RussianJoo

Useless Member
10+ Year Member
Jun 7, 2004
2,231
41
261
Rock City
Status
Fellow [Any Field]
http://www.bostonherald.com/news/us_politics/view/20100402florida_doctor_tells_obama_supporters_go_elsewhere/


Florida doctor tells Obama supporters: Go elsewhere
By Stephen Hudak / The Orlando Sentinel | Friday, April 2, 2010 | http://www.bostonherald.com | U.S. Politics

MOUNT DORA, Fla. — A doctor who considers the national health care overhaul to be bad medicine for the country posted a sign on his office door telling patients who voted for President Barack Obama to seek care "elsewhere."

"I'm not turning anybody away — that would be unethical," Dr. Jack Cassell, 56, a Mount Dora urologist and a registered Republican opposed to the health plan, told the Orlando Sentinel on Thursday. "But if they read the sign and turn the other way, so be it."

The sign reads: "If you voted for Obama ... seek urologic care elsewhere. Changes to your healthcare begin right now, not in four years."

Estella Chatman, 67, of Eustis, whose daughter snapped a photo of the typewritten sign, sent the picture to U.S. Rep. Alan Grayson, the Orlando Democrat who riled Republicans last year when he characterized the GOP's idea of health care as, "If you get sick, America ... Die quickly."

Chatman said she heard about the sign from a friend referred to Cassell after his physician recently died. She said her friend did not want to speak to a reporter but was dismayed by Cassell's sign.

"He's going to find another doctor," she said.

Cassell may be walking a thin line between his right to free speech and his professional obligation, said William Allen, professor of bioethics, law and medical professionalism at the University of Florida's College of Medicine.

Allen said doctors cannot refuse patients on the basis of race, gender, religion, sexual orientation or disability, but political preference is not one of the legally protected categories specified in civil-rights law. By insisting he does not quiz his patients about their politics and has not turned away patients based on their vote, the doctor is "trying to hold onto the nub of his ethical obligation," Allen said.

"But this is pushing the limit," he said.

Cassell, who has practiced medicine in GOP-dominated Lake County since 1988, said he doesn't quiz his patients about their politics, but he also won't hide his disdain for the bill Obama signed and the lawmakers who passed it.

In his waiting room, Cassell also has provided his patients with photocopies of a health care timeline produced by Republican leaders that outlines "major provisions" in the health care package. The doctor put a sign above the stack of copies that reads: "This is what the morons in Washington have done to your health care. Take one, read it and vote out anyone who voted for it."

Cassell, whose lawyer wife, Leslie Campione, has declared herself a Republican candidate for Lake County commissioner, said three patients have complained, but most have been "overwhelmingly supportive" of his position.

"They know it's not good for them," he said.

Cassell, who previously served as chief of surgery at Florida Hospital Waterman in Tavares, said a patient's politics would not affect his care for them, although he said he would prefer not to treat people who support the president.

"I can at least make a point," he said.

The notice on Cassell's office door could cause some patients to question his judgment or fret about the care they might receive if they don't share his political views, Allen said. He said doctors are wise to avoid public expressions that can affect the physician-patient relationship.

(EDITORS: STORY CAN END HERE)

Erin VanSickle, spokeswoman for the Florida Medical Association, would not comment specifically.

But she noted in an e-mail to the Sentinel that "physicians are extended the same rights to free speech as every other citizen in the United States."

The outspoken Grayson described Cassell's sign as "ridiculous."

"I'm disgusted," he said. "Maybe he thinks the Hippocratic Oath says, 'Do no good.' If this is the face of the right wing in America, it's the face of cruelty. ... Why don't they change the name of the Republican Party to the Sore Loser Party?"
 

Surfer

10+ Year Member
7+ Year Member
Jun 6, 2007
428
10
151
Status
Resident [Any Field]
That's right folks, apparently the govt thinks it can force you to buy insurance, but what they don't understand is they can't force us doctors to do shiite.
 

miamidc

Senior Member
7+ Year Member
15+ Year Member
Oct 15, 2002
182
0
0
Visit site
Status
That's right folks, apparently the govt thinks it can force you to buy insurance, but what they don't understand is they can't force us doctors to do shiite.
Strike on all but emergent care for 1 to 2 weeks? Then we'll see who wears the pants in healthcare.
 

Eta Carinae

Removed
Oct 20, 2009
1,209
1
0
Secession-ville
Status
Post Doc
That's right folks, apparently the govt thinks it can force you to buy insurance, but what they don't understand is they can't force us doctors to do shiite.
Strike on all but emergent care for 1 to 2 weeks? Then we'll see who wears the pants in healthcare.
:thumbup::thumbup:

Everyone has their breaking point. I'm glad Dr. Cassell had the fortitude to say aloud what many physicians feel.

It has always amazed me that a profession which provides what some would argue to be the most invaluable products (sustenance of life, health) to any society is frequently encumbered by conflicts over scope/exclusivity of practice (by the likes of CRNAs, NPs, RN+[fake] PhD) and salary/income.

When hedge fund managers who provide no intrinsic value to the economy, generate no real product, consistently come away with unopposed windfalls in the billions per individual, per year, no one seems to complain. Congress has made a habit of turning the other direction.

Something has got to give. And I'm elated to see people like Dr. Cassell take some action.
 

starsop93

Junior Member
10+ Year Member
7+ Year Member
Nov 12, 2004
153
0
0
Status
I think this guy is unethical. He's clearly treating his patients different based on their politics. Cheer him on if you like, but his actions reflect VERY poorly on doctors, and give ammunition to those who would like to stiff specialists in pay.

Also, if I were that guy, I'd be really worried about a big spike in malpractice insurance premiums. He is doing exactly the opposite of what should be done to decrease liability. A wronged Obama supporter wouldn't think twice about suing his ass.
 

Coastie

Junior Member
10+ Year Member
Oct 17, 2005
2,538
6
241
Status
Resident [Any Field]
I think this guy is unethical. He's clearly treating his patients different based on their politics. Cheer him on if you like, but his actions reflect VERY poorly on doctors, and give ammunition to those who would like to stiff specialists in pay.

Also, if I were that guy, I'd be really worried about a big spike in malpractice insurance premiums. He is doing exactly the opposite of what should be done to decrease liability. A wronged Obama supporter wouldn't think twice about suing his ass.
Unethical? Hardly. He said he will treat anyone who comes in, and doesn't quiz patients on their politics. "If they turn around because of the sign, so be it".

We (doctors) don't have to treat everyone who comes into our office. Last time I checked, we aren't slaves. Ethics are to "do no harm", but that doesn't mean "treat whoever comes into your office".

The gov't wants to stiff us? Forget that. This fascism is reaching new levels, and doctors need to stiffen up their spines and start rejecting this unconstitutional takeover of 1/6 of the economy. I applaud him for posting how the new bill is effecting his ability to deliver patient care.
 

Narcotized

7+ Year Member
May 10, 2009
1,255
1
141
Status
When hedge fund managers who provide no intrinsic value to the economy, generate no real product, consistently come away with unopposed windfalls in the billions per individual, per year, no one seems to complain.
It amazes me how few people realize this, that most of Wall Street provide and create basically nothing and is simply a glorified casino (an exception being generating startup capital). Too many people focus on "jobs created" and "people are working," but if you aren't creating or producing anything then you are simply transferring money around and adding no intrinsic value to the economy. Another classic example of this is when people talk about Census Jobs being great for the economy, or almost every Stimulus "Job."
 

Coastie

Junior Member
10+ Year Member
Oct 17, 2005
2,538
6
241
Status
Resident [Any Field]
Cassell may be walking a thin line between his right to free speech and his professional obligation, said William Allen, professor of bioethics, law and medical professionalism at the University of Florida's College of Medicine.

Allen said doctors cannot refuse patients on the basis of race, gender, religion, sexual orientation or disability, but political preference is not one of the legally protected categories specified in civil-rights law. By insisting he does not quiz his patients about their politics and has not turned away patients based on their vote, the doctor is "trying to hold onto the nub of his ethical obligation," Allen said.

"But this is pushing the limit," he said.
Hey Professor Allen, forget you. This isn't pushing any limit. This guy has the right to free speech, and his professional obligation only extends as far as his office hours. He has the right to see or not see anyone based on any reason not within the civil rights law.

Because Prof. Allen doesn't like it, I'm sure he and his ill-beral buddies are going to push for greater "civil rights protections" for political beliefs. This nanny-state-must-control-speech stuff has got to stop.
 

badasshairday

Vascular and Interventional Radiology
10+ Year Member
Apr 6, 2007
3,896
312
281
Status
Resident [Any Field]
I may not agree with what the doctor in the article did, but I admire him for speaking out. More doctors need to speak out. We should be in charge of healthcare, not a bunch of monkey suit wearing puppets in DC or in the Insurance bizzness.
 

WholeLottaGame7

10+ Year Member
Jul 10, 2005
1,944
994
281
Right here.
Status
Attending Physician
Something has got to give. And I'm elated to see people like Dr. Cassell take some action.
Yeah, I'm elated to see Dr. Cassell take it out on patients and not politicians...

If he wants to discuss politics with his patients and they don't like it and don't go back to him, fine. But telling patients to go elsewhere? C'mon. There's no way he could get away with inserting someone's race, gender, ethnicity, religion, sexuality in there, why is this any different?

There are better and more mature ways of speaking out than punishing people lower on the pecking order than yourself.
 

Eta Carinae

Removed
Oct 20, 2009
1,209
1
0
Secession-ville
Status
Post Doc
Yeah, I'm elated to see Dr. Cassell take it out on patients and not politicians...
Absolutely he should.

And he's not taking anything out on anyone because he's not checking wrists for voter registration tattoos that announce who a patient supported, and then denying them care on that basis.

In the end, the point he's trying to make is that the end result on the politicizing over healthcare on Capitol Hill is that patients ultimately take the hit. If the public option were ever to have passed, for instance, our health system would more closely mirror that of the NHS in the UK. and who is most disadvantaged by that system but potential patients?



If he wants to discuss politics with his patients and they don't like it and don't go back to him, fine. But telling patients to go elsewhere? C'mon. There's no way he could get away with inserting someone's race, gender, ethnicity, religion, sexuality in there, why is this any different?
there is a HUGE difference! it's the same as physicians who will not accept medicare patients because of the govt's horrendous (and still falling) reimbursement rates.

Besides the civil rights act does not include political preference. Even if it did, there is no way to ascertain a patient's party affiliation AND for those patients who advocate a govt control of healthcare, they should be allowed to receive govt-funded level healthcare ie county systems. So when you make the choice for anything, you should be prepared to live with that choice- is basically his message.

There are better and more mature ways of speaking out than punishing people lower on the pecking order than yourself.
If he were the only urologist in the country, that might present an undue burden. But I'd hardly categorize this as punishing anyone.

I mean if you voted for govt health care, then by all means, feel free to obtain it. I'm pretty sure Dr. Cassell doesn't work for the public system, so no patient can insist on forcing him to provide service.
 
Last edited:
Apr 30, 2009
163
1
0
Status
the dude's a urologist who's pushing 60. meaning he's already made a ton of money when the going was good and can retire comfortably if push comes to shove. i'd like to see some younger docs give this type of middle finger to medicine/their patients. oh that's right they can't. this reminds me of one of our chief residents who has started talking back to nurses and even attendings now that he's only a couple months away from finishing residency and has a lucrative job he brags about all lined up. but when he was an intern/junior resident he was as docile as the rest. it's easy to puff out your chest and be brave when you already have one foot out the door.
 

WholeLottaGame7

10+ Year Member
Jul 10, 2005
1,944
994
281
Right here.
Status
Attending Physician
Absolutely he should.

And he's not taking anything out on anyone because he's not checking wrists for voter registration tattoos that announce who a patient supported, and then denying them care on that basis.

In the end, the point he's trying to make is that the end result on the politicizing over healthcare on Capitol Hill is that patients ultimately take the hit. If the public option were ever to have passed, for instance, our health system would more closely mirror that of the NHS in the UK. and who is most disadvantaged by that system but potential patients?




there is a HUGE difference! it's the same as physicians who will not accept medicare patients because of the govt's horrendous (and still falling) reimbursement rates.

Besides the civil rights act does not include political preference. Even if it did, there is no way to ascertain a patient's party affiliation AND for those patients who advocate a govt control of healthcare, they should be allowed to receive govt-funded level healthcare ie county systems. So when you make the choice for anything, you should be prepared to live with that choice- is bascially his message.


If he were the only urologist in the country, that might present an undue burden. But I'd hardly categorize this as punishing anyone.

I mean if you voted for govt health care, then by all means, feel free to obtain it. I'm pretty sure Dr. Cassell doesn't work for the public system, so no patient can insist on forcing him to provide service.
I mean, if he's in private practice for himself, and he paid for his training on his own, he can do whatever the hell he wants. He could only treat WASP Republicans making >$100K for all I care. I think it's terrible in more ways than one, but it's his business.

And I think there's a huge difference between limiting how many Medicare patients you take in an effort to be financially stable and what this guy is doing. I understand if a doctor says, "I can't take any more Medicare patients due to financial constraints." I don't understand if a doctor says, "I can't take any Democrats because they voted for government health care."

It seems like in this fight between the government and physicians, patients are caught in the middle. And I guess to me, just because the government uses the patients as pawns first, doesn't mean we should resort to it, also.

Obviously there'll come a point at which patient care is impacted. We might be nearing that point now. But I think half of the problem is physicians that are concerned with their "declining reimbursements" instead of their "ability to care for patients."
 

WholeLottaGame7

10+ Year Member
Jul 10, 2005
1,944
994
281
Right here.
Status
Attending Physician
the dude's a urologist who's pushing 60. meaning he's already made a ton of money when the going was good and can retire comfortably if push comes to shove. i'd like to see some younger docs give this type of middle finger to medicine/their patients. oh that's right they can't. this reminds me of one of our chief residents who has started talking back to nurses and even attendings now that he's only a couple months away from finishing residency and has a lucrative job he brags about all lined up. but when he was an intern/junior resident he was as docile as the rest. it's easy to puff out your chest and be brave when you already have one foot out the door.
Exactly. The argument would carry a lot more weight coming from an FP who still has a ton of debt looming overhead, rather than a private practice doc sitting on a couple of mil in the bank.

Generally, I think part of the declining respect for doctors (pride and financial) is the trend towards viewing health care as a business. Obviously, that's not all physicians' fault. It started awhile ago, and we sat back and watched it. And now we have to deal with the consequences. There is a non-insignificant number of doctors who are businessmen first and physicians second. So they shouldn't be surprised when they're negotiated with like businessmen.
 

Eta Carinae

Removed
Oct 20, 2009
1,209
1
0
Secession-ville
Status
Post Doc
I mean, if he's in private practice for himself, and he paid for his training on his own, he can do whatever the hell he wants.
but it's his business.
You and I both know, it is MOST LIKELY that he paid for his training on his own...as most of us do.



I don't understand if a doctor says, "I can't take any Democrats because they voted for government health care."
:laugh:
I interpret his statement more as, "I'm not the govt healthcare you voted for. In case you were looking for it, its' down XXX street."

But I think half of the problem is physicians that are concerned with their "declining reimbursements" instead of their "ability to care for patients."
As they should be. Of all sectors of the economy, healthcare is the only sector in which the primary deliverers (in this case physicians ONLY) suffer from declining rates of reimbursement

The concept of just income/wages commensurate to years spent in training, level of expertise, hours worked, intellectual demands of work and liability/risk assumed is lost in medicine. And if nothing is done or said about it, I'm concerned the level of decline with become even steeper.

Most will tell you, sincerely, that money was not the primary driving force for the choice of a career in medicine. But it is just insulting to continue the endless battle over how much you're reimbursed when only a very small percentage of the population can or is willing to sacrifice as much as you have or expend as much energy, passion and devotion as you have including bear the risks that you have to, in order to do what you do everyday.





PS: pardon the run-ons.
 

kmurp

Junior Member
10+ Year Member
Apr 23, 2005
288
23
251
Status
I personally wouldn't go as far as refusing to provide care for an Obama supporter, but I would refuse an anesthesiologist that supports Obamanomics. If you are that inept with math, I would prefer not to put my life in your hands in a field so dependent on basic math.
Just how would you go about doing this? Hand thew case off to another anesthesiologist. What if you were on call? How would you even know what the anesthesiologist patient's position on the healthcare bill was?
Or were you talking about hiring? Is it legal to refuse employment based on a persons' politcal views? Would you quiz the candidate on these matters in the job interview?
 
Last edited:

kmurp

Junior Member
10+ Year Member
Apr 23, 2005
288
23
251
Status
You and I both know, it is MOST LIKELY that he paid for his training on his own...as most of us do.




:laugh:
I interpret his statement more as, "I'm not the govt healthcare you voted for. In case you were looking for it, its' down XXX street."


As they should be. Of all sectors of the economy, healthcare is the only sector in which the primary deliverers (in this case physicians ONLY) suffer from declining rates of reimbursement

The concept of just income/wages commensurate to years spent in training, level of expertise, hours worked, intellectual demands of work and liability/risk assumed is lost in medicine. And if nothing is done or said about it, I'm concerned the level of decline with become even steeper.

Most will tell you, sincerely, that money was not the primary driving force for the choice of a career in medicine. But it is just insulting to continue the endless battle over how much you're reimbursed when only a very small percentage of the population can or is willing to sacrifice as much as you have or expend as much energy, passion and devotion as you have including bear the risks that you have to, in order to do what you do everyday.





PS: pardon the run-ons.
No: healthcare is not. Washing machines haven't gone up in price in years (until recent front loaders were developed for the consumer). Snow blowers the same. Inflation leads to lower real (inflation adjusted) revenue which must be adjusted to by lowering the cost of production.
Many groups have already done this in our field by leveraging CRNAs. Some, because their per room revenue is low. Many have done this to increase the physicians' income.
 

Eta Carinae

Removed
Oct 20, 2009
1,209
1
0
Secession-ville
Status
Post Doc
No: healthcare is not. Washing machines haven't gone up in price in years (until recent front loaders were developed for the consumer). Snow blowers the same. Inflation leads to lower real (inflation adjusted) revenue which must be adjusted to by lowering the cost of production.
Many groups have already done this in our field by leveraging CRNAs. Some, because their per room revenue is low. Many have done this to increase the physicians' income.
That's very funny.

In fact, that's so funny I forgot to laugh. (yes, corny, I know)

We're talking about wages here and you bring up washing machines? Well has the cost of malpractice insurance gone up for snow blowers?

And if you read the article, even after adjusting for inflation, reimbursement is still in decline. Let's not even go to the article. Let's just talk everyday practical stuff. When was the last time your insurance contractor wrote you to say that the reimbursement for CPT/DRG 4555 (made up, obviously) has gone up? Even just to keep up with inflation?

The more likely scenario is a letter telling you that the reimbursement has decreased or no longer exists.
 

WholeLottaGame7

10+ Year Member
Jul 10, 2005
1,944
994
281
Right here.
Status
Attending Physician
You and I both know, it is MOST LIKELY that he paid for his training on his own...as most of us do.

:laugh:
I interpret his statement more as, "I'm not the govt healthcare you voted for. In case you were looking for it, its' down XXX street."


As they should be. Of all sectors of the economy, healthcare is the only sector in which the primary deliverers (in this case physicians ONLY) suffer from declining rates of reimbursement

The concept of just income/wages commensurate to years spent in training, level of expertise, hours worked, intellectual demands of work and liability/risk assumed is lost in medicine. And if nothing is done or said about it, I'm concerned the level of decline with become even steeper.

Most will tell you, sincerely, that money was not the primary driving force for the choice of a career in medicine. But it is just insulting to continue the endless battle over how much you're reimbursed when only a very small percentage of the population can or is willing to sacrifice as much as you have or expend as much energy, passion and devotion as you have including bear the risks that you have to, in order to do what you do everyday.

PS: pardon the run-ons.
Oh I know, I just figured someone would bring up some government-run scholarship program to combat my point, so I was just being as specific as possible.

I'm not going to argue with you that physicians are underpaid compared to several other fields (business, law, etc). I think teachers are woefully under-compensated, also. And I agree that, in both instances, it is often times because people in service professions let themselves be taken advantage of to a certain degree. But that's just a reflection of their priorities, and not necessarily a bad thing. If you phrase your arguments in terms of maximizing reimbursement potential, you are denoting a change in priorities, which is problematic in it's own right.

Maybe it's just a difference in mindsets. In general, I'm more reactive than proactive when it comes to politics. Mostly it's because the older I get, the more I realize that nobody on the national scale knows a flying f*** what the consequences of their actions will be. Everybody THINKS they know the "right" way to do something, but really, only history decides who is right.

So rather than prognosticate, I'd rather concentrate on doing what you can with what you have. If patient care suffers because my ability or willingness to practice medicine is impacted by a political ruling, then it is the responsibility of the people affected to voice their concerns with their politicians.

Physicians will always be a minority when it comes to voting, so it is a necessity that we have the population on our side. And if we frame the arguments from a patient standpoint and not a reimbursement standpoint, I feel like we will be all the more effective.
 

SleepIsGood

Support the ASA !
10+ Year Member
5+ Year Member
Apr 16, 2006
1,965
2
0
Status
Fellow [Any Field]
he's a urologist. Why shouldnt think be ok to say/do?

If people have a problem with it, they can go elsewhere.

It's not like he's a ER turning away emergently ill patients. It's his business and he has the right to say this.

Docs should try to band together. We ought to repeal the anti-trust laws. It's ridiculous that every other profession except ours can. The BS that we are 'above' that shouldnt be listened to. It's a ruseto distrct us from banding together.
 

WholeLottaGame7

10+ Year Member
Jul 10, 2005
1,944
994
281
Right here.
Status
Attending Physician
I'm not talking about healthcare, I'm talking about Obamanomics in general, the laughable economic concept that if you borrow more money and blow it on junk you will build wealth and your debts will magically disappear. I was also referring to myself as a patient, not an employer. I don't care about "political views" such as abortion or gay marriage, but I do care if the guy putting me to sleep basically can't add 2 + 2.
Personally, I haven't been impressed by either party's economic acumen. One party turned a blind eye to major corporations running amok with the nation's money, and the next forgave them for it. If I tried to base my health care decisions based on that, I wouldn't be getting much care, period.
 

coldweatherblue

10+ Year Member
Nov 24, 2007
1,085
8
251
Status
Medical Student
I disagree with Obama's health-care plan but I can't imagine this sort of publicity is a good thing. We want the public to view us as tireless workers providing care for as many sick patients as possible, who oppose the plan because it will make it more difficult for us to provide the best quality care for our patients, not one-stop doc shops who preferentially treat patients based on their political ideology.

Not to say I don't find the sign amusing, I just don't think it's the best way for the medical community to express political dissatisfaction.
 

Eta Carinae

Removed
Oct 20, 2009
1,209
1
0
Secession-ville
Status
Post Doc
Physicians will always be a minority when it comes to voting, so it is a necessity that we have the population on our side. And if we frame the arguments from a patient standpoint and not a reimbursement standpoint, I feel like we will be all the more effective.
As the passing of this largely opposed health bill shows, even the majority cannot influence policy decisions any more in this country. The Rasmussen poll taken just before the final vote on this unpopular piece of legislation showed that 58% were opposed to its passage. In spite of that fact, demagogues, I mean, democrats, forged ahead. In spite of the referendum against this bill delivered by the crushing defeat of Coakley in the bluest of blue states, MA, in a willful act of lambaste against the desire of the majority, congress continued to pursue the bill's passage.

My point being, even being in the majority no longer seems sufficient in a democracy.

Physicians are in the minority...as are wall street tycoons, as in big pharma, yet somehow they have congress in their pockets.

I respect your stance. Mine is quite different. I believe by whatever ethical means necessary and for a just cause, we must continue to voice our discontent with a system that increasingly downplays our role/contribution in this society...lest we turn into another Europe.

And, if conditions continue to deteriorate for physicians, I hope we continue to fight. I cannot defect to Europe because this is my country and it's the only one I have. I can and will be consistently engaged and resort to civil disobedience if necessary.
 

WholeLottaGame7

10+ Year Member
Jul 10, 2005
1,944
994
281
Right here.
Status
Attending Physician
As the passing of this largely opposed health bill shows, even the majority cannot influence policy decisions any more in this country. The Rasmussen poll taken just before the final vote on this unpopular piece of legislation showed that 58% were opposed to its passage. In spite of that fact, demagogues, I mean, democrats, forged ahead. In spite of the referendum against this bill delivered by the crushing defeat of Coakley in the bluest of blue states, MA, in a willful act of lambaste against the desire of the majority, congress continued to pursue the bill's passage.

My point being, even being in the majority no longer seems sufficient in a democracy.

Physicians are in the minority...as are wall street tycoons, as in big pharma, yet somehow they have congress in their pockets.

I respect your stance. Mine is quite different. I believe by whatever ethical means necessary and for a just cause, we must continue to voice our discontent with a system that increasingly downplays our role/contribution in this society...lest we turn into another Europe.

And, if conditions continue to deteriorate for physicians, I hope we continue to fight. I cannot defect to Europe because this is my country and it's the only one I have. I can and will be consistently engaged and resort to civil disobedience if necessary.
But see, regardless of my opinion on the subject, the example you cited in MA is proof that the system still works, at least to some degree. If the majority of people are truly displeased with the legislation, they will speak with their votes. Call me idealistic, but I still have faith in the US as a whole. Individual leaders, not so much. Which I guess is the point of a democracy in the first place.

That said, I do find the anti-Europe sentiment intriguing. "Lest we turn into another Europe?" My understanding is that people there probably don't bitch about their health care any more or less than we do here. They probably just exchange one set of gripes for another.
 

Eta Carinae

Removed
Oct 20, 2009
1,209
1
0
Secession-ville
Status
Post Doc
But see, regardless of my opinion on the subject, the example you cited in MA is proof that the system still works, at least to some degree. If the majority of people are truly displeased with the legislation, they will speak with their votes. Call me idealistic, but I still have faith in the US as a whole. Individual leaders, not so much. Which I guess is the point of a democracy in the first place.

That said, I do find the anti-Europe sentiment intriguing. "Lest we turn into another Europe?" My understanding is that people there probably don't bitch about their health care any more or less than we do here. They probably just exchange one set of gripes for another.
Actually, that statement was not meant to confer an "anti-Europe" sentiment. They (Europe and the U.S.) are two very different systems and there are merits to both. However, you CANNOT implement a European-model in this country, except perhaps a German style approach to healthcare delivery where the govt's major role is the policing of the health insurance industry and the curtailing of unethical or immoral practices by the industry. IT (European-style system) WILL NOT WORK here. The individualistic bent/culture of America will not make such a system feasible. For a broader discussion on the difference between the two systems, I proffer Brooks' debate in the NY Times on the merits and characteristics of both in a general sense.

In the same vain, our unique system may not be feasible in the European culture, particularly in a country like Sweden where strong socialist sentiment persists...And the citizenry seems to be very satisfied with their quality of life.

So that statement was not a vilification of Europe. You just cannot fit a square peg into a round hole.

And inspite of the victory in MA, what this bill represents is the slow disintegration of the principles of a democratic process in favor of this suddenly popular (in congress) concept of a "representational democracy" :rolleyes:...only, of course, when it suits their purposes.
 

RussianJoo

Useless Member
10+ Year Member
Jun 7, 2004
2,231
41
261
Rock City
Status
Fellow [Any Field]
[YOUTUBE]http://www.youtube.com/watch?v=ePGHkBxOVMg[/YOUTUBE]


[YOUTUBE]http://www.youtube.com/watch?v=TLBN4LlBZfg[/YOUTUBE]
 

WholeLottaGame7

10+ Year Member
Jul 10, 2005
1,944
994
281
Right here.
Status
Attending Physician
Actually, that statement was not meant to confer an "anti-Europe" sentiment. They (Europe and the U.S.) are two very different systems and there are merits to both. However, you CANNOT implement a European-model in this country, except perhaps a German style approach to healthcare delivery where the govt's major role is the policing of the health insurance industry and the curtailing of unethical or immoral practices by the industry. IT (European-style system) WILL NOT WORK here. The individualistic bent/culture of America will not make such a system feasible. For a broader discussion on the difference between the two systems, I proffer Brooks' debate in the NY Times on the merits and characteristics of both in a general sense.

In the same vain, our unique system may not be feasible in the European culture, particularly in a country like Sweden where strong socialist sentiment persists...And the citizenry seems to be very satisfied with their quality of life.

So that statement was not a vilification of Europe. You just cannot fit a square peg into a round hole.

And inspite of the victory in MA, what this bill represents is the slow disintegration of the principles of a democratic process in favor of this suddenly popular (in congress) concept of a "representational democracy" :rolleyes:...only, of course, when it suits their purposes.
Gotcha. I would agree that there would be significant cultural boundaries to be crossed. I don't think it's insurmountable, as hundreds of thousands of military families have quasi-socialized health care. But I understand your point.

And I was under the impression that we've always had a "representational democracy." I don't think anything's really changed on that front.
 
Sep 16, 2009
8
0
0
Status
I get really irked when the politicians keep comparing US to Europe and how we should be more like them. I was born in Europe, grew up in the US, and have studied medicine under one of these socialized European systems.

There are 3 key differences: Medical school is free, medical lawsuits are nearly non-existent (they are becoming more common but frivalous lawsuits almost do not exist) and doctors still have a dictatorial role in care delivery.

What does this translate to: When I had my ER rotation, teen busts his head skateboarding. I say do Head CT, mom wants one for son also. ER Doc does quick neuro exam says observe for 4 hours and send home. CT too expensive, no point. Everyone shuts up.

Next point: Rationing. No matter what the politicians tell you socialized care is rationed. Every department gets a fixed amount of money for a fixed amount of procedures and they must do with it.

Example: My best friends gf is 21 years old and has really severe RA for which she is on MTX, steroids, and now sulfasalizine. Poor girl has moderate to severe destruction in wrist joints. Through a bunch of contacts and favors we get her seen by the Chairman of Rheumatology for the entire country. Really nice guy, speeds up things immediately puts her on biological therapy list (infliximab) but still says it might be a year before she gets it because the HC system only allows 2 new patients per month on this expensive therapy.

The point, do you think this would fly in America? Picture this being your daughter. So when Obama parades around these poor kids who dont have insurance I can easily find and parade around kids from socialized systems just as easy.
 
Sep 16, 2009
8
0
0
Status
Oh and some one mentioned it above, the grass is always greener on the other side.

People in Europe in nearly every country bitch about their health care also.
 

kmurp

Junior Member
10+ Year Member
Apr 23, 2005
288
23
251
Status
That's very funny.

In fact, that's so funny I forgot to laugh. (yes, corny, I know)

We're talking about wages here and you bring up washing machines? Well has the cost of malpractice insurance gone up for snow blowers?

And if you read the article, even after adjusting for inflation, reimbursement is still in decline. Let's not even go to the article. Let's just talk everyday practical stuff. When was the last time your insurance contractor wrote you to say that the reimbursement for CPT/DRG 4555 (made up, obviously) has gone up? Even just to keep up with inflation?

The more likely scenario is a letter telling you that the reimbursement has decreased or no longer exists.
I know we don't make washing machines... My point was that other industries have had to adjust to situations where they get less revenue in inflation adjusted terms for their product. They adjusted by lowering their cost of production. For us, that means more CRNAs, unless you are already in a practice that maximizes the use of CRNAs. If you are in this kind of practice now, you likely are making very good money.
As far as malpractice insurance goes, ours has declined in cost over the last ten years on an inflation adjusted basis. The company is PPM.
As far as when we last got an increase in our ASA conversion factor: I got a letter yesterday from our largest private payor giving us a small increase. Last year our three largest private payors and Medicare gave us an increase.
Going forward, I expect our average $ collected per ASA unit to stagnate or decrease. If we want to maintain our income, we will need to somehow lower our administrative overhead, or lower our personnel overhead or both. I expect us to replace any departing docs with CRNAs in the future.
 

Eta Carinae

Removed
Oct 20, 2009
1,209
1
0
Secession-ville
Status
Post Doc
My point was that other industries have had to adjust to situations where they get less revenue in inflation adjusted terms for their product. They adjusted by lowering their cost of production. For us, that means more CRNAs, unless you are already in a practice that maximizes the use of CRNAs.
1. Even if I were to agree with your argument, the overhead costs which contribute most to healthcare costs are: hospital administrative costs and insurance industry administrative costs.

2. You still fail to realize that physician incomes are in decline and have failed to keep up with inflation. Here's another article showing that between 1995-2003, documenting a general inflation rate of 21% with physician pay falling 7% in that period. If you have some sources to support your claim that pay in this sector is purely influenced by cost of production, I'd sure like to see.

3.Of course, there's always the option of receding physician recruitment in favor of CRNAs- for you guys anyway. That's precisely the sort of strategy that sustains this specialty as a MEDICAL specialty and ensures its longevity. :thumbup:


Going forward, I expect our average $ collected per ASA unit to stagnate or decrease.
My point exactly.

Reimbursement per unit in healthcare is artificially determined and fixed by third parties, not the market (as it would be for other sectors). Who determines what you get paid is the govt and your insurance contractor.


I expect us to replace any departing docs with CRNAs in the future.
WOW!
:thumbup::thumbup::thumbup:
I see you and the great Mao-Chairman share the same philosophy...or wait is that Sebelius?
 

Eta Carinae

Removed
Oct 20, 2009
1,209
1
0
Secession-ville
Status
Post Doc
Gotcha. I would agree that there would be significant cultural boundaries to be crossed. I don't think it's insurmountable, as hundreds of thousands of military families have quasi-socialized health care. But I understand your point.
That sort of system will never have broad applicability. Which is why it's restricted to the military for now. If you examine the train wreck of the MA commonwealth care, you'll see that even without the hefty govt subsidies (which this new socialist bill provides to a large percentage of the population and) which are provided to well deserving military patients, the program is fiscally unsustainable.

Here is a direct quote from the link:

Third, the program is not affordable for many individuals and families. For middle-income people not qualifying for state-subsidized health insurance, costs are too high for even skimpy coverage. For an individual earning $31,213, the cheapest plan can cost $9,872 in premiums and out-of-pocket payments. Low-income residents, previously eligible for free care, have insurance policies requiring unaffordable copayments for office visits and medications.

Fourth, the costs of the reform for the state have been formidable. Spending for the Commonwealth Care subsidized program has doubled, from $630 million in 2007 to an estimated $1.3 billion for 2009, which is not sustainable.

Fifth, reform does not assure access to care. High-deductible plans that have additional out-of-pocket expenses can result in many people not using their insurance.

Susanne L. King
Mass. healthcare reform is failing us

March 2, 2009


Now imagine trying to implement that sort of system on a national scale.

Bear in mind, the population, MA = 3.5m
Population, US = 304m
scale = 1: 86

In other words, multiply the rise in costs of the program (double in 2 years) and the cost of the program itself ($1.3bn) by a scale of about 80.

It's just not nationally feasible.


And I was under the impression that we've always had a "representational democracy." I don't think anything's really changed on that front.
:laugh:
Oh yeah, absolutely.

However, congress only conveniently revives the use of that tenet when it plays to their advantage.
 
Last edited:

kmurp

Junior Member
10+ Year Member
Apr 23, 2005
288
23
251
Status
2. You still fail to realize that physician incomes are in decline and have failed to keep up with inflation. Here's another article showing that between 1995-2003, documenting a general inflation rate of 21% with physician pay falling 7% in that period. If you have some sources to support your claim that pay in this sector is purely influenced by cost of production, I'd sure like to see.

My only evidence would be the well known fact that the personnel cost per operating room is less with a highly leveraged crna ratio vs. an all MD ratio. Our groups' income has kept up with the CPI. We have had to hire some Crnas to achieve this. Don't really get the Mao reference regarding our groups future staffing plans. Any decision we make on future staffing will be made by us, not some central committee.
If you are interested in a physician only staffing model, I suggest that you generally would look in the western states.


My point exactly.

Reimbursement per unit in healthcare is artificially determined and fixed by third parties, not the market (as it would be for other sectors). Who determines what you get paid is the govt and your insurance contractor.



WOW!
:thumbup::thumbup::thumbup:
I see you and the great Mao-Chairman share the same philosophy...or wait is that Sebelius?[/QUOTE]
 

Eta Carinae

Removed
Oct 20, 2009
1,209
1
0
Secession-ville
Status
Post Doc
My only evidence would be the well known fact that the personnel cost per operating room is less with a highly leveraged crna ratio vs. an all MD ratio. Our groups' income has kept up with the CPI. We have had to hire some Crnas to achieve this. Don't really get the Mao reference regarding our groups future staffing plans. Any decision we make on future staffing will be made by us, not some central committee.
If you are interested in a physician only staffing model, I suggest that you generally would look in the western states.
Yes!

So the chairman thing was a joke. At one point, it seemed one of the current administration's strategies in its little bag of tricks to lower health costs was to rely even more heavily on midlevels. I remember something about Sebelius being pro-independent CRNA practice. To be honest, I haven't followed up on it nor do I have specifics.

You obviously have more experience than I. I tend to rely heavily on stats/sources because for the most part, my real-life experience is deficient, give or take a few anecdotal incidents. So I will defer to you on this argument of ACT models, which is most cost-efficient and unit reimbursement.
 
Last edited:

s204367

Member
7+ Year Member
15+ Year Member
Feb 25, 2004
86
0
0
46
Visit site
Status
That's right folks, apparently the govt thinks it can force you to buy insurance, but what they don't understand is they can't force us doctors to do shiite.


Actually, they can force you do do lots of shiiiiite,at least if you want to maintain a medical license. Opting out of the new gov system will become tied to your license to practice, much as it is in MA. Balance Billing is outlawed. There will be a strong push to outlaw opting out of medicare/medicaid, and as son as private insurance no longer exists, if you opt out, there will be no patients left......
 
Mar 29, 2010
4
0
0
Status
Great article. Obama's health-care reform is going to line the pockets of the insurance companies while reducing the standard of care. Dr. Jack's anger is justified. Unfortunately some of his patients might suffer from the expressed ambiguity about treating them.