EMERGENCY MEDICINE
I don’t think the public, or the government, really cares. Kind of sad. Good questions but for those of us in hospital-based practices (I’m in the ER) the last 2 questions are not even an option. Family Medicine
FAMILY MEDICINE
Private practice is not dying. It died a while ago. Insurance types have made sure of that. The future is with groups and subsidized clinics, run by people who can deal with the parasites which are entrenched in American medicine.
CARDIOLOGY
It does help to talk with patients. I have been doing that, and many of them are unaware of the impact of this legislation that has been rammed down our gullets. Have changed a few opinions. Several have even stated that they are sorry they voted for Obama.
NEUROLOGY
EMERGENCY MEDICINE
INTERNAL MEDICINE
This is a major change in how our country works. It is unreasonable to expect that the first round of legislation regarding this healthcare reform will be perfect. As with any major socio-economic program, it will require multiple adaptations and improvements. How many more decades were we going to wait before embarking on this major undertaking together? Rather than bash this legislation, those that are not pleased should constructively offer their recommendations so that all can benefit.
1. The coverage of the tens of millions of so-called ‘uninsured’ may somehow result in greater sympathy of (or at least empathy with) MD’s problems, most outstandingly need for medical reform.
2. The prospective need for billions/trillions more $ for O’care may impel not only recission of the much-maligned tax-cuts-for-the-rich of the Bush era but also the salutary improvements of:
2a. Implementation of much-needed taxation of lower-income Americans who now pay nothing (but get loads of gov’t benefits), e.g Nat’l Sales Tax &/or VAT (like in Europe);
2b. A rationalization & modernization of our present antiquated general tax -&-spending structure, e.g.:
>Presidential line item veto &/or impoundment of expenditures (desired by every US Prez since US Grant);
>’Sunset’ laws for phasing out of antiquated &/or ineffectual Gov’t programs (supported even by Lib-Left Democratic 1972 Prez candidate Sen George McGovern);
>Recission of the silly Constitutional prohibition against Export Taxes,
>Ending (or minimizing) the ‘double-taxation’ of dividends,
>Decreasing (or even eliminating) capital gains taxes,
>Phasing out agri-subsidies for domestic rice, sugar & tobacco growing (while buying more of same from those tropical 3rd world countries to whom we now send ‘foreign aid’ in the form of graft & armaments),
>Getting rid of all excise & other special taxes (e.g. Fed tax on gasoline) in favor of aforesaid NST &/or VAT. I could go on but ’nuff said for now!
We will be broke… in 7 years… and will have to start all over… Will we be able to pick up the pieces from whats left… Capitalism is dead… the wrong people are in control of health care… Government allowed the drug makers to charge whatever they wanted… because we had insurance… We give an 80 yo quadruple bypass to live another 4 years. We give every vaccine that comes out… We try the new flavor of the month in allergy meds… Patients demand that they are entitled to every procedure because they do not pay for it…
Its over… We all need to have a drink… and toast the good ole days…
The cardiologist above better go read Robin Hood one more time…. Because he is in fantasy land…
An electrician came to my house for a repair… and handed me his card.and I quote.. “I will come any time day or night… but you might not want to pay me what I charge to come out at 2 AM” Where does this sound unreasonable? Do you as a cardiologist want to run to the hospital and put in a balloon pump… when your wife is delivering your child via c-Section.. YOU ARE A DOCTOR…. and you were trained on someone else’s expense? and you are not entitled to a life? or at least get paid to do it? You mean you are not deserving of being paid more than some Wallstreeter… who traded some stocks today?
And as for the promise of “information technology”, this is going to be just another tax on physicians activity, profitable for the database designers, but not physicians, until some breakthrough actually facilitates greater efficiency for the physician, not just the statisticians monitoring the “evidence”. I spent much of the day reviewing the proposed requirements for an electronic health record to be “certified”, so its use qualifies a physician for the government subsidy. Improved physician efficiency is not one of them.
Sorry to be such a pessimist. Perhaps if the debate now raises the real issues, the appropriate answers may become apparent.
We are the physicians and we need to promote the quality of care our patients deserve and we know how to give. We can wine and grovel and push back but that is not the right thing to do because this bill provides the access to care for millions of people that could not access it before. It is a great opportunity to get it right, but, we have to take the reigns and deliver what we know is the right thing to do.
For everyone’s sake, let’s make this work. Let’s pull it away from the POLs. If we go along with the political “bull” we will get what we promote and it won’t be pleasant.
No one cares about docs, because they no longer value us as anything more than the puny copay they pay the front desk. Docs have done this to themselves by allowing third parties to dictate control of their practices.
Strikes will only make us even more of a villain.
If everyone would just get a backbone and opt-out of all third party plans, and deal directly with patients, we would once again be respected and valued. If not then get used to Obamacare, as it slowly and methodically crushes our profession.
MillionMedMarch
FAMILY MEDICINE
2. Subsidized care. Model where hospitals or the government owns the practice.
Reimbursement will fail to adequately compensate physician movement into primary care—it will ultimately fail as the next generation of physicians decline to pursue this tract. Extenders appear to be the government’s plan to provide this service.
As overhead continues to increase and fees are minimized by the third-party payers, the era of private practice has passed. The exception will be markets where the populace can afford private-care outside of the main-stream model.
(Presently), in the fee-for-service model, the average primary care physician provides about $2mil in down-stream revenue to a hospital system. They are the only player in the current system that can afford to pay physicians. However, the question in my mind is whether it will be in the hospital’s interest to employ the physician; or, if the government will so control the delivery of care that physicians are necessitated to work for the government directly.
“Most bad government has grown out of too much government”
“Government big enough to supply everything you need is big enough to take everything you have … The course of history shows that as a government grows, liberty decreases”
I’m all for providing low cost health care to those who do not have it-especially the children, but just look to Tricare or the VA system to see that government cannot do it right.
1. Employed by another medical group or physician.
2. Works for a HMO as a low paid employee.
3. Academic physician on salary working for a University.
4. Retired physician who feels guilty about his/her success from the prior practice of medicine.
Emergency Physician in (horrors) Massachusetts
Hysterical FOX NEWS type comments on this matter have no substance!( like almost on everything else)
We hire well, pay decently and have decent benefits for our ancillary staff of seven. We have been on an integrated practice management/EHR system for > 16 years, mostly because it took up the least amount of space in our tiny original office.
We DO NOT outsource our billing, maintain contracts with institutions that perpetually screw us, or take our reputation with our patients lightly.
What is our secret? We make all of our decisions based on whether or not we can live with ourselves while making a living, and we do not expect illness and disability to make us rich. Consequently, we enjoy the privilege of what is still the most powerful force in all of medicine, the good will of the people we serve and the staff we work with. Our patients and staff want to see us succeed so we will be around a long time to share their lives.
Call me idealistic, it’s been said before, but through ups, downs and dire predictions, I still have seen nothing that threatens any MD’s power to choose their response or to care about how they do things. It is a very hard choice, however, when everyone, including your colleagues, is telling you the sky is falling and you should run for cover. Don’t get me wrong, “The System” is an absolute mess. It rewards the wrong things and holds no one truly accountable. And the blame can be shared by all of us.
Truth is, the sky is always falling, but the essential nature of what goes on behind an exam room door never changes…unless we let it.
What do you think of this? There are 19 doctors in the House of Reps, and several in the Senate.
Obama is not the enemy, the insurance companies are.
This is by Leonard Peikoff and available as a recording or in printed form from the
>AynRandBookstore.com<
Get it. It is very pertinent and enlightening.
We truly took one on the chest with this stink feast. No meaningful liability reform, increased taxes, no SGR fix, and the cream de la cream the Independent payment Advisory panel. This group is appointed not elected, has almost no oversight, determines what is covered and what we can charge. To think this group has our patients or us in their best interest is naive at best. I also love how it is a true jobs creation bill 16000 new IRS auditors. Hurray I cant think of a better use of taxpayer money can you. Oh i forgot about fraud and abuse losing the portion regarding intent. as crazy as the coding process is you could have everything confiscated for coding errors with no intent involved. To praise the piece of rubbish is to not no what is in it.
All Americans except for our Sermo Doc 120s in Congress took one on the chin with this law. The real battle begins now. we must get all who run in November to work on repealing the grossly onerous portions, keep what is good, and if the president wont agree de-fund a lot of the law and wait. To the person who mentioned the VAT. I think that is certainly on its way but will just be another tax already on top of the other taxes. Lastly from meeting with members of Congress I certainly think that they believe NP and PAs can do away with the primary care physician and that we will continue to take whatever crumbs they give because we don’t have the sense to say no.
Please don’t misinterpret … we must continue say what we feel is in the best interest of ourselves and our patients. We must continue to lead with our head held high. We will always have value to the patients no matter what the financial forces try to dictate… ALWAYS!
I have really started to feel depressed and that I should have chosen another field. I do not mind sacraficing some income but what I fear is coming is that we will be making a ridiculously low wage for our expertise. I really dont think I would have done 14 1/2 years post high school education to make what I could have with a four year degree or less.
“Ask any physician that you know, and I guarantee that >95% of us realize that ramming a nontransparent bill down the public’s throat (against the majority’s will, I might add) is NOT the type of reform we need. Not once has there been any meaningful discussion of tort reform (which would save billions of $$ spent on unnecessary “CYA” testing) or increasing insurance competition across state lines (another simple, easily-implemented way to lower costs). The medical field is NOT happy with this bill in its current state, let me assure you.”
His reply:
“450,000 (signed) physicians completely disagree with you. See www.healhealthcarenow.org ”
Of course, if you read the article carefully, 450,000 docs did NOT sign this “petition” or whatever you’d like to call it; but it was a group of organizations that “REPRESENT” 450K docs. Sounds a little like the AMA chiming in with their claims that they are the voice of the US physician.
My practice consists of mainly welfare patients on Medicaid, the government run “universal health care program”. Due to the recession, my practice now has increased up to 80% Medicaid. So I am intimately familiar with with this system. And unfortunately, it is not good. The reimbursement is poor, 40-50% less than private insurance, the amount of paper work is atrocious, the hassle factor is horrendous, and the DENIAL of care is HORRIFIC. And unfortunately, this is how the new bill will save money.
As 16 million Medicare patients get moved over to Medicaid, care will be significantly rationed. Most doctors do not participate with Medicaid and the few of us that do are presently overwhelmed. With the addition of more Medicaid enrollees, I’m convinced that they will not have any doctors to care for them. Medicaid is a joint financially shared Federal and State government program. Unfortunately, by moving Medicare (Fed only) to Medicaid, the states will be even more strained. What does this mean? Well, Medicaid doctors like myself will see reimbursements reduced even further and payments get delayed. Last I heard was 3 months. This will cause an ever greater strain as more doctors opt out of Medicaid. So, when I want to refer to a specialist, there are almost none. And if I can plead, beg, and pull strings, the wait time to see a specialist is very…very long.
I’ve not covered the impact on small rural hospitals but the effect is just as bad and many will have to close, further reducing availability of health care. So overall, I am not optimistic about this new law. I’ll try to add more comments but I just got called to an emergency….
1- Obama’s refusal to take tort reform seriously.
2- Obama dropping the insurance companies’ freeze on premiums
3- Obama lengthening the the drug companies’ time on brand names
Where were the President’s principles when he cut these backroom deals? To me, this makes this law a travesty.
And what happens when rationing of health care occurs down the line when budgets are at their breaking point?
I am very unhappy to hear about the longer patents. I didn’t know that was part of the deal. There are so many psych drugs that don’t have generics and won’t for awhile yet as it is, well, in the antipsychotic class anyway. I’m pretty happy with most of the cheap antidepressants and alot of the generic antiepileptic mood stabilizers and lithium, and like haldol alot, too, actually. I treat alot of uninsured and underinsured patients, and so have to know about these things… But sometimes those medsdon’t work, or have intolerable side effects. And even the generic psych drugs often aren’t cheap, and are out of the reach of many of my patients, financially. Or the brand-name ones are Tier-3 for insured patients, which means they pay 50%, and for a $400-700/month drug, well, that isn’t going to happen. Sucks when it was covered in the past, and then at the first of the year the insurance stops paying (no longer on the formulary). But it is rather sad that they have to charge that much to begin with, though I understand that the economics of drug development sometimes justify it. You can’t exactly ask a rat if it is still hearing voices after it got the drug. Or did understand until they started intense TV advertising, now I don’t buy it, as I think that is why they have to charge so much… Anyway, big sell-out to extend the patents. I will have to protest that to my legislators. Thanks for the info.
I looked at Americanthinker.com and read that Obama is going around the country selling his Obamacare and speeding up its acceptance hoping that the American public will forget his consitutional betrayal.
What I think will be more helpful would be suggestions and concrete recommendations and a plan on what we can do as citizens and physicians to help people not forget, and to make sure our voices are heard in the elections and to help prepare for the future Aside from reading Ayn Rand ,praying and buying gold(someone suggested this in another post before our triple A rating goes down) what can and what should we do in the meantime? I hope the D4PC can give us the leadership and guidelines we need. Praying for their successful trip and mission.
As socialism is very good…for others, right?
For one thing, no one wants ex-doctors! You will be considered over-qualified or under-experienced. You will probably have to start at an entry-level position, low-paying. And, your skill set and way of thinking does not necessarily translate well into the corporate-business way of doing things.
Sales, however, is a natural fit for physicians, who are used to interviewing people. However, selling is hard work, and requires considerable effort at prospecting (something foreign to doctors) and a very thick skin (rejection happens every day, and one must be able to deal with it–no ego strokes).
There are over 800,000 docs in the US. You have polled what, 1,000 on a mostly very conservative site?
GIGO
The employed docs are doing just fine right now… I am private practice and I am doing just fine.. There will be accommodations in the current system to cope with the new laws.. and when things don’t work, the laws will be modified… while we all wish the current bill was different in many ways, guess what, it isn’t…
We should all be working to get more economically conservative legistlators in the Congress and then try to incrementally improve this puppy.
It is not going to be overturned… the lawsuits are a waste of time… The Supreme Court does not involve itself except in rare cases with these kind of public laws… There is nothing in the Constitution about a mandatory income tax.. but guess what.. don’t pay yours and you will end up in a cell next to Wesley Snipes!!
Back door deals, bribery, blackmail….apparently that is what makes todays world go around.The passage has ushered in a virus that will never be killed. I do appreciate Dan’s work and all of those of you who cared enough to post on sermo. It does give some comfort that I am not the only one willing to fight.
We may have the info here and there but we haven’t asked ourselves that simple question and figured out the answer. If we figure that one out, we could have some idea of whether any contract makes sense or not.
My multispecialty group looks at what it costs us to see patients for each contract (based on time to reimbursement, administrative costs to meet information requirements of the plan [do they ask for patient past records on every claim to see if they can get out of paying it or is their formulary so restrictive that we have to prior auth anything not on the Wal-Mart $4.00 list] and do they have a lot of patients in the area [such that we can batch our billing to them and generate economy of scale or are they a little fish that we have to assign a specific billing specialist to so that we can get it right when we bill them.])
We also look at how often do they pay us correctly, because we have found that many of the plans “do not have the correct fee schedule loaded” for us, and that for some reason, it usually underpays us a couple of bucks. The ones that seem to know what they agreed to pay us and pay us accordingly do not require as much effort to get correctly paid so their contract rate does not have to be as high as ones that seem to stack the deck in their own favor.
Bottom line on the new healthcare bill… they havent even finished it yet, so neither they nor us know fully what is in it. We need to read it, dissect it and wrangle the intent out of each section to know what helps, what hurts and what it will do to medicine. Back in school we divided the work up in study groups to help cover the massive amount of material, and we need to do the same here. As my mom told me many times, “It’s just like eating an elephant, you have to do it a bite at a time”
To close, I will pull from the great philosophers Lilo and Stitch. “Aliens are all about rules” which means, if we learn the provisions and figure out how to put them to work for us, (or change them if they cannot work by exerting appropriate pressure for specific points rather than just “throw it all out and start over”) the powers that be will have no choice but to live up to the specifics.
Dan,
I couldn’t find an email address for a personal note to you. I will have to share this note to you with the entire SERMO community. Come to think about it, perhaps it may not be such a bad idea sharing my comment with the whole community there may be at least one other other physician in the USA who finds a bit of truth in my comments.First, I’m probably one of the few physicians in America who thinks that you should stop having Rush Limbaugh, Randy Neugebauer, Glen Beck, and Gerry Callahan construct your survey questions. A move to someone a little more balanced such as Karl Rove would probably be a step forward. But let me get to the the point of this comment.
From January to June of 1965 I found myself in the bluegrass of Kentucky finishing my internship. The King-Armstrong bill was moving through congress. Most of the medical community across the country was up in arms predicting that the private practice of medicine would no longer be possible after July 1, 1965, if the bill passed. The sky was falling in and and physicians would become paupers or low level government employees. It was a scary time but fortunately President Johnson sent me a letter of greetings inviting me to take a vacation in Vietnam, wherever that was. I accepted and spent 2 eyeopening years waiting to see what would happen. After my trip to Disneyland East and and a re-entry stay at Fort Devens, I accept an honorable discharge and returned to the land of tobacco. Much to my surprise the sky was still blue and it hadn’t fallen in yet.
Over the next 40 odd years I observed physician’s earning a living wage in an interesting profession that was making progress in treating illness. I was happy to see that most of my physician colleagues were able to live in nice communities and could afford to educate their children in good schools. But I also observed some not so happy situations. Unfortunately, we were 32nd in health status. However, we did spend twice as much on medical care than other developed countries.
Then in November of 2008, I again heard that the sky was going to fall in. After spending four decades in the silver age of medicine, I was too old to take a vacation in Iraq, Iran, or Afghanistan. I didn’t know what to do. Then on March 21, 2010 the sky fell in 219 to 212. On March 24, 2010 your survey arrived and forced me to face reality and make a decision. Confronted by the poll, I decided to take a gamble and vote for history repeating itself. So, I am now looking forward to a golden age in medicine where physicians will live long and prosper and their patients will have an improved health status.
You ought to look at the old clips from 1965 they may give you a different perspective on what might happen in a rational system that makes healthcare a right for all not just a perk for the wealthy and powerful. You could even take a look at Ignatius and his emphasis social justice. When people are suffering hardship and oppression, their business is our business. Social justice calls us to open up our eyes to the needs of others who may be suffering due to the way we conduct business.
So I voted in the poll. I believe that we have taken the first step toward considering the community’s stake in health care. I am convinced that this will lead to a truly fulfilling and rewarding career for physicians in the future. We certainly can’t stay on the path we are currently taking.
You are making the logical error that many make, which is the assumption that because some of us are opposed to the complexities and totality of THIS bill, that we are opposed to any sort of reform.
We are not. Most of us would welcome rational reform. What we are opposed to is sweeping reform that threatens the economy because cost controls are not addressed.
You see, the world is not as simple as A or B; up or down; black or white–it’s actually a thousand shades of gray, and all the colors in the rainbow. Which means that if we don’t want “x” it doesn’t mean we want “the opposite of x.” There may be many other options.
This is so much more than just a Healthcare Reform. I hope that is not a revelation. They couldn’t care less about the uninsured. It is about control. Well, let’s turn it on its head.
The Bill is flawed, no doubt. The insurance companies make out like like the bandits they are and the pharmaceutical industry still doesn’t have to negotiate prices for meds. That will change as good sense starts to percolate to the top.
Perhaps even some measure of tort reform will evolve which would be a good thing. That being said, malpractice claims never contributed more than 2-3% to the total cost of medical care. Still, it’s nonsensical and we’re the only society in the developed world that tolerates it (kind of like being the only society that doesn’t have a single payor system). Last week, I had dinner with an Irish attorney who tries an occasional malpractice case. Contingency fees are illegal in Ireland and most (if not all) of the rest of Europe. Anyone interested in adopting the whole ball of wax as exercised by the remainder of the developed world? Their approach seems to be much less expensive and delivers better results according to most actuaries.
boiled down: Do away with accepting reduced fees via contracts: The Insurance fraud law needs to be changed to eliminate penalizing i=the uninsured with the Full Price! Wall Street Journal front page editorial approx 3years ago “The 20,000$ Appendectomy. And another editorial a week or two later “The Pricing of Generic Drugs”!
Have a national insurance clearinghouse for insurance applications, and claims.
There is no rational reason that an individual is charged premiums higher than the “Group Rate” from an insurer! The Actuarial risk of the individual is unchanged by being an employee! The Group Rate doesn’t apply—the N should be 300,000,000 ! The premium should be the same for all. A national clearing house eliminates the excuse that it costs more to administer the paperwork to an individual!
Eliminate the expectation that the employer is responsible for providing insurance! Make it portable and increase the N to 300,000,000! But still use Private insurers!(Is this what is done in the German Health Plan?)
Have a National professional regulatory board which meets at regular intervals and which negotiates fees and rules, which includes medical and insurance & gov. participants.
Nationally regulate the health insurance industry/ take that away from States! With an agency sorta like that of the Banking Industry(but better :)…to get uniformity of rules and solvency!
The times are definitely changing, whether we like it or not. I think the change provided by the current legislation is misdirected, in terms of achieving best patient care, but medicine is NOT going to stay the way it’s been up to this point, regardless. In my own specialty of diagnostic radiology, our greed for avoiding night call by using tele-radiology is now progressing to the point where most small hospitals that cannot a full staff of specialized radiologists are going to the model of having one generalist on site to perform fluoro and other basic procedures, and farming everything else out by tele-radiology. Is this good for patients? YES! The problem cases can now be read by sub-specialists or sub-sub-specialist who will be far more conversant with the problems presented than the generalist ever could be. Is this good for the individual radiologist? NO! Unless you’re an interventionist, and can still pick & choose where you want to practice, you’ll either be a non-procedural specialist sitting in front of a PACS screen as an employee, or a generalist practicing in an area where you wouldn’t even consider bringing your family to live 5 years ago. or working as an employee in a major urban health care center. I myself am a generalist who just saw a hospital in a small mountain town with no amenities and an hour from even a middling-size city fill a permanent slot with a radiologist who came from all the amenities of the DC area, because that’s the best he could find in this situation! I myself am such a generalist, but too close to retirement, and too happy with where I’m located, to move. I’d hoped to do locums for 2 more years before retiring fully, but in the limited market for my type, this will probably not be an option. My penalty will be having to dig into savings earlier than planned, and having a slightly-lower quality of life in retirement than I’d hoped, so I don’t get off quite scott-free, but I’m glad I’m not in this specialty, 40 years of age, and facing another 25 years in the current market. NEVERTHELESS, if we truly believe that the patient comes first, it’s probably a better way of practice for the patient’s benefit.
For other docs, the greed is in signing on NP’s and PA’s to bring in extra revenue while taking off a large portion of what they earn for our own profit. Where do you think the manpower to take care of the newly-insured will come from? Do you really thing you’ll be able to limit scope of practice for these people in the future? Primary care docs better be preparing to see their practice opportunities and income go down, as well- you’re likely to lose most, if not all or more, of what you think you may gain under Obamacare.
For all of us, we’d better prepare for being gov’t. or employee “slaves”, or setting up insurance-free practices, and trade some of the patient base and income we’ll lose to maintain control over our lives and practices. in almost ALL cases, prepare for a drop in income and lifestyle, and I pray that you weren’t living up to your last dollar of income, but chose a lesser lifestyle, and to save some money, before all this hit the fan.
thanks Dan. Just about every poll says 60-40 against just like the overall polls in the country 40% conservative, 35% indi (who split 60/40), 25% libtard. And its the latter with the power right now so shame on the other 75%.
I get a laugh at the MDs who post that the survey is biased, its underpowered, its written by Rush Limbaugh. Have heard the same crap for years at credentials, peer and quality committees from physicians confronted with facts. . . And to the PCPs and ED docs who think this is a zero sum game and when the specialists lose you win – think again – the independent NP is going to replace you at 75% of the cost – and guess who gets to do primary care for everyone Mr. ED doc – just like Mass. now.
From the study
<<Only 16% say they are basing their clinical decisions on what they think is
best for the patient rather than what payers are willing to cover>>
Anyone thinks we dont have covert rationing going on right now???
It sounds like you are in the ~50% that are optimistic-and that’s great. (As an employed, salaried doc I am fairly optimistic about my personal security, I just don’t know why we are letting our profession get raked over the coals in this bill while everyone else gets plate after plate of pork shoveled their way.)
BTW, if you don’t like this survey’s methodology, you must have hated the AMA physician practice survey, which was based on 36 responses, concluded that most cardiology offices did not use paid staff, that practice expenses decreased by >30%, that equipment was in use 100% of the time, and was in direct opposition to three other validated and current practice surveys out there. CMS chose the AMA’s survey. Go figure.
Please note my post above. None of the legislators with ANY health care experience voted for this bill. Zero. What does that say?
Now Obama and the dimwitcrats have passed another vast entitlement, so large that we none of us (and certainly none of them) can know what is written in the bill. Passing a law, and entitling the bureaucrats to make rules and regulations is an invitation to further physician abuse and harassment. When the extra 30 million have Medicaid, they will flock to the ER’s because the private guys won’t see them, just like now! The government will respond eventually by forcing docs to see ’em. To follow will be determinations of what specialty training and how much is allowed, as well where the young doc will practice. Witness the reports of recent federal actions against a group of docs who refused to sign new Medicare contracts in the midwest. Unprecedented, but emboldened and desperate bureaucrats feel safe in doing this in our times.
The Arabs have a saying: don’t let the camel get its nose under the tent; he will soon be in your bed!
Thomas Jefferson was right about government. It will (has) become the danger. DeTocqueville thought so, and looks like he was right also.
In many cases, high malpractice and increasing administrative costs associated with the growing reporting requirements and P4P pressures will make it very difficult to maintain a private practice. In this new reality, physicians must be business savvy and learn very quickly how to play the survival game.
I don’t know if you can say that the sky is falling for physicians but the fact that we are being squeezed from every direction is very clear. Lack of transparent leadership has been a major historical problem. I think our best bet is to figure out a way to direct the flow of the changes on the horizon in our favor in order to optimize how we care for our patients. We need to do this through innovation and strong leadership.
by Leonard Peikoff (January 23, 1998)
Delivered at a Town Hall Meeting on the Clinton Health Plan
Red Lion Hotel, Costa Mesa CA
December 11, 1993
Good morning, ladies and gentlemen:
Most people who oppose socialized medicine do so on the grounds that it is moral and well-intentioned, but impractical; i.e., it is a noble idea — which just somehow does not work. I do not agree that socialized medicine is moral and well-intentioned, but impractical. Of course, it is impractical — it does not work — but I hold that it is impractical because it is immoral. This is not a case of noble in theory but a failure in practice; it is a case of vicious in theory and therefore a disaster in practice. So I’m going to leave it to other speakers to concentrate on the practical flaws in the Clinton health plan. I want to focus on the moral issue at stake. So long as people believe that socialized medicine is a noble plan, there is no way to fight it. You cannot stop a noble plan — not if it really is noble. The only way you can defeat it is to unmask it — to show that it is the very opposite of noble. Then at least you have a fighting chance.
What is morality in this context? The American concept of it is officially stated in the Declaration of Independence. It upholds man’s unalienable, individual rights. The term “rights,” note, is a moral (not just a political) term; it tells us that a certain course of behavior is right, sanctioned, proper, a prerogative to be respected by others, not interfered with — and that anyone who violates a man’s rights is: wrong, morally wrong, unsanctioned, evil.
Now our only rights, the American viewpoint continues, are the rights to life, liberty, property, and the pursuit of happiness. That’s all. According to the Founding Fathers, we are not born with a right to a trip to Disneyland, or a meal at Mcdonald’s, or a kidney dialysis (nor with the 18th-century equivalent of these things). We have certain specific rights — and only these.
Why only these? Observe that all legitimate rights have one thing in common: they are rights to action, not to rewards from other people. The American rights impose no obligations on other people, merely the negative obligation to leave you alone. The system guarantees you the chance to work for what you want — not to be given it without effort by somebody else.
The right to life, e.g., does not mean that your neighbors have to feed and clothe you; it means you have the right to earn your food and clothes yourself, if necessary by a hard struggle, and that no one can forcibly stop your struggle for these things or steal them from you if and when you have achieved them. In other words: you have the right to act, and to keep the results of your actions, the products you make, to keep them or to trade them with others, if you wish. But you have no right to the actions or products of others, except on terms to which they voluntarily agree.
For the rest of the article… www.capmag.com
EMERGENCY MEDICINE
It is probably well-intentioned but nonetheless deceptive in presentation.
It can be attributed to self-serving economic forces (the evil empire of the insurance sector and their friends in corporate America) and to our completely ineffectual national leadership (which has consistently sold physician interests down the river for decades).
Also we must never underestimate the unsympathetic attitude toward the medical profession in the aggregate by the general public. It’s completely different from the one on one doctor-patient relationship.
We need majorities in the both houses of true citizen conservatives, not party loyalist on either side.
This little Independent plans to vote for every Republican that I can.
and I pray that Palin does not have the arrogance to run in 2012
PEDIATRICS
I have been as adament as anyone, but the facts are, we DONT MATTER. We are now pawns to be used. the next step is Hospital envelopement of docs, employment at ridiculous wages, more regulation. Private practice is dead, and so is independent practice. BO is very arrogant, and for a reason, he can be. He all but dared the House/Senate to try to repeal the law, and is it not likley he would be so bold if he didn’t know something we don’t.
Docs4Patientcare sounds great but the fact is that this and any other physician move is good natured and in the patients best interest. Both factors that mean nothing to congress or most obama supportors who want something for nothing.
I am very disheartened and feel little hope for my let alone my childrens future, in what used to be the greatest country on earth. Proof of the depths of our depravity…..Fidel Castro has formally endorsed Obamacare…..Has it really come to that?
So, people can *still* refuse to obtain insurance, refuse to pay the fines, and face no prosecution or penalty. Who in their right minds would pay for insurance, or pay the fine for NOT having it, knowing that there is no fear of prosecution or penalty, and they can *still* obtain insurance at any time, with guaranteed acceptance and limited lifetime benefits?
In the end there will be a finished product. Be it a sculpture of manure or a fine Sermo Doc 120piece remains to be seen.
I see a lot of people who are losing their insurance, and I care about them.
I see rude partisan statements here, particularly from the left. I don’t care – you can judge a tree by it’s fruit.
I will close my doors when I must. 21% might just do that.
1. Chicken sh**
2. Bullsh**
3. or suicide….1. You work for the chicken feed the insurance companies and medicare want to pay you. (chicken sh**)
2. You as a doctor start selling vitamins and doing facials or dispensing dope..(bullsh**)
3. You work your butt off trying to game the system and die early…
I gonna be selling real estate guys and gals, I’d love to have your referrals and list your homes that you can’t afford any more. I can sell them to insurance execs and dope dealers, politicians and other criminals who can afford them!
In the name of the people.
That was not the question asked. The question asked was more like: Will the health reform changes lead you to “consider” dropping Medicare and Medicaid? And in a frustrating moment, doctors are much more willing to say Yes, as a vote of anger. But realistically, they are not going to drop Medicare. Perhaps metropolitan elite practices have the option to do so, but middle America lives off Medicare. It will never happen.
It is disappointing that this open forum (just like our congressmen) cannot present results that are meaningful, accurate, and not skewed by biased question structure. Who is lobbying Sermo?
Be honest with yourselves- you believe the current state of affairs is pretty terrible. Please admit to yourselves that your statements about where we are NOW on this board, to colleagues, family, and anyone who will listen have been overwhelmingly negative. Abuses of the insurance industry, intrusion into our practices and our interactions with patients, declining reimbursements, the malpractice situation…these just scratch the surface of our discontent. Please acknowledge how bad things are now-don’t take my word for it…YOU have been saying so.
Take a “snapshot” of where we are now, and realize it has NOTHING to do with the bill that was signed 72 hours ago. I ask that you do that so you can honestly assess the effects of the bill. A day, a week, a year from now, many of you will be blaming “Obamacare” for screwing up healthcare. If you can remember how terrible you thought things were on March 21, 2010, a day before it passed, you will be able to more accurately assess the impact of the bill. Unfortunately, many are already blaming the bill, when in fact it hasn’t even been implemented yet.
My income has dramatically increased since I opted-out 12 years ago. The free market works just fine, and will get better as more clueless doctors close their doors. The demand for doctors is increasing as the supply shrinks daily.
My fees are going up. The Laws of Economics are as sound as the Law of Gravity.
The 21% cut happens April 1. There is no money for a Doc-Fix, and no one in Washington will add 280 billion to the deficit for us. Tom Coburn M.D. himself blocked a one month extension. Good for him, and our country.
Here is another thought:
Making money and caring about patients are not incongruent.
There is no reason to feel guilty for wanting to earn a great income.
My training and experience are worth a great deal.
For those above who feel guilty – that is fine – kindly leave the rest of us out of it.
Regards,
For cash MD 🙂
Meanwhile, charging a 35 dollar annual administrative fee. Have patient sign a short letter designed by our healthcare attorney. This was done about two years ago. Have not rechecked to see if it is Ok.
A couple of thoughts…….Physicians need to realize this fight is not over, it is just beginning. In Massachusetts, there is already a bill in front of the state legislature to make participation in Medicare/Medicaid a condition of licensure. This is important for number of reasons, not the least of which is that the MA universal healthcare reform, enacted several years ago is extremely similar to the one we just implemented on a national level. Tying your medical license to participation in these programs is simply the next step towards socializing medicine. As best as I can tell the Mass Medical Society are completely MIA on this….
Daniel Palestrant, MD
Founder & CEO
Sermo, Inc.
daniel@sermo.com
INTERNAL MEDICINE
Real effect is more eg do they count effect of job losses which are in healthcare segment?
They won’t even discuss tort reform,how they can possibly keep things defecit neutral,how patients can keep their present physician and insurance plan when they are hell bent on destroying both,etc.,etc…….
How can they expect anyone with half a brain to accept their non-answers and arrogance??Or are there more surprises coming?
What did she expect after YEARS OF GOV MEDICINE??
the Irony here is that this evolution has no other plan to STEAL FROM..
GOVERNMENT MEDICINE IS FEAST or FAMINE and anyone who has actually worked in GOV spots KNOWS THIS.
ok , so Medicaid ran out of money, STEAL from Medicare
VA ran out of money STEAL From Medicare.. Indian reservations out of gov medicine money .. just run down..
It is great to be altuistic and want best for all, but reality is WHO WILL PAY.. certainly NOT the GOV who gave themselves EXEMPTION from this CARE.. so ROYALTY WHO PASSED THIS will be in one CLASS of HEALTH CARE and the rest of us in the Famine GOVERNMENT health care.. btw.. those of you who are happy, I will be so happy when you get your cont pay cuts below cost of providing services…. but then only so many of you can go work in the Presidents CASTLE.. and since your character will be in line with His.. ,, well , a patient in his 80s taught me that those patients who go to docs just like themselves.. get exactly that.
PS WORK TO KEEP further american students OUT OF MEDICINE>. they are NOT going to the MISSION FIELDS with DEBT…
He is NOT telling Property owners in NY state that the Medicaid increase which is 90% linked to property will tax homeowners out of their homes.!!i am amazed at the ability to lie with a straight face by Pelosi and Shumer and Reid and OB
to those of you who are optimistic of this and blaming past docs charging too much, I must inform you that it was
President Johnson who CUT the copay and premium to 1/5 th of what they KNEW Medicare would cost in 1965 and so it was predicted by the Insurance Commission in 1965 that Medicare would run out of money in 1990.. In 1990 medicare started PRICE fixing and CLAIMING that the docs were charging too much and technology cost too much INSTEAD of taking any personal responsiblity.. DO NOT ask ME to take Responsibility.. In my field i was taking asthmatics who were repeatedly hositalized and stabilizing them and improving quality of life and decreasing their costs… THE GOV LIES AND BLAMES YOU and NEVER THEMSELVES… do NOT be so IGNORANT anymore.. WAKE UP .. or try to as eventually you will learn the hard way…………..
DUH
we are just the patsies to get them their power
My guess is that they did not get care until they got really , really sick and then put a bigger stress on the system–on the emergency services, intensive care units, etc. I think alot of them had to get emergency medicaid anyway, which requires a big beauracracy itself. I don’t think they stayed out of the system by staying healthy and then dying.
So, if we are to save medicine as we know it; YOU must get involved. That means contributing time and money on an individual basis. It is only at the ballot box that this usurpation can be stopped and controlled. Don’t give these so called socialist credit for just trying to help people. They are trying to help themselves to hierarchy within the new order. And since they have no moral compass, they move by any means available or necessary.
PHYSICAL MEDICINE & REHAB
You will be punished in hell, and we probably will too, but you (all politicians currently serving, with Bush and Cheney included) will be punished longer! It’s my curse anyway and I hope it comes true!
The reforms have the potential to remove the proprietary interest physicians have in their business and will not be able to practice in a way that is fair and ethical to themselves and very bad for the patients who will lose a champion.
The present system has to be changed. It has the character of a Greek tragedy. Do you want the Devil or The Deep Blue Sea?
We know the Devil and I’m glad that will go but what will come in it’s place. The battle has just begun. Those who quit or threaten to should go. Most are ‘blowhards ‘anyway.
This is the chance for physicians to reclaim medicine for themselves. Quit whining and act positively.
This makes it impossibly expensive. “no limits” does not exist in the real world and something is going to have to give and that something will be the hard work of doctors not getting appropriately compensated and taxes going sky high and of course extremely high premiums for commercial insurances thus forcing many who don’t want to to go to government insurance…. thus creating the universal (and totalitarian) system the left wants. Money has to come from somewhere people; it does not fall from the sky. Let the people hold the money and they themselves can ration it as they see fit. This will cause price shopping and will then reduce costs eventually.
We are so worried about what this 21% Medicare cut will do to us! Our situation is not the same as other physicians. We have the added expense of 24/7 care for a severely disabled child in our home, which we elected not to place in residential care.
I suppose I don’t have to add that there is little $ left over with the outrageous taxes I pay! And I understand they will only go higher! Makes me wonder why I stay in such a stressful field for such little reward…
Thanks AMA… you A…holes!!!!
Categories: Uncategorized
