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Why I Tattooed My Health Data Over My Heart | WTF Health with Casey Quinlan

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By JESSICA DAMASSA

WTF Health – ‘What’s the Future’ Health? is a new interview series about the future of the health industry and how we love to hate WTF is wrong with it right now. Can’t get enough? Check out more interviews at www.wtf.health. 

How can patients help usher in a better future for healthcare? Start speaking up. LOUDLY.

In this WTF Health interview, meet one of health’s most outspoken patient advocates, Twitter voices (@mightycasey) and podcasters, Casey Quinlan of Mighty Casey Media, who talks about her patient journey as a cancer survivor — and why the awful experience led her to tattoo a QR code linking to her electronic medical record to her chest.

Casey’s ‘physical political protest’ is tied to her passionate views about the lack of data liquidity in healthcare and how patients suffer as a result. She’s launching a new “If-You’re-Selling-My-Health-Data-Cut-Me-In” Movement and weighs in on why more patients aren’t clamoring after their health data to push real change in the healthcare system.

Filmed at Health Datapalooza in Washington DC, April 2018.  

Stay Out of my Wellness

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By VA WEST HAVEN COE CLINIC

On a sunny New England morning at a secluded guest house with a perfectly manicured lawn, medical residents, each with their own brightly colored yoga mat, were getting ready to assume the downward dog position. They were on an annual retreat organized by their residency program to promote wellness. One embraced the opportunity with delight, smiling through every pose.  Another grimaced  as his back spasmed. And yet another wandered off towards a lake to find his own kind of respite.

Physician wellness has become something of a buzzword in recent years, and rightfully so considering that the rates of burnout and suicide within medicine are rising. Individual residency programs have found burnout rates between 55% and 76%. Such burnout erodes well-being over time and may be contributing to suicide, which is now the second leading cause of death among residents nationwide. In 2014, the suicides of two medical interns in New York prompted the American College of Graduate Medical Education to take action. A series of initiatives to combat burnout were rolled out, including the consideration of wellness in its review of residency programs during site visits. In 2017, emergency medicine physicians convened the first Residency Wellness Consensus Summit to devise a module-based curriculum on wellness. Hospital systems have attempted to respond as well, through the hiring of chief wellness officers.

It is unsurprising that the medical community has taken such an analytical approach towards diagnosing burnout, much as we do with other diseases, in search for a cure. But perhaps such a prescriptive approach fails to capture the highly individualized and somewhat abstract concept of wellness. The reasons for resident burnout are personal and vast. Decreased wellness has been attributed to the lack of time for self-care, inadequate sleep, social isolation, negative work environments, excessive paperwork, long work hours, poor relationships with colleagues, and insufficient mentorship, among others in a lengthy list. Any attempt to standardize the definition of wellness should be met with caution.

So how do we as a society go forward in ensuring our resident physicians are well?Continue reading…

Sending the Questions to the Data

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By John Halamka

As hospitals and practices form accountable care organizations, they will accelerate their efforts to build healthcare information exchanges and novel analytics that support community-wide lifetime care rather than siloed episodic care,   This requires “freeing the data” from the EHRs, hospital information systems, and laboratories in which it resides.

There are two basic ways to analyze data for a panel or population.

1.  Send the data from multiple sources to a central repository for analysis.

BIDMC has partnered with the Massachusetts eHealth Collaborative on such an approach to build a quality data center supporting its ACO strategy.

2.  Send the question to the data.

The new federal Query Health initiative is a standards-based approach that enables standardized questions to be sent to multiple federated databases without moving the data itself.

In Massachusetts, we’ve implemented such an architecture in two ways.

I2B2/Shrine which links together the Harvard hospitals (and many other sites nationwide) with query tools supporting clinical trials and clinical research.

MDPHNet, an ONC funded Challenge grant which sends questions to data sources,  answering public health questions.

MDPHnet is being developed under contract with the Massachusetts eHealth Institute to implement a secure web-based query tool which enables predefined and ad hoc queries to be sent to participating sites, including selected practices within the Mass League of Community Health Centers and potentially, Atrius Health.

Queries are executed locally, securely returned after optional review, and then presented to the requester and displayed in a variety of ways – heat map, histogram, table etc.  Results contain no patient-identifiable data.  Data holders control authorization of requesters and their specific query capabilities.

The current focus for predefined reports is syndromic surveillance (Influenza-like illness) and chronic disease surveillance (diabetes).  It can also support other uses, such as pharmacovigilance and quality measurement.

MDPHnet uses PopMedNet open source software developed by the Harvard Medical School Department of Population Medicine at the Harvard Pilgrim Health Care Institute, with support from AHRQ and FDA. Lincoln Peak is co-developer.

There is great synergy among i2b2, PopMedNet and MDPHnet, since they use a common architectural approach. Query Health incorporates PopMedNet in its design.

MDPHnet uses the Electronic Health Record Support of Public Health (ESP) common data model.  ESP  was developed by the HMS/HPHCI Department of Population Medicine with support from a CDC Center for Excellence in Public Health Informatics.

The Massachusetts League of Community Health Centers transforms data from their clinical data warehouse into the ESP format. Commonwealth Informatics supports the process as needed.  Additional participants will extract data from their EHR and put it into the same schema (ESP) with help from Commonwealth Informatics.

MDPHnet can be readily expanded to cover other datasources such as the I2B2 nodes which are hosted at over 60 sites nationwide.

Over the next few years I believe that for many use cases we will be sending questions to the data instead of sending the data to centralized registries.    I2B2,  MDPHnet, and Query Health will show us how.

John D. Halamka, MD, MS, is Chief Information Officer of Beth Israel Deaconess Medical Center, Chief Information Officer at Harvard Medical School, Chairman of the New England Healthcare Exchange Network (NEHEN), Co-Chair of the HIT Standards Committee, a full Professor at Harvard Medical School, and a practicing Emergency Physician. He’s also the author of the popular Life as a Healthcare CIO blog.

Money, Medicine and Ethics

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By John Goodman

The American College of Physicians has published their updated manual on ethics for physicians and the following passage is causing quite a stir:

Physicians have a responsibility to practice effective and efficient health care and to use health care resources responsibly. Parsimonious care that utilizes the most efficient means to effectively diagnose a condition and treat a patient respects the need to use resources wisely and to help ensure that resources are equitably available.

On the right, American Enterprise Institute scholar Scott Gottlieb writes “Parsimonious, to me, implies an element of stinginess, and stinginess implies an element of subterfuge.” (Quote of the Day in American Health Line.)

On the left, Aaron Carroll writes:

I would fight tooth and nail to get anything — and I mean anything — to save [his own child]. I’d do it even if it cost a fortune and might not work. That’s why I don’t think you should leave these kinds of decisions up to the individual. Every single person feels the way I do about every single person they love, and no one will ever be able to say no. That’s human.

Similarly, I don’t think that it’s necessarily fair to make it a physician’s responsibility. I also want my child’s doctor to fight tooth and nail to get anything that might save my child. Many times, physicians have long-standing relationships with patients. Asking them to divorce themselves from the very human feelings that compel them to do anything that might help their patients is not something that I think will necessarily improve the practice of medicine. They also should be human.

So whose job is it? Well, mine for instance. That’s what I do as a health services researcher. That’s what policy makers should also do….

That’s a roundabout way of saying that only the government can ration care the right way. Here is Don Taylor’s (Incidental Economist) take on the subject.

My view: people in health care have become so completely immersed in the idea of third-party payment that they have completely lost sight of the whole idea of agency.

[youtube]http://www.youtube.com/watch?v=BQMI7TksYo0&feature=player_embedded[/youtube]

This game of life I play
Living and dying with the choices I made

Can you imagine a lawyer discussing the prospects of launching a lawsuit without bringing up the matter of cost? What about an architect submitting plans for a building but completely ignoring what it would cost to build it?  Outside of medicine, can you imagine any professional anywhere discussing any project with a client and pretending that money doesn’t matter? Of course not.

Then what is so special about medicine? Answer: the field has been completely corrupted by the idea that (a) patients should never be in a position to choose between health benefits and monetary cost, (b) doctors shouldn’t have to think about such tradeoffs either, (c) in order to insulate the patient from having to choose between health care and other uses of money, third-party payers should pay all the medical bills and (d) since no one else is going to think about what anything costs, the third-party payer is the only entity left to decide which services are worthwhile and which ones aren’t.

To appreciate how doctors could do the same thing other professionals do in advising patients on how to spend their own money, take a look at the graphic below. These numbers are several years old and there may be more recent studies, but the graphic will serve our heuristic purpose. Armed with this information, what would a responsible doctor tell her patient about Pap smears and how often the patient should get them?

Source: Tammy O. Tengs et al., “Five Hundred Lifesaving Interventions and Their Cost-Effectiveness,” Risk Analysis, June 1995.

 

Note that getting a Pap smear every four years (versus never getting one) costs $12,000 per year of life saved, when averaged over the whole population. What the responsible doctor should say is, “In the risk avoidance business, this is a really good buy. Based on choices people like you make in other walks of life, this is a good decision. This type of risk reduction is well worth what it costs.”

What about getting the test every three years (versus every four) or every two years (versus every three)? Here the doctor should say, “Now we are moving toward the upper boundary of what most other people are willing to spend to avoid various kinds of risks. So at this point, serious thought needs to be given to whether the test is really worth what it cost.”

How about getting the test done every year (versus every two years)? Here the responsible doctor will say, “This is definitely a bad buy (unless there is some specific indication). The cost of an annual Pap smear in relation to the amount of risk reduction achieved is way outside the range of choices most people make with respect to other risks.”

Notice what is going on here. The responsible doctor, functioning as an agent of a patient who is not familiar with the medical literature and who is not skilled at evaluating risks or trading off risk reduction for other uses of money, advises her patient in these matters. She helps her patient manage both her health and her money — because both are important.

When Dr. Carroll says “I’d do it even if it cost a fortune and might not work,” I am sure he is being sincere. But I am equally sure that is not how he normally makes decisions. It is in fact easy to spend a fortune to avoid small-probability events. The EPA makes the private sector do it every day. But if an ordinary family tried that, they would end up spending their entire income avoiding trivial risks. And that is not what normal people do.

Here is another example of a money-is-no-object-no-matter-how-improbable-the-prospects-if-life-and-death-are-at-sake choice. This is Zeke Emanuel, writing in The New York Times the other day:

Proton beam therapy is a kind of radiation used to treat cancers. The particles are made of atomic nuclei rather than the usual X-rays, and theoretically can be focused more precisely on cancerous tissue, minimizing the danger to healthy tissue surrounding it. But the machines are tremendously expensive, requiring a particle accelerator encased in a football-field-size building with concrete walls. As a result, Medicare will pay around $50,000 for proton beam therapy for a patient with prostate cancer, roughly twice as much as it would if the patient received another type of radiation.

Emanuel claims there is no evidence the treatment works for prostate cancer — so the therapy is a waste of $25,000. Is he right? I don’t know. If you’re paying the extra $25,000 out of your own pocket, listen to what the doctors at Mayo have to say (in favor of its use) and then listen to what Emanuel has to say and make up your own mind.

Bottom line: helping patients manage their health dollars as well as their health care should be what doctoring is all about.

John C. Goodman, PhD, is president and CEO of the National Center for Policy Analysis. He is also the Kellye Wright Fellow in health care. His Health Policy Blog is considered among the top conservative health care blogs where health care problems are discussed by top health policy experts from all sides of the political spectrum.

Are Entitlement Spending Cuts Bad for Young People?

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By John Goodman

Almost everyone agrees that without significant entitlement program reform, there is little hope for a solution to the looming decade of out-of-control deficit spending. That said, there is little agreement on how to do so. The inclination on the right is to cut spending; the inclination on the left is to raise taxes.

Critics of proposals to reduce spending claim that younger workers will be short-changed. For example, when Paul Ryan proposed to reform Medicare by making the federal government’s contribution (“premium support”) grow less rapidly than the rate of medical inflation, critics charged that this would shift costs to future retirees.

What the critics missed: If future Medicare benefits are smaller, then the taxes and premiums needed to pay for Medicare will also be smaller. In other words, Medicare benefit cuts produce partly offsetting taxpayer gains. Take the cuts in Medicare spending already enacted as part of ObamaCare. According to a National Center for Policy Analysis report by our colleagues Courtney Collins and Andrew Rettenmaier, lower taxes and premiums will offset about one-fourth of the benefit cuts for today’s 65-year-olds. They will offset almost one-half of the benefit cuts for 45-year-olds.

Continue reading…

Who Knew? California May Have a Public Option

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By Linda Bergthold

During the health reform debate, there was controversy and disappointment over the failure to include a public option in the Affordable Care Act. Not only did the public option idea not die, it is alive and well in California.

In northern California last week, Kaiser Health News correspondent Sarah Varney interviewed the CEO of the Alameda Alliance for Health, Ingrid Lamirault, about their intention to participate in the California Health Benefit Exchange when it goes live in 2014. The Alameda Alliance is a non-profit insurer (governed locally) that competes with private for-profit plans in the county to deliver health services to Medicaid beneficiaries (called “Medi-Cal”) and public employees.

California does not have a monolithic or centralized Medicaid program. There are a variety of innovative programs that deliver cost-effective high quality care to Medi-Cal beneficiaries. Alameda Alliance is one of fourteen “two plan” counties that serve 3 million beneficiaries. Alameda has to market to Medi-Cal members in competition with a commercial plan. These public plans have been competing with the private sector for over a decade, and despite initial concern from both the left and the right, Medi-Cal beneficiaries and providers are pretty satisfied with the program, which has been able to live within its budgetary limits.

Continue reading…

Direct Access to Lab Results: Helpful or Harmful?

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By Patricia Salber

I am a big fan of DIY (do-it-yourself) healthcare, at least for the bulk relatively minor issues that plague people.  I think the days when doctors were needed to control, interpret and dole out health data and information are waning.  There are simply too many ways, primarily via the internet, to get good, reliable, easy-to-understand information about our own health.

The Quantified Self (QS)people who use sensors, mobile apps, and other devices to collect data on themselves may be taking it to what some would consider extreme, but I think it is the wave of the future.

Now, no one would question who “owns” the data collected in this manner, but how about data collected via a medical laboratory?  Is that somehow different and something we, the patients, should not be allowed direct access to lest we harm ourselves by misinterpretation.  Interesting question!

The issue is explored in a commentary in the December 14, 2011 issue of the Journal of the American Medical Association (JAMA).  Traber Davis Giardina, MA, MSW and Hardeep Singh MD, MPH, ask the question:  “Should Patients Get Direct Access to their Laboratory Test Results?”  They find that it is “An Answer with Many Questions.”

Continue reading…

Surviving Workplace Wellness Preorder Now Available!!

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The Doctor Is In (And Extremely Annoyed)

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It’s no secret that many doctors are unhappy about the changes to the healthcare system planned by the Obama administration.   But just how unhappy are the majority? And what will happen when the series of ambitious reforms approved by the Senate last month begin to go into effect?  It’s hard to say with any certainty.   But we have clues of what may be coming, In the days after the passage of the health reform bill, sermo.com, an online community for physicians, and athenahealth, a web based healthcare IT provider, asked doctors for their reactions to the news.
The responses give a good sense of how doctors are taking the news and their likely responses.  Hundreds of doctors responded, giving a unique snap shot of a rarely polled court of public opinion. From specialists like oncologists and OBGYNS to general practicioners.  We’re reprinting the full text of their comments in these pages.

A couple of caveats. web-based polls and surveys are notoriously non-scientific. By definition they tend to attract those who are already engaged with a cause and activists who’ve already made up their minds about the issue being examined. (The well known echo chamber effect that many observers credit with reducing civilized discourse to snark. )  Another limitation: By asking people their opinion of an issue hours after , you run the risk, what could be described as the  “Oh My God!” effect.  The same kind of distrotion you’d get if you asked people what they thought about airline security the day after a plane crash or financial regulation , hours after after . something news organizations have become expersts at asking.  – or a plane crash, or a terrorist . What do they really think? Well, they’ll have to think about it. Chances are it will change.
For further background, please visit sermo.com/blog/ . It should go without saying, that THCB does not necessarily endorse or support the views expressed by the commenters in this thread.  We do feel however, that understanding  the evolving healthcare ,
OBGYN

I really think that the public needs to know how WE feel, since there still has been only a little press coverage u ntil very recently about how physicians perceive the changes that will come about. It is indeed alarming how many of us realize that private practice is dying. I do hope that we can”level the playing field” with insurers, but I also wonder if this will be a temporary fix until “Obamacare” goes into full swing.

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.

FAMILY MEDICINE

Look folks, the public doesn’t give a crap how we feel and won’t until they are personally inconvenienced. The thing that could have saved us would have been a strong lobbying organization which the AMA proved conclusively they are not.

CARDIOLOGY

This trend will lead to more of us exiting medicine earlier than planned.
INTERNAL MEDICINE

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.

INTERNAL MEDICINE

Who do we think we are fooling? Physicians are idiots, working on surveys like this. Nothing will be any different than it has been for the past 15 years UNLESS WE STRIKE! Then people will listen……..Then things will change.
INTERNAL MEDICINE
You should have also asked how many MDs are considering retiring to escape ObamaCare. I will cast the first vote for the affirmative. I will either retire, or greatly scale back my work. I will do whatever I can to minimize my involvement with government, or insurance companies which will become tools of government control. Thanks to Congressman Dingle, we now know for certain (as if we had any doubts) that the ultimate goal of the “progressives” is to “…control the people.” –Dingle.

NEUROLOGY

Many thanks Dan for staying in the fray and keeping our little voice out there. The media is not much interested yet in what physicians have to say, but this will be a good start to letting them know how physicians will begin to think in resoponse to the heavy handed government plan, the insurance company legacy and just how difficult it might be to get in to see a physician in the near future.

EMERGENCY MEDICINE
You are having a heart attack, stroke, in pain – call your democratic congressman/woman. Maybe he/she can help you because I will have retired.

INTERNAL MEDICINE

Is it foreseeable that some physicians may very well be better off under this reform bill because cost containment will be at the forefront as opposed to just pure-click system as we currently have it? I would be curious to hear others thoughts.
PEDIATRICS
Anyone who thinks the healthcare system will be benefitted by the control of those who control the (failing) post office, the (failing) social security system, the (failing) medicare structure, the (pitiful) Indian Health system…is either completely out of the loop or needs a urine drug screen. Thought the following link that was sent to me was interesting (from a doc to a senator), although I haven’t checked out the details (too busy dictating letters of medical necessity for my many special needs kids!). americanlibertyriders.ning.com
CARDIOLOGY

This bill, while not perfect, is the most morally righteous action performed by our government in 20 years. The opposition of many of my fellow physicians to this legislation is selfish, narrow-minded, and a betrayal of the highest principles of our profession. I support this legislation whole-heartedly, regardless of whether it reduces my income.

FAMILY MEDICINE

Maybe it is time to look for a new career. Insurance companies tell us what we can order for patients from tests to drugs to home care equipment. Now the federal government is going to tell us what our services are worth. That’s a little too scary for me. I plan on voting them all out in November. If not enough Americans agree, I am sure I can find something else to do where I can earn a living that reflects my training and expertise instead of putting me on a level with a postal employee.
FAMILY MEDICINE

We need to get real here. Congress doesn’t care what we think. Ultimately, it’s insane to think attorneys should write any laws regarding the delivery of medical care. I think it would be interesting if they let us write a “reform” program for lawyers. Legal counsel would be a right not a privilege, for things less than significant criminal charges. The poor could have subsidized legal counsel. Everyone would be required to belong to a Legal Maintenance Organization or be prepared to pay a fine if they’re sued or get busted for something and they’re not covered.I could go on, to no avail. At least Tom Coburn is ragging Congress. No Viagra for sex offenders strikes me as a good idea. The attorneys general of 13 states may make some progress here.
SURGERY, SURGICAL ONCOLOGY

Unfortunately I seem to be in the minority of physicians who actually went to medical school and subsequently have spent years training to help people. It is so heart-breaking to see patients with dire situations who do not have any health care coverage and are subsequently denied the treatment that they need.Yes, it is frustrating to deal with uninsured patients who do not take care of themselves and end up with potentially preventable injuries or conditions. But there are also those people who unfortunately develop unpreventable injuries or condition. And thanks to the current legislation, we will begin to be able to take care of *all* Americans, not just the privileged.

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.

FAMILY MEDICINE
bye bye American pie and practice-I’ll still be in business just not medicine- sad, after 26yrs of caring for others…i no longer care…. except for my family.
PSYCHIATRY
Silver linings in the dark cloud of Big Oh’s health care plan (O’care):

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!

INTERNAL MEDICINE

Listen, y’all. The only way Obama can make this scheme work is if we are complicit in his plans. Have any of you read “Atlas Shrugged?” If you haven’t, then read it; that is your IMMEDIATE asignment. In the book, the government took over productive enterprises, but soon discovered that it was the mind behind the enterprises that made business successful. John Galt led the productive people to a secret place where they could work and enjoy the fruits of their labor. Guess what happened to those left behind? The ones whose only hope of survival was to live off of the productive of society? If you know the answer to that question, you are getting close to the answer to our dilemma.
EMERGENCY MEDICINE
Agree with the many comments. Polls etc. are helpful, but until we start getting in there and legislating like the lawyers did, we’ll never have anything done in our favor….

PHYSICAL MEDICINE & REHAB

Agree totally with Sermo Doc 5. The public and govt don’t care about docs- they think docs make too much money, a 21% or even higher cut will not make much of a dent in their income and they probably feel its even justified. They don’t know the expenses of practice. They will only care when they can’t find a doctor who will see them for the pittance they are willing to pay or have to wait 2 months to see one.
EMERGENCY MEDICINE
The main problem, is that we simply cannot afford this plan (especially with the economy and tax base where they are). Also, 85% of people are satisfied with their insurance plans and there is no reason to change the system for everybody. Why couldn’t Congress simply develop a plan to subsidize, based on need, the working un- and under-insured? The rest can go on Medicaid which is already there for them. This is simply a power grab and has nothing to do with the Dem Congress actually caring about people. Since the Democrats love unions so much, they would love it if we unionized, right?
PSYCHIATRY

Interesting…are those physicians who think that President Obama is this huge socialist going to accept Federal stimulus money for their Electronic health records? I smell a rat!

PEDIATRICS

Well I think the general public does not want to support a system where people get benefits for not contributing back to the system. I really think that as the taxes go up and that is why some changes dont kick in for several years to make it look like nothing is different…. until all hell breaks loose. I studied in a communist country in which everything was subsidized to keep the peace until it could hold together any more…  We need a better way of paying for health care…. and how the money is spent… to provide these services…. You cant have everything… and not pay for it…
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…
PATHOLOGY
I agree with Sermo Doc 9 that everyone should read “Atlas Shrugged” to see the ominous parallels between that novel and the current Obama/liberal socialist agenda. But for most of us, dropping out of practice is not a viable alternative at this time. We should become more politically active and campaign tirelessly to get these corrupt, power-hungry scumbag politicians thrown out in November. If the Dems could lose the Mass. senate race, they are vulnerable everywhere.
FAMILY MEDICINE
It is clear that this current Federal government cares nothing about what anyone thinks.
PEDIATRICS
This may be the biggest legislation ever passed… but it is not fair by any means…
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?

SURGERY, GENERAL
Resign from the AMA now,
ENDOCRINOLOGY
Surveys are of interest, unfortunately, only to those who care about or benefit from the results. Nowhere in the health care reform debate has any thought or attention been given to calculating, or even just estimating, the reimbursement for physician services needed to sustain the practice of medicine, in any model.Costs go up, and payments go down, the business plan of bankruptcy. Significant attention to reducing the cost of medical practice is completely lacking: Tort / liability insurance reform , billing simplification, decreasing the expense entailed in satisfying the growing, and growing more complex body of regulations that mostly have no relation to the quality of care, for a few examples.

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.

FAMILY MEDICINE

I can understand the sentiment of the physicians in the field. We have not been treated fairly or with any knowledgeable deference. But whose fault is that?I think it is our own. We have accepted the unacceptable because it was the easy way, required not much thought and we were making money, weren’t we?

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.

FAMILY MEDICINE
Obama and the liberals won the vote in Congress, but will lose big in November.

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.

ANESTHESIOLOGY

The general public still thinks we’re overpaid, so if we do any bellyaching, they think we are just whining. They don’t realize that they are going to eventually feel the effects of these changes, both in their pocketbook, and in a decrease in service. Docs are going to be getting out ASAP, and there won’t be enough of them coming out of training to fill the void. Certain specialties are already seeing this. Before long, I fear it may spread to all of medicine. I’m getting to the age where things start going wrong, so I’m not real happy about this as a patient either. I may have to keep practicing to take care of my family when the wheels fall off of this thing. November is Coming.
ANESTHESIOLOGY
Exactly the road Argentina traveled down from 1910 until present. Egged on by entitlements and expansion of debt spending, which accelerated though the Peronist years. Everything finally came to a head in the late 1980’s when the government and the economy collapsed. Years of 3000+% inflation reminiscent of the Weinmar Republic in 1930’s Germany. Only recently though the most austere budgets have they somewhat recovered. Just to think in 1910 they were on par with America as the two best economic powers in the western Hemisphere. Well as they say those who don’t study history are doomed to repeat it……..

SURGERY, PLASTIC

What do you think the poll results would show if the dems proposed a tax on everyone to raise x-billions to cover the un-insured under Medicaid? No body likes to pay more taxes, but at the end of the day the majority of the medical community would rally behind such a proposal. But that is hardly the proposal that was rahmed down our throat. This reform is not about caring for the un-insured, it is about CONTROL. If you’ve ever lived under a dictator, you would recognize these maneuvers intended to nationalize certain industry. These maneuvers just happened to be a little craftier in order to beat the major obstacles in the way: The US Constitution and Rule of Law. Try to get it out of your head that this a “socio-economic” program. This is about power and control. This is the power and control that the Founding Fathers warned us about. They also knew how corrupt and tyrannical governments will inevitably become with more power.You must also understand that even though we took an oath, we never took an oath of misery.

MillionMedMarch

FAMILY MEDICINE

I see private primary care medicine following two paths:1. Fee-for-service rendered (cash-based).

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.

FAMILY MEDICINE

Count me in with those who support the current reforms. While the proposed changes are not perfect, I think we’re headed the right way.
CARDIOLOGY
I anticipate forced retirement since if will likely be financially insane to practice in an area where Medicare is the HIGHEST payor. When the physician population of retirement areas is depleted, there will be a second real estate crash when people realize that they cannot retire to Florida, Arizona, etc. since they cannot get medical care there.
ANESTHESIOLOGY
Might as well go to Canada….. the medicine is socialized as it will be in the US, but at least they have tort reform via the English rule (loser pays ALL costs), seems to have all but eliminated frivolous lawsuits.
PEDIATRICS
the voice of Thomas Jefferson says a lot:
“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.

CRITICAL CARE

ALL physicians who supported this bill are one or all of these:
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.
PHYSICAL MEDICINE & REHAB
I personally will begin to phase out seeing patient’s on Medicaid and Medicare. The only way we as physicians can have an impact is if it is more difficult for patients to see physicians. This in turn will infuriate them and hopefully will have an impact on the government. Its a shame that the AMA sold physicians out, as they could have had a stronger impact. Their goal was to get the medicare reimbursement SGR formula changed. Where has that led us? No where. We are headed to a 21 percent cut in reimbursement.

MEDICINE/PEDIATRICS

Um, I don’t think the voice of the conservative Sermo crowd is at all representative of physicians at large in this country. I am ecstatic that we have the beginnings of health insurance reform here and as a citizen of a leading nation that has not yet seen healthcare as a right, I am proud to see this change and even willing to sacrifice a little of my own self interest if that is what is needed. Anybody want another option? Check out National Physicians Alliance!
EMERGENCY MEDICINE
I think we should accept only the insurance plans the Congress will make sure they still can choose for themselves! The only savings in this plan will be through rationing. Patients will get much less than what we think they will need. Follow the numbers (and the money)!
FAMILY MEDICINE
In my 15 years in this profession, I have yet to see someone acutally denied the care that they needed, maybe it happens more in your areas, but to this family doc, it just didn’t happen. Docs took care of the stuff, myself included, knowing we we not going to get paid. So, I don’t know if I buy all the “people left to die” stuff that the media throws out there.
EMERGENCY MEDICINE
I am very disappointed that the general sentiment seems to be based solely upon self interest rather than the general public health. It’s less than flattering to the profession. The reason I chose to practice medicine was to help others, not for the income (though it’s welcome) or the independence (it was clear that such an era in medicine was ending back when I graduated from medical school in 1979). As with almost any legislation, it is less than perfect; there should be more emphasis on tort reform (it would be of psychological benefit if nothing else) and better income incentives for those who practice primary care. So, keep working to improve primary care reimbursement; as for many specialists (of which I am one), we earn – and will continue to earn – a very good living. Excessively solipsistic hand wringing is unattractive. And yes, I’ve taken care of many patients that some of you refused to because they cold not pay.

Emergency Physician in (horrors) Massachusetts

EMERGENCY MEDICINE

Govt control will be no joking matter. I can not wait for all the performance measures and added restriction requiring enormous overhead to comply. When group insurance rates skyrocket by 300 percent next year, watch out. I am seriously considering cash only practice.
INTERNAL MEDICINE
We all care. I have paid my dues, just like you did. In my 30 years as an MD, I have cared for countless souls who never paid me, or even thanked me. You entirely miss the issue. There is no question that the ill and infirm need care. There is also no question that MDs deliver enormous amounts of uncompensated care. The question being raised here is, “Who makes the decisions?” If the decisions are made between me and my patients, I am “all in.” If it is government, then count me out.
EMERGENCY MEDICINE
Did it ever occur to you that the Sermo docs are bright enough, not just to become docs, but to see that conservatism is the only way for the US to remain a place where everybody has the opportunity to succeed? Handouts do not help over the long term as they cannot last and are never enough and “eventually you run out of everyone else’s money” – Thatcher. Although I am not trying to speak for everyone, did you consider that perhaps Sermo docs seem to be “conservative” because as a group we value a small, non-intrusive federal government, states’ rights, personal freedom (to succeed or fail), and as docs, we value our relationship with our patients and don’t want K. Sebelius in the room with us?
ANESTHESIOLOGY
Having worked almost 8 years in 2 western European countries ( Belgium and France) with socialized medicine (everybody with legal status insured), I can predict over long haul ( min 7-10 years) things would even out , expect more cost,almost certainly more deficit and consequently more taxes on higher incomers , but also more patients per physician, and consequently similar income ( lack of enough physicians per population to cover the newly insured population is practically balanced by more and more non physicians practicing medicine ( nurse practitioners, physician assistants, CRNAs, etc) in the US , a factual unfortunate event , but a remedy in this particular situation!
Hysterical FOX NEWS type comments on this matter have no substance!( like almost on everything else)

MEDICINE/PEDIATRICS
Our small, completely independent 4-doctor internal medicine/pediatrics practice in North Carolina is thriving and by all appearances will continue to do so. We have a mix of insured, self-pay, and government funded patients. We keep our overhead low, see patients 17-20 hours a week, have most appts for 30 minutes. We insist that our doctors take 4-8 weeks off a year and we both love what we do and do it in a manner that makes us proud.

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.

PEDIATRICS
An observation on the “compassionate” aspect of these health care reform bills — it is not compassionate to promise something that a system is too inherently flawed to deliver, at least over the long term, in a sustainable manner. If you think that systems built on a no-visible-cost, no-accountability premise will be sustainable, must agree that you are: ignorant, naive, or on drugs. Please observe prior examples given above of entitlement-based, tax-the-“rich” economies that have collapsed multiple times in past history. Socialism & its cousins can only be sustained while you have an incentive-based capitalistic source of income to support it. This bill/law will not affect my practice immediately or for several years, but I worry about societal trends and deterioration of accountability. I see it in the families coming to my clinic, & this bill reinforces the trend.
FAMILY MEDICINE
I heard today at the hospital (and this may or may not be true) that NOT EVEN ONE person in Congress who voted FOR Obamacare has had ANY experience whatsoever in the health care industry. Not one!

What do you think of this? There are 19 doctors in the House of Reps, and several in the Senate.

PSYCHIATRY
Yes, I think I will accept federal stimulus money, (which was my money before it was theirs) to pay for the EHR system which the government has made it clear they will mandate us to be using within a short few years or face penalties in payment of fees for services. I smell a rat too… all the way from Washington.
INTERNAL MEDICINE
Re: Whakerhill:” You are having a heart attack, stroke, in pain – call your democratic congressman/woman. Maybe he/she can help you because I will have retired.”Guess what, until this reform passed, you are now stuck in your job, if you even had one because another insurance company would refuse to cover you for preexisting conditions.
Obama is not the enemy, the insurance companies are.

ANESTHESIOLOGY
Get ready for another wave of early departures from active practice. Back in the 1990s I recall seeing something about surgeon’s disability insurance risk rating being dropped to the same level as meat packing workers. Managed care made it seem better to cash-in on their disability policies than try to slog on through the aches and pains that they previously ignored.

EMERGENCY MEDICINE
Eliminate Private Insurance. Save 25%…..
OTOLARYNGOLOGY
Now that everyone is going to be insured and the government is going to take care of everyone- I suspect there is no further need for charity care. All the volunteerism of physicians, hospitals and pharma goes right out the window. Everyone will expect to be paid for everything, and the government will cover it. I have always put my faith in the most generous people in the world-Americans, from the small business man, the hourly worker, the churches, and my fellow physicians. American government has been great because it was of these people, but it is no longer. Physicians have not always been vocal and public with their charitable works, but when you see the great works that have been done you couldn’t help but be encouraged. True, everyone did not participate, but many have. Rather than pay lobbying fees and bribes to politicians, many of us have been giving to our patients. Foolish we were, but I suspect no more. The loss of this philanthropy will not only add costs to the system, but will destroy the essence of our profession. The giver gets far more than the receiver from charitable works, but even that has been robbed from us. I suspect there will be even less “professional duty and ethic” in the next generation of physicians as a result of the government take over.
GASTROENTEROLOGY
I’m tired, really tired of people trying to squeeze the last drop of blood from us. I hope Athena is not trying to pitch the value of EMR stimulus to doctors! that will be the last straw…
ANESTHESIOLOGY
Despite the liberal ideology expressed by a few above, many (?most) physicians entered into medical practice for mainly selfless reasons, but don’t feel we owe our souls to the government or to the public. The amount of time, dedication, sacrifice, etc. we give warrants a good reimbursement, especially considering that a good portion of our pay (or at least mine) goes to life and disability insurance. It’s not like I live in a mansion, or that I have excessive money to spend on luxury. I have hundreds of thousands in debt, I am advanced in age related to retirement, and I have to protect my family because of all that debt (i.e., life & disability). There is nothing wrong with wanting some payment for all the years of sacrifice. We, on a daily basis, give of ourselves in many ways to those who can’t pay. I don’t need the govt. shoving this crap down my throat…it makes me feel much less generous overall.
ANESTHESIOLOGY
To insure all is, indeed, a noble quest. Just this morning, I was questioned by a mother of 3 (all present, the youngest one 2.5 months) with chronic low back pain, multiple prescriptions for narcotics, positive urine drug test for marijuana and cocaine, asking for more pain medications. I refused, citing the above clinical anomalies. “You just wait!! Obama will get YOU!!” I’ve got news for you, lady: he already did, thanks to the AMA.

RADIOLOGY
“The Forgotten Man of Socialized Medicine, the Doctor”

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.

PATHOLOGY
This is the start of the end. I really feel sorry for physicians just finishing residency. They are know indentured servants. I wish I had a few more years end and I would retire. We have started to change from a society that rewards the productive, self discipline, delayed gratification, and those of merit to one that encourages sloth and poor choices. The economics of this law are absolutely insane an in no way sustainable. Frankly the law assumes every physician and productive member of society is a complete moron. Who will continue to invest work harder and take risks when their is absolutely no benefit. In the end everyone will be poorer, everyone will get worse care, and the deficit will grow. We are not only on the road to serfdom we are getting pretty damn close to the village. I think those that made this law no it stinks to high heaven and that is why they exempted themselves from it.
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.

INTERNAL MEDICINE
One thing that concerns me about this bill is the low cost of the fines for not buying insurance. If you calculate what the actual fine would be, a family with a $30,000 income would only pay $250 a year in fines. What’s to prevent healthy patients for opting to pay the fine instead of pay for insurance and then the minute they get sick go buy insurance? There’s no pre-existing condition exclusion now so that would be possible. That will cost the system a fortune and significantly lower the number of healthy people in the pool to offset costs. There has to be a better way to implement coverage for more Americans slowly and systematically. I can’t foresee how we won’t all be getting & giving a lower level of care in a few years. I also am concerned about how this is going to overload the emergency rooms with all of the patients that are now “insured” but can’t get in to see a doctor. And does anybody else in primary care really think it stinks to be getting hit with Medicare payment cuts (when all other insurers also base their rates on Medicare rates) and then be taxed additional Medicare and capital gains tax in addition? For a 2 doctor household like mine, that really cuts into the bottom line. And I agree with the many comments above that we didn’t just go into this profession for the money but we did delay making income for many years longer than average and then still spent years paying off debt so it takes a little momentum to get the retirement savings to where you need it. What’s wrong with finally enjoying the benefit of years of hard work? I’m getting my MBA, there will be lots of administrative jobs available.

PSYCHIATRY
Well now we docs can all work less and we can’t lose our health insurance either! Awesome! Way to go Obama! Come on everyone..there are huge forces at play out there that us docs cannot control anymore. It is obvious to me as the comments suggest that they think we are replaceable/substitutable for something cheaper, etc. The only thing to do is continue to be the best and when we are missed they will look back at what they had. When we can’t practice anymore and we leave or whatever, some Americans will look back with regret for the loss and others with some idealized joy that everyone in America now has health care whether it is good or bad. I surmise that the former is going to outweigh due to fact that Americans expect the best and demand the most convenient of everything. They will not be happy with the system they will be getting. In the end, we can say we told them but no one listened. So sorry…just keep on keepin on everyone and treat patients as they should and as you were trained. Let the chips fall where they may….it is not worth being miserable. Just don’t compromise your happiness or integrity over this or they will have won control completely.
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!
CARDIOLOGY
I’m thinking of charging a administrative fee for all my patients for increasing overhead and declining reimbursement. This is the only way to stay in business as cost to run a practice is rising. Has anybody done the same?
PULMONOLOGY
Obama did not kill medicine. Doctors allowed things to get messed up many years ago. We did not do enough to control costs, inform our patients of the realities of med. care, ensure reasonable billing practices across specialties and gen./fam. medicine, and fight for reforms long ago. The system is a mess. The reform bill will likely be a mess in many respects as well. But NO good solution will be possible in the United States where medical care is expensive and the American people demand ‘the best of everything’, and where competition (unlike in all other economic systems) increases costs, not decreases it. At least soon many more people will have access to care. I also fear the future, but I have not spent 2 minutes of my professional life fighting with medicare to provide for my patients (granted, I didn’t get paid much). But I have spent literally thousands of hours arguing with insurance companies to get appropriate studies, drugs, procedures and hospital days paid for. When there comes some absolutely cataclysmic disaster, MAYBE something reasonable will be done. But I doubt it….it’s too late…and Obama’s reform bill isn’t the reason.

PATHOLOGY

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.

FAMILY MEDICINE
Too little, too late. We “greedy docs” have been demonized along with the health ins companies, drug companies, etc. Only the trial lawyers were unscathed, as they go laughing on their way to the bank.
INTERNAL MEDICINE
You can pretend all you like, but you speak of drizzles, and fail to see the torrent on the horizon. The die is already cast, the torrent is coming my friend. We might have time to build a stronger dike to hold back the waters, but time is short. Those like you that hide from the truth will benefit from the heavy lifting of those willing to fight the beast if we are successful. But if you fail to engage the battle, you weaken the effort, and you deserve what you get if we fail. Good luck my friend.
CARDIOLOGY
My group plans on accepting no Medicaid patients (actually we don’t to begin with)- but the massive # of patients who will now be able to get on Medicaid will need to find Cardiology care elsewhere- there is no way that we can accept nearly 1/2 of what Medicare pays to care for those who tend to be sicker and more litigious. And by the way may the Chairman General Pelosi, and Dingy Harry be subjected to waterboarding (although they will have Eric Holder there to bail them out. This country is being turned into a Socialist experiment.
INTERNAL MEDICINE
I believe that we as physicians can have a huge impact on deciding how the system is set up if we will only have the gumption to stand up and be counted. We need to make it clear what we want, and make it loud and clear that the AMA does not represent the average US physician. If we as a group make it clear that we will not cooperate with the system Obama and his socialists are building, we might be able to force a change. It might be too late, but the longer we wait, the tighter the stranglehold will be.
FAMILY MEDICINE
The road of American Medicine has yet to be traveled. The first major cross road will be the Public “only” Option and then the detour of licensure from a federated states licensure to a single federal license tied to the public optIon. But I”m no soothsayer.
EMERGENCY MEDICINE
Here’s the problem: The general public thinks that “most doctors” support this reform. Case in point: a friend of mine lobbed a ridiculous article at me when I said to him:

“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.

PEDIATRICS
A physician’s view…As a solo practice pediatrician in a very rural, isolated, and medical shortage area, I’ve been following this bill very carefully as it will affect health care in my area, state, and the US very significantly. There are some good points such as no limits on costs of treatments,no denial due to preconditions, and a few others but the majority of the bill will not do what its intended to do. Unfortunately, this bill was crafted by politicians with very little input from doctors in the field. Yes, many from the AMA and its affiliates such as the AAP(American Academy of Pediatrics) supported this bill…but without consulting again, we doctors in the “trenches”. Those doctors in the administrative positions are often far removed from the realities of medical economics or the hassle of dealing with insurance companies and especially, government run health care.

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….

PSYCHIATRY
There is a lot here, much well-said. One thing I would disagree with, though, is the concept of “increasing insurance competition” across state lines. The insurance monopolies are too big already. Instead I think they need to end the anti-trust exemption (and give it to us instead!) and to break them up like they did AT&T when they created the “Baby Bells” to increase competition. The state insurance commissioners are sometimes the last line of defense against egregious violations, even if they are generally worthless except in the most outrageous cases. But to think of trying to get justice out of some politically-connected insurance commissioner in, say Florida, calling from northern WI, fighting some national giant like Wellpoint, is, Well. Pointless. So would leave us even more powerless than we already are.

FAMILY MEDICINE
As a fourth generation physician, I have seen many changes. When the changes really became bad was in the mid 1980’s with the establishment of HBO’s which began to ration care and make obscene profits. That’s what brought the costs up. We will never see affordable healthcare without the public option. We must have this option to give competition to the insurance industry. The bill passed over the weekend will make some improvements, but costs far too much. Only when the healthcare industry is willing to help their country instead of filling their pockets will we be able to provide quality health care at a reasonable price.
INTERNAL MEDICINE
I would actually think this bill had some validity were it not for 3 things
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.

PSYCHIATRY
My biggest concern is the polarization of all facets of the American Community. Unfortunately, we do not seem to be immune. In this area, we have brought many of these changes on ourselves. I find myself passionate about both ends of the spectrum, hoping for Leadership that could bridge the middle is some reasonable fashion. The lack of addressing malpractice issues in any reasonable way, clearly shows the lack of interest of politicians in our input. I am concerned for all patients in the future– including each of us that will need physicians to take care of us. Gladly serving, yet very tired!! God bless!
INFECTIOUS DISEASES
I was just thinking-what would you tell a medical student, with a mountain of debt, who is looking at all of this unfolding to full bloom by the time they are ready to enter practice?<