See, this part bugs me. Over the past two decades, my "entrepreneureal" practice has spent literally tens of millions of dollars out-of-pocket to provide modern cancer care to an area where there would otherwise be none. Is the deus ex machina you describe above going to start buying linacs and paying for service contracts as it ratchets down reimbursement? I'd also ask you to define "benefit to society as a whole", because a brief but by no means inclusive list of beneficiaries of our entrepreneurealism are the 120 families of nurses, therapists, PAs and ancillary staff for whom we provide a good living, thousands of patients who have been cured or palliated under our care, and thousands more that we have treated according to the established standard of care without regard to their insurance status or ability to pay. Not because it's profitable, but because it's RIGHT. Oh yeah, the docs do OK, too. We could do better if we cherry-picked good insurance and high reimbursement treatments, but we'd rather make a modest profit and benefit more individuals in the community than try to fleece the system. See, capitalism works when one doesn't lose sight of high ethical standards.
I commend you on your ethics and profesionalism. Of course if the system ran correctly the patients you care for both the paying consumers and the pro bono would have adequate access and coverage (and I dont mean medicaid rates. We have made a good living at Medicare rates) although they may need to drive 20-30 minutes rather than down the block .
I refer to the unfortunate waste of resources where there are multiple linacs in an area, none of which are utilized fully and too often the one who put them up used a refurbished linac so as to maximize profits rather than provide high quality care. Im not critcizing entrepreneurs only. It is wasteful that virtually every hospital feels a need to have every piece of major technology to keep up with the Joneses.
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