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May 22, 2010

Government Management of Doctors

Doctor:  I dreamed of being a doctor, and earned my M.D.
Mike:  I'm puzzled. Why are you managing a government department?
Doctor:  As a doctor, I realized I was mostly managing a government department. This way, I get paid to do it, and I go home at 4:00.

The Trend to Cash Medical Practice
05/21/10 - Chicago Boyz by Michael Kennedy

Medicare has degraded to the point where reimbursements minus imposed costs are not enough to support doctors. The true, awful promise of Obamacare is to make this worse. Medical prices have been grossly distorted along the way, with more distortions to come.

[edited]  I have written about doctors dropping out of Medicare, many quitting all insurance. I met a woman geriatrician who is the only fellowship trained geriatric specialist in central Iowa. Geriatrics as a specialty is a university subsidized field. There is no private geriatric practice because the doctor can’t survive on what Medicare pays. She tried and had to quit.

Quitting Medicare is remarkable when all your patients are of Medicare age. Medicare was harrassing her because she was seeing patients too often. Many were frail elderly living at home. She dropped out and began charging cash. She made a decent living after a year and was happy with her decision.

Another doctor discovered he was able to do very well financially, have high patient satisfaction, and deliver good quality of care, by avoiding the administrative and bureaucratic hassles of Medicare. Surprisingly, most of his patients are not wealthy. Half have no insurance, and another 15% use Medicare for other doctors.

If a doctor accepts any Medicare payments, Medicare requires that he charge their grossly inflated price. Then they pay 10-20% of that price. If Medicare discovers that a doctor has charged less to a cash patient, Medicare reduces his “profile” price to that cash price and pays 20% of that. A doctor simply cannot go to cash medicine and stay enrolled as a Medicare provider.

Newport Beach is one of the wealthiest communities in California. Their busiest hip surgeon has dropped Medicare and charges $1200 cash for a total hip. Patients are surprised, because total hips cost $5000. No, that is the Medicare price. He is charging cash at the same rate he would be paid by Medicare. People don't realize the discounting that goes on because insurance companies have been able to sign doctors to contracts.

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05/21/10 - MDOD by 911Doc

I am dismayed at what our thoughtless political leaders are doing to a vital profession. Literally vital, maintaining life. Citizens, wake up, and don't allow our politicians to continue to screw this up. To borrow a phrase, if you think medical care is expensive now, just wait until it is "free".

[edited]  Over the last fifteen years a quiet coup has taken place in medicine. Decisions about reimbursement, schedule, responsibilities, and the shape of a physician’s practice have been co-opted by all manner of clipboard carrying administrative drones and academicians.

I don’t believe the drones to be evil per se; they are simply doing what we cannot now do. They work to support themselves and their families to the BEST possible extent within their comfort zone. But their ‘normal’ existence and the laws, rules, and regulations which have allowed their rise, has come at the direct expense of physicians and patients.

The expense to physicians is in money lost, and more importantly in confidence. The monetary loss is easy to understand: EMTALA and other government redistribution programs are unfunded, medical care comes at a cost, and someone must pay. Physicians, nurses, and taxpayers pay the most as providers of the services.

This redistribution has given to the poor, both deserving and underserving. It has supported illegal aliens by the hundreds of thousands. It has also paid cash from our pockets to the new drone class in medicine. After all, there has to be a drone class to file the papers and hold meetings about how other people’s resources and money should be distributed. It has to be done with a semblance of “fairness” even though the act is unfair on its face.

Physicians have been quiet as their stuff has been taken, their time at the hospital increased, their power quashed, and their ability severely limited to practice medicine as they had trained. Uncertainty has replaced confidence. A generation of academicians and older physicians have submitted to bullying, or worse, encouraged it.

In the comments, 911Doc advises a doctor in training:

[edited]  Do not look to medicine to provide some deeper meaning, or prestige, or mojo, or whatever. For better or worse, today, it's a job. That's all it is.

Now, you and I probably know differently, because we feel that there is something special about what we do, that we practice a noble and giving profession, and hopefully that counts for something somewhere. But perceptions, while often wrong, carry weight, and the perception now is that what we do is just a job, and that health care is a commodity and not an art. This perception may change, but if it does, it will be decades hence.

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A Doctor Describes Government Management of Medical Care
07/03/10 - Big Government by Bret Jacobson  (YouTube video 3:37)

This doctor treated Medicare Patients, and was routinely denied payment. Medicare said: "We can't pay you right now, the computer is down". The computer was down for 18 months when she gave up.

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The Political Distribution of Wheat
01/17/10 - EasyOpinions

A short analogy to what is happening in the market for medical services. What does a market for wheat have to do with healthcare? It is easier to understand.

[excerpt]  A politician sees a warehouse full of wheat. He takes some of it to distribute to poor voters and prospective voters in his district. The warehouse will have to bear the burden. He is applauded for his sensitivity and charity.

The politician is dismayed at the consequence. Maybe the warehouse goes out of business, as people switch to using a warehouse that the politician doesn't see or can't tax. Or, the price of wheat goes up as the warehouse is not completely refilled. The politician ignores the people who paid for the wheat or were expected to buy it.

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