The problem with this thread is that people who are against healthcare reform take any statement out of context and turn those statements against the person who stated them.
Sure I chuckled when I saw the Obama speech a few days ago, when he used that tonsillectomy example. It does show that he is not well versed in patient care. He's not a doctor, and it shows when he has to answer questions on the fly.
But his heart is in the right place. 40-50 million Americans are uninsured. They are dying due to lack of care. The deathtoll has got to be more than one hundred thousand a year.
How can a physician turn a blind eye to this predicament?
What are the sources of the fear of reform?
That answer is money, profit and greed.
It is understandable that physicians earning over 250k per year are wary of reforms that could possibly affect their earnings. Plus Obama plans on hitting them with a surtax on high income to pay for the changes which makes them understandably hate it even more.
But even with reforms, we will still have a fee for service system. If there are 40-50 million more patients with access to care, it could only mean more money for physicians. It means more patient visits, diagnostics, and procedures. The cost will be payed for by the rest of society while physicians in private practice will have a windfall.
The current system is broken and unjust. An uninsured patient who is least able to pay has to face excessively high charges that could amount to double to triple what an insured patient pays through an insurer. This occurs through a constant battle of insurers disallowing charges and providers responding by increasing charges. The uninsured gets walloped with that inflated charge, because by contract the insurer is predicating his allowable charges on what the providers charge to the community.
In comparing the reasons for reform, saving the lives of many Americans versus uncertain declines in compensation for physicians, a reasonable person would choose the former over the latter as being more just.
Of course this will bring us to another argument. Physicians deserve the high pay because of the brutal training requirements. They earn crap wages during training and amass large debt to obtain the medical education. Nobody can honestly say that they did not know this before they signed up for medical school. You do not go to medical school to become a millionare but many physicians do so anyway because the pay is still damn good. During your medical school interviews, did you say I want to make a lot of money as a reason for attending? Chances are the admissions committee would have questioned your suitability for medicine if you did so. Non-disclosure of such a sentiment should not free you of the social obligations of this profession. You probably said that you wanted to go to help others. Now once you are done, you have that chance.
Physicians also tend to forget when they are earning crap wages as a resident, their state and federal gov't subsidizes their training to the tune of 150k per year for a generalist, maybe more for a specialist. For example it could cost 450k to train an internist. If that internist gets a cardiology or GI fellowship expect to add another 600k. So to train those specialists it may cost government entities 1050k. Granted, subtract the direct wages and benefits of the resident/fellow during those years, the training subsidy may still exceed the average cost the resident accrues during medical school.
Physicians owe society a debt as much as society repays its physicians in respect and compensation. American physicians remain disproportionately compensated for their services. They may not earn in real dollars as much as a generation ago, but it is still alot by any standard except in NY.
In this debate about reform, just remember who you are fighting for. Hopefully it's that American who comes to see you without insurance that needs your help. You cut corners because they don't have the money to pay for the diagnostics. You prescibe generics. You negotiate with drug reps to get lots of samples to give away with a tacit understanding of returning the favor if they can just help your less fortunate patients. You accept 30 bucks cash for an office visit. Sometimes a family comes in with bronchitis but only the children are insured. You over-prescribe with the understanding the uninsured family members use the excess to get better so they can get back to work to support their families. I won't even go into the more extreme rule bending scenarios; but damn, a physician should not have to put his license on the line to improve the condition of another person.
The physicians that are most likely to witness how this situation is FUBAR are ER docs and PCPs that take Medicaid. Other physicians can just turf the ethical dilemmas by refusing to see such poor populations.
I just hope you guys understand that people are dying in numbers that dwarf 9-11 many fold. Things have got to change.
