be heard on what we want changed, so let's use it to the best of our ability and we can fight with the AMA in private or in places like this. I think everyone understands that the AMA is out of step with the majority of physicians in this country, now let's tell them what's missing from the current healthcare reform... Thanks for all of your work!
The "public option" presents a perfect opportunity for physicians to establish a Physicians' Healthcare Delivery System that is funded by the government. It is a meaningful opportunity for us to gain a significant measure of control over healthcare decision-making. Please re-visit prior posts on this issue. See md.sermo.com
Let us have a vigorous debate on Sermo on this subject, and advance the outcome as a suitable "co-operative" to fill the public option vacuum.
Obama has recently spoken about his health plan and has revealed his lack of understanding about aspects of medical practice and the reasons for rising health-care costs.
One theme the president has focused on is doctors' motives. During a prime-time press conference on July 22, the president referred to a doctor who muses that she makes "a lot more money if I take this kid's tonsils out", even if the child might not need surgery. Responding to a woman whose spry 100-year-old mother was given a needed pacemaker despite her age, the president said a few weeks earlier (at an ABC News town-hall event at the White House) that doctors should let patients know that sometimes "you're better off not having the surgery, but taking the painkiller."
Obama's clinical scenarios represent an excessive, erronious view on how doctors are influenced by financial incentives.
This view on medical decision-making may explain why programs Obama is proposing to lower health-care costs rely on the direct regulation of medical decisions. If Obama is serious about lowering costs, he'll drastically reform the economic structures in medicine, especially programs like Medicare.
Obama's policies will directly regulate doctors and their decisions.
LOL to us all.
a SIMPLE and cost effective solution to the mess is to open Medicaid CLINICs in each county for those on medicaid and those who refuse to buy insurance... You can staff it with medical aides. lpns etc... there is NO progress unlesss the Legal Reform occurs.. It is amazing to me when they toute that we have higher costs in america and poorer quality that NOONE points out the LEGAL COST In American is why most Pharmaceutical co have gone Abroad!! Schering Plough was our last one we lost this year! also I guess infarcting in Canada is cheaper than preventing scar damage and CHF.. amazing how that is "bettter care"
EVERYONE get active NOW and FIGHT THIS government GARBAGE .. IT is the GOVERNMENT PROGRAMS that are cost shifing to Private plans and destroying them.. along with Legal Mafia.. for 30 years i worked on the left and right to improve health care.... the Dems never used common sense.. only power control and cut back on the Providors (US) to solve every cost overun... They never cut their salaries or benefits
Since I was raised in a moral democrat family, I was shocked at the meanness to us>
After seeing Obama's Physician say he never had the gov interfer with his practice of medicine I can see WHY OB is still smoking!.. I am pleased that I prevented Meningitis in adults who i gave Hib and PCV to and ran the rath of Idiots at Medicare.. who could have cared less that i prevented life threatening illness.. Eventually I made the patients BUY their own vials and only charged them for the shot.. so i would not activate the Stupidity in the ranks! (whoops, maybe i should NOT have used That word!)
we need to start a campaign to prevent med students from going into debt for TRAINING.
that will lower our ranks and maybe someone on the left might wake up.. but dont count on it..
Americans, meanwhile, have clearly shown that they have a great deal of common sense (generally) as borne out in their ability to tell HR3200 would be medically and financially destructive. Americans want the health care reform process to slow down, be well thought out, not destroy the high quality aspects of our health care system, and not financially burden the country. Talk of tort reform is even out there a little more.
3 weeks ago, it seemed like HR3200 was a speeding train and unstoppable. The Blue Dog pause on the legislation and force of the American people may have derailed this destructive piece of legislation.
HR3200 - may be derailed. Daniel is getting on CNN and other news channels, and he's been down to Washington.
We have a window and a little more momentum to truly have ourselves heard.
Each of us has to do our own practical things to help the cause. I'm doing the following, and would encourage everyone to do the same:
1) Voting as much as possible on Sermo
2) Telling/contacting as many colleagues as possible about joining Sermo to be heard
3) Discussing my thoughts with my patients about health care reform - including putting postings in my office (Our opinions hold a great deal of weight with most of our patients. I like to tell them how bad reform may harm the care I try to provide them.)
5) Directly contacting my House and Senate members with snail mail and email about health care reform
6) Contacting as many friends and family members as possible to contact their House and Senate members to do the same
7) Emailing friends/family on important health care issues that are being debated
8) Talking to my patients about what practicing MD
We have to keep up the fight. We're making some headway. I know there are some huge obstacles to some things we want (tort reform), but if enough of us hammer away at it endlessly, we can make a difference in many ways.
Justin G. Matrisciano MD
How about also organizing as CORPORATE entities of physicians locally, then coalesce regionally into entities that form a "public option'?
(capitation or number of covered lives) and a secondary specialist group that paid fee for service with a quality modifier for outcomes. Maybe even a third group- hospital based which are paid by hospital compensation mechanisms- RAP/EM (aptly named, unfortunately)- ie salaried. This will end up reducing or eliminating doctor owned hospitals, ASC's and imaging centers, which the large insurers are trying to do. The real need is doctors to form larger groups as primary care and specialists and "corporate" themselves as real providers of care, including insuring and risk taking for coverage contracts.
You do not pay the provider less. We are the front line. The hundreds of unreimbursed hours spent laboring on someone's behalf. The incessant interruptions throughout the day that must have the information contained in each be placed into some coherency. Always feeling rushed, always worrying about what might have been missed. It's time for fairness in this system of exploitation and servitude. The public says it's all about "me, me, me". Just do this for me. I don't care if you can't make ends meet -- heh, it's not my problem.
I need my airline bag . . .
Re: Lou Dobbs report: It's all about Lou Dobbs!
We need to serve our patients and get paid by the patients for doing so. If our patients have more control over their insurance money, they get to decide whether the doctor has earned his fee. People need doctors: they need educated, dedicated, experienced, sophisticated, caring doctors who answer their phones and run their offices for their patients: not for CPT codes and fluffed up bills.
Insurance/Health care reform that restores payment for service, not for cpt code, is the only thing that will give our patients what they want and give us and our colleagues a great way to care for the well/sick and earn a good honest living.
So long as we complete with each other for CPT money, then we will be increasingly overwhelmed by NPs and PA-Cs and we will see our professional satisfaction decompose as we try to bill more bone densities, profit share in CT scans, and dream of self centered concierge practice.
Tort reform is the second leg: we are forced to treat everyone the same because of standard of care paranoia. Tort reform will enliven our care as we try to meet the needs of our well and sick, and not try to fill in the check list for bogus standard of care.
Thanks.
Wow! Well\done Dr. P! Dr. Nielson AGREED with Sermo's positions and showed 'equivocation' over HR3200 that was hard to miss!
Well said, Dan!
President Obamma at his meeting with AMA said that doctors should get their priorities straight. If someone suffers from a malpractice act deserves awards and we can not take that away from them. A simple question for our president: Why doesn't your bill contain a clause saying that there should be a maxium cap of 10% commision on lawyers fees? (instead of the current 40%-45%) so that the victims of malpractice can get all that they deserve?
I just watched both posts, and really I could not agree with you any more ! Thank you for pushing this forward. I think that we should, as Physicians, organize further. Sermo is a great tool for this. I think this who concept needs to go to the next step, create an organization that truly has the patient's and Doctor's interest at heart. Count me in if we can create a new voice- we can organize locally, fund raise, lobby, be true advocates for what the health care system should be- WE NEED TO DO THIS- or we will be run over and left for dead-
HHS Secretary said this weekend that they may forego the Public Option and push for Co-Ops! Co-ops never worked before so here we go again.
Obama said he'd accept a Bill without the Public Option so it appears he'll back the Co-Op Plan now. Sen. Conrad (D),ND, said Obama never game them any plan and they don't have the votes in the Senate for a Public Option. What? Obama never had a Plan?! So, he'll take whatever gets him reelected in 2012!
Obama likes "Death Panels" though and was quoted in the WSJ OPINION page on Friday, 8/14/09:
"Well, I think that there is going to have to be a conversation that is guided by doctors, scientists, ethicists. And then there is going to have to be a very difficult democratic conversation that takes place. It is very difficult to imagine the country making those decisions just through the normal political channels. And that's part of why you have to have some independent group that can give you guidance. It's not determinative, but I think has to be able to give you some guidance. And that's part of what I suspect you'll see emerging out of the various health care conversations that are taking place on the Hill right now."
I'd suggest Congress scrap all these Bills and, instead, draft a TORT REFORM bill and save $30 Billion in malpractice costs. Vote Sen. Specter and the other Trial Lawyers out of office in 2010.
Lastly, maybe Sermo and Dr. Daniel can look into having the Justice Dept. investigate the 5 big insurance companies, big PHARMA, and the big Hospital companies as a monopoly. Break up the insurance companies by simply enforcing existing anti-trust law and let innovation take place for the rest of us. Think of it this way — If we break the five biggest companies in each of the insurance, pharma, and hospital industries into five or ten companies each — by simply removing the anti-trust law exemption that these industries get, then we'd instantly have competition throughout the industry and we'd have 25-50 new companies in each industry innovating and trying to provide "better" service, creating new jobs, removing their control of doctors...what's to lose?! That's why we have anti-trust laws. Yes, these companies do have an "anti-trust law exemption" thanks to Government lawyers! Remove their "EXEMPTION".
God Bless Us All.
You are right on target: no insurance reform + no tort reform = no healthcare reform. If this bill goes through as is, we are done. We have to keep up the good fight...
www.nytimes.com
you are a welcome voice of reason and sanity in this important debate.
Will you be there for the Million Med March Oct. 1st?
RADICAL IDEA: INCREASE PAYMENT FOR COGNITIVE TIME!
Do not penalize doctors for thinking through treatment plans.
Unfortunately, the problems are more complicated than the thoughtful, excellent post that begins this discussion.
We DO need to proceed incrementally BECAUSE no one can be sure how to disentangle the knot.
Something getting lost in all of this is the MAIN point of the IOM study of a decade ago: All the systm problems are so big, those in the system cannot see them.
That is also why no one practice style is THE ANSWER, one size doesn't fit all, and the supposed inefficiency is also a strength because it allows for options, experimentation, adaptability.
We have to face thereality that all the proposed answers squeeze air out of the system at one time, then the escalator begins to go up again.
Former Gov. Dean calls public option indispensable
AP - 43 mins ago
WASHINGTON - Former Democratic Party Chairman Howard Dean, a leading figure in the liberal wing of his party, said Monday he doubts there can be meaningful health care reform without a direct government role.
The first causality of divide and rule tactics of government price fixation was Cataract surgery the gold standard of any surgery. In a simple cataract the cutting edge microsurgery IOL restores the sight back for good, rehabilitates the visually disabled with economic independence, lifts up the spirit and confidence to purse productive and happy life.
The cataract surgery being the most common surgery performed in USA at $1573 in 1989 became the object of unabated series of pay cuts thanks to irrational irresponsible people comments... The 2007 payment was $608. The gold and oil command the more price than sand unless it is a computer chip. The market forces of demand and supply determine the price of a service or commodity. People attach high importance to eye care all over the world pay well as it is a good value for high quality of visual function.
The two eye together account for 80% of total body function. The surgery demands micro surgical skills, dexterous operation of technologically advanced tools besides mere cognitive skills to achieve the precise visual function. All specialties and primary care are important for the health care delivery. The coronary by pass surgery is valued higher than surgery for intestinal obstruction, though both relieve obstruction. That is effect of market forces of demand supply of skills and the value public attach to a given surgery. The cataract surgery fee includes initial evaluation and 90 days post op care.
The couch care implanting ideas and prescribing the expensive psychiatric drugs on long time basis and charging for every second of every visit with no permanent cure is a lot more expensive than cataract surgery and less value for the money. There is day and night difference between cataract surgery and couch care in the complexity of care and quality of out comes and value given by public. The time is not the only factor paid for as in psychiatry listening to clients. Why should the president be paid $400,000 for administration and Wall street CEO paid millions? If one practices communism no one should be paid better than Psychiatrist. This class war fare fuels the Obama health care reform pitting cognitive versus Sermo Doc 69s, divides the physicians unity and in the end every one losses the deserved pay scale. When you have cataract if you go to psychiatrist he can listen and talk for ever and prescribe medications in vain to restore your sight. The cataract surgery is the most under valued surgery in the modern age for all the benefits bestowed upon the IOL recipients.
Government monopoly simply reduces physician pay every year under some pretext or SGR or using socialist principles. The RBRVS of 1992 assigned RVU s based upon intensity, time, overheads, professional liability and geographic practice index. This further modified on budget neutrality and SGR adversely effect surgical payments. As the seniors increase in numbers the cataract surgery demand increases especially with good visual results yet the fee is cut every year. IT is not group psycho therapy each surgery is performed individually.
The first causality of divide and rule tactics of government price fixation was Cataract surgery the gold standard of any surgery. In a simple cataract the cutting edge microsurgery IOL restores the sight back for good, rehabilitates the visually disabled with economic independence, lifts up the spirit and confidence to purse productive and happy life.
The cataract surgery being the most common surgery performed in USA at $1573 in 1989 became the object of unabated series of pay cuts thanks to irrational irresponsible people comments... The 2007 payment was $608. The gold and oil command the more price than sand unless it is a computer chip. The market forces of demand and supply determine the price of a service or commodity. People attach high importance to eye care all over the world pay well as it is a good value for high quality of visual function.
The two eye together account for 80% of total body function. The surgery demands micro surgical skills, dexterous operation of technologically advanced tools besides mere cognitive skills to achieve the precise visual function. All specialties and primary care are important for the health care delivery. The coronary by pass surgery is valued higher than surgery for intestinal obstruction, though both relieve obstruction. That is effect of market forces of demand supply of skills and the value public attach to a given surgery. The cataract surgery fee includes initial evaluation and 90 days post op care.
The couch care implanting ideas and prescribing the expensive psychiatric drugs on long time basis and charging for every second of every visit with no permanent cure is a lot more expensive than cataract surgery and less value for the money. There is day and night difference between cataract surgery and couch care in the complexity of care and quality of out comes and value given by public. The time is not the only factor paid for as in psychiatry listening to clients. Why should the president be paid $400,000 for administration and Wall street CEO paid millions? If one practices communism no one should be paid better than Psychiatrist. This class war fare fuels the Obama health care reform pitting cognitive versus Sermo Doc 69s, divides the physicians unity and in the end every one losses the deserved pay scale. When you have cataract if you go to psychiatrist he can listen and talk for ever and prescribe medications in vain to restore your sight. The cataract surgery is the most under valued surgery in the modern age for all the benefits bestowed upon the IOL recipients.
Government monopoly simply reduces every year under some pretext or SGR using socialist principles. The RBRVS of 1992 assigned RVU s based upon intensity, time, overheads, professional liability and geographic practice index. This further modified on budget neutrality and SGR adversely effect surgical payments. As the seniors increase in numbers the cataract surgery demand increases especially with good visual results, yet the pay is cut annually. IT is not group psycho therapy each surgery is performed individually.
And it hit me this morning that this is what I was sold while being trained in a very fine Medical school- that I should be able to see a patient every 8 minutes and that to not do so was inefficient and wasteful. I've spent the last two years beating myself up to see more and more people and FOR WHAT? A constant headache, stress and now patient complaints that I'm TOO busy, too hurried and unavailable as I strive to see 40 patients a day for a large corporation.
I would love to see tort reform, insurance reform and patients taking responsibility for themselves. I would love to have 20 min patient visits, HA! Then maybe I wouldn't dream of doing something else.
Keep getting our voices out there!
www.theonion.com
Agree with arguing for the complete removal of the tort system and all participation by lawyers in the health care injury claims adjudication process. I believe that this should be ONE of a NUMBER of "demands" by physicians for participation in a Public Option.
Arguing from a position of stating "there must be tort reform for health care reform" is not going to get us anywhere in the health care debate. We must be clear what we will contribute to health care reform in return. Participation in a Public Option could be coupled with an expression of support to: 1) participate in an objective means of adjudicating health care injury claims, 2) use a free, well designed, physician-friendly EMR that contains agreed upon outcome of care measures that can be objectively defined with data collected in an unbiased manner, 3) provision of a physician-driven, continuous quality improvement mentality and work ethic, 4) do CME based on identified practice issues, 5) participate with other health care personnel to improve coordination and cooperation across the spectrum and continuity of care, 6) participate in comparative effectiveness studies when feasible in our practices, 7) continuous guard against interference with the Dr-patient relationship by outsiders except where that interference is explicitly agreed upon by physicians, patients and the government, *) self-critique our performance to ourselves, patients and to the government. In return we could "demand":
1) a no-fault, lawyerless adjudication process for health care injury claims
2) fair, negotiated payment at the time of visit
3) loan and expense "forgiveness"
4) the ability to apply behavioral economics to encourage better self care
5) only one review agency involved in practice reviews
6) guarantees that physician reimbursement could not be manipulated for political or government bureaucrat gain
7) a continuous quality improvement mentality and action by the government
Agree with all your points.
2. Tax Reform - given individuals tax deductions for having at least one physical a year, keeping their lipids, HbA1c, weight and waist circumference in normal range and having their age appropriate cancer screenings. Eliminate all other personal income tax deductions. See how everybody gets on a health kick, rather than a healthcare kick.
3. Health Insurance Reform - Mandate nationwide common forms. Mandate everyone to have catastrophic health insurance only for claims > $ 50,000. The rest people can pay out of pocket or HSA
4. HSA reform - Eliminate 'use it or lose it' provisions. Allow accumulating as much money as a person wants in an HSA. Allow using any money in the account for > 5 years to be used for any other purpose besides buying healthcare. Allow heirs to inherit HSA, though without any deductions or step-up in basis.
We, the physicians can control costs if there is no interference in our work. If the policy of the government is to insult us with crappy programs like the ones suggested by both Democrats and republicans who are so corrupted with lobby money, trying all these crazy mechanizations behind our back, there is no reason for us to even try to help, expect no cooperation.
Physicians today are in a unique position to be brazenly confrontational when insulted and tell politicians off. We do not need to grease their palms. If it is a bare-knuckles fight, let us go for it. This is our last chance.
TOP TEN INDICATORS THAT YOUR EMPLOYER HAS CHANGED TO OBAMA'S PLAN:
(10) Your annual breast exam is done at Hooters.
(9) Directions to your doctor's office include "Take a left when you enter the trailer park.."
(8) The tongue depressors taste faintly of Fudgesicles.
(7) The only proctologist in the plan is "Gus" from Roto-Rooter.
(6) The only item listed under Preventative Care Coverage is "an apple a day."
(5) Your primary care physician is wearing the pants you gave to Goodwill last month!
(4) "The patient is responsible for 200% of out-of-network charges," is not a typographical error.
(3) The only expense covered 100% is.. "Embalming."
(2) Your Prozac comes in different colors with little M's on them.
AND THE NUMBER ONE SIGN YOU'VE JOINED
OBAMA'S HEALTH CARE PLAN:
(1) You ask for Viagra, and they give you a Popsicle stick and duct tape!
1. PROSTITUTED by 3rd PARTY intruders (non-medical, government, pharmaceuticals, insurers private or govenment, trial lawyers, paramedical NPs, PA's, chiroquactors, acupunctrists, soothsayers, etc, etc, in the NAME of the ALMIGHTY DOLLAR!!!!
2. PHYSICIAN outcry is LEAVE US ALONE we can manage health care!
AMA has orphaned us and had been in bed adulterous since the wedded gown is now despicably outworn in smithereens!
BUT the proverbial PHYSICIAN KNOW THYSELF is the only panacea in bringing back the TRUST and CONFIDENCE of the patient (3rd party and all!). The loss of confidence carries a hallmark of GREED, loss of compassion, crowned with a $$$ilver lined halo on our head!
The most touted EBM (evidence based medicine) is a cane crouch just like a drunk straddle over a night post in the middle of the street while the sober medical doctor races home for a late dinner as wife in tears mulling for a divorce and children already snoring in bed!
3. PATIENT INDULGENCE, irresponsibility, dependence because of health care AVAILABILITY magnified by the ALMIGHTY $$$ doleouts, social insurance security, cultural drug propagation without motivation, character and discipline.
Our ZEAL as adulterous but impervious as we are, NEEDS an SOS resuscitative cleansing among ourselves!
At the SERMO table, pray as need each other shoulder to lean on and cheer on Dan our SERMO President to go on!!! WE thank SERMO for representation just like David faces the G"O"liath in Washington, Congress Ataliah, AMA Aholibamah, the legal pundits of Ahab and the villous Deborah of Big Pharma, Cigna and Medicare!
On the heights of heaven, God stood and looked at our despondent hearts, as the glimmer of smile, courage and wisdom unite us all in prayer and praise that we still don the white coat of purity and victory!
Funny Isledoc! :-)
1. Tort Reform
Remove trial lawyers like Specter (PA) from Congress in 2010 and stop Trial lawyers PAC and lobbyists. Pass a Tort (Malpractice) Reform Bill.
2. Insurance Reform
Break up 5 largest Health Insurersinto 25 smaller competitors using Justice Dept. and ant-trust investigation. Remove Ant-Trust Exemption from these large insurance companies which prevents free maket competition!
3. Implement Employer HSA's adding tax credits/deduction for Employers and/or patients who use them.
4. Kill all Obama bills.
Inform your patients, the media could care less as they love B.O.
1) Nothing is free in life. If a patient requires medical treatment then the patient should be responsible for paying for that service. Medical Insurance should be no different than homeowners or car insurance. If I have a plumbing problem in my house i call the plumber and pay his fee. If a tree falls on my house (a catastrophe which actually did happen to me) I call the insurance company. That is how health insurance needs to be approached. The predominant mindset that patients are entitled to all care for minimal cost is absurd and leads to disaster. Yes we have indigent patients and they should be cared for, but all of America is not indigent.
2) Tort reform. How can we practice medicine when some lawyer is capable of ruining us for doing our best and getting a bad result?
3) Why are physicians the only profession that is banned from unionizing?
WSJ OPINION
AUGUST 18, 2009, 7:16 P.M. ET
"Overspending is far preferable to artificially limiting the availability of new procedures and technologies."
By MARTIN FELDSTEIN
"Although administration officials are eager to deny it, rationing health care is central to President Barack Obama's health plan. The Obama strategy is to reduce health costs by rationing the services that we and future generations of patients will receive.
The White House Council of Economic Advisers issued a report in June explaining the Obama administration's goal of reducing projected health spending by 30% over the next two decades. That reduction would be achieved by eliminating "high cost, low-value treatments," by "implementing a set of performance measures that all providers would adopt," and by "directly targeting individual providers . . . (and other) high-end outliers."
"In the British national health service, a government agency approves only those expensive treatments that add at least one Quality Adjusted Life Year (QALY) per £30,000 (about $49,685) of additional health-care spending. If a treatment costs more per QALY, the health service will not pay for it. The existence of such a program in the United States would not only deny lifesaving care but would also cast a pall over medical researchers who would fear that government experts might reject their discoveries as "too expensive." '
Wonder how many QALY's we'll each have as we age. The Obamamorons will turn us all into "SOYLENT GREEN" if they have their way.
Town Halls have accomplished a lot. We haven't accomplished much at all with all our "Postings" and "Comments". Kill Obama's bills, break up the big Health Insurers, and add a Tort Reform bill by taking action.
Time is running out for us. We can educate every patient who comes to our office...they vote, they go to town halls, they talk to their Reps. and Senators, and they like us as "their doctor". Do it now or we all go down together!
Everybody from the Republican and Democrat Regime seems to agree that more competition in health care in general and in health insurance specifically is a good thing. Some say that a public option is good for competition, others say that a public option is bad for competition. If we want competition in health insurance, why don't we simply enforce anti-trust laws that are supposed to be the laws of the land in this country. The 50% market share enjoyed by BCBS and WellPoint, for example, in the Northeast US underscores that we should just enforce anti-trust laws against these insurance companies if the government wants competition.
But no - the insurance lobby industry makes sure that nobody even talks about simply enforcing anti-trust laws as a method of creating competition and trying to cut costs in the industry. Breaking these giant roll-up companies like United Health would certainly cut down on the lobbying powers of these companies. As it sits now, the health insurance industry actually has a full-on exemption from the anti-trust laws of this country.
That anarchic lawless exception to our country's laws stems from a 1945 bill that was supposed to enable the federal government to "regulate" health insurance.
The McCarran-Ferguson Act, 15 U.S.C. § 1011, is a United States federal law. The McCarran-Ferguson Act was passed by Congress in 1945 after the Supreme Court ruled in U.S. v. South-Eastern Underwriters that insurance could be regulated by the federal government via the Commerce Clause. The Act also provides that federal anti-trust laws will not apply to the "business of insurance" as long as the state regulates that area, but federal anti-trust laws will apply in cases of boycott, coercion, and intimidation.
Companies like United Health in particular took advantage of this loophole in US anti-trust law and gobbled up the competition to become ever more powerful. And now they might be too big to fight. United Health hasn't just been illegally consolidating their industry horizontally by rolling up competitors to their health insurance business. They also have been illegally consolidating their industry by rolling up their suppliers and customers.
We need to press our friendly lawyers and Reps. in Congress, our lawyer patients, our friends in the Justice Dept., and the AMA to press Congress to remove the "Anti-trust Exemption" from the large Health insurers, break them up like AT&T, create 25 smaller companies who will compete in a free market, lower costs, and give Docs a better deal on reimbursement and other issues.
A recommendation for improvement from Cody Willard, 8/12/09.
Keynote speakers urge AHIP to press Congress on healthcare IT.
At AHIP Institute 2008, Thompson especially promoted the use of healthcare IT and innovation, and called on AHIP members to play a role. "It's an exciting time today," he said. "I can't think of a better opportunity for AHIP."
He said AHIP and its members need to lobby Congress to pass healthcare IT legislation. "IT is the way to go. We can save a tremendous amount of money," he said.
Breaux agreed, saying that healthcare IT is "part of the answer," and Congressional influence by AHIP should be exerted.
Thompson said that as payers, health plans need to force providers to use healthcare IT such as e-prescribing. He cited 98,000 deaths last year attributed to medical mistakes, with 50 percent attributed to the wrong medication having been given.
While William Frist, former Senator (R-Tenn.) was less optimistic about the scope and shape of reform, he and former Sen. John Breaux (D-La.) and former Health and Human Services Secretary Tommy Thompson said healthcare IT is part of the solution for healthcare reform.
Need we say more?
The other has a Chacago based IT business that will be at the center of EMR junk.
See my previous posts with all the links on this.
Also, the majority of the country doesn't want what is being forced upon us by the radicals in the democratic party. Baucus, Conrad et al represent centrist populations.
Run the plan past Maxine Waters. If she disapproves, then it is likely 75% of the country will like it.
Becasue we have elevated nurses to professional status when many of them are simply morons. Go into the specifics of the IOM report that is the basis of all of this.
You know what you find?
Malpractice is usually system errors, not doctor error.
Nurses are generally morons and the basis of most malpractice.
Hospital administrators are self important jerks who are the source of the bulk f the rest.
Too bad no one wants to address that reality.
Remember, while nurses tend to be morons, they tend to be unionized morons with great clout in the democratic party, and the spend more time talking to patients.
Hospital administrators are represented by a trade organization that doesn't pretend to be a humanitarian enterprise, it just represents the intersts of it s members. We, on the other hand, have organized medicine.
we all need a reality check. there is no way everyone can be covered without raising taxes by at least 20% for every one in some form or the other.( direct taxes, VAT/Sales tax etc). This will toss US into the grabage bag in the world marketplace.
Rationing care is NOT wrong so long as the patient who is willing to pay for those services is not denied extra services( that is capitalism).
Catastrophic care with well defined and limited benefits is appropriate under our current bankrupt system and may reduce costs overall. Example: This may mean No screening colonosocpy,mammography after 75 years or no dialysis over 70. No politician has the gall to mouth these hard facts.Pres. Obama has laudible points, but has been drowned out by hatemongers. Unfortunately he is uneducated about complex issues related t healthcare and has failed to solicit physicians and practicing MDs to help him formulate policy. For this he will pay with failure.
High deductible insurance and HSA must be encouraged. This should be the model for all other plans. It imposes restraint, pain, thought and appropriate use of services and actually empowers patient.
Doctors who provide free care should be given tax breaks. Arlen Spector and Lindsey Graham want to give a tax break for trial attorneys who work on contingency basis! I wonder what planet these senators came from.
Docs or their business who do "pro-bono" work or install EMR's should be given "Credits", not lesser deductions.
On the AHIP, the 50% market share enjoyed by BCBS and WellPoint, for example, in the Northeast US underscores that we should just enforce anti-trust laws against these insurance companies if the government wants competition.
Like Anthony Hopkins and Brad Pitt said (Legends of the Fall), "screw the politicians" or something similar! Specter is a the number one disgrace to Humanity among Trial Lawyers!
WHAT AN INSULT to colleagues who had SELFLESS efforts in the name of helping, sacrificial sharing their love, compassion and talents to those who are in need for GOD's righteousness ...
GOP Should Shut Down Senate If Dems Use Procedural Tactic to Ram Health-Care Bill Through, says Conservative Leader(CNSNews.com) Gary Bauer who warned Wednesday that Democratic leaders in Congress will try to ram through their unpopular health-care reform plan later this fall, employing a little-used tactic first conceived as a way to maneuver around the budget deficit battles of the 1980s. The tactic, known as "reconciliation," is designed to get around the filibuster. "It's a little esoteric, but the bottom line is that they will be able to ram this through with just 51 votes," Bauer said.
Do 51 corrupt votes represent 65% of Americans who oppose this Bill or are not sure? Do we still live in a Democracy or is it now an Autocracy?
WHERE'S THE AMA AND ALL OUR MEDICAL SOCIETIES NOW WHEN NEEDED??
I sense your pain / frustration, but it doesn't help the dialog to declare that nurses are morons. Most of them aren't morons. A really good nurse can save a hospitalized patient's life. The problem on the inpatient side is that they spend too much time entering data (a la CPT and medmal) and don't have enough time to provide care.
We cannot run medicine without nurses who nurse.
Further, for every "the NP killed the patient" story we share, believe you me there is an equivalent story of an MD who killed the patient, through laziness instead of ignorance.
Be Positive
Can we stop criticising each other? Look at how we could use our energy to accomplish something.
We need urgent Tort Reform. Investigate the Trial Lawyers PAC Lobby and how much they pay Congress to support them. Indict the crooks and remove Sen. Specter (PA) in 2010, the worst of the bunch.
Have the Justice Dept. investigate the largest Health Insurance Cos., remove their ANTI-TRUST EXEMPTION, and break them up like AT&T. Many smaller cos. can compete effectively in a free market and work with us fairly.
The HSA is one solution that could solve many of our health-care problems. For example, Whole Foods Market pays 100% of the premiums for all team members who work 30 hours or more per week (about 89% of all team members) for a high-deductible health-insurance plan. They also provide up to $1,800 per year in additional health-care dollars through deposits into employees' Personal Wellness Accounts to spend as they choose on their own health and wellness.
We can place short handouts re the above in our offices, in the doc's lounge, and in our bills; post a notice on our office door, talk briefly to our patients who like us in the exam room and lab about health reform, write a letter/fax to a local paper and to our Congressmen, speak on local talk radio or Rotary, go to a town hall, and talk to colleagues who may be complacent about reform. Together we are a vital force! Look at what you've accomplished over years of hard work and what you can do now.
Sorry for the preaching but if a Food Co. can do something, can't we?
People have strong opnions about the issues but I would guess not even 5% of those on this site have actually have done anything this legislative season to make their lawmakers aware of their concerns. I commend those of you that have. The reality is that healthcare reform is coming -something WILL eventually be passed even if it does not get through this season- no matter how much you stamp your feet. Stop suggesting unrealistic fantasies (let's go back to the days of everyone paying out of pocket) and actually make sure that we are included in the process.
Agree Sermo Doc 87 that there are SPECIFIC issues that we can all agree need to be addresses no matter where we fall on the healthcare spectrum. Perhaps some strategic campaigning for those issues since all can't get accomplished at once.
Patients will not be able to pay for better care than the basic "standard." Sorry, Bill Gates!!!!!
The McCarran-Ferguson Act was passed by Congress in 1945 after the Supreme Court ruled in U.S. v. South-Eastern Underwriters that insurance could be regulated by the federal government via the Commerce Clause. The Act also provides that federal anti-trust laws will not apply to the "business of insurance" as long as the state regulates that area, but federal anti-trust laws will apply in cases of boycott, coercion, and intimidation.
Companies like United Health in particular took advantage of this loophole in US anti-trust law and gobbled up the competition to become ever more powerful. And now they might be too big to fight. United Health hasn't just been illegally consolidating their industry horizontally by rolling up competitors to their health insurance business. They also have been illegally consolidating their industry by rolling up their suppliers and customers.
We need to press our friendly lawyers and Reps. in Congress, our lawyer patients, our friends in the Justice Dept., and the AMA to press Congress to remove the "Anti-trust Exemption" from the large Health insurers, break them up like AT&T along with Big Pharma and Hospital CO's, create 25 smaller companies who will compete in a free market, lower costs, and give Docsand patients a better deal on reimbursement and other issues.
Equal and Fair Justice for all!
This gives working physicians a fighting chance to be heard. Sermo is picking up momentum. Physicians who have not understood the complexities of this issue are beginning to take time, read and wake up to the reality of the grievous threat that is posed to our profession.
Thank you again for playing a major role in our education and voice!
Competition lacking among private health insurers
By RICARDO ALONSO-ZALDIVAR (Associated Press Writer)
From Associated Press,August 22, 2009 11:45 PM EDT
WASHINGTON - One of the most widely accepted arguments against a government medical plan for the middle class is that it would quash competition - just what private insurers seem to be doing themselves in many parts of the U.S.
Several studies show that in lots of places, one or two companies dominate the market. Critics say monopolistic conditions drive up premiums paid by employers and individuals.
For Democrats, the answer is a public plan that would compete with private insurers. Republicans see that as a government power grab. President Barack Obama looks to be trapped in the middle of an argument that could sink his effort to overhaul the health care system.
Even lawmakers opposed to a government plan have problems with the growing clout of the big private companies.
"There is a serious problem with the lack of competition among insurers," said Republican Sen. Olympia Snowe of Maine, one of the highest-cost states. "The impact on the consumer is significant."
Wellpoint Inc. accounted for 71 percent of the Maine market, while runner-up Aetna had a 12 percent share, according to a 2008 report by the American Medical Association.
www.google.com
Justice Dept. must remove TRUST EXEMPTION and break up large insurers into many small companies who can compete fairly and give us all a better deal.
START OVER PLAN:
1. Tort Reform
Remove trial lawyers like Specter (PA) from Congress in 2010 and stop Trial lawyers PAC and lobbyists. Indict corrupt lawyers, Lobbyists and politicians. Pass a Tort (Malpractice) Reform Bill.
2. Insurance Reform
Break up 5 largest Health Insurersinto 25 smaller competitors using Justice Dept. and ant-trust investigation. Remove Ant-Trust Exemption from these large insurance companies which prevents free maket competition! Allow interstate sale of health insurance with more competition, lower premiums, portable policies, and better deals for docs. No Government regulation of Reimbursement to Docs.
3. HSA's: Implement Employer HSA's adding tax credits/deduction for Employers and/or patients who use them. Allow docs to negotiate with HSA's. Checkout Wholesale Foods Plan.
4. Defeat all Obama bills.
5. Tax defer Medicare/Social Security taxes paid by employees and self-employed.
Inform your patients who vote, the media could care less as they love B.O.
a) Growing un-insured aggravated by the annual growth of thousands of new American citizens every year from the deliveries of foreigners who are illegally in our country.
b) Malpractice Reform: Golden Calf of the Democratic Party. How much money goes into 6 figured premiums along with the less tangible brain drain on the specialty.
c) Un-investigated monopolies of insurers like United Health Care who also now can cross into other industries by owning prescription databases to sell back to the pharmas.
d) Something like 30 to 40% of academic "thought leaders" in Medicine make significant revenue from pharmas and biotechs that they "investigate"
e) How can a country force you to "buy" billing codes that are mandatory? How can that company claim to represent doctors?
d) Loss of the Campaign Promise to make cooperative or individual prescription purchases by patients via established mail order processes "from whatever country gives the best prices." Why do Americans pay more than Canadians for the same drug still under patent?
e) How can the World Health Organization dictate to American medical software vendors and billing systems that we must switch to ICD-10 or more recently (and quietly they hope) something called "SNOMED-CT" that we have to put into our patient encounters like data clerks to be paid?
Two things I would do I had the funding:
a) Do five to ten 30 minute "day with the doctor" stories that cover a range of geographies and specialties. I don't think most people know what it is like to be in an independent medical practice. They don't know that when you see a new patient for 30 minutes, you are responsible for her or him 24/7 for emergencies at no additional cost. BUT PATIENTS KNOW THEY WANT TO CHOOSE THEIR OWN DOCTOR--too bad that under current trends you will be fortunate if you get to see an MD after a long wait in the "que"
b) Do a careful and independent financial analysis of the real income trends and debts between i) doctors of various specialties ii) insurance senior management iii) pharmaceutical senior management iv) trial lawyers. What it would show is that no matter what is said about healthcare inflation, there is an unprecedented deflation in physician incomes which will eliminate the best and brightest from all but the bariatric Sermo Doc 69s, dermatology, and the few surgical specialties left that can make ends meet.
You can't keep lowering physician reimbursement without causing a shift toward abandonment of current practices--sudden or incremental depending on the geography. I know that most of the Sermo doctors will go out on the weekends and do what we can for the poor, but our real jobs will be in some other related field: working on computer models for robotic care of various chronic diseases.
Recent quote from Dr. Sermo Doc 69 who listened to Obama Telephone Conference:
"Sermo Doc 69 Surgery, General Posted Aug 26, 2009 at 11:27 AM
Listened to the one hour conference call last night led by Kavita Patel a formerly practicing internal medicine specialist and David Semus(sp?) of the White House Communications office, with more than 2000 docs on line. I took voluminous notes. From my point of view, the priorities of the White House were clearly deliniated;
Insurance Reform consisting of
No exclusion for pre-existing conditions
Limitations on out-of-pocket expenses
No lifetime or annual caps on benefits
Eliminate Co-pays for preventative care
No loss of insured status due to occurence of a disease.
They stated a clear and specific desire to eliminate the fee for service model and pursue a Global Payment system nationally."
I wonder if "eliminate the fee for service model and pursue a Global Payment system nationally" means establish a Medicare type of physician reimbursement for services to patients with private health care insurance. I wonder if B.O. will then fix premiums globally for said insurance, and later add Bill for Death Panel Rationing?
Sounds like this could be a slick, modified new "Public Option" plan?!
Any thoughts??
Two years ago my wife was treated for breast cancer. After several years of savings, the HSA INSURANCE paid for this far better than our prior PPO. After the annual contribution was exhausted we were on the hook for about $2K, beyond which coverage was 100% rather than 80%.
What people now refer to as insurance is really pre-paid medical care. As such, it is rational to spend lavishly to get the maximum bang for your contract bucks. HSA's change that incentive overnight.
We need urgent Tort Reform. Investigate the Trial Lawyers PAC Lobby and how much they pay Congress to support them. Indict the crooks and remove Sen. Specter (PA) in 2010, the worst of the bunch.
Have the Justice Dept. investigate the largest Health Insurance Cos., remove their ANTI-TRUST EXEMPTION, and break them up like AT&T. Many smaller cos. can compete effectively in a free market and work with us fairly.
The HSA is probably the one solution that could solve many of our health-care problems. For example, Whole Foods Market pays 100% of the premiums for all team members who work 30 hours or more per week (about 89% of all team members) for a high-deductible health-insurance plan. They also provide up to $1,800 per year in additional health-care dollars through deposits into employees' Personal Wellness Accounts to spend as they choose on their own health and wellness. The employees love their plan and have voted the Union out!
We can place short handouts re the above in our offices, in the doc's lounge, and in our bills; post a notice on our office door, talk briefly to our patients who like us in the exam room and lab about health reform, write a letter/fax to a local paper and to our Congressmen, speak on local talk radio or Rotary, go to a town hall, and talk to colleagues who may be complacent about reform. Together we are a vital force! Look at what you've accomplished over years of hard work and what you can do now.
Sorry for the preaching but if a Food Co. can have a good HSA, can't our great Government and magnificant one do something, can't they, please!?
The message on the Teleconference was that a Uniform Global Reimbursement Plan will be forced on the private Insurance Co's! This is nothing but blaming the Insurance Co's. for this mess and disguising another Public Option in its' place.
B.O. is getting pretty slick like his cronies!
Will Doctors Opt Out Of A Public Option?
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Date: 2009-08-26, 7:10PM PDT Craiglist
Reply to: comm-ucahn-1344356949@craigslist.org [Errors when replying to ads?]
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It appears at least some plan too. Dr. Alfred Bonati, who heads the American Society of Medical Doctors, says he plans to say "no" to accepting patients under a government run plan and, according to a poll he cites, so do an awful lot of other physicians:
Perhaps this is why a nationwide, nonpartisan poll of physicians this month found that a full 70 percent oppose the health care reform proposals under consideration by Congress. Sixty-six percent feel that a government-run health insurance plan would restrict doctors' ability to give the best advice and offer the best care possible to their patients. Perhaps most importantly, 60 percent said they would not accept new patients covered by a government insurance plan.
Nearly all the doctors polled have worked with Medicare. Most have likely been denied Medicare reimbursement, or given minimal reimbursement, for a course of treatment that they prescribed that best fits the needs of a patient and that patient's family.
I share the view of the 60 percent in the August poll -- those doctors who are planning to "just say no" if government-run health coverage is implemented. Many of us already do not accept patients who are on Medicare or Medicaid because of restrictions those programs put on our decisions as doctors. It pains us to turn away a patient in need, but the narrow rules of government reimbursement programs stymie our ability to follow our oath, so we simply opt out and work with patients who are also in need but have more flexible, private coverage.
If a government option gains the popularity that is expected -- after all, who would not choose the most affordable option available, and how could any option compete with one that is subsidized by taxpayers -- millions of Americans will face severely limited options in choosing a doctor. As physicians reject working with a system that does not honor our oath, patients will be left opening their own checkbooks, or going into credit card debt, to get the treatment they need and deserve.
The law of unintended consequences again raises its head. The government may indeed put a public option in place - whether or not the citizens of the nation want it or not. And they may, through legislation, force insurance companies to take everyone without exception, but -at least not at this point- they can't force doctors to accept patients under plans that don't feel reimburses at a rate commensurate with the care given or doesn't allow them to treat a patient in accordance with the oath they took.
Of course that then leaves that system with a problem and the government with a dilemma - does it then force MDs to take anyone who applies (as it will insurance companies) regardless of insurance plan? And if so, how do you suppose doctors and other health care providers will react?
It is these sorts of problems, dilemmas and unintended consequences that few are talking about in this great "debate". What if it is doctors who become the Atlas that shrugs when all is said and done? What options would the government then have - in this land of the "free" and home of the brave?
www.cms.hhs.gov