im sorry, i didnt realize it was 2014 already. i thought it was December 28th, 2013. are people are already paying 7 times more already, even though the rules dont go into effect for another week? (ps the posts i am commenting on state that).
its not about you, the doctor. the idea is to make healthcare affordable for the average american. id guess the average pain PP does not take medicaid, definitely does not take "FINA". the ACA's current iteration sucks, of course, but access to healthcare is for this demographic - 16-20% of the US population.
essentially, this argument is petty. just because PP pain docs wont take the little money they will be given by an insurance that they dont take, then "we'll show you" and the PP clinics that stay in business will be the opioids ones. "Waa waa if you dont give me what i want, i wont love you any more!!"
this is not the argument an established and intellectually competent specialty wants to present.
the implicit assumption is also that pain as a profession can be "bought". if you pay us less, then the profession will do what it needs to stay afloat, and that is to prescribe more opioids.
after reading your post, i now feel it is unethical to threaten CMS, congress, the american public with this suggestion.
Correct me if I'm wrong but:
You've said you are hospital employed so none of this affects you or your patients.
Of course you think it's great that CMS will pay your hospital owned Pain department and employer 4-7 times more for the same service as provided by others and any counter argument to that as an outrage and "unethical."
This will have the hardest effect on those who just started or are about to start practices, who prescribe opiates
conservatively, utilize procedures
conservatively, those who have
not "gamed the system," and those who made the financial investment to spend a year training in fellowship. For them, the goal will be how to practice good Medicine and survive.
You've said you're a supporter of single payer.
That being said, it's easy to sit back, unaffected, while private practice doctors who are already providing the same services at 1/4 the cost, be punitively targeted no matter how qualified, highly-trained or conservative in their practices, while such services will be driven to the hospital setting where they can be performed in identical fashion, now at a cost to the American taxpayer at 7 times the cost. It is no consolation knowing it's for the end of achieving single payer any cost, which in it's supposed nobility, justifies any means.
It's also easy to pretend it will never affect patients or have any unintended negative societal consequences and call anyone who even argues otherwise "unethical."
It's a form of an ad hominem attack to throw around an accusation of being "unethical" for even voicing an argument or viewpoint that isn't politically correct or in agreement with yours. The goal is to shut people up by intimidation. Did you it was "unethical" and a "threat" for those that warned 25 years ago that the plan to radically increase opiate prescribing would lead to adverse effects and overdose deaths?
Those who are truly unethical, running pill mills and procedure mills, aren't here on SDN Pain debating ideas. Save the name calling for them. The vast majority of us are plenty ethical, and to play the "ethics card" every time someone disagrees with your viewpoint renders the term meaningless.
