[Heineken]

The system of underrewarding primary practice physicians and overrewarding specialists is part of the total problem, but only a modest part as I see it.

The barriers to and costs of medical education are now completely out of whack with reality and needs.

Also, the laws that protect physicians' business interests (and the interests of allied health care personnel, such as pharmacists) are beginning to severely crimp the access of the public to basic health care.

There is way too much turf-guarding among the medical professions, backed up by the aforementioned laws the medical lobbies have pushed through Congress. Turf equals money.

We need a system slanted more toward training average people to fix average ailments, and not toward training elite personnel to treat the exotic diseases of the elite.

If I am skilled at rendering first aid and can have that skill certified, I should not be legally blocked from rendering that care to people who desperately need it and cannot afford to get it from the system currently in place.

Ultimately the problem is for-profit health care. The two are incompatible when it comes to providing basic care affordably to all people, which has been declared a human right by the UN.

Health care is already rationed. But it is not rationed rationally.

[ki11ercane]

$this->bbcode_second_pass_quote('smallpoxgirl', '')$this->bbcode_second_pass_quote('frankthetank', 'A') doctor should be like a plumber. Just has a set rate, and you pay him that. No insurance necessary.

[pedalling_faster]

$this->bbcode_second_pass_quote('Tyler_JC', 'W')hy can't he just buy a year's supply of the drugs at a time? Alternatively, why can't he just buy this stuff straight from a pharmacist?

[vision-master]

$this->bbcode_second_pass_quote('ki11ercane', '')$this->bbcode_second_pass_quote('smallpoxgirl', '')$this->bbcode_second_pass_quote('frankthetank', 'A') doctor should be like a plumber. Just has a set rate, and you pay him that. No insurance necessary.

[mattduke]

My wife occasionally suffers from a skin rash. She has since she was a child. It causes discomfort, but there is a creme that treats it. She had a case of it in Mexico once. We went to the store and bought a tube of the creme in about 2 minutes. Here in the US we would first have to see a doctor. If we disobeyed, the government would hurt us. What a remarkably pleasant experience, to be free.

[ki11ercane]

$this->bbcode_second_pass_quote('vision-master', '')$this->bbcode_second_pass_quote('ki11ercane', '')$this->bbcode_second_pass_quote('smallpoxgirl', '')$this->bbcode_second_pass_quote('frankthetank', 'A') doctor should be like a plumber. Just has a set rate, and you pay him that. No insurance necessary.

[Dreamtwister]

$this->bbcode_second_pass_quote('coyote', '')$this->bbcode_second_pass_quote('Dreamtwister', 'T')hey'll be trading their services for chickens soon enough.

[bluster2000]

Well, I had a serious skin problem leading to ER visits, lengthy and expensive antibiotics treatments for years in the United States with no effect whatsoever... I can´t even calculate the full cost and the suffering...

One visit to a doctor in Brazil (covered by full private insurance of about US$70 per person per month with no deductables and great hospital and doctor network) lead to a US$3 per tube medication prescription (non-antibiotic) that effectivly took care of the problem for good within weeks.

Doctors here actually talk to patients and take extensive health histories, there are no waiting rooms in medical offices.... Third world indeed, they haven´t figured out yet how to run their medicine as a business



$this->bbcode_second_pass_quote('mattduke', 'M')y wife occasionally suffers from a skin rash. She has since she was a child. It causes discomfort, but there is a creme that treats it. She had a case of it in Mexico once. We went to the store and bought a tube of the creme in about 2 minutes. Here in the US we would first have to see a doctor. If we disobeyed, the government would hurt us. What a remarkably pleasant experience, to be free.

[smallpoxgirl]

$this->bbcode_second_pass_quote('vision-master', 'S')umthing is fooken wrong!

I got's me a receipt right here in my grubby little paws from when I fooked up my elbow when a kid.

Itasca Clinic

August 3, 1964

Elbow Xray = $8
Office Vist = $5
Sling = $.25

Total fooken bill was $13.25

X'plain pleaze.

[mattduke]

$this->bbcode_second_pass_quote('smallpoxgirl', '')$this->bbcode_second_pass_quote('vision-master', 'S')umthing is fooken wrong!

I got's me a receipt right here in my grubby little paws from when I fooked up my elbow when a kid.

Itasca Clinic

August 3, 1964

Elbow Xray = $8
Office Vist = $5
Sling = $.25

Total fooken bill was $13.25

X'plain pleaze.

[smallpoxgirl]

$this->bbcode_second_pass_quote('mattduke', 'G')ot to love that condescending physician attitude.

[jasonraymondson]

Actually, if people would stop pay for the high priced medical equipment, medicines and go back to the old ways. The monsters who make billion ripping off the little guy would have to lower their prices.

[ohcomeon]

Until the previous two years I worked in health care administration and insurance. I have worked both sides, managing A/R departments for large physician practices and small ones, and also being an adjustor for CIGNA. "Maximizing" reimbursements from third party payors (insurances) was my trade when I worked for the physicians, and I was good at it. But my conscience got the best of me and after years of dissatisfaction and burnout I finally left the profession. I miss the money but not the stress. And I know it's because of medicine's business model that a whole industry of medical billing has arisen. I don't really blame the doctors too much. For one practice (OB) our malpractice costs increased over $1,000,000 in a year. No suits or anything filed. Just an increase... In addition, there are so many clerical and ancillary employees to pay that the practice must generate enough income to cover it. And that's not to mention the provider's own salary needs, as SPG has already spoken of. There was always the pressure from administration above me to find ways to increase revenue. I have even had instances where I was asked to use "creative coding" practices (read illegal) to generate income.

When I worked for CIGNA, I never had anything of the sort. There were clear rules. We followed them. We made mistakes sometimes, but we could correct them. I never was asked to make a decision that I thought was legally questionable. Just the opposite.

I hate insurance companies, too. I wish medicine would back away from the form it currently exists in. However, some party in the triangle is going to have to give first. It likely won't be the doctors who will voluntarily lower prices, and it definitely won't be the insurance company who begins to practice responsible profit taking or even more equitable RVU assignments or valuations. And the patients will always take the "best" (read most extensive) care they can for their insurance dollar instead making choices with those healthcare dollars as if they were coming from their own pockets. But it'll likely be the patient who gets the raw end of this deal again.

No matter what happens, universal healthcare or not, the transition is going to be bad. Doctors in the last practice I worked for have opened a "boutique" clinic of sorts. A separate building for cash only patients. Much nicer decorations. Caters to women wanting hair removal and laser wrinkle fixes. Also does cosmetic tatooing. Treats minor ailments for cash payors. This clinic operates on a part-time (few days a week now) basis for the time being. But it is very new. Most of their patients are self-employed people... Minimal staff is required, even with the fine office appointments they charge the cash payments way less than they charge the insurance patients in the other office.

[Lumpy]

$this->bbcode_second_pass_quote('smallpoxgirl', '')$this->bbcode_second_pass_quote('frankthetank', 'A') doctor should be like a plumber. Just has a set rate, and you pay him that. No insurance necessary.

[smallpoxgirl]

Yeah. I love seeing cash only patients. Saves me mountains of paperwork. In our office, cash patients get a 20% discount. I'm definitely not running a boutique practice. Much more along the lines of trying to cobble together health care for people with no insurance and no money. I'm pretty serious about providing healthcare in a way that uses less resources. I frequently have long discussions with patients about why I want to give them a prescription for the $10 drug instead of giving them samples of the $60 drug. There are a lot of insurance and medicaid patients that get really offended by the idea of getting less expensive medicine. If the other one costs more it must be better right?

[PenultimateManStanding]

$this->bbcode_second_pass_quote('mattduke', 'M')y wife occasionally suffers from a skin rash. She has since she was a child. It causes discomfort, but there is a creme that treats it. She had a case of it in Mexico once. We went to the store and bought a tube of the creme in about 2 minutes.

[ohcomeon]

Lumpy,

If your claims aren't past timely filing limits I might be able to help you get that money... I can usually audit the claim data with the notes and RA and figure out what it needs to get it through the system. I am not saying you don't know what you're doing or intend to insult your ability. Just to offer some assistance.

Anyway, you can pm me if you are interested and haven't just chalked it up.

[smallpoxgirl]

$this->bbcode_second_pass_quote('Lumpy', ' ')It was the totally screwed up Medicare/Medicaid paperwork snarls that we kept trying to unsnarl.

[kpeavey]

I've been playing doctor for a couple of decades and let me tell you, it aint got me noplace. I dont even get those tax credits and medicare payment the fed puts out. If things dont change, and I mean soon, I'm out of here!

[3aidlillahi]

That survey would certainly explain this.

$this->bbcode_second_pass_quote('', 'C')HICAGO — Only 2 percent of graduating medical students say they plan to work in primary care internal medicine, raising worries about a looming shortage of the first-stop doctors who used to be the backbone of the American medical system.