PM&R without Medicare

[AviatorDoc]

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In light of recent economic declines, I have been soul-searching in regards to the future of PM&R, and I've come up with some questions that may be tough to consider, but important nevertheless.

Assume the worst -- medicare, medicaid, and worker's compensation programs are eliminated from federal and state budgets. Do physiatrists continue to operate in the manner in which they have been trained?

If the whole of the physiatric world could be divided into neurorehab and musculoskeletal medicine (a truly artificial divide, I know), which will do better when the gov't starts to hack-and-slash funding to "non-essential" procedures, consultations, etc.

What role, if any, does physiatry play in an economic post-apocalypse?

Please don't mistake my questioning to be a referendum on whether or not physiatry has intrinsic value to the patients we serve -- of course it does. The point is essentially, How can we as physiatrists position ourselves to advocate for our patients (and thus our own sustainability) when we are in a more direct competition with other specialties for funding?

 

[ShrikeMD]

In light of recent economic declines, I have been soul-searching in regards to the future of PM&R, and I've come up with some questions that may be tough to consider, but important nevertheless.

Assume the worst -- medicare, medicaid, and worker's compensation programs are eliminated from federal and state budgets. Do physiatrists continue to operate in the manner in which they have been trained?

If the whole of the physiatric world could be divided into neurorehab and musculoskeletal medicine (a truly artificial divide, I know), which will do better when the gov't starts to hack-and-slash funding to "non-essential" procedures, consultations, etc.

What role, if any, does physiatry play in an economic post-apocalypse?

Please don't mistake my questioning to be a referendum on whether or not physiatry has intrinsic value to the patients we serve -- of course it does. The point is essentially, How can we as physiatrists position ourselves to advocate for our patients (and thus our own sustainability) when we are in a more direct competition with other specialties for funding?

Pure speculation. Who really knows what will happen? My crystal ball works no better than the next person's.

Aside from death and taxes, things pretty close to certainty include more documentation requirements for less pay. Eventually, the gov't will be much closer to its ideal of having the providers pay for the services of those receiving the health care service, with the gov't merely acting as a middle man. 🙁

 

[PMR 4 MSK]

MSK will survive better in this scenario, simply because people will pay for pain relief before they'll pay for disability treatment.

How often have you seen someone pay cash for inpt rehab? Almost never. How often does an uninsured para come in for f/u care? Almost never.

How often will people pay cash for pain treatments? All the time, but they are very judicious in what they will pay for when it's their own money. When it's someone else's, they want everything. When it's their money, they want Vicodin and Elavil. Usually just the vicodin. Oh, and some Somas if you got 'em. Oh, and can I get a few Xanaxes with that...

The more likely scenario is the death of commercial insurance companies and the movement toward a national health care plan. Then the bean counters start looking at what has "Evidence Based Medicine" to support it and most of what we do is not gonna be paid for.

BTW, work comp is government mandated (except Texas) but not govt funded. There is WC for govt workers, but private businesses buy their policies from private insurance companies (Zurich, CNA, others).

 

[dc2md]

MSK will survive better in this scenario, simply because people will pay for pain relief before they'll pay for disability treatment.

good point!!

The more likely scenario is the death of commercial insurance companies and the movement toward a national health care plan. Then the bean counters start looking at what has "Evidence Based Medicine" to support it and most of what we do is not gonna be paid for.

Medicare currently pays for PLENTY of non-evidence-based treatments. And not just in PMR. Rheum, cards, neuro, psych, nephro...they all use meds and other treatments/therapies off-label. but understandably so, they won't cover EXCESS. for instance: monitoring LBP with yearly MRIs; 10 epidurals with each showing minimal short-term pain relief; 2-wks of inpt rehab for an uncomplicated bilateral TKA.

I think we can all agree that if Medicare gave us all whatever we want, we'd end up doing WAY too many procedures and other billables that are in excess and are a waste of tax-payer money. So let's not put a blanket statement out there that ALL government control of healthcare is bound to be horrible. Limits are good. Just think what could happen if the government lets banks loan wildly without oversight and limits. Geez, it's good that'll never happen!! ;-)

 

[ShrikeMD]

MSK will survive better in this scenario, simply because people will pay for pain relief before they'll pay for disability treatment.

How often have you seen someone pay cash for inpt rehab? Almost never. How often does an uninsured para come in for f/u care? Almost never.

How often will people pay cash for pain treatments? All the time, but they are very judicious in what they will pay for when it's their own money. When it's someone else's, they want everything. When it's their money, they want Vicodin and Elavil. Usually just the vicodin. Oh, and some Somas if you got 'em. Oh, and can I get a few Xanaxes with that...

The more likely scenario is the death of commercial insurance companies and the movement toward a national health care plan. Then the bean counters start looking at what has "Evidence Based Medicine" to support it and most of what we do is not gonna be paid for.

BTW, work comp is government mandated (except Texas) but not govt funded. There is WC for govt workers, but private businesses buy their policies from private insurance companies (Zurich, CNA, others).

I would agree that in this rough scenario (some imaginary license required), MSK would do better than inpt-based rehabilitation. Then again, both would take a hit, probably a big one, with inpt taking a far larger hit.

I agree with your basic premise (that MSK would fare better than inpt rehab), but I might suggest alternative supporting examples. Cost/ability to pay is the principal issue in these scenarios, not necessarily effectiveness. The cost of inpatient rehab is prohibitively expensive, but there are people who will pay a modest chunk of change to facilitate a succesful transition home. There are still others (perhaps unfortunately), who will pay any price for hope, (but especially if someone else is paying for the price of hope). (I consider this problematic, as there are a # of less ethical places that will take advantage of poor rehab candidates with expendable wallets. When I was starting my residency program, we had a 30day inpatient pain program. By the time I finished my residency, it was gone. My point is that any treatments whose cost/benefit isn't overwhelmingly weighted toward obvious benefit, will fare less well. People who have some ability to pay (e.g. who are still working/can work) will be more likely to pay.

As for paying cash for pain treatment, most outpatient treatment costs far less than inpatient (rehab) treatment, but the more expensive treatments would also take a hit. Spine surgeries would likely take a hit too. Certainly, there are numerous people (not necessarily patients) who pay cash for narcotic analgesics and pain drugs, but there are a subset who recoup a portion of these expenditures by selling to others abuse the drugs.

Compliance of uninsured pts with paraplegia for f/u is ltd, their lifestyles prior to injury may have played a role in this (non)compliance, not necessarily the issue of the disability-related basis for treatment. I have a number of compliant patients without insurance. Their lack of funds limits access to needed services, medications, and transportation. These factors, not the nature of the services provided, are probably most important.

Finally, I also share your general viewpoint regarding the bean-counters and their love of EBM, and its negative implications for reimbursement. As always, however, they will likely apply EBM selectively; EBM that supports a policy of nonpayment/limited access will be relied upon far more (even case reports) often than evidence supporting utilization of treatment/new procedures (they will make us wait for numerous, large-scale randomized clinical trials).

 

[ShrikeMD]

good point!!



So let's not put a blanket statement out there that ALL government control of healthcare is bound to be horrible. Limits are good. Just think what could happen if the government lets banks loan wildly without oversight and limits. Geez, it's good that'll never happen!! ;-)

Come on, DC2MD, cite for me a major, government-run service that is consumer-responsive, effective, and NOT absolutely bloated with layers of bureaucracy/waste. The VA is loaded with staff who don't contribute to service provision, far more than any private hospital or hospital system (not that they are perfect either. They waste tons on marketing, etc.). They spend millions on rehab research (a good thing), but their limited pool of applicants (minimum 5/8ths VA paid personnel) may contribute to funding some projects whose scientific rigor would never be reviewed, much less funded, at the NIH, or even NIDRR. Prior to the present conflicts (Afghan/Iraq), rehab beds were in a major drawdown throughout the VA system. Now they can't throw money at the polytrauma centers fast enough. We'll see how long they continue supporting these new initiatives.

"Government control of healthcare isn't HORRIBLE" is hardly a ringing endorsement. "Limits are good". Tell that to the stroke patients receiving 17 days of inpt rehab, a few more weeks of outpatient rehab. Do we really think arthroplasty patients are better off now that they can't receive inpt rehab? Some limits are better than others, and I have little confidence in delegating the responsibility for the decisions to middle level career govt personnel who are accountable to no one, and can never be fired.

Bottom line: Rehab/rehab pts is/are not likely to be a priority for any politically-manipulated, resource-limited, government healthcare bureaucracy. That will apply whether a (D) or (R) is attached to the person in the White House.

 

[SSdoc33]

Come on, DC2MD, cite for me a major, government-run service that is consumer-responsive, effective, and NOT absolutely bloated with layers of bureaucracy/waste. The VA is loaded with staff who don't contribute to service provision, far more than any private hospital or hospital system (not that they are perfect either. They waste tons on marketing, etc.). They spend millions on rehab research (a good thing), but their limited pool of applicants (minimum 5/8ths VA paid personnel) may contribute to funding some projects whose scientific rigor would never be reviewed, much less funded, at the NIH, or even NIDRR. Prior to the present conflicts (Afghan/Iraq), rehab beds were in a major drawdown throughout the VA system. Now they can't throw money at the polytrauma centers fast enough. We'll see how long they continue supporting these new initiatives.

"Government control of healthcare isn't HORRIBLE" is hardly a ringing endorsement. "Limits are good". Tell that to the stroke patients receiving 17 days of inpt rehab, a few more weeks of outpatient rehab. Do we really think arthroplasty patients are better off now that they can't receive inpt rehab? Some limits are better than others, and I have little confidence in delegating the responsibility for the decisions to middle level career govt personnel who are accountable to no one, and can never be fired.

Bottom line: Rehab/rehab pts is/are not likely to be a priority for any politically-manipulated, resource-limited, government healthcare bureaucracy. That will apply whether a (D) or (R) is attached to the person in the White House.

i dont know if i agree with all of this. the government would run a better system that costs WAY less than our current system. WE would make less money as docs, but the overall health of the country would be better. there are countless examples out there of other countries (many of whom are a lot poorer than we are financially) who's people are a crapload healthier than us.

when you cut to the chase, things like preventative medicine, prenatal care, and oncology are a lot more important than epidurals or botox injections. sure it may take a while to get an MRI, and we may have to use neurontin instead or lyrica. in the end, the country wont go bankrupt because of our medical system. i guess thats not the american way, however. we like to be cowboys over here......

 

[ShrikeMD]

i dont know if i agree with all of this. the government would run a better system that costs WAY less than our current system. WE would make less money as docs, but the overall health of the country would be better. there are countless examples out there of other countries (many of whom are a lot poorer than we are financially) who's people are a crapload healthier than us.

when you cut to the chase, things like preventative medicine, prenatal care, and oncology are a lot more important than epidurals or botox injections. sure it may take a while to get an MRI, and we may have to use neurontin instead or lyrica. in the end, the country wont go bankrupt because of our medical system. i guess thats not the american way, however. we like to be cowboys over here......

Yes it will (run better)...No it won't...Yes it will...No it won't.
Who really knows? We may find out...the hard way, or not.

My point is not that we COULDN't come up with a better government-run system, but that it is highly unlikely because our government DOESN'T run service-oriented systems effectively or efficiently. Whether one looks at education, mass transit, retirement benefits, disability compensation, or healthcare, our record does not support your contention ("government would run a better system that costs WAY less than our current system").

While I agree that we would make less money as physicians, there is no evidence that the overall health of the country would be better.

As for your contention regarding "countless examples ... of other countries who's people are ... healthier than us", this statement fails to account for societal issues whose relative prevalence in different countries may influence specific indices of health of the country, but have less to do with the healthcare systems per se. (Examples: inner city crime/violence, teenage pregnancy, poverty, obesity, availability of vacation/recreation/exercise, education.)

 

[SSdoc33]

Yes it will (run better)...No it won't...Yes it will...No it won't.
Who really knows? We may find out...the hard way, or not.

My point is not that we COULDN't come up with a better government-run system, but that it is highly unlikely because our government DOESN'T run service-oriented systems effectively or efficiently. Whether one looks at education, mass transit, retirement benefits, disability compensation, or healthcare, our record does not support your contention ("government would run a better system that costs WAY less than our current system").

While I agree that we would make less money as physicians, there is no evidence that the overall health of the country would be better.

As for your contention regarding "countless examples ... of other countries who's people are ... healthier than us", this statement fails to account for societal issues whose relative prevalence in different countries may influence specific indices of health of the country, but have less to do with the healthcare systems per se. (Examples: inner city crime/violence, teenage pregnancy, poverty, obesity, availability of vacation/recreation/exercise, education.)

you are right that we dont know if it would be better or not. and i do agree that a government-run health care system may be about as effective and efficent as FEMA, but it would (let me correct that) SHOULD cut out a lot of the nonsense. f

slovenia has better health care than we do. ouch.

as far as WHY we are unhealthier, there are a number of different things to look at and you mentioned a bunch of them, probably the most important is that we are fat as hell and eat things that shouldnt even really be classifies ad food (if anyone is interested, i strongly suggest "in defense of food" by michael pollan").

back on point, i think a system that is privatized but heavily regulated would be the best option to try to transition to a health care system that is both affordable and gets the job done. but to be honest, with the financial crisis, i dont see any serious health care reform happening for several years, maybe upwards of 10. insurances will cost more, employers wont provide as much, and the medicare/aid population will grow. it'll continue to be a a huge cash sink-hole for a while. only if the economy absolutely falls off the deep end will sudden reform occur. otherwise, its honestly not on the top of the agenda.

 

[dc2md]

but to be honest, with the financial crisis, i dont see any serious health care reform happening for several years, maybe upwards of 10. insurances will cost more, employers wont provide as much, and the medicare/aid population will grow. it'll continue to be a a huge cash sink-hole for a while. only if the economy absolutely falls off the deep end will sudden reform occur. otherwise, its honestly not on the top of the agenda.

although since health care costs are the number one reason for filing for bankruptcy (i believe), it may be a reason to take that out of the equation for american households.

 

[AviatorDoc]

I guess what I was trying to hint at is that the "National Health Care" argument may be entirely moot if we get into a severe economic depression. I don't know what exactly would happen, but my hunch is that we would be forced into a bloated, over-regulated single payor system, in which fields like ours are relegated to the very bottom of the priority list, not because of the reality of what we do, but because of the perception of what we don't do.

 

[dc2md]

i think some of what we do IS very questionable in efficacy at best. and if that's true, we either shouldn't be paid for it, or we'd better start doing the studies necessary to prove they're better than placebo.

BUT, i think other specialties have just as much to worry about. a study just came out showing that a good percentage of patients don't get the stress test needed to prove that have functional blockages in their coronary arteries before getting balloon interventions. so those $10,000-15,000 procedures may be WAY over performed in the Medicare population (that we of course pay for with our tax money). and i'm not cool with that. ALSO, another study just came out showing knee scopes to be no more effective than shame for knee pain (and that's the second such study to show that). so the orthopods shouldn't be doing so many of those.

so if a national health care system cracks down on such useless (and possibly harmful) procedures, i'm all for it. if it means i get paid less, than so be it. we either should come up with proven procedures/interventions or quit wasting everyones money. right? maybe i'm not thinking clearly though. that just makes sense to me.

 

[ShrikeMD]

i think some of what we do IS very questionable in efficacy at best. and if that's true, we either shouldn't be paid for it, or we'd better start doing the studies necessary to prove they're better than placebo..

Perhaps the Feds should be willing to pony up the cash to fund the study that demonstrates the lack of efficacy/degree of response BEFORE cancelling our check. Don't you think?

 

[ShrikeMD]

BUT, i think other specialties have just as much to worry about. a study just came out showing that a good percentage of patients don't get the stress test needed to prove that have functional blockages in their coronary arteries before getting balloon interventions. so those $10,000-15,000 procedures may be WAY over performed in the Medicare population (that we of course pay for with our tax money). and i'm not cool with that. .

I would be cautious regarding interpretations asserting a "lack of necessity" that appear so popular in the lay press.

Not all potentially significant coronary occlusions are demonstrated on stress tests. Not all patients with sudden death related to MI have atheromas completely occluding the coronary vessels. (Of course, large atheromas increase the risk, but not everyone has high grade stenosis prior to the MI.) While I recognize the obvious incentives for both interventional cardiologist AND the patient to have the procedure, there exists considerable controversy regarding the interpretation of the data coming from these interventional cardiological studies.

BTW, should our colleagues in cardiology be accorded ANY of the credit in the relative decrease in overall mortality associated with cardiovascular disease seen in the past decade? I would be more inclined to accord them some of the credit, as opposed to the nameless bureaucrats who would deny a patient the opportunity of getting a life-saving procedure (until it is their heart with a 70% LAD occlusion-->then it's "medically necessary".)

 

[ShrikeMD]

..so if a national health care system cracks down on such useless (and possibly harmful) procedures, i'm all for it. if it means i get paid less, than so be it. we either should come up with proven procedures/interventions or quit wasting everyones money. right? maybe i'm not thinking clearly though. that just makes sense to me.

I think you give the nameless souls (if they have them) that will run this "national health care system" too much credit. I have no doubt there will be "useless (and possibly harmful) procedures" that are reduced or eliminated, along with a number of other promising, safe, and useful treatments that will be reduced or eliminated for lack of funding of the studies needed to demonstrate their efficacy. (I suspect that rehab interventions and other expensive treatments will rank high on this list.)

The individuals given the authority to operationally deny the funding for these procedures are not motivated by asking the question whether the treatment works or not, they just don't want to pay for it. IF THEY REALLY CARED ABOUT WHETHER THE TREATMENT WORKS (OR NOT), THEN THEY WOULD ALSO FUND THE STUDIES TO ADDRESS THIS QUESTION.

 

[dc2md]

Perhaps the Feds should be willing to pony up the cash to fund the study that demonstrates the lack of efficacy/degree of response BEFORE cancelling our check. Don't you think?

let me start by saying i'm not 100% gung ho about a single-payer national health care system. i AM though definitely leaning that way.

as far as efficacy of procedures, i think it is more of OUR (the doctors, drug/equipment company's) responsibility to prove a therapy is more effective than placebo or the current gold standard. let's just pick on the orthopedists a bit. if they want to continue getting reimbursed for knee scopes, then THEY should pony up the money and fund the research to prove its effectiveness. why should the government do that?? or at least a certain percentage of the funds.

and just the reduced administrative BS. i had a patient this week that's in severe pain b/c her new insurance company (the employer-based plan switched d/t money issues) wanted proof from the treating doctor that she needs enbrel infusions. so while she's trying to get a hold of the busy rheumatologist, she's been off the meds for her RA for 2 months. that wouldn't happen if there was only one system.

also, how many times have u wanted to look up exactly what another doctor said about a certain other medication (or anything else), but couldn't find out in that one visit b/c it takes too long and you don't have the man power in the office to call the other physician's office and have their "man power" take the time to find the requested information and fax it over. WAY too many steps. a national health care system would have a universal computerized system as well (like at the VA). you'll EASILY know exactly what doctor X is saying about the patient's other medical conditions. what did that neurosurgeon say about the cervical stability? what did the endocrinologist say about the thyroid? WHO ELSE IS PRESCRIBING NARCOTICS? what is Mr. Johnson's recent renal fxn labs before starting on analgesics? what about the liver fxn?

way too much wasted time for the physicians. way too many return visits for the patients (and therefore their time off work as well).

i see way too many positives for a national health care system to be 100% against it and closed-minded.

 

[Ligament]

let me start by saying i'm not 100% gung ho about a single-payer national health care system. i AM though definitely leaning that way.

as far as efficacy of procedures, i think it is more of OUR (the doctors, drug/equipment company's) responsibility to prove a therapy is more effective than placebo or the current gold standard. let's just pick on the orthopedists a bit. if they want to continue getting reimbursed for knee scopes, then THEY should pony up the money and fund the research to prove its effectiveness. why should the government do that?? or at least a certain percentage of the funds.

and just the reduced administrative BS. i had a patient this week that's in severe pain b/c her new insurance company (the employer-based plan switched d/t money issues) wanted proof from the treating doctor that she needs enbrel infusions. so while she's trying to get a hold of the busy rheumatologist, she's been off the meds for her RA for 2 months. that wouldn't happen if there was only one system.

also, how many times have u wanted to look up exactly what another doctor said about a certain other medication (or anything else), but couldn't find out in that one visit b/c it takes too long and you don't have the man power in the office to call the other physician's office and have their "man power" take the time to find the requested information and fax it over. WAY too many steps. a national health care system would have a universal computerized system as well (like at the VA). you'll EASILY know exactly what doctor X is saying about the patient's other medical conditions. what did that neurosurgeon say about the cervical stability? what did the endocrinologist say about the thyroid? WHO ELSE IS PRESCRIBING NARCOTICS? what is Mr. Johnson's recent renal fxn labs before starting on analgesics? what about the liver fxn?

way too much wasted time for the physicians. way too many return visits for the patients (and therefore their time off work as well).

i see way too many positives for a national health care system to be 100% against it and closed-minded.

She should pay for her treatments out of pocket just like any other purchase she would make. Why should I have to pay for her illness?

A single payer national health care system will make a SLAVE out of you and I. Why would you want that?

 

[ShrikeMD]

as far as efficacy of procedures, i think it is more of OUR (the doctors, drug/equipment company's) responsibility to prove a therapy is more effective than placebo or the current gold standard. .

Do you have ANY idea how much it COSTS to conduct an adequately powered study to determine the COMPARATIVE efficacy of any treatment against another?

Medical science, whether we like it or not, tends to work in evolutionary/incremental steps forward (and backwards too, occasionally), NOT revolutionary steps. I think that many treatments could show the incremental benefit, but the cost of the study to generate the incremental benefit, coupled with the qualitative judgement over whether the incremental benefit justified the additional cost, would likely stifle innovation in all but the largest potential markets.

For those of us who care for our rehab patient populations, few will want/be able to fund studies to the standard you propose (without some larger funding agency helping out).

I am not suggesting that your proposal is a bad one, it's reasonable, but there are unintended consequences that can accompany such a mandate without adequate funding mechanisms for comparative studies.

 

[ShrikeMD]

and just the reduced administrative BS. i had a patient this week that's in severe pain b/c her new insurance company (the employer-based plan switched d/t money issues) wanted proof from the treating doctor that she needs enbrel infusions. so while she's trying to get a hold of the busy rheumatologist, she's been off the meds for her RA for 2 months. that wouldn't happen if there was only one system.

What makes you so sure there would be reduced administrative BS? There might be, then again there might not. It is likely to be influenced by the treatment/intervention concerned. I have virtually NO hassles getting doctor visits, vaccinations, and common pediatric treatment for my children through my private insurance plan (thank the Lord they are healthy). Conversely, getting a new/appropriate tilt-in-space w/c for one of my profoundly impaired TBI adults through medicaid (a gov't healthcare funding agency) is a huge hassle. Indeed, ask any oncologist about the effects of CMMS reimbursement for chemotherapeutic agents (reimbursing these expensive drugs at a loss to the practice) on the ability to provide these treatments in the outpatient clinic setting.

It is easy to imagine the theoretical virtues or problems of any new entity, drug, plan, etc., before it is created. (I sometimes find it amusing to consider the "new and improved" side effect profile of any new drug, primarily because it hasn't been around long enough for us to get to know its not-so-improved side effect profile.)

 

[ShrikeMD]

also, how many times have u wanted to look up exactly what another doctor said about a certain other medication (or anything else), but couldn't find out in that one visit b/c it takes too long and you don't have the man power in the office to call the other physician's office and have their "man power" take the time to find the requested information and fax it over. WAY too many steps. a national health care system would have a universal computerized system as well (like at the VA). you'll EASILY know exactly what doctor X is saying about the patient's other medical conditions. what did that neurosurgeon say about the cervical stability? what did the endocrinologist say about the thyroid? WHO ELSE IS PRESCRIBING NARCOTICS? what is Mr. Johnson's recent renal fxn labs before starting on analgesics? what about the liver fxn?

This issue may or may not be fixed in a single payer system.

In fact, with some legislative support, some of these issues could be (partially) remedied with some legislative changes in our current systems.

The software used for med records in the VA system is available to practitioners and hospitals (I believe this is the case) for free. A big problem is that it will cost $$$$$ to support it once the software is acquired and customized, and I don't know of anyone who will help with that. If CMMS REALLY wanted to see broader implementation of a computerized medical record system akin to that of the VA, it would provide competititve grants to software companies/computer svcs "solutions" companies to provide, customize, support and upgrade these systems at a cost that small practices and private practitioners can afford. We don't need to spend trillions on a new healthcare system to implement this.

 

[ShrikeMD]

i see way too many positives for a national health care system to be 100% against it and closed-minded.

Again, there are potential positives AND negatives for a national healthcare system.

I will finish by saying that I am neither 100% against it or closed-minded about it. I believe that I am realistic that there are possibilities for both upsides and downsides, and that I am not willing to ascribe altruistic motives to this theoretical healthcare system (and its undoubted legion of bureaucrats who will operate it) simply because it is gov't run, or does not operate by our conventional definitions of a for-profit bottom line. (I have cited a # of examples in the preceding posts). In particular, I am concerned about the unintended consequences of any proposal that would impact upon the lives of the vulnerable patient population I care for.

 

[dc2md]

She should pay for her treatments out of pocket just like any other purchase she would make. Why should I have to pay for her illness?

A single payer national health care system will make a SLAVE out of you and I. Why would you want that?

Pay for it out of her pocket? Sure, we all have an extra $1,200 a month for health care costs...and that's just one med. That particular woman is out there working, and it's her company that switched health insurance companies. Now the patient is stuck in the middle of all the chaos. I was using her as an example of the simplicity that a single-payer system would bring to the situation.

 

[SSdoc33]

She should pay for her treatments out of pocket just like any other purchase she would make. Why should I have to pay for her illness?
quote]


because health care is a right (or at least it should be IMHO for something like RA).

the real question to be asking is: "why do her enbrel shots cost S1200/month"

or "why do i have to pay for diabetes treatments for the slob who eats 5 bags of doritos at one sitting"?

or "why do i have to pay for detox for the alcholic"?

i realize that i have raised a few different issues, but i thought id just stir the pot a bit.

 

[PMR 4 MSK]

because health care is a right (or at least it should be IMHO for something like RA).

How much healthcare? A Yugo in every garage or a Caddy?

the real question to be asking is: "why do her enbrel shots cost S1200/month"

Capatilism combined with a third party-payer system = "Greed is good."

or "why do i have to pay for diabetes treatments for the slob who eats 5 bags of doritos at one sitting"?

Because the poor slob can't help himself, he has a disability. It's a brain defect. Forces conspired against him. It's not his fault. Blame McDonalds. Blame Frido-lay!

I'm actually amazed how many patients I see who are on disability primarily for diabetes.

or "why do i have to pay for detox for the alcholic"?

We told him it's not his fault, he has a faulty gene that forces him to drink too much. Blame his parents and up-bringing. Blame Miller Brewing Co for those damn comercials. Blame the guys who raised the Budweiser Clydesdales.

i realize that i have raised a few different issues, but i thought id just stir the pot a bit.