Why would anyone go into primary care nowadays?

[tdram]

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So a poor child's chances after getting hit by a truck are dependent on how the on call surgeon is feeling?

Yes. The child does not have a right to the surgeon's time. The surgeon is not a slave. If he decides to not treat the child, that is a horrible thing to do yes, but he has complete right to do it.

If you can't pay for a child, don't have one. It's not like children just "happen". Don't make one if you can't support it.

 

[DermViser]

Bull****

Medicare doesn't cover anything and I'm not giving myself end-stage renal disease. It covers literally nothing and I'm sick of it. I'm already paying for it and I'm not satisfied at all.

You're now just being foolish. Medicare covers a lot of ridiculous things. Don't lie and say it covers nothing.

 

[Nidor]

.

 

[DermViser]

http://www.un.org/en/documents/udhr/index.shtml#a1

Article 25.

• (1) Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control.

The rights you are disputing are such a basic part of human dignity and modern society that they where specifically mentioned in the universal declaration of human rights. It is not 'fairness' that you are defending, it is the fundamental belief that right to life itself is bound to merit, it is saying that an 8 year old child with an appendicitis and poor parents doesn't deserve care, it is letting people rot and die.

There's also a law against indentured servitude as well.

 

[Nidor]

.

 

[PL198]

Original signatories: Afghanistan, Argentina, Australia, Belgium, Burma, Bolivia, Brazil, Chile, China, Colombia, Costa Rica, Cuba, Denmark, Dominican Republic, Ecuador, Egypt, El Salvador, Ethiopia, France, Greece, Guatemala, Haiti, Iceland, India, Iraq, Iran, Lebanon, Liberia, Luxembourg, Mexico, The Netherlands, New Zealand, Norway, Nicaragua, Pakistan, Panama, Paraguay, Peru, Philippines, Siam, Sweden, Syria, Turkey,United Kingdom, United States of America, Uruguay, and Venezuela



So a poor child's chances after getting hit by a truck are dependent on how the on call surgeon is feeling?

I'm not a member of our nation's military or government, which I'm pretty sure are the only times the UN declarations our country agrees to are binding in terms of a person's actions. The UN has no authority over my actions. For instance if a war happened in America, I would not be bound by the rules of the various Geneva Conventions. Also I'm quite aware of who makes up the UN....

 

[tdram]

Did the child choose to be born?

Did I choose for the child to be born? Did I have any say in it? Why should I have to pay for the child? You didn't answer my question.

 

[DermViser]

Oldbearprofessor, I'm doing my first rotation in peds at an outpatient clinic and the topic of the medical home came up. All the attendings and residents were against it because even though it sounds good in theory, in practice, it doesn't work well just like most things that are implemented from the top down. They have a social worker who is excellent but the rest of it is just eh. Like people thought that giving patients educational papers at the end of visits would improve care but no one reads those things. I'm a medical student and I just throw them out. And the worst part is that you have to chart that patients received it. So it wastes time, effort and paper for no good reason whatsoever.

@oldbearprofessor, was also talking to his pediatric residents, as if they're really going to tell how they really feel.

 

[Nidor]

.

 

[tdram]

There is no duty in Health Care then?

Does a landscaping service have a duty to maintain everyone's lawn even if you can't afford it? Are we all forced to pitch in to maintain each other's lawns? Healthcare is, at the core, no different.

 

[DermViser]

This is not true, past, present or future. Please avoid personal commentary about me and my medical practice and focus on the discussion about pediatric/primary care motivation.

So then for every uncompensated patient (the illegal immigrant apneic baby - in your example), you're willing to pay for it out of your paycheck or perform your services for free? Yes or No?

 

[Nidor]

.

 

[PL198]

Legally binding perhaps, morally binding is a whole other issue.

I have a moral binding to no one besides myself, just like anyone else. No outside organization can regulate morality.

 

[DermViser]

This is a slippery slope argument (http://www.nizkor.org/features/fallacies/slippery-slope.html). Naturally and unfortunately there is some point where not everybody can be helped, where the line is drawn is for a society to figure out.

The fact that not everybody can be helped is a weak argument to support not helping anyone though

It's a slippery slope argument to consider that your magical level of thinking has actual fiscal consequences?

 

[tdram]

Because that's part of being in a society, if you don't like it, go be independent somewhere on your own. Be sure not to use any of the roads paid for by the community or the primary education you enjoyed compliments of tax payers to get there though.

For your information, I went to a private school and paid full tuition in addition to my parents paying school tax for a public school I never attended. Therefore, the tax payers should actually be thanking me because they made a profit off of me.

As for roads, police, etc. we all pay taxes, myself included. As physicians, we will be paying far more than 99% of the others in the community, so in reality they should be thanking us.

I would be very happy to use private roads, if the government allowed such a thing. Unfortunately they force us to use their roads and pay for them. If you don't want me to use your roads, let me build my own.

 

[Nidor]

.

 

[Nidor]

.

 

[PL198]

You're comparing the grief of a mourning parent to the disappointment about not winning the neighborhood's prettiest lawn competition

Ok, so healthcare is this magical exception, where physicians are expected to bend over their backs for the good of the herd? Show me any other profession like this

 

[deleted480308]

http://www.un.org/en/documents/udhr/index.shtml#a1

Article 25.

• (1) Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control.

The rights you are disputing are such a basic part of human dignity and modern society that they where specifically mentioned in the universal declaration of human rights. It is not 'fairness' that you are defending, it is the fundamental belief that right to life itself is bound to merit, it is saying that an 8 year old child with an appendicitis and poor parents doesn't deserve care, it is letting people rot and die.

the UN deciding you have a right to my services without paying my fees (or by semantics, the right to make me pay someone else to treat you) is no more proof of a right actually existing than the UN deciding everyone has a right to sex with the person of their dreams

no one has a right to someone else's labor/goods

 

[Nidor]

.

 

[DermViser]

Sounds a lot like a specific implementation strategy that isn't working, as the concept is decades old and has been successfully implemented in many places. My point actually in the post in which I originally mentioned it was just to note that the field of general pediatrics is not stagnant or "declining" as had been suggested. Rather innovative approaches to patient care continue to be tried and these have the possibility, when done properly, to improve the world of general pediatrics as well as specialty pediatrics. Do you find that your attendings and residents wish they were not in pediatrics? That's the real question, not the challenges in the implementation of the medical home concept.

If the implementation strategy affects your daily clinical practice then it is a problem. The PCMH model is 1) effectively a gatekeeper and 2) not been shown to REDUCE costs. It's "stagnant" or "declining" (not my words) bc of govt. intervention which has led to the PCMH model in which Pediatricians can't even practice like they want to practice.

 

[el_duderino]

Do you guys consider ER physicians and nurses to be "enslaved" or "indentured servants"? What about police officers and judges?

 

[DermViser]

I can't, that's part of why I choose medicine. 🙂 but gentlemen, even though it has been fun, its getting quite late in my country, we'll continue this some other day.

You should at least put in your avatar location that you're from Belgium so that your comments can be given the appropriate importance accordingly, which is none.

 

[DermViser]

Do you guys consider ER physicians and nurses to be "enslaved" or "indentured servants"? What about police officers and judges?

Do you actually think that ED physicians and nurses are paid directly by your taxes? Really? You actually think that they are public employees/officials like police officers and judges are?

 

[Nidor]

.

 

[deleted480308]

Do you guys consider ER physicians and nurses to be "enslaved" or "indentured servants"? What about police officers and judges?

emtala is absolutely an example of societal slavery...telling a private business they have to provide services without payment is crazy

imagine by analogy a law that farm hands must pick cotton without being able to require payment... <---do you see how insane it is

 

[DermViser]

http://www.nizkor.org/features/fallacies/ad-hominem.html

Nothing ad hominem about my statement at all. Try again.

 

[tdram]

You're comparing the grief of a mourning parent to the disappointment about not winning the neighborhood's prettiest lawn competition

Absolutely. You are adding an emotional component to the matter, which doesn't belong in this argument. Property rights are not decided by emotion. You cannot seize my property without my permission, whether it is to pay for a lawn or a sick kid.

 

[DermViser]

🙂 oh don't be upset, I'm sure you'll get to win some argument again someday.

By showing that you live in Belgium, you proved my argument completely.

 

[el_duderino]

Do you actually think that ED physicians and nurses are paid directly by your taxes? Really? You actually think that they are public employees/officials like police officers and judges are?

Directly? No. The hospital is for Medicaid and Medicare recipients, and the hospital pays the ED staff.

 

[el_duderino]

emtala is absolutely an example of societal slavery...telling a private business they have to provide services without payment is crazy

imagine by analogy a law that farm hands must pick cotton without being able to require payment... <---do you see how insane it is

I think EMTALA is madness, but necessary without major reform making sure everyone has actual coverage. EMTALA would be completely unnecessary if we actually guaranteed all people actual coverage.

 

[DermViser]

Directly? No. The hospital is for Medicaid and Medicare recipients, and the hospital pays the ED staff.

WRONG. Physicians are not obligated to take you bc you have Medicare/Medicaid. Just bc your insurance plan, is a govt. plan that reimburses for services, not salaries, does not make the physician or the nurse, a government employee. No wonder your thinking is so twisted.

 

[tdram]

Directly? No. The hospital is for Medicaid and Medicare recipients, and the hospital pays the ED staff.

No business should be forced to provide goods or services without compensation, regardless of whether it is a pizza shop or an emergency department. That is simply theft of services. The fact that one involves sick people and the other doesn't, does not change the principle behind it.

 

[deleted480308]

I think EMTALA is madness, but necessary without major reform making sure everyone has actual coverage. EMTALA would be completely unnecessary if we actually guaranteed all people actual coverage.

the point is that it is not the role of government to ensure that anybody has anything

 

[DermViser]

I think EMTALA is madness, but necessary without major reform making sure everyone has actual coverage. EMTALA would be completely unnecessary if we actually guaranteed all people actual coverage.

Wrong, it wouldn't bc hospitals/providers are not obligated to take your specific coverage.

 

[oldbearprofessor]

So then for every uncompensated patient (the illegal immigrant apneic baby - in your example), you're willing to pay for it out of your paycheck or perform your services for free? Yes or No?

I've asked you nicely repeatedly not to personalize your arguments and will not continue to discuss this and respond to you if you can't honor that request. I believe that, in this country, all children deserve good health care regardless of the ability of the family to pay and that it is the obligation of the government to ensure that this is provided including appropriate payment to those who provide the care. Whether the children or their parents have legal entry to our country is not, in my view, relevant to this point. I've said the same thing repeatedly in this thread as it is what I actually believe. I realize that some don't agree, but my point relative to this thread is that providing care to those who are indigent as well as advocating for their health care needs, is one aspect of what I, and other pediatricians (but not all of them, of course), like about our field.

 

[DermViser]

I've asked you nicely repeatedly not to personalize your arguments and will not continue to discuss this and respond to you if you can't honor that request. I believe that, in this country, all children deserve good health care regardless of the ability of the family to pay and that it is the obligation of the government to ensure that this is provided including appropriate payment to those who provide the care. Whether the children or their parents have legal entry to our country is not, in my view, relevant to this point. I've said the same thing repeatedly in this thread as it is what I actually believe. I realize that some don't agree, but my point relative to this thread is that providing care to those who are indigent as well as advocating for their health care needs, is one aspect of what I, and other pediatricians (but not all of them, of course), like about our field.

It's not an argument. It was a question.

 

[tdram]

I've asked you nicely repeatedly not to personalize your arguments and will not continue to discuss this and respond to you if you can't honor that request. I believe that, in this country, all children deserve good health care regardless of the ability of the family to pay and that it is the obligation of the government to ensure that this is provided including appropriate payment to those who provide the care. Whether the children or their parents have legal entry to our country is not, in my view, relevant to this point. I've said the same thing repeatedly in this thread as it is what I actually believe. I realize that some don't agree, but my point relative to this thread is that providing care to those who are indigent as well as advocating for their health care needs, is one aspect of what I, and other pediatricians (but not all of them, of course), like about our field.

That is a fine belief to have, but it becomes problematic when it is imposed on others who don't agree. If you and others wish to start a charity to provide good care to every child regardless of the ability of the family to pay, feel free. Get everyone who wants to contribute together and pay for all the sick children. But a law forcing everyone to pay for this care whether they want to or not, is unfair and it is theft.

 

[el_duderino]

WRONG. Physicians are not obligated to take you bc you have Medicare/Medicaid. Just bc your insurance plan, is a govt. plan that reimburses for services, not salaries, does not make the physician or the nurse, a government employee. No wonder your thinking is so twisted.

Are there a lot of hospital EDs that don't accept Medicaid/Medicare? Is this common?

 

[tdram]

Are there a lot of hospital EDs that don't accept Medicaid/Medicare? Is this common?

It's not common but it is also not required. IT doesn't make sense not to accept whatever the patient has because the ED must treat them - that is required.

 

[DermViser]

Are there a lot of hospital EDs that don't accept Medicaid/Medicare? Is this common?

I was talking about physicians IN GENERAL. You insurance plan does not make nurses and providers government employees, contrary to your opinion. Also hospitals are known to patient dump for a reason. Just ask Michelle Obama when she was part of UChicago Medical Center.

 

[el_duderino]

Indeed.

 

[tdram]

the point is that it is not the role of government to ensure that anybody has anything

100% agree. It is an individual's responsibility to acquire what they need.

 

[deleted480308]

I do know a great deal of physicians don't take medicare/aid...a number of friends on it have had trouble finding physicians and some have been dropped recently as they went cash only

 

[el_duderino]

I don't even care about Medicaid/Medicare. Maybe one solution is to expand Medicaid across the board and force physicians to accept it.

 

[deleted480308]

I don't even care about Medicaid/Medicare. Maybe one solution is to expand Medicaid across the board and force physicians to accept it.

how do you suppose it is just to force someone to take payment that they find insufficient? (I'll go ahead and re-mention the idea of government forcing someone to pick cotton for less payment than they want)

 

[tdram]

I don't even care about Medicaid/Medicare. Maybe one solution is to expand Medicaid across the board and force physicians to accept it.

Forcing physicians to accept Medicaid will just lead to more physicians going bankrupt and leaving practice because Medicaid doesn't even pay close to enough to cover the physician's costs. That is a terrible idea. You'll make the problem far far worse.

 

[PL198]

I do know a great deal of physicians don't take medicare/aid...a number of friends on it have had trouble finding physicians and some have been dropped recently as they went cash only

If I could somehow have a cash only practice, I'd literally cry myself to sleep in happiness every night. If I could somehow a cash only rads practice, I'd probably go mentally insane in happiness and disbelief because things that good are more rare than winning the lottery.

 

[el_duderino]

Forcing physicians to accept Medicaid will just lead to more physicians going bankrupt and leaving practice because Medicaid doesn't even pay close to enough to cover the physician's costs. That is a terrible idea. You'll make the problem far far worse.

Sounds like NPs and PAs will be happy to pick up the slack.

This is where DermViser's head explodes.

 

[tdram]

Sounds like NPs and PAs will be happy to pick up the slack.

This is where DermViser's head explodes.

I'm perfectly fine with NPs and PAs providing lower cost services to patients who can only afford that much. What bothers me is when the government mandates (as it has in Oregon) that NPs must be paid the same as physicians for the same services.