Let's Talk About Health Care!

Off Topic Politics and World Issues
41

[quote]MaximusB wrote:
heavythrower wrote:
MaximusB wrote:
heavythrower wrote:
MaximusB wrote:
heavythrower wrote:
MaximusB wrote:
If you thought Emergency Rooms were busy now, it’s going to get worse I bet.

just in the last 3 years, I have seen a DRAMATIC increase in ED traffic. due to dwindling reimbursements(read money) for healthcare means fewer hospitals, fewer private doctors, which means the hospitals that are still open are more busy.

not just sick people, but EDs are a dumping ground for law enforcement, mental health agencies and nursing homes who dont have the resources to deal with people with medical, or social or psychological issues.

jails used to have drunk tanks, medical facilities with a small staff, now if you are arrested, and get the hiccups, you end up in the ED cause the jails dont want the liability. not much of an exaggeration.

i could tell you how fucking easy it is to avoid going to jail in this state, and get a “free” trip to the ED. just say the magic words: “chest pain” or “i feel like i am a danger to self or others” boom, handcuffs off, your in the Emergency room.

at any given time in our 35 bed department, we have people waiting 12-48 hours taking up a valuable room needed for really sick patient waiting for mental health placement. now these often are NOT foaming at the mouth lunatics, but somebody who got drunk or high, made an ass of themselves in public or at home, and some good Samaritan or family member calls 911,

they say they are depressed, made a couple of superficial scratches to their wrists that dont even need a bandaid, and BOOM! all night stay in ED while mental health tries to place them in THEIR underfunded overburdened system. it is INSANE.

Recently, a woman here in Los Angeles, went to the ER because she complained of having horrible pain in her abdomen. She called 911 from the ER waiting room, and the operator told her she couln’t help her since she was already in a hospital.

The woman made so much noise, the police were called, and dragged her out onto the sidewalk, where she died. She had peritonitis, which is very deadly, trust me I know I had it.

The ER charge nurse resigned while the police who dragged her out were put on leave during the investigation. Because of this, Martin Luther King Jr./ Drew Hospital has been shut down. The entire hospital is no longer open.

that was a well publicized incident that made national news, your point being?

If perhaps the ER wasn’t so incredibly busy, they might have been able to tend to her promptly, SO SHE WOULDN’T HAVE DIED. I am rather shocked that you missed this.

take it easy, i assumed since it was such a well known incident and discussed ad-nauseum in various media, that you had some angle or particular aspect of the case that you wanted to present to make a larger point. I dont shock so easy. i see death every day.

people die in front of me on a weekly basis. people drive up to the ED with their dead parents/grandparents in their car and still in their soiled pajamas. i see people crushed to pieces in horrible MVCs and shot and stabbed to hell all the time. i see young healthy college students who were playing soccer the day before come into the ED with septic meningitis and are dead in 48 hours.

i bet if i could get a hold of the details of that case(just a guess) especially the persons med hx and what other things were going on in that ED on that day, i bet the story would be a little different than how the media played it.

This is not a situation of someone being mangled or stabbed. That has no relevance in this situation. The way she was treated was a fucking disgrace, she died while laying down on a sidewalk outside an ER,after trying to get treatment.

You don’t see something wrong with this? This is ok to you? Her medical history was such that it made a charge nurse decide to resign before any investigation even began. That right there tells you something wasn’t right, and the patient is only being a patient.

What in her medical history would justify someone leaving her alone like that? Vomiting blood is not an indicator of some really bad shit going on? This probably won’t hit you, until it hits you. Until it’s you who needs the help only to be blown off, will you realize how bad it can be. I have seen this shit all the time while being in the ER, it’s pathetic. [/quote]

ok this is the part you get personal with the insults to me(as usual on an internet board) and i have to spank you and let you know youdont know what the fuck you are talking about. somebody dies in an emergency room. happens all the fucking time. when i have worked at HUGE facilities in the bay area, at any given time there would be half a dozen people laying in their own vomit/urine/feces on the floor unconscious. what? we are supposed to call a code blue and respond with a whole team for every one of them, when there are ALREADY 60 patients with the SAME FUCKING PROBLEM already in the department(that only has 40 beds, and we are stacking people up in the hallways on gurneys and wheelchairs).

she was vomiting blood? really? did you see the “blood”? the charge nurse resigned? no shit?? wow! it must be because she is really incompetent, NOT that due to the broken and failed and overburdened system that she has been put in an untenable situation, no? i would NEVER, NEVER take a charge nurse or triage nurse position in a ER. in those positions, you are responsible for EVERY single patient in the lobby and in the department. do you have any fucking concept of what that means?

you have a lobby full of screaming complaining people, 90% are complete bullshit, 8% are sick, but dont need EMERGENCY care at all though, and maybe, maybe 2% are real emergencies.
abdominal pain, is one of the more tricky ones to deal with. we are trained to treat ALL abdominal pain as an emergency until proven otherwise. but, SO many people come to the emergency room with “the worst stomach pain ever” screaming and having a fit, we do a 10,000 dollar workup that includes comprehensive labs and imaging, and we usually dont find shit.

point? well, if we rushed everyone who falls out in the lobby screaming in pain on a busy night, well, we would see nobody else. we have to use our judgment, because despite what we are trained to do(treat all abd pain as an emergency until proven otherwise) it is not possible. see mufasa’s post on CHANGING EXPECTATIONS.

I am willing to bet one of my testicles, that the patient in this case came to the emergency room all the fucking time with similar complaints, and also had a mental health history. that staff probably rushed her in dozens of times ahead of others thinking it was a real emergency and been BURNED so often they quit taking her seriously. though it is not politically correct, and wont protect you from a lawsuit in this overly litigious society, in the REAL world, you can cry wolf one too many times and it will cost you.

back to the “vomiting blood” thing. like i said, i would have had to be there. you know how many times i hear that complaint? when i finally do see the actual emesis, there might be a spot or two of red in it, hardly what was described and NOT an emergency at all.

here is what happened recently at the facility i work at now. a typical hysterical idiot comes in with complaint of vaginal bleeding. she was well know to us, often coming in with, you guessed it, c/o ABDOMINAL PAIN(cue thunder and lightening and scary music), which we did the huge multi-thousand dollar workups and found nothing. well this time she came in with abd pain and vaginal bleeding. triage found vital signs to be good, and she appeared non-toxic(good skin signs, etc.) she was triaged at a low acuity on a very very busy day and had to wait for a long time in the lobby. she eventually threw herself on the floor, and then left. some other patients called the local news, saying we ignored a lady screaming in pain and “laying in a pool of her own blood” the local media showed up, took some video of the TWO TINY DIME SIZED SPOTS OF BLOOD on the floor where i guess her tampon leaked when she lied on the ground, an ran with it. we got tons of bad press, and when this pinhead came back in to the department we had to roll the red carpet out for her and jump her to the front of the line ahead of other patients. guess what the final workup revealed? NOTHING!!! just a heavy period.

we are expected to be perfect in a totally fucked up over burdened overwhelmed and abused by the public system. though tragic, mistakes like the one that you referenced happen, and will happen more and more as the system breaks further.

your right, pathetic, but on levels you dont fully understand as a layperson(not in the field). that is why i started this thread, to try to shed some light on what is really going on, NOT to be preached to by you.

42

[quote]tom63 wrote:
belligerent wrote:
Why are most medical professionals so health illiterate?

They’re not, they deal with an extreme of health a serious disease or injury state. Most docs know about fiber, better diets, and exercise. It’s just that the patients don’t want to listen. do you seriously think that we have all of these fatasses because of doctors? they don’t advocate candy, smokes, liquor, and laying on the couch.[/quote]

very good post tom. the public has been taught by the drug companies that whatever the problem, just go to the doctor and he will give you a magic pill that will fix it. if you can afford the pill, then no other effort is required of you. but we know that is not really the case.

i cant tell you how often we see patients that when we go through their medical history, they are on dozens of medications, literally 20-30 different ones. pretty much every time that person went to a doctor, they just added a medication. sometimes the doctors dont really think another med is needed, but the public has been taught to expect drugs when they see a health care professional, and if something is not prescribed, the dont feel they got their moneys worth.

43

[quote]thunderbolt23 wrote:
One possibility to counter the built in costs of legal insurance: change the standard for medical malpractice from “negligence” to “recklessness” - as in, merely negligent behavior that results in harm is not actionable.

I do not necessarily endorse this proposal - it was suggested by someone I know. I offer it up as food for thought - if doctors know that they are legally insulated from malpractice claims until a higher standard of carelessness is satisfied, it frees up unnecessary tests and reduces the cost of insurance.

On the other hand, victims aren’t compensated for negligent behavior on the part of doctors.

Is it worth the trade-off?[/quote]

good question. that is a tough one. one of the best doctors i work with USED to be a very good clinician, and was good at doing appropriate testing for the stated problem, until had a bad outcome, and got reviewed, and now has a lawsuit pending. NOW, he does a FULL workup on EVERYBODY. somebody comes in with sinus congestion, he orders a CAT scan of the head and about a million different labs. he has gotten so out of control, other doctors have talked to him, but he wont back down. he is determined never to get sued again, no matter what the cost to the system.

44

There is a common misconception that the health-care industry is completely profit driven. This is very far from the truth. Actually, the majority of hospitals in this country are not for profit. There is also a large number (possibly a majority, I can’t find any statistics) of mutual insurance companies offering health plans. While in no way do I reject the idea of a for-profit insurance company, I personally would not purchase any insurance product from any company other than one that is mutually owned and operated.

Health care in this country has been on a downhill spiral since the 60’s when LBJ added Medicare and Medicaid to another atrocity of a piece of legislation known as the Social Security Act. I have a number of ideas to straighten things out that all eventually revolve around dismantling these three schemes.

heavythrower does make a good observation that is rarely discussed. Like in many aspects of our society, Americans have a sickening sense of entitlement when it comes to health care, and this is only being perpetuated by our current administration. I would hate to see a world where the government decides how much money another week, day, month, or a few years is worth, but this is still an issue that the individual and their families must discuss. Preferably long before one gets sick. This is something that should be carefully considered when purchasing an insurance product and/or a prescription plan. Just like any other technology, if you expect to receive the latest and greatest treatment and medicines, you better have the means to pay for it. This can all be taken care of beforehand and discussed with your health provider. Some plans only allow for generic prescriptions, while others will provide you with the latest and greatest, but there is a substantial cost difference. This should not be a surprise to anybody, but I’ll present my idea to make the best technology more available to everyone later on.

The first thing that needs to be done before phasing out medicare, medicaid, and ultimately social security also is to allow interstate commerce for health insurance, for a simple reason. If we want a free-market system, we can’t put artificial constraints on competition.

The second measure is to tax health benefits. This is one area where many insurance companies are lobbying and acting solely in their self-interest. The employer-based system simply adds a middleman to the equation that hides the true cost of insurance for the individual. If we ultimately want prices to be reduced, we must ensure that insurance companies are working for the individual, and that the cost of the policy accurately reflects the risk that it is covering. This is not the case in group policy’s in which the young and healthy subsidize the unhealthy.

This brings up another point. Health-care providers frequently overcharge. We as consumers, don’t typically have a good idea of what services should cost. Insurance companies do, and frequently negotiate with providers to lessen prices, thus helping both the insurance company (and therefore all of the company’s policy holders in the case of a mutual company) and the consumer. This is a good thing but it is only necessary because of the lack of transparency between the health-care provider and the consumer. A world full of bureaucracy will do that to you.

The third thing we must see is a reduction of lawsuits, aka tort reform. Malpractice insurance is getting astronomical for doctors. heavythrower has thrown out numerous examples of blame being placed on physicians. He did not mention if this led to lawsuits, nor if the plaintiff actually won the lawsuit. I think one simple way to bring down these lawsuits is to require the patient to pay the doctors attorney fees should the judge rule in favor of the doctor. This in and of itself would substantially decrease the number of frivolous lawsuits and likely many that simply revolve around negligence. We could get into another very lengthy discussion on tort reform, but it admittedly isn’t of as much interest to me. BTW TBolt, currently in cases involving negligence without recklessness punitive damages are not awarded. In the case of negligence awards cannot exceed the cost of expenses, care, and missed work. I am ok with this, so long as the current system is not abused.

Finally, with the repeals of medicare and medicaid, and a reduction of employer-based insurance, I would like to see a lifetime insurance product. Basically it would work similar to a life insurance insurance policy in that you purchase it at an early age, pay monthly or yearly premiums at a fixed rate, and you are insured for life. Being that the premium is fixed, the policy would carry a cash value. Part of the premium would cover risk for that time period and part of the premium would add to the cash value, just like life insurance. As a result, we would pay a little more while young (actually probably less than we do now, more later), but would have the guarantee of being covered later. The cash value would also allow for one to maintain coverage for a period of time if payments cannot be made, so long as the current cash value can cover the risk for the oncoming period.

This product would prevent people from being uninsurable because of pre-existing conditions. The product would allow for riders so that dependents can be added at birth. With the money that we would save from medicare/medicaid and the subsiding in group policies, payments should actually be less at a young age. There are of course more details that would have to be addressed, namely covering the elderly once medicare is gone, but this would provide a long-term solution. I would propose a phase out period of medicare for those that have contributed for a certain time period to ensure that they get some benefit. For other’s close to my age, we would simply lose everything we have put into the system, but in the long run it would be more than worth it.

45

i like a lot of what you are saying tedro. the sense of entitlement is quite sickening as you stated. how often does a patient come into my department, who wants free prescriptions because he cannot pay for them, yet smokes cigarettes every day, and tests positive of pot on a drug screen? cigs and weed he has money for, but not for antibiotics that might save his life?

some of the cases i mentioned are still pending, do not know the outcome yet. i do feel a sense of irony that while we have trillions to spend on a “war” that the vast majority in this country do not support, yet we are letting our nation’s infrastructure crumble and cannot care for our sick.

also, you mentioned the disparity of a supposed “free market system” that has artificial(government) mandated restraints. very good point. we are forced to treat and test everbody to a certain standard by government, but we do not have the same protections that a government entity has. in other words, if we are forced by the government to see everybody regardless of risk management, then we ought to have the same protections that a federal entity has against lawsuits/liability.

46

Heavy…good posts.

I just want to add: profit is not a bad thing.

Oh and: The current UHC bill will only make your situation worse.

47

Again…great thread, guys…!

Mufasa

48

What do you mean by sense of “entitlement”…I work hard for my insurance. Everything I do goes through my Primary care… I expect to be able to get an appointment within 2 or 3 days of calling and to see a specialist when needed…is that too much? Or are you speaking just of ER’s?

The only way I can think of to fix ER’s is to CHARGE people something that approaches the actual cost of service.

And what is an ED?

49

The most cost effective way to strengthen the health care system is through preventive medicine. It is well past the time for governments to start educating the general masses on personal health care. This needs to be started at the preschool entry level and continue right through secondary schooling.

The government needs to give tax brakes to companies that start fitness programs. Companies that sell unhealthy products need to be taxed. Such as fast food and tobacco companies.

So much of the strain is also through the abuse of the system. The penalties for medical scams needs to be far more sever.

Solving the problems is not so much the problem as finds those willing to make it happen. There is far to much money being made through sick people than healthy at the moment. There can be just as much money made through healthy people but not enough is being invested in this style of living.

The way the systems, not just the medical but the entire system is being governed is wrong. Unfortunately most governments are afraid of what a healthy educated population is capable of doing. Can you imagine what a proactive population would accomplish, everyone healthy and active. Not sitting around being brain drained by the media but actually out there doing things that will make themselves and their country a stronger and a healthier place to live. Blasphemy how could I think such thoughts. Giving power to the people, blasphemy!

50

[quote]Valor wrote:
What do you mean by sense of “entitlement”…I work hard for my insurance. Everything I do goes through my Primary care… I expect to be able to get an appointment within 2 or 3 days of calling and to see a specialist when needed…is that too much? Or are you speaking just of ER’s?

The only way I can think of to fix ER’s is to CHARGE people something that approaches the actual cost of service.

And what is an ED?[/quote]

“ED” is an “Emergency Department”.

There hasn’t been just a “room” for emergencies since perhaps the 50’s and 60’s.

Mufasa

51

Two questions: (1) Must a man go to prison if he doesn’t want to pay for someone else’s health care?

(2) What if doctors mind take orders from flunky bureaucrats?

52

[quote]engerland66 wrote:
I’m in med school at the moment, and to sum things up, a lot of my fellow students are thinking along these lines:

I’m graduating with $200k debt, why would I enter family medicine when I could stay on for a few more years and get to:

  • learn more about a particular specialty (aka…nearly master a part of the body…a big motivational factor for us geeky types)
  • perform procedures so that my day isn’t completely routine visits
  • and most importantly, make more money to pay off this debt and work less hours (on average)

Altruism brought a lot of us here, but to ignore the fact that healthcare is a business is foolish. Perhaps realigning incentives to reward those who choose to enter family medicine or other first-line fields is a way forward as the demand increases. But, the way things stand now, entering those fields doesn’t make a lot of sense for the majority of future doctrs.

[/quote]

Let’s also look at the other end of arc of a medical career.
About 75% of medical care is provided in private arrangements, outside of Universities and government Clinics.
Let’s suppose that a large number of docs, some with 25 or more years of experience are looking at the following:

  1. On Jan 1, 2010, the reimbursement on MediCare will be cut by 20% (Yes, this is a fact.)
  2. Some specialties will see a further cut of 8%, due to rotten survey of provider’s costs. Insurance tends to follow MediCare’s lead in cutting back on compensation.
  3. In my zipcode, for example, elderly women can no longer find gynecologists willing to take on new MediCare patients. Other specialties may follow.
  4. In some communities, there is a rising number of internal medicine docs who are contracting their practices; they have established themselves as “concierge” or “VIP” practices in which the patients pay a $1500 surcharge, just for the standard meticulous care that used to be provided as routine.
  5. There is a new specialty, “hospitalists,” because internists, who have abandoned the care of their patients in hospitals because compensation is so poor. Hospitalists, who do not care for the same patients outside the hospital, whose chief obligation to the hospital is to get MediCare patients out earlier, can save a medium sized community hospital $80 million per year. So there is economic drive to have disjointed care, and earlier discharges, all of questionable benefit.
  6. Now suppose that the tax rates are changed. We are not talking about just a 4% increase in the top marginal rate on the Federal Income tax. There will be a removal of the ceiling on MediCare tax (add 6 +%), increased self-employment and social security taxes, and many states will increase their state income taxes by the end of this year.

Ok.
Now suppose these doctors are faced with these pressures–and ObamaCare becomes law–why would experienced and highly productive professionals choose to work marginally harder ? WHy would I stay at work 3 hours longer for a sick older patient, when the effort is so poorly compensated? If the effort is taxed so high, how many producers will stay in the game, or cut back to go golfing?
If enough doctors so decide, can the collapse of MediCare, or even of standard medical insurance, be far off? It is hard to come up with replacements for well-trained and experienced workers.

(So, engerland, if you think that one “gains mastery” of a specialty, I can assure you that it takes more than 6 or 12 years of post-graduate medical training. It takes a lifetime. )

Society has jiggered the rules, and these rules now express how low it values experience, effort, and the individuation of care for our sick and elderly. Even professional altruism must have its limits, and I worry that a shrinking number of experienced docs will not be able to provide even the same level of care in the very near future.

53

[quote]Headhunter wrote:
Two questions: (1) Must a man go to prison if he doesn’t want to pay for someone else’s health care?

(2) What if doctors mind take orders from flunky bureaucrats?[/quote]

To answer #1, I would say perhaps. I met a guy who stole an endangered species plant on an Indian Rservation and was put in minimum security prison. He was given only 6 weeks, but we all laughed at him.

54

[quote]DrSkeptix wrote:
engerland66 wrote:
I’m in med school at the moment, and to sum things up, a lot of my fellow students are thinking along these lines:

I’m graduating with $200k debt, why would I enter family medicine when I could stay on for a few more years and get to:

  • learn more about a particular specialty (aka…nearly master a part of the body…a big motivational factor for us geeky types)
  • perform procedures so that my day isn’t completely routine visits
  • and most importantly, make more money to pay off this debt and work less hours (on average)

Altruism brought a lot of us here, but to ignore the fact that healthcare is a business is foolish. Perhaps realigning incentives to reward those who choose to enter family medicine or other first-line fields is a way forward as the demand increases. But, the way things stand now, entering those fields doesn’t make a lot of sense for the majority of future doctrs.

Let’s also look at the other end of arc of a medical career.
About 75% of medical care is provided in private arrangements, outside of Universities and government Clinics.
Let’s suppose that a large number of docs, some with 25 or more years of experience are looking at the following:

  1. On Jan 1, 2010, the reimbursement on MediCare will be cut by 20% (Yes, this is a fact.)
  2. Some specialties will see a further cut of 8%, due to rotten survey of provider’s costs. Insurance tends to follow MediCare’s lead in cutting back on compensation.
  3. In my zipcode, for example, elderly women can no longer find gynecologists willing to take on new MediCare patients. Other specialties may follow.
  4. In some communities, there is a rising number of internal medicine docs who are contracting their practices; they have established themselves as “concierge” or “VIP” practices in which the patients pay a $1500 surcharge, just for the standard meticulous care that used to be provided as routine.
  5. There is a new specialty, “hospitalists,” because internists, who have abandoned the care of their patients in hospitals because compensation is so poor. Hospitalists, who do not care for the same patients outside the hospital, whose chief obligation to the hospital is to get MediCare patients out earlier, can save a medium sized community hospital $80 million per year. So there is economic drive to have disjointed care, and earlier discharges, all of questionable benefit.
  6. Now suppose that the tax rates are changed. We are not talking about just a 4% increase in the top marginal rate on the Federal Income tax. There will be a removal of the ceiling on MediCare tax (add 6 +%), increased self-employment and social security taxes, and many states will increase their state income taxes by the end of this year.

Ok.
Now suppose these doctors are faced with these pressures–and ObamaCare becomes law–why would experienced and highly productive professionals choose to work marginally harder ? WHy would I stay at work 3 hours longer for a sick older patient, when the effort is so poorly compensated? If the effort is taxed so high, how many producers will stay in the game, or cut back to go golfing?
If enough doctors so decide, can the collapse of MediCare, or even of standard medical insurance, be far off? It is hard to come up with replacements for well-trained and experienced workers.

(So, engerland, if you think that one “gains mastery” of a specialty, I can assure you that it takes more than 6 or 12 years of post-graduate medical training. It takes a lifetime. )

Society has jiggered the rules, and these rules now express how low it values experience, effort, and the individuation of care for our sick and elderly. Even professional altruism must have its limits, and I worry that a shrinking number of experienced docs will not be able to provide even the same level of care in the very near future.
[/quote]

excellent post and very good points you bring up. we have a hospitalist program here where i work, and most of them are actually were once family practice/internal medicine doctors who had private offices in the community before. but with more and more cutbacks in reimbursements, they found they could no longer afford the high overhead of running there own businesses, and decided to punch a clock for the hospital instead.

the result? they saved money, but as you stated there is no continuity of care. once discharged form the hospital with whatever medical problems and drug regimens, there is nobody in the community for them to follow up with. these patient usually end up back in the ED with the same problems.

55

[quote]DrSkeptix wrote:
engerland66 wrote:
I’m in med school at the moment, and to sum things up, a lot of my fellow students are thinking along these lines:

I’m graduating with $200k debt, why would I enter family medicine when I could stay on for a few more years and get to:

  • learn more about a particular specialty (aka…nearly master a part of the body…a big motivational factor for us geeky types)
  • perform procedures so that my day isn’t completely routine visits
  • and most importantly, make more money to pay off this debt and work less hours (on average)

Altruism brought a lot of us here, but to ignore the fact that healthcare is a business is foolish. Perhaps realigning incentives to reward those who choose to enter family medicine or other first-line fields is a way forward as the demand increases. But, the way things stand now, entering those fields doesn’t make a lot of sense for the majority of future doctrs.

Let’s also look at the other end of arc of a medical career.
About 75% of medical care is provided in private arrangements, outside of Universities and government Clinics.
Let’s suppose that a large number of docs, some with 25 or more years of experience are looking at the following:

  1. On Jan 1, 2010, the reimbursement on MediCare will be cut by 20% (Yes, this is a fact.)
  2. Some specialties will see a further cut of 8%, due to rotten survey of provider’s costs. Insurance tends to follow MediCare’s lead in cutting back on compensation.
  3. In my zipcode, for example, elderly women can no longer find gynecologists willing to take on new MediCare patients. Other specialties may follow.
  4. In some communities, there is a rising number of internal medicine docs who are contracting their practices; they have established themselves as “concierge” or “VIP” practices in which the patients pay a $1500 surcharge, just for the standard meticulous care that used to be provided as routine.
  5. There is a new specialty, “hospitalists,” because internists, who have abandoned the care of their patients in hospitals because compensation is so poor. Hospitalists, who do not care for the same patients outside the hospital, whose chief obligation to the hospital is to get MediCare patients out earlier, can save a medium sized community hospital $80 million per year. So there is economic drive to have disjointed care, and earlier discharges, all of questionable benefit.
  6. Now suppose that the tax rates are changed. We are not talking about just a 4% increase in the top marginal rate on the Federal Income tax. There will be a removal of the ceiling on MediCare tax (add 6 +%), increased self-employment and social security taxes, and many states will increase their state income taxes by the end of this year.

Ok.
Now suppose these doctors are faced with these pressures–and ObamaCare becomes law–why would experienced and highly productive professionals choose to work marginally harder ? WHy would I stay at work 3 hours longer for a sick older patient, when the effort is so poorly compensated? If the effort is taxed so high, how many producers will stay in the game, or cut back to go golfing?
If enough doctors so decide, can the collapse of MediCare, or even of standard medical insurance, be far off? It is hard to come up with replacements for well-trained and experienced workers.

(So, engerland, if you think that one “gains mastery” of a specialty, I can assure you that it takes more than 6 or 12 years of post-graduate medical training. It takes a lifetime. )

Society has jiggered the rules, and these rules now express how low it values experience, effort, and the individuation of care for our sick and elderly. Even professional altruism must have its limits, and I worry that a shrinking number of experienced docs will not be able to provide even the same level of care in the very near future.
[/quote]

Thanks for that insight. Do you think it is likely that more doctors are going to stop accepting medicare/medicaid once reimbursements drop even further?

56

Obama JUST spoke the truth!

Listen carefully…he promises greater “Inefficiencies”!

57

[quote]Rockscar wrote:
Obama JUST spoke the truth!

Listen carefully…he promises greater “Inefficiencies”!

VIDEO: Obama's gaffe - POLITICO [/quote]

That is change I can believe in.

And yes, he can.

58

Heavythrower-

My fiance is a APN (worked ER, ICU at Hopkins) and I think she agrees with almost everything you said, especially the treatment cost for people at the end of life–insane waste of resources.

One discussion she and I have is what does health care cost. Medicare does post what they will pay for items, but what if I want to now what the cost of a blood panel from my Family Practioner…I asked my Family Practioner this and she didn’t have a clue. I think step one is to publish what things cost. Step two is to remove the idea of free health care.

I think the trick to all of this is to produce a little competition between medical providers by making them tell patients what things cost up front-so patients can be responsible consumers. And second make everyone pay something–a percentage of what things actually cost–for their procedures. If you make people pay something for their health care they will shop around (because they will know what things cost, reducing cost) and they will not show up at the ED for stupid shit or ask for unreasonable life extending procedures at the end of life (reducing strain on the system). It is a free market idea.

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Heavythrower-

My fiance is a APN (worked ER, ICU at Hopkins) and I think she agrees with almost everything you said, especially the treatment cost for people at the end of life–insane waste of resources.

One discussion she and I have is what does health care cost. Medicare does post what they will pay for items, but what if I want to now what the cost of a blood panel from my Family Practioner…I asked my Family Practioner this and she didn’t have a clue. I think step one is to publish what things cost. Step two is to remove the idea of free health care.

I think the trick to all of this is to produce a little competition between medical providers by making them tell patients what things cost up front-so patients can be responsible consumers. And second make everyone pay something–a percentage of what things actually cost–for their procedures. If you make people pay something for their health care they will shop around (because they will know what things cost, reducing cost) and they will not show up at the ED for stupid shit or ask for unreasonable life extending procedures at the end of life (reducing strain on the system). It is a free market idea.

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[quote]BigJawnMize wrote:
Heavythrower-

My fiance is a APN (worked ER, ICU at Hopkins) and I think she agrees with almost everything you said, especially the treatment cost for people at the end of life–insane waste of resources.

One discussion she and I have is what does health care cost. Medicare does post what they will pay for items, but what if I want to now what the cost of a blood panel from my Family Practioner…I asked my Family Practioner this and she didn’t have a clue. I think step one is to publish what things cost. Step two is to remove the idea of free health care.

I think the trick to all of this is to produce a little competition between medical providers by making them tell patients what things cost up front-so patients can be responsible consumers. And second make everyone pay something–a percentage of what things actually cost–for their procedures. If you make people pay something for their health care they will shop around (because they will know what things cost, reducing cost) and they will not show up at the ED for stupid shit or ask for unreasonable life extending procedures at the end of life (reducing strain on the system). It is a free market idea.[/quote]

We more or less have that in Austria and nobody gives a fuck.

Either you pay yourself, then you shop around, or you don’t, then you don’t.