More $%#@ing pay cuts!

[DrDawg]

No... They're just trying to be profitable businesses.

Physicians are the real idiots. If physicians could ban together and not sell each other out the minute they see an opportunity to, then maybe we could develop an effective lobby like the trial lawyers, the dairy farmers, all these other idiots who flood Washington every year wooing legislators.

You think that email Dr. Tom Russell of the ACS sent out was really taken to heart by the majority of surgeons who got it? No. That's because everyone thinks it's the "other guy's" problem.

Every specialty has its own lobby group, but it's nothing. There's strength in numbers. If you band each and every one of the nearly 650,000 physicians in the country together, then maybe something can happen. Unfortunately the only large group we have, the American Medical Association, is too busy worrying over how the trailer park mom with the BMW parked out front is going to afford preventive care for her six kids by three fathers.

Despite a multi million dollar campaign to increase its number AMA membership has remained stable or decreased over the last several years. Only a fraction of MD are a member.

---

Members don't see this ad.

 

[Blade28]

Huh...I didn't know that. I knew AMSA was losing popularity, but hadn't realized that the AMA was as well.

 

[MossPoh]

You know, it's kind of interesting.

Usually right about now there'd be some tree-huggin' pinko from the Bay Area or Massachusetts (and almost always one of those Harvard, Stanford types whose parents paid their way through everything in life) who's so up-in-arms about what I've just said, that they'll stage a hunger strike to protest or start telling me what a Nazi I am for thinking of my colleagues and myself instead of the "poor" schmoe who goes to the charity clinic because he's a victim of society.

Here. I'll be that guy just so you can get mad at someone. OH but everyoneeeeee deserves free health care. I mean, look at what michael moore proved in sicko! He has to be right. There can't possibly be any other angle. Nobody cheats the system and doctors make sooooooo much money as it is!

There you go.

Now for reality. I consider myself fairly moderate, but all these cuts piss me off...even as a premed. I had some law girl here go off on me about universal health care and nearly every single one of her arguments was taken from Sicko...Give me a ton of money, a camera, and lots of time and I can twist any argument you want. Of course, they don't show other countries like Germany where the doctors are bolting the hell out of there because they make little to nothing.

There will come a time when this system will break and people will realize how unrealistic it is to be a physician. I'm stubborn, but if it ever reaches the point where I am swamped in debt to the point I can't retire till I'm 75...I'm dropping medicine and going into consulting where I can make a cool 6 figures for a heck of a lot less work. I agree that there are people that NEED the benefit of free health care. The salt of the earth, hardworking type that just can't catch a break...but these people that talk about free health care for all need to spend a couple days in an ER, General Surgeon's office, or anywhere else and see how backwards things are. I was in the ER and a this woman's kid was REAL sick. He was written a rx for antibiotics and what not...grand total= $10. She said she couldn't afford it and asked for the stuff for free. Look in her bag and surprise surprise..3 packs of cigarettes. Covered in tats with piercings all over. She has enough money to buy cigs, get tats, and pierce every part of her body..but not to pay for some generic Tylenol and antibiotics.

 

[ufgrad00]

Thanks for sharing that; the students at my medical school get together to watch Sicko on a regular basis, and they freakin love communism and socialized medicine. Makes me sick.

Yeah, after watching the part where they went to Cuba, I wish I had never watched it. It was disgraceful.

Since I was a child, my parents have sent money to a company, which I think is out of canada or the UK, about every two or three months in order to make sure supplies got to my family. These are things like extra toilet paper or vitamins, things we take for granted are forcibly rationed in Cuba. And not because these things are scarce either, but really because the communistas want control.

Cubans, (except those in government or living in Havana) can't even get medications like aspirin, and if they do get aspirin, its most likely from a 1970's stockpile. Yet, wealthy tourists like Michael Moore get access to free health care in Cuba, which is not available to Cuban citizens. The European and South American tourist industry mostly funds this elite health care system in Cuba for the wealthy and a very small number of Cubans that live in the immediate geographical region.

I get really irritated when people bring up the imaginary "superior health care" in Cuba and site Sicko, like it gives them expertise. Its like saying you know how law enforcement is conducted by watching a few episodes of Cops.

 

[jubb]

I think part of the problem is that the old doctors made tons of money and everyone knows it. They see the old doc driving around in one of his multiple fancy sports cars and fail to see the young guy trying to make his car from med school carry him a couple years into practice.

We definitely all need exit strategies so that we don't get bent over in the future as we try to make our payments on our huge houses and expensive cars if we try to live up to the old image of being a doctor. I'm going to live cheap and invest so nothing is held over my head when they try to get me to work 80 hour weeks for 80k, while trying to console me by telling me it's twice what i made in residency.

I don't understand how we can jump to universal healthcare, it just seems like such a big step. We've skipped requiring everyone to buy insurance. Everyone who drives has to have auto insurance. Why doesn't everyone have to have medical insurance? I think Romney was on the right track in Massachusetts, tax penalties for the uninsured who make enough to afford it and don't have it. The money for universal health care will be taken from the taxpayer's any way, why not just universally mandate the purchase of health insurance and avoid full fledge communism. Ideally I'd like to go back to the days of the patient paying the Doctor directly and then getting reimbursed from their insurance company. Of course you'd have to tell them that 50% of the money they pay you is going to overhead and insurance to cover you if they sue you so that you don't seem quite so greedy. I just would love to see the insurance companies have to compete for price and providing a quality product that meets the patients needs. That would cut out the pork that was and is so prevalent in companies like united healthcare who please a corporation that is offering there insurance as a benefit(because it's cheap), ignore the patient, and screw the doctor and walk away with billions.

Justin

 

[DrDawg]

I agree taxing the user seems to be something that is pretty common place in business when the bottomline gets effected. I have a ton of associated fees with my cellphone, Fly on a plan- 9-11 tax, rent a car from an airport - point of use tax, buy tires or a car battery recycling tax, deposit on soda cans, in VA if your a doctor - baby with birth defect tax, buy a home - there are a lot of fees and taxes I don't get, but you get the point.

 

[Castro Viejo]

But you guys are forgetting that health care is a "right" in the United States of America. "How can the richest country in the world not be able to afford healthcare for all its people?"

 

[filter07]

The solution to the healthcare mess is simple. Many of us agree that healthcare is not a right but a privilege. It's time to act like it.

Get companies out of healthcare. Repeal mandatory insurance coverage for employees.

Have patients pay for healthcare out of pocket. If they want private insurance, bill the patients directly and have the patients get reimbursed by the insurance companies. Let's see how much screwing the insurance companies can do when they're dealing with angry customers rather than overworked physicians with learned helplessness.

Set up payment plans for patients up to 5-10 years so that they can pay back bills gradually while negotiating with insurance companies or earning enough to pay it themselves.

Make retroactive insurance policy removal illegal. The insurance companies should do a better job of assessing a patient when they first sign up. If they unknowingly take some patient with a chronic problem they didn't find, tough cookies.

Extraordinary measures should not be taken unless it can be paid for either from the patient or from their insurance carrier. Extraordinary measures means measures that are not ordinary. Therefore coverage for them should not be ordinary.

Provide no charity care except at designated charity care centers funded by the government.

Finally, let the people who believe healthcare is a basic human right to provide care as they see fit, while they leave the rest of us alone. It's a free country, why force one group into servanthood just because another group wants to be "compassionate"?

This is the only rational way of dealing with healthcare. Every single other system is doomed to fail because it tries to provide maximum coverage without maximum funding or maximum resources. This is impossible. Having universal insurance coverage doesn't make money appear out of thin air. The only way to solve the problem is by cutting the crap and by rationing care in a rational (if somewhat heartless) manner.

 

[gida]

Letters to congressmen: at least on the American Gastroenterology Assn site (www.gastro.org) they had a link to write you congressmen....all you do is click your state, click some other box, type in your name, and hit send.
It is better than nothing. In return, your Senator or House person eventually sends you some generic email about how they are 'very concerned about these issues as well, and will work hard blah blah blah..." and you just hit delete. I hate the AGA too by the way and believe its a crappy self serving society of academic rhetoric!

Castro...there are ways to pad to your wallet in academics even....
1) try to invent some trinket to patent (but don't do it for the U.)
2) let U of Whomever farm you out to an ASC/private group part time
3) And this I advise but am not in the process of doing...MARRY RICH!!

Let's just hope we have at least 10 or more good years to bank in the US system....and vote Republican in '08!!

 

[gida]

And they want to cut doctors' salaries????

United Health Group's mission statement is "the company directs its resources into designing products, providing services and applying technologies that improve access to health and well-being services; simply the health care experience; promote quality; and make health care more affordable." (See this fact sheet.) Rather, it seems to be directing a good chunk of its resources into salaries of top management employees. How a $124.8 million CEO salary can be reconciled with a mission to "make health care more affordable" is completely beyond me.

 

[jubb]

United Healthcare is the root of all evil.

I really like how simply filter07 put it. It is really that simple. Stop forcing companies to give crappy health care packages to employees. If you wanna make them give a credit to employees for medical insurance purposes that's fine, but the person on the receiving end should be responsible for picking the company and plan people will figure it out after hearing a couple stories of people getting screwed.

 

[Castro Viejo]

Castro...there are ways to pad to your wallet in academics even....
1) try to invent some trinket to patent (but don't do it for the U.)
2) let U of Whomever farm you out to an ASC/private group part time
3) And this I advise but am not in the process of doing...MARRY RICH!!

Amen brother! I'm already working on No. 3 (pretty much a done deal).

Are universities routinely farming out their faculty to private groups/community hospitals? But aren't you just billing for the machine and not eating what you kill?

I've seen several examples of that. In fact, my future fellowship's faculty does just that. The university sends them out to cover a couple of community hospitals in the area that are marginally affiliated, and they see patients and perform operations there. But are they collecting for their own pocket? Or part to the university and part to their wallet?

Let's just hope we have at least 10 or more good years to bank in the US system....and vote Republican in '08!!

Amen again!

 

[Castro Viejo]

Despite a multi million dollar campaign to increase its number AMA membership has remained stable or decreased over the last several years. Only a fraction of MD are a member.

Yeah, I think the figure is somewhere in the neighborhood of fewer than 40%, and that was about six years ago.

The AMA is pretty ******ed. But I kind of like JAMA. So I send them my $45 a year as a resident and fellow. Once that runs out and I'm supposed to pay 'em like $500, screw that! I'd rather spend my money on the RNC.

 

[Castro Viejo]

Huh...I didn't know that. I knew AMSA was losing popularity, but hadn't realized that the AMA was as well.

AMSA's the biggest problem, really. They're the ultra-liberal pollyanna group of idiots who waste money on these candlelight vigils in the first place! They're trying to teach the nation's budding physicians that the 48 million uninsured are OUR problem? Are you kidding me?

Who cares for the caretakers of this world?

 

[Castro Viejo]

She said she couldn't afford it and asked for the stuff for free. Look in her bag and surprise surprise..3 packs of cigarettes. Covered in tats with piercings all over. She has enough money to buy cigs, get tats, and pierce every part of her body..but not to pay for some generic Tylenol and antibiotics.

Just like in the Matrix. It's all about the choices one makes.

 

[Winged Scapula]

And they want to cut doctors' salaries????

United Health Group's mission statement is "the company directs its resources into designing products, providing services and applying technologies that improve access to health and well-being services; simply the health care experience; promote quality; and make health care more affordable." (See this fact sheet.) Rather, it seems to be directing a good chunk of its resources into salaries of top management employees. How a $124.8 million CEO salary can be reconciled with a mission to "make health care more affordable" is completely beyond me.

Interestingly enough, according to our practice manager and the gal who is doing my credentialing and getting me on insurance plans, United is one of the slowest payors, with eligibility taking the longest to get.

Glad to see that they're not only helping the poor CEO out, but also delaying payments to physicians who've worked for the money, undoubtedly much harder than that CEO and top management.

 

[rgarrig]

And I'm sure they're watching it on an environmentally unfriendly plasma or LCD screen television while consuming fossil fuels and increasing their carbon footprints because of the Hummers they drive around Palo Alto in. Kind of reminds me of Al Gore who flew around the country in a private jet to promote his "Inconvenient Truth." I know, I know... A lot of you guys probably adore Al Gore. I think he's a smart guy too, but he's every bit of a publicity hound and, thus, a celebrity and NOT an activist as these Hollywood types are.

Just why the hell do I care what Kanye West has to say about global warming?

Bastards. I don't like hypocrites.

They cycle between "An Inconvenient Truth" and "Sicko". It's sad because most of them are pretty cool, very smart, otherwise worthy human beings, and yet they fall for people like Al Gore and Michael Moore. I just don't understand.

 

[Blade28]

AMSA's the biggest problem, really. They're the ultra-liberal pollyanna group of idiots who waste money on these candlelight vigils in the first place! They're trying to teach the nation's budding physicians that the 48 million uninsured are OUR problem? Are you kidding me?

Who cares for the caretakers of this world?

(1) Yeah, WAY too socialist/progressive for my tastes.

(2) Don't get me started again!

 

[Castro Viejo]

(1) Yeah, WAY too socialist/progressive for my tastes.

Hmmm... There are four letters in AMSA and four letters in USSR. Coincidence? I think not.

Communists.

 

[jubb]

They cycle between "An Inconvenient Truth" and "Sicko". It's sad because most of them are pretty cool, very smart, otherwise worthy human beings, and yet they fall for people like Al Gore and Michael Moore. I just don't understand.

I understand why they do it, it's cuz they are sheep looking to the media and hollywood to guide their thoughts and feelings. Then they latch onto some pathetic cause that is currently being promoted and then some how believe it makes them a better person than everyone else. It makes me want to vomit.

 

[Celiac Plexus]

Hmmm... There are four letters in AMSA and four letters in USSR. Coincidence? I think not.

Communists.

lmfao...

 

[gida]

Are universities routinely farming out their faculty to private groups/community hospitals? But aren't you just billing for the machine and not eating what you kill?

I've seen several examples of that. In fact, my future fellowship's faculty does just that. The university sends them out to cover a couple of community hospitals in the area that are marginally affiliated, and they see patients and perform operations there. But are they collecting for their own pocket? Or part to the university and part to their wallet?

Well, I'm a gastroenterologist, but I have seen them let one attending go eat what he kills privately 2 days per week. (Initially they wanted half of what he killed). But his situation was unique cuz they wanted his grant $$.

It seems not that many academic guys wanna get farmed out because if they wanted more $$ they would get off their asses and go make it. I see 3 types staying in academics
1) those true academicians, be it researchers or teachers -god bless 'em
2) lazy assess who couldn't make it in PP -classic lazy ass
3) EGOmaniacs who blow loads when they get to add a manuscript to their resume and get off on being an "expert" -who cares?

I just couldn't take collecting $1 million per year and then having them pay me $180,000 as they build some new bullsh8t endocrine center or whatever with my hard earned $$. I'd rather pay my own overheads and keep the rest myself!!

The way I see it, it is a matter of business. Academia is a $$$ hungry business as well (they just profess not to be, but all they care about is $$$ just like everybody else---that's why I'd just rather go do PP and the money goes into my pocket and not theirs, plus I'm my own boss!). At any rate...it is a matter of supply and demand....if they are short sugery staff, or want to fill ORs maybe they will farm you out a couple days per week +- a cut....remember it's business, EVERYTHING IS NEGOTIABLE....also before you begin negotiating I'd try figure out how much your are worth!!!

 

[rgarrig]

The solution to the healthcare mess is simple. Many of us agree that healthcare is not a right but a privilege. It's time to act like it.

Get companies out of healthcare. Repeal mandatory insurance coverage for employees.

Have patients pay for healthcare out of pocket. If they want private insurance, bill the patients directly and have the patients get reimbursed by the insurance companies. Let's see how much screwing the insurance companies can do when they're dealing with angry customers rather than overworked physicians with learned helplessness.

Set up payment plans for patients up to 5-10 years so that they can pay back bills gradually while negotiating with insurance companies or earning enough to pay it themselves.

Make retroactive insurance policy removal illegal. The insurance companies should do a better job of assessing a patient when they first sign up. If they unknowingly take some patient with a chronic problem they didn't find, tough cookies.

Extraordinary measures should not be taken unless it can be paid for either from the patient or from their insurance carrier. Extraordinary measures means measures that are not ordinary. Therefore coverage for them should not be ordinary.

Provide no charity care except at designated charity care centers funded by the government.

Finally, let the people who believe healthcare is a basic human right to provide care as they see fit, while they leave the rest of us alone. It's a free country, why force one group into servanthood just because another group wants to be "compassionate"?

This is the only rational way of dealing with healthcare. Every single other system is doomed to fail because it tries to provide maximum coverage without maximum funding or maximum resources. This is impossible. Having universal insurance coverage doesn't make money appear out of thin air. The only way to solve the problem is by cutting the crap and by rationing care in a rational (if somewhat heartless) manner.

Bravo, good sir or madam, bravo.

I'd love to see the health insurance companies actually have to answer to THEIR CUSTOMERS, and not just bully doctors while promoting the false image that doctors are overpaid. That'd be such a beautiful mess, it brings a tear to the eye.

 

[filter07]

Bravo, good sir or madam, bravo.

I'd love to see the health insurance companies actually have to answer to THEIR CUSTOMERS, and not just bully doctors while promoting the false image that doctors are overpaid. That'd be such a beautiful mess, it brings a tear to the eye.

Believe it or not this is how the system used to work. Then the government decided to mix healthcare benefits into job benefits, and slowly created the mess it is today.

Dentists still bill patients directly like this, and it's up to the patients to recoup the costs from the insurance provider. Needless to say, dentists are now enjoying a great lifestyle and great income.

Medicine has become what it is now because people uninvolved in providing care decided that healthcare was a right. Shouldn't that be something that the actual healthcare providers determine? After all, it would be us that are forced to work to preserve this "right".

Remember, there are no rights without duties. And when someone has a right to get something, someone is forced to give it. Things don't happen magically; no one gets healthcare out of thin air. It's us who are forced to provide not only our time but resources and money to provide care for all these people. And who forces us? A bunch of politicians working in Congress maybe 60 days out of the year, who have no problems passing laws to increase their own salaries, and who have no part whatsoever in the actual delivery of healthcare. What's it called when someone else forces you to do something? When someone else forces you to give something? Slavery? Larceny?

Ironically, the reason why dentistry, or even derm, or plastics, is well reimbursed is because people don't think good dental care, skin care, or boob care is a right. The screwed up thing about our system is that the more necessary and urgent something is, the less we pay for it. The more unimportant and frivolous it is, the more we pay, and quite happily too. We have a strange way of preserving the things we value.

 

[Faebinder]

Believe it or not this is how the system used to work. Then the government decided to mix healthcare benefits into job benefits, and slowly created the mess it is today.

Dentists still bill patients directly like this, and it's up to the patients to recoup the costs from the insurance provider. Needless to say, dentists are now enjoying a great lifestyle and great income.

Medicine has become what it is now because people uninvolved in providing care decided that healthcare was a right. Shouldn't that be something that the actual healthcare providers determine? After all, it would be us that are forced to work to preserve this "right".

Remember, there are no rights without duties. And when someone has a right to get something, someone is forced to give it. Things don't happen magically; no one gets healthcare out of thin air. It's us who are forced to provide not only our time but resources and money to provide care for all these people. And who forces us? A bunch of politicians working in Congress maybe 60 days out of the year, who have no problems passing laws to increase their own salaries, and who have no part whatsoever in the actual delivery of healthcare. What's it called when someone else forces you to do something? When someone else forces you to give something? Slavery? Larceny?

Ironically, the reason why dentistry, or even derm, or plastics, is well reimbursed is because people don't think good dental care, skin care, or boob care is a right. The screwed up thing about our system is that the more necessary and urgent something is, the less we pay for it. The more unimportant and frivolous it is, the more we pay, and quite happily too. We have a strange way of preserving the things we value.

And that's why I stated in another post, true emergency needs to be established. Is an acute appy an emergency or an urgency? Once it's an emergency, the trauma service will have to do it and it wont matter if the patient can or cannot pay for it. "Elective" cases will always pay more.

 

[Miami_med]

Believe it or not this is how the system used to work. Then the government decided to mix healthcare benefits into job benefits, and slowly created the mess it is today.

Dentists still bill patients directly like this, and it's up to the patients to recoup the costs from the insurance provider. Needless to say, dentists are now enjoying a great lifestyle and great income.

Medicine has become what it is now because people uninvolved in providing care decided that healthcare was a right. Shouldn't that be something that the actual healthcare providers determine? After all, it would be us that are forced to work to preserve this "right".

Remember, there are no rights without duties. And when someone has a right to get something, someone is forced to give it. Things don't happen magically; no one gets healthcare out of thin air. It's us who are forced to provide not only our time but resources and money to provide care for all these people. And who forces us? A bunch of politicians working in Congress maybe 60 days out of the year, who have no problems passing laws to increase their own salaries, and who have no part whatsoever in the actual delivery of healthcare. What's it called when someone else forces you to do something? When someone else forces you to give something? Slavery? Larceny?

Ironically, the reason why dentistry, or even derm, or plastics, is well reimbursed is because people don't think good dental care, skin care, or boob care is a right. The screwed up thing about our system is that the more necessary and urgent something is, the less we pay for it. The more unimportant and frivolous it is, the more we pay, and quite happily too. We have a strange way of preserving the things we value.

I have said this all the time. In the US, the way to make the most money in medicine is to do the least important job. It's the same for malpractice. If you attempt to do something higher yield, you run the risk of being sued at a much higher rate. Every hot appendix removed in a 20 year old quite possibly gives 60 more years of life. It pays a few hundred bucks. If you mess it up, it costs you millions. A laser peal comes with virtually no liability and pays more. The appy probably won't pay at all. If you refuse to see the appy, you can lose your license and go to jail thanks to EMTALA. The laser provider gets paid up front. No wonder Derm and Plastics are the two most competative specialties.

 

[ice_23]

Ironically, the reason why dentistry, or even derm, or plastics, is well reimbursed is because people don't think good dental care, skin care, or boob care is a right. The screwed up thing about our system is that the more necessary and urgent something is, the less we pay for it. The more unimportant and frivolous it is, the more we pay, and quite happily too. We have a strange way of preserving the things we value.

This is an interesting conclusion; I'd never thought about it that way.

Disclaimer: I am certainly not pro-socialized medicine and if you look at my previous posts, you'll see that.

However, for all the vitriol against healthcare being a "right", what exactly do you all suggest we do with these poorer people? If we were to keep everything the same but simply state that now doctors were suddenly under no obligation to treat uninsured patients and could not be sued at all, would you suddenly stop treating poorer people because they cannot pay?

That is to say, the problem that someone will exist who cannot pay for care but needs it will always remain...but if it is not considered a "right" then how do we solve that problem? Let them die/suffer? Quarantine poorer peeps and hope that someone more liberal takes care of the problem for you? Assume that because now people know they won't get healthcare, they'll be motivated to work harder and those that don't/can't are SOL?

Again, when it comes to this particular issue, I'm no liberal, and I realize that much of this thread is (rightful) venting, but the reason why this economic mess in the first place exists is because we don't have a way to reconcile the profession's need for financial security with its apparent desire not to let people suffer at any cost.

-Ice

 

[Faebinder]

This is an interesting conclusion; I'd never thought about it that way.

Disclaimer: I am certainly not pro-socialized medicine and if you look at my previous posts, you'll see that.

However, for all the vitriol against healthcare being a "right", what exactly do you all suggest we do with these poorer people? If we were to keep everything the same but simply state that now doctors were suddenly under no obligation to treat uninsured patients and could not be sued at all, would you suddenly stop treating poorer people because they cannot pay?

That is to say, the problem that someone will exist who cannot pay for care but needs it will always remain...but if it is not considered a "right" then how do we solve that problem? Let them die/suffer? Quarantine poorer peeps and hope that someone more liberal takes care of the problem for you? Assume that because now people know they won't get healthcare, they'll be motivated to work harder and those that don't/can't are SOL?

Again, when it comes to this particular issue, I'm no liberal, and I realize that much of this thread is (rightful) venting, but the reason why this economic mess in the first place exists is because we don't have a way to reconcile the profession's need for financial security with its apparent desire not to let people suffer at any cost.

-Ice

I'd love to see physicians "eat what they kill". Sir, you want an appendectomy? My fee is $500 dollars upfront. Nope, I wont be going to collect it from your insurance, that's up to you to do. Cough it up now, we know you pay more than that to whiten your teeth.

It's really that simple... yet so hard.

 

[jubb]

Come on, if people can get bail bonds they can get the money for their appendectomy.

There is a clinic on Cozumel that services cruise ships that runs all their business that way and has been doing so for years for emergency stuff. The people call friends and get them to wire them the money, or people max their credit cards. They pay cash and then they hit up the insurance company. If people picking insurance companies knew they would have to fight like doctors do to get the money the insurance companies would have to change their ways.

If that's what it takes, that's what it takes. I just wonder if people would still bet against the market with a crappy insurance company to save 100 dollars, thinking they'll just go bankrupt if something serious happens and the insurance company won't give them the money.

 

[Enough]

It is simple. With all the education and training, we do not have the leverage. We do the work and ask for the money later. Capitalism is always going to work against us.

We need to identify the surgeons that want to work for free or close to it, and give them all the charity cases.

The rest of us need to work hard to get the leverage back. We have to put our kids through good schools and pay our student loans.

All these years of hard work -------The end result is insulting.

 

[pagemmapants]

Hmmm... There are four letters in AMSA and four letters in USSR. Coincidence? I think not.

Communists.

Castro, while I was reading this thread I thought I was falling more and more in love with you.

This sealed the deal.

 

[thusell]

Capitalism is always going to work against us.

Maybe I misunderstood you, but that makes no sense. Capitalism never works against you unless you're lazy or stupid, in which case capitalism seems quite unfair. Medicine is not capitalistic.

Medicine demands that everyone get treatment, regardless of ability to pay. Then it reimburses you pennies on the dollar for your work. Also, you (or someone) has to be available at all hours, but not for more pay. Does that sound like capitalism?

Another problem is that, as medical treatments become more complex and expensive, they still have to be available to everyone. You can be a complete bum, but if the standard of care indicates that you should get IVIG at a cost of thousands of dollars a dose, you get it. You can refuse to take care of your wound dressing and say "I could never learn how to wrap a piece of gauze around my leg because I didn't go to medical school" and you get at least a few visiting nurse sessions. Even then, you can ignore the problem and show up at the hospital a few weeks later with the same bandage on and curse America because "ain't nobody care 'bout my leg, you all done just throw me out and ignore me."

I could go on and on about this stuff.

 

[thusell]

Another thing:

If you don't care about your health, you should die. If you don't want to take care of your wound and you get a complication or it doesn't get better, then you should just have to live with that stuff. Because you chose for that to occur.

If you don't want to pay for your care, you should die. Because people are fine with "maximum care" and making 90-year-olds full code when insurance (i.e., you and me) is footing the bill, but if they have to pay more than $10 suddenly they realize that ol' grand-dad wanted them to unplug the breathing machine.

This is common sense stuff, but since it deals with "life or death" people try to act like it's different. Hey, if your life is so important, why don't you put some effort into it? I can see how much some of these patients value their lives and I value their lives just as much. Which is to say, not at all.

 

[thusell]

However, for all the vitriol against healthcare being a "right", what exactly do you all suggest we do with these poorer people? If we were to keep everything the same but simply state that now doctors were suddenly under no obligation to treat uninsured patients and could not be sued at all, would you suddenly stop treating poorer people because they cannot pay?

Most people don't understand the concept of medical care at all because they get all crazed about how someone will die who could have lived. If you carry that out far enough, you have what we have now: some eighty-year-old person who has multiple co-morbidities, has had a few surgeries, taken lots of medications, had a number of hospitalizations, throw in dialysis for months to years, and is now in the ICU. Total cost? Maybe a few million dollars and thousands of man-hours. Meanwhile, at some point literally everyone is like, "um, this guy should die," but they can't do anything because the family wants "everything done." Sound familiar?

That's why you can't make decisions in life based on "feelings."

Now, someone may say, "well, let's have what we have NOW except when it gets that far, we can say we'll stop." OK, now you have society deciding based on monetary value how long your life will be because you're wasting money that could go to others. Wow, that's WAY better than what all the mean capitalists are saying. See what I mean?

 

[Castro Viejo]

However, for all the vitriol against healthcare being a "right", what exactly do you all suggest we do with these poorer people? If we were to keep everything the same but simply state that now doctors were suddenly under no obligation to treat uninsured patients and could not be sued at all, would you suddenly stop treating poorer people because they cannot pay?

Is it that they can't afford healthcare or is it that they don't want to pay the "exorbitant" prices for health insurance so that they can buy each one of their 20 kids a pair of "baby" Jordans? I've never owned a pair of Air Jordans in my life!

Liberals are so damn keen on everyone being as accountable for every little crap thing as possible, why not build another federal agency to monitor oversight and be sure that people who are milking the system out of government-sponsored healthcare are really, in fact, unable to pay for it? Verify income. Verify essential expenses incurred by the family. Shopping at Baby Gap or buying the latest Fubu crap isn't the smartest thing to do if you're strapped for cash.

And if it's absolutely true, after intense scrutiny, that a particular family can't afford proper healthcare, then the government offers assistance.

As much as it would surprise some here, I probably wouldn't mind being taxed 2% of my income if I knew it was going to a family that really needed it. I'd do a charity case here and there, why not? But I'm not going to do it if I walk into the charity clinic to find a waiting room filled with people who drove up in a Lexus, BMW, or Mercedes. To hell with that.

 

[thusell]

As much as it would surprise some here, I probably wouldn't mind being taxed 2% of my income if I knew it was going to a family that really needed it. I'd do a charity case here and there, why not? But I'm not going to do it if I walk into the charity clinic to find a waiting room filled with people who drove up in a Lexus, BMW, or Mercedes. To hell with that.

You lost me there. That's Marxism. Why treat people differently based on their income. Some people were complaining about "rich people" trying to get free health care the other day and I was puzzled. Why would rich people NOT try to get free health care? Why pay for something that other people are getting for free? And that you're paying for anyways, via taxes/your insurance premiums? If society tells me that health care is a "right" and that means that poor people get it for free, then that also means I get it for free, even if I do drive a Lexus or BMW.

Poor people can get free health care if we're allowed to use them like farm animals or something. Seriously, they should be put to work as recompensation. Instead, we just give them handouts and are like, "awwww, they're so poor. Awww ...." They should be plowing fields in Idaho or something.

 

[Castro Viejo]

Poor people can get free health care if we're allowed to use them like farm animals or something. Seriously, they should be put to work as recompensation. Instead, we just give them handouts and are like, "awwww, they're so poor. Awww ...." They should be plowing fields in Idaho or something.

I don't believe in limitless handouts. I don't even really believe in charity care (although it's great for resident education). What I'm saying is to balance out the physician's need for self-preservation and his need to not let people suffer and drop dead in front of him, what I've proposed (at least in my mind) would work.

I agree with you that "workfare" should be something people are more willing to participate in, but ask a guy with a pussed out leg or a hip fracture to plow the fields in Idaho, and see how far you'll get.

Or would you rather build a colosseum, dress them up like gladiators, and have them fight ostriches all day? And if they survive, great! We'll amputate your leg for free since you have provided the populace with entertainment!

 

[thusell]

I agree with you that "workfare" should be something people are more willing to participate in, but ask a guy with a pussed out leg or a hip fracture to plow the fields in Idaho, and see how far you'll get.

Well, if he can't work, at least he can fertilize the fields, if you know what I mean.

 

[Miami_med]

There is no problem with charity. The problem is with the entitlement. I can give or receive whatever I want. It's when I demand that someone give it to me that we start getting hairy.

 

[labst]

There is no problem with charity. The problem is with the entitlement. I can give or receive whatever I want. It's when I demand that someone give it to me that we start getting hairy.

I can agree with that. Conversely, the more people force others to "volunteer" or "donate," the less inclined I am to give a crap about anyone. That's why right about now I really couldn't care less if some patients lived or died. No, I take that back. I'd care if they died because then I could take them off my list.

 

[StealthNerd]

I can agree with that. Conversely, the more people force others to "volunteer" or "donate," the less inclined I am to give a crap about anyone. That's why right about now I really couldn't care less if some patients lived or died. No, I take that back. I'd care if they died because then I could take them off my list.

This is exactly the problem with our f*cked up system. Doctors are discouraged to do real charity. I read an article about an OB/GYN in some inner city area that routinely spent every friday giving free pap smears, etc, to all the dirt poor women. Wonderful concept. Worked out great until Medicare cuts came down and she had to start taking paying customers on Friday to keep her business open. ... ... Whoops. Now she's forced to stop giving her services to the REAL needy so that she can give super cheap or free care to the "needy" women on their Iphones.

Just from a psychological aspect alone folks are a lot more likely to do charity cases because the choose to and it makes them feel good, then they are if the goverment forces them to due to cuts in reimbursements.

I'm with the rest of you: make as much as you can as quickly as possible while living as cheaply as you can... invest every dime and secure your retirement. Then if we start getting ham strung by our government, kick back and do it as a hobby.

 

[labst]

The other thing is that nobody is going to provide charity care to someone if they're going to turn around and sue them. I'm not saying it's OK to make mistakes on poor people and not on rich people. However, it's a little silly to get angry at someone for making a mistake while helping you out for free. However, currently, it's actually the poor people who try harder to sue in many instances because they view it as their shot to get rich. They don't even have any gratitude towards their free care (and, yeah, I realize that in many instances their free care isn't that great) and are just surly and abusive. Then they get upset that nobody wants to take care of them. I once took care of some illegal alien and, while I despised the guy for being an illegal alien, at the very least he was a model patient. He did whatever you told him to do, he didn't complain or whine at you, and he was polite. Don't get me wrong, I'd still turn him in if I could, but at least he was a nice guy.

 

[DrDawg]

Did anyone call their congress persons? I did and that when I stopped getting emails from Dr. Russell. Thought I would at least get to hear what all that emailling accomplished. A quick internet search seemed to suggest that the 10% cut would have to occur in 6months. It seems to me, and I don't completely understand this, that this is actually worst than if it when into place on 1-1-08. Docs could either opt out or remain a provider by the first of the year. With the cuts not taking place till 6 months down the road, it seems that more doc are like just to take it.

 

[Blade28]

I didn't call my local US Representative - but I did email.

 

[Tristero]

Castro brought up some great points. I come from a medicine family and am fortunately debt free, but the points that you have made are valid for the vast majority of my peers. I don't know if I would have made the same career choice if I had to saddle that debt. I have been fighting for YEARS as a student to enlighten my peers of whats going on on Washington, and the great power struggle thats going on in Medicine today. There is some great stuff written on this by an economist named Regina Herzlinger, a famous Harvard economist.

I have worked extensively in organized medicine...and I have seen metrics for the shceduled cuts for every year since 2005. I have discussed the issue with Ron Davis, president of the AMA, in strategy meetings.

Some of my feelings:

1. Despite overwhelming populist support, socialized healthcare is unlikely for a variety of reasons. The biggest lobbying groups in Washington (insurance companies, HMOs, trial lawyers) are all against this idea for different reasons. The impending influx of baby boomers is going to make this idea less appealing. The tax hikes necessary to fund this system would be extremely unpopular, even if hidden initially.

2. The reimbursement cuts although huge 10-15% are not evenly distributed. That is so important to understand. The last metrics I saw were heavily weighted towards radiology cuts, and those docs will make up their money on volume. I still deeply disagree with the cuts, especially with the insane inflation of medical overhead over the last 15-20 years.

3. The key to solving this problem is deregulation. Not only getting the government less involved, but insurance companies as well. They are they only ones who are raking in massive profits. There was an interesting article in The Economist maybe about a year ago about the inflation medical costs.They compared the costs of american healthcare over 10 years (which rose steeply over the regular inflation rate) and the costs of specifically LASIK and plastic surgery. The cost surves were LASIK and plastic surgery were almost flat over 10 years, and lower than inflation if I rememebr correctly. Why? COMPETITION. COMPETITION. wake up people!

4. JMO, but I see the future of medicine to be more like law. You will have huge groups with tiers of doctors (a la partners and associates). This would satisfy the hard workers and the lazy salary doctors which have pervaded our profession.

5. THE SKY IS FALLING! Maybe, but I doubt it. This debate has raged on since the 1970s. I think it is particularly in focus now because of a huge Democratic swing due to an unpopular war, economic downcycle, and of course the fact that HILLARY CLINTON was the lead candidate. Unfortuantely for Hillary, socialized medicine is the only thing she can peddle and she will soon be a nonfactor in the race. These things are cyclical, and I'm willing to bet as the economhy improves, and if this war resolves, socialized medicine will not be pushed down our throats by the media as it currenty is.

6. There's always plastics.

 

[HMSBeagle]

Great post above.

 

[Castro Viejo]

5. THE SKY IS FALLING! Maybe, but I doubt it. This debate has raged on since the 1970s. I think it is particularly in focus now because of a huge Democratic swing due to an unpopular war, economic downcycle, and of course the fact that HILLARY CLINTON was the lead candidate. Unfortuantely for Hillary, socialized medicine is the only thing she can peddle and she will soon be a nonfactor in the race. These things are cyclical, and I'm willing to bet as the economhy improves, and if this war resolves, socialized medicine will not be pushed down our throats by the media as it currenty is.

Hillary Clinton may not be much of an issue soon, but Barack Obama's plan for healthcare ain't very physician friendly either and promotes a government-sponsored insurance plan that'll just drain everyone's pocket. I'm sure somewhere in there that socialist has plans to take from physicians even more than the general public. "'Cause people are OUR responsibility."

 

[dienekes88]

Castro Viejo, the liberals are all in Pre-Allo.

 

[Castro Viejo]

Castro Viejo, the liberals are all in Pre-Allo.

Believe me, I know.

Most medical students and premeds are nothing more than a bunch of liberals who will balk at anything remotely conservative. It's just not cool these days.

Fast forward a few years after they've been in residency a while or are in practice, and they'll see how ******ed it is to be a liberal when they've worked their butts off for so long only for a Democratic President to want more money out of their pockets and redistribute it to "that guy who's too poor to afford to pay doctors' fees and drove to his appointments in a brand spanking new BMW."

And that's why organizations like AMSA burn me up. Instead of educating medical students about the realities of medical practice, medical economics, and what to do to position themselves and the profession more aggressively in the future to fight reimbursement cutbacks, they spew this ultra-liberal/"progressive" bull$hit that the uninsured in America are our profession's problem and, somehow, medical students can fix it by holding candlelight vigils, sit-ins, and other stupid hippy crap.

 

[HMSBeagle]

Believe me, I know.

And that's why organizations like AMSA burn me up. Instead of educating medical students about the realities of medical practice, medical economics, and what to do to position themselves and the profession more aggressively in the future to fight reimbursement cutbacks, they spew this ultra-liberal/"progressive" bull$hit that the uninsured in America are our profession's problem and, somehow, medical students can fix it by holding candlelight vigils, sit-ins, and other stupid hippy crap.

Wow Castro this has to be one of the best posts ever really. I don't know how some people can put up with all that AMSA BS. What has AMSA done for us students? Wait, whats that....ohh thats right NOTHING!!