Health Care Reform: 450,000 Doctors Can't Be Wrong
My husband is a physician, he signed this over a year ago. Health Care Providers are at the mercy of health insurance too. The amount of time a provider can spend with the patient has become shorter, the amount of patients, they see in one day have increased. When 450,000 Doctors believe health care is lacking, we should be listening.
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Comments: 56
Just kidding. Neither Malpractice nor Health Insurance Premiums, NOR the cost of ANY medical activity or procedure was reduced. In fact, the RATE of INCREASE didn't even decrease!
Blaming doctors for health costs is a tad silly, t'would seem.
It's way past time we started pointing fingers at the real highjackers of health care - the insurance companies! Health care should NOT be an industry!
Remember how they pushed for "tort reform" that was supposed to decrease cost? It didnt stop a dime of increases....
Providers had to contract with insurance companies to continue to see their patients. If a physician doesn't contract with your insurance, they do not get paid, unless you are willing to pay out of pocket. Part of that contract is an agreement to accept what the insurance company deems as fair and reasonable payment or customary.
Although Medicare was never meant to be used as a guide for private health insurance physician payment schedules, insurance companies and health plans have based their rates of payment on Medicare. No matter how much we pay for private insurance, their payment to physicians is either slightly above Medicare rates (for better insurance companies) or BELOW Medicare rates. It is not uncommon for some insurance companies to pay 10-20% LESS than Medicare.
Let's say I go see my cardiologist in which the bill is $140.00 for my office visit. If I do not have insurance, I would pay the full bill. If I had insurance, I would pay my co-pay of $45, when I received my Explanation of Benefits (EOBs) I would see my insurance company paid my doctor $40. With the $45 dollar co-pay my doctor received $85 on the $140.00 bill. The heart center charges this amount knowing full well they won't receive that for a reimbursement.
Health care reform sounds great. Throw out the evil insurance companies and replace them with who? Ah, let’s turn to the government and all the built in accountability they have. Medicare is run by who and how well does it compensate doctors?
I am glad those 450,000 doctors are so trusting of Congress to get it right that they support health care reform without even knowing what it entails.
I have yet to see a bunch of people including Congressman get anything right if they don’t first decide what they want the results to be.
For me health care should be about quality of care, innovation in care, accessibility to care, and cost of care. Pick 3 of the 4 because you can’t control all 4. If health care reform is solely focused on cost control they will succeed and we will get cheap health care.
I hope you watched the video, the doctors are concerned about quality of care. They would like for health care to be between the doctor and patient. Personally, I don't want my health care decided by an insurance company, since they ( the ones without medical degrees) are only concerned about their profit and not my health.
I have gone to the VA and for years, its government run and they have done wonders for me.... I had bad medical problems for a long time till I gave up and went to the VA.. they had only one concern, that was what I needed to get better.. the private doctors I went to had other priorities because of the money involved and the insurance companies.
I'm glad to hear that about the VA, those who have served this country deserve that and more. Medicine is a science and business but also an art. When practiced as an art, the patient's health and well being are priority.
I truly feel that the doctors believe in quality care, but unless there are some metrics for quality included with the reform cost will win out. Are those doctors truly enamored with Medicare because as I understand it part of the health care reform is going to further reduce the payments for care given.
Do you recall health care before health insurance was readily available? We had county hospitals with 30 or more patient to a ward, they used ether for an anesthetic. The insurance companies were created to help the patients pay the bills. Maybe the doctors should stop taking on insurance company patients and deal directly with the patient or even better rely solely rely on government (how much is California and Michigan raising the payments).
I have been grateful for the various health care insurance companies I have had over the years, it ensured the doctors that cared for me and my family were paid and I had time to recover my finances so I could have care in the future.
I have to admit I learned a long time ago that a doctor is a service provider similar to any other, when they whine about not getting paid what they want and claim they provide quality care but are resistant to providing data on how good that care or how the patient can recognize the qulityr of care, I begin to loss sympathy.
I am resistant to the health care reform because there are no measures for quality of care or for innovation of care, the only focus is on paying for it on the cheap. I learned a long time ago that if you blindly trust others even doctors, the results are usually are not as good as when I ask questions and become part of the solution. It is surprising that doctors have such blind trust in out Congress and government employees who have so little knowledge and experience in delivery health care to reform it.
"Personally, I don't want my health care decided by an insurance company, since they ( the ones without medical degrees) are only concerned about their profit and not my health. " That suprises me, in my small town if a person shows up at the emergency room they get the best life saving treatment the doctors can provide and they don;t delay waiting for an insurance company to approve. What town fo you live in? I surley want to avoid those doctors becuase they must be spending more time on the phone than with the patient.
Most doctors are busy taking care of patients. However, you ask as to why they would trust. That is probably the best question I have heard in a long time. You would have thought their ability to trust would have already been damaged by managed care and the insurance companies.
I am grateful that the doctors, nurses, and other health care professionals are willing to make the years of sacrifice to gain the knowledge and skills necessary to relieve my suffering and that of other people. It takes both the ability and the mindset to do that and there far fewer than we can use that do.
For me the provide good value for what they earn. However, they need guidance just like the rest of use.
Maybe the reform we should be discussing is about how we might change the medical care delivery and individual health quality rahter than denigrating the people in the insurance industry. Maybe health care reform should start with establishing what quallity medical care is, what personal health is, who has what responsibilities (including the individual), how we can best measure these things, and other elements of health/medical care.
Once we have determine what the results should look like, then we can work on the system to achieve those results, and finally how we finance the system. Right now the focus is on how to make it cheaper, how bad the insurance people are , and little if any talk about quality of care.
Right now you would be hard pressed to find a health care provider who didn't agree with you. That is exactly what these 450,000 doctors are talking about.
The problem is right now things are at a stand still. People without health insurance cannot get preventive care. When they are sick enough they can go to the ER. Which costs more in the long run, if they are admitted, we all pay for it, though the higher cost of our health care. If they aren't admitted there is no follow up at the ER. The Emergency room is for that emergencies.
I am not speaking malevolent about the insurance companies because I need someone to blame. The truth is they are making a huge profit off of healthy individuals, and denying the truly ill.
Not only are most personal bankruptcies due to medical bills beyond the ability of the consumer to pay,but most of the households declaring bankruptcy for this reason do so despite having health insurance coverage. Health insurance appears to be useless when it is most needed.Twenty-five percent of insurance companies cancel coverage immediately when an individual covered suffers a disabling illness. Within a year, another twenty-five percent of insurers cancel coverage.
Insurance is a business, one for profit. Imagine making money on someone's misfortune, being canceled from your insurance because you have been diagnosed with cancer, it happens everyday.
The insurance companies are using their profit right now to lobby against change. Nothing will change as long as insurance companies are running the show, they have no reason to want to cut into their profits, they like the way things are.
Check out my article: Health Care Reform in the USA: the Shona Holmes scare tactic
You can find it here:
http://www.gather.com/viewArticle.action?articleId=281474977758731
“When they are sick enough they can go to the ER. Which costs more in the long run, if they are admitted, we all pay for it, though the higher cost of our health care.” I am skeptical. It sounds logical but do you have data tp demonstrate that is true.
At a previous employer, many years ago, engineers would request capital dollars to improve the processes to make chemicals. Over the years if the yield improvements we as good as the claims were they would have been making more chemicals from the raw materials then was theoretically possible. So my employer employed and data gathering method that required the promised dollar savings were tracked for a minimum of two years. Are the doctors willing to do that or do they want us to trust them like they do the politicians? I believe that preventive care can be both better for te person and more cost effective for the system. However, without the discipline of tracking performance I have too often seen the people with good intentions abuse the trust and spend the moneys for un approved things and the politicians are the worst offends. So, unless the doctors are willing to establish a disciplined approach they have good intentions but no stomach for self discipline, kind of like patients that won’t follow their recommended lifestyle changes for better health.
“Insurance is a business, one for profit. Imagine making money on someone's misfortune, being canceled from your insurance because you have been diagnosed with cancer, it happens everyday.” I am sympathetic to what you describe. But what if that cancer was from smoking? What about the choices the person made? What about the diabetic that refuses to change their lifestyle and to take the prescribe medicines? What kind of conditions could that create and the related costs?
You may say you are not denigrating the insurance companies, but simply saying they cancel coverage while ignoring individual contributions to the situations seems a bit biased.
You have talked about how good the doctors are, how bad the insurance companies are, you haven’t mentioned the patients contributions, or what we would have done for the past 60 years without the insurance companies.
“The insurance companies are using their profit right now to lobby against change.” I see doctors using their profits (thru the AMA) to lobby how those changes will be made. I believe in lobbyists for all, do you only believe in lobbyists for the doctors and not the insurance companies?
It seems that the whole focus keeps coming back to blame and no discussion about solutions other then give more money.
I believe the system needs to change, individual responsibilities and actions need to change, and if we can define what we want the system to achieve (so its performance can be measured) then we will be able to change it with the help of all the participants.
I do believe in profits (every person that is paid more than enough to cover basic food, shelter, and clothing is earning a profit) in whatever activity people receive money for, it is at least one way for practices to be measured.
You stated, "I am sympathetic to what you describe. But what if that cancer was from smoking? What about the choices the person made? What about the diabetic that refuses to change their lifestyle and to take the prescribe medicines? What kind of conditions could that create and the related costs?"
So you propose that we micro-manage, judge and determined who earns medical care? Oh sorry you are overweight or underweight. Alternatively, sorry you didn't eat enough fruits and vegetables this month. You couldn't afford your insulin this month, because you had to feed your children, well too bad, no more medical care for you. Many medical conditions are inherited from our family, not all conditions are due to lifestyle. Oh wait you didn't go to the gym three times this week, you say, you couldn't find the time, you had to put in overtime at work, too bad for you. There is no ethical, reasonable, or even feasible way to enforce what you are talking about.
What about children who have no control over their well being, they have to rely on their parent or guardian to make sure, they choose a healthy lifestyle. Who do we deny care to at that point?
The bottom line is private insurance companies are paid monthly premiums to cover people in the event of illness. Why should they be allowed to back out of the deal?
“What about children who have no control over their well being, they have to rely on their parent or guardian to make sure, they choose a healthy lifestyle. Who do we deny care to at that point?” So when you don’t like the comment rather than show how it goes wrong, bring in the innocent children, sounds like a successful politician. I said nothing about kids or denying care I simple offered that people have a part in their health and you simply ignore it. Talk to a physician or two and asked them how much better we would be if people did what the health care professional recommended.
“So you propose that we micro-manage, judge and determined who earns medical care?” Do you think it is wrong for us to pay our taxes through user fees such as tax on gasoline or tolls for roads and bridges?
Why shouldn’t we trust to the medical professionals to describe what the best practices are for an individual and if they don’t follow those practices, why not raise the deductible for conditions directly related to their lifestyles or include a co-pay for more than a single visit per year?
If you believe that the health care should change and the patients have no part/no responsibility than I am highly doubtful real health will improve.
The apparent current focus is to make medical care cheaper for people, pay the health care professionals, and don’t change anything else.
To me it seems the people most vocal about health care reform are no different than the people whose lifestyles cause their personal health to be so poor. They only want others to do something so they can keep doing what they like not what is good.
What I am surprised with is no one ever challenges me when I suggest individual responsibilities/actions, performance measures, or any other ways of changing the system. It is as if people either don’t want to think about how the changes may affect them or they are afraid they will have to think about what it may take to change, or that they might have to think rather than rely on emotions and preconceived notions.
The problem I see with this, is who gets to decide? Many illnesses can be related to lifestyle, the same illnesses can be related to genetics. It isn't black and white or cut and dry.
"What I am surprised with is no one ever challenges me when I suggest individual responsibilities/actions, performance measures, or any other ways of changing the system. It is as if people either don’t want to think about how the changes may affect them or they are afraid they will have to think about what it may take to change, or that they might have to think rather than rely on emotions and preconceived notions."
A very broad generation, it would be a preconceived notion to assume everyone with lung cancer smoked. Approximately, ten percent of lung cancers, cases, occur in non-smokers. Non-smokers with lung cancer-related deaths annually in the U.S, are believed to be at least partially related to radon gas exposure. Radon gas can travel up through soil and enter homes through gaps in the foundation, pipes, drains, or other openings. Cirrhosis is an alcohol-related liver disease. However, it can also be caused by hepatitis C,B,and D. As well as, autoimmune hepatitis. Other causes of cirrhosis include drug reactions, prolonged exposure to toxic chemicals, parasitic infections, and inherited diseases. Doctors are not going to want this ethical dilemma. So tell me who is going to decide?
I could see you being challenged if this was to become a possibility. Living here in the land of the Free, people don't like to be told what to do. Lawsuits would increase, if you had to pay more for your health care call 1-800-attorney. Doctors don't want to be sued, because they made the diagnosis of self imposed illness.
"So when you don’t like the comment rather than show how it goes wrong, bring in the innocent children, sounds like a successful politician. I said nothing about kids or denying care I simple offered that people have a part in their health and you simply ignore it. Talk to a physician or two and asked them how much better we would be if people did what the health care professional recommended."
What is with the straw man argument? To better understand what you are saying, I asked about children. They are a part of our society, it was a very legitimate question. If you are not saying that we deny care, if people don't take care of themselves or listen to their doctors. Then what exactly are you saying?
I don't ignore that people have a responsibility for their own health, I don't have a problem with that. I am very active in my own well being and health. How do you propose that we insist that people do everything they are told for their own good? You can lead a horse to water, but can't make them drink. This isn't something new, it has always been this way. I don't need to ask a couple of doctors, I am married to one and have some as friends. I'm pretty sure my family doctor and cardiologist would agree with them too.
As an example, let's say a woman visits her doctor. She is diagnosed with type II diabetes. Her doctor gives her medication but tells her if she loses 20lbs, exercises, and follows a special diet, she may not need the medication, her doctor wants a follow up in six months.
After six months she goes back in, she has lost 20lbs, exercises three times a week and is thrilled with her diet. The doctor takes her off of her medication, and she is good to go.
However, more than likely she may have gained 5lbs, couldn't find the time to exercise, between her kids, job, and house work. She also couldn't find the time to cook the meals on her meal plan. The doctor gives her another prescription for the next six month of medication, and asks her to follow up.
You tell me, what do you propose we do with her?
Let me start with the denial of insurance coverage. I don’t know what triggered the denials, I know that many insurance policies have a maximum payout and people can decide if they want to pay more for greater coverage. What was the reasoning for the denials, was it in the policy, was it at the point of policy renewal, what? Without offering more about the terminations you imply that it is capricious, if that were the case and it was in the middle of the coverage period there seems that legal action could be taken. It is always easier to focus on the outliers rather than start with the system and get that right before addressing the few. If we can get a system that address 80% we can always write specialized rules to bring in the other 20%. If we focus all our energies on the 1% we will never get to figuring out how to properly address the 80%.
“The problem I see with this, is who gets to decide?” The individual gets to decide on their lifestyle. However, they also get to receive all of the benefits/consequences of their choices. Just as we have to pay more gas tax as we drive more so could the individual pay for more medical treatment related to lifestyle choices. If a motorcycle rider chooses not to wear a helmet why shouldn’t they have a higher deductible for brain damage related to a motorcycle accident?
“Many illnesses can be related to lifestyle, the same illnesses can be related to genetics. It isn't black and white or cut and dry.” If a person smokes a pack or more of cigarettes a day, do you doubt that the smoking is a significant contributor to their condition? I suspect all medical illnesses have a degree of genetics in them. Have you ever heard the centagenian asked about their longevity and have them say it was that smoking and drinking or that cigar a day. There are some people that can abuse their systems in many ways and not suffer the most common consequences while others that hardly use or never use something like cigarettes and will suffer a condition to the bad habits. Life isn’t fair and that why we have such a large health care system. However, I don’t say it has to do with the condition. Rather I focus it on the personal practices that contribute to the condition. I have two reason for this; one is that the person is making the best effort to suffer the health problems and second is that it is one mechanism to chance that lifestyle choice.
“Radon gas can travel up through soil and enter homes through gaps in the foundation, pipes, drains, or other openings.” If radon is so bad what is the OSHA twa, PEL, and others exposure restrictions. I would think that radon would be at highest risk in mining work and there would be government restrictions and those would be a good level to determine if the general public is being over exposed. As far as I can tell there are different parts of the country that have higher concentration of radon, have you ever seen a map of lung cancer (or other related cancers such as throat) over laid on a map of radon concentrations to see where all of those cases you mention fit in that pattern?
“Living here in the land of the Free, people don't like to be told what to do. Lawsuits would increase, if you had to pay more for your health care call 1-800-attorney. Doctors don't want to be sued, because they made the diagnosis of self imposed illness.” We already have the legal lottery of suing anyone including doctors. If the system formally acknowledges that lifestyle was a contributor to various diseases, I wonder if that could be part of a defense against a health related lawsuits.
“You can lead a horse to water, but can't make them drink. This isn't something new, it has always been this way.” You accept it and don’t talk about it because you don’t see a solution. You affect people’s behaviors (because that is what the vast majority of lifestyle is driven by) through recognizing that people respond best when something is immediate, personal, and certain. Using that approach, you might be surprised how people can change.
“You tell me, what do you propose we do with her?” If you really want to know how, consider picking a problem that you can relate to, for someone you know and would like to help them achieve a particular goal? I suggest this so you can challenge me in a way that is real to you and not a “strawman”. However, I am more than willing to address the Type II diabetic scenario, my only concern is that without the practical challenges you may not be able to give it a real time test.
Since you didn’t offer an alternative scenario I have gone with, “As an example, let's say a woman visits her doctor. She is diagnosed with type II diabetes. Her doctor gives her medication but tells her if she loses 20lbs, exercises, and follows a special diet, she may not need the medication, her doctor wants a follow up in six months.”
Start with the goals: reduce blood sugar levels to below 106, lower triglycerides levels to below 99 (believe they are a precursor to blood sugar and other issues such as cholesterol), and to lower weight by 20 lbs. Eliminate related medications.
What behavior will influence these desired changes; control carbohydrates 180gms/day (allow up to 200 if 50gms is fresh fruit/vegetables), restrict caloric intake to 2000 or less depending on the body size, increase physical activity to 1 hour aerobic activities per day 3 days a week with non consecutive and ½ hour low impact exercise each of the other days of the week.
Develop a log/chart to measure the activities each. The log will include a test of the blood sugar each morning, the nutritional value (carbs, calories) and portion size of all foods for each day and total carbs and calories at the end of each day, the exercise completed each day, personal weight for each day, and chart results for each day. At the end of six months visit the doctor to review performance and log, visit doctor at end of first year.
By establishing goals you have given a reason for behavior, by describing the desired actions you have defined behaviors to do, by creating the log and charting activities you have reinforced the behaviors, and by measuring blood you have provided feedback on the goals. The doctor visits and review of log establishes accountability and validation.
This approach makes the activities personal, immediate, and certain. I would like to see the accountability monthly for the first 6 months, so if the review with someone other than family or close friends as a surrogate for the doctor would be good.
Please let me know why you don’t think this will work.
Since you didn’t offer an alternative scenario I have gone with, “As an example, let's say a woman visits her doctor. She is diagnosed with type II diabetes. Her doctor gives her medication but tells her if she loses 20lbs, exercises, and follows a special diet, she may not need the medication, her doctor wants a follow up in six months.”
Start with the goals: reduce blood sugar levels to below 106, lower triglycerides levels to below 99 (believe they are a precursor to blood sugar and other issues such as cholesterol), and to lower weight by 20 lbs. Eliminate related medications.
What behavior will influence these desired changes; control carbohydrates 180gms/day (allow up to 200 if 50gms is fresh fruit/vegetables), restrict caloric intake to 2000 or less depending on the body size, increase physical activity to 1 hour aerobic activities per day 3 days a week with non consecutive and ½ hour low impact exercise each of the other days of the week.
Develop a log/chart to measure the activities each. The log will include a test of the blood sugar each morning, the nutritional value (carbs, calories) and portion size of all foods for each day and total carbs and calories at the end of each day, the exercise completed each day, personal weight for each day, and chart results for each day. At the end of six months visit the doctor to review performance and log, visit doctor at end of first year.
By establishing goals you have given a reason for behavior, by describing the desired actions you have defined behaviors to do, by creating the log and charting activities you have reinforced the behaviors, and by measuring blood you have provided feedback on the goals. The doctor visits and review of log establishes accountability and validation.
This approach makes the activities person, immediate, and certain. I would like to see the accountability monthly for the first 6 months, so if the review with someone other than family or close friends as a surrogate for the doctor would be good.
Please let me know why you don’t think this will work.
I'm apologetic that I didn't get back to you sooner. I chose Type II Diabetes, since it is estimated there are equal amounts of people walking around with the diease and do not know it, as are those who are diagnosed yearly. It is a silent diease, meaning that you can walk around and function, without being treated. It is also a diease that can be treated by diet, exercise and lifestyle.
The immediate goal of treatment is to lower high blood glucose levels. The long-term goals of treatment are to prevent diabetes-related complications, such as amputation of limbs, blindness, heart disease, or kidney failure.
In all honesty, I really do think your plan would work, for all the reasons you state. It was always meant to be a team, between patient and provider. That is a preventive approach, it is a great approach, I strongly believe in preventive care. 450,000 Doctors above do so as well, they don't want to see patients after a diease has ravaged their body and can't be fixed.
Not only is it less expensive to treat the diease early, it is definitely beneficial to the patient as well. The bottom line is access is lacking, many people do not have the money out of pocket to see their doctor. Many do not have health insurance, moreover if they do they can't afford their co-pay. Too many have been laid off, which affects their group insurance, they have the option of cobra, which is generally too expensive for someone who has just become unemployed.
This leaves people ignoring the chest pains because they can't afford a doctor visit, but they will be seen some day at the ER having a heart attack.
If it was up to him we would be passengers on planes without licensed pilots.
So be forewarned, with this guy personal experience trumps everything even education which is collective learning. He's also is very anti-Obama (that's his right) but is beyond reasoning and has a lot of free time on his hands so he'll argue and debate with you Nanina for days anything that may remotely support an initiative of Obama and really get into splitting hairs and you may have to ban him from posting on your work.
If doctors were serious about money issues, they would agree to stop peer review of themselves when they mess up and have consumers deciding their fates.
When it comes to health care, one has to trust the people in charge. It's hard to trust a liar, Spartan.
There are many people who have had to change doctors because their provider was no longer contracted with their insurance company. Many insurance company contracts base their payments on “usual and customary” fees. For every insurance company, there are mounds of paper work. For every private insurance company, there are tons of rules.
No doubt Medicaid and Medicare is far from perfect, private insurance companies are far from perfect too, yet they make a profit, a huge profit.
"If doctors were serious about money issues, they would agree to stop peer review of themselves when they mess up and have consumers deciding their fates."
This doesn't make sense to me, I'm not sure what peer review and money have to do with one another. Seriously, peer review is necessary, unless the consumer has a medical degree.
The reality is doctors complain the most about frivolous lawsuits the most. Frivolous lawsuits are the reason malpractice is high. It also varies depending on the specialty and the state in which you are licensed.
State Medical Boards are staffed with many physicians, who would review a grievance and in turn would decide what action if any to take against a physician. They decide if a physician license should be suspended. Malpractice insurance is for lawsuits, so that is a different ball of wax.
And if you've ever had to do any business with the government, you'd realize that the paper work for government is 10 times that for free markets.
The HCFA 1500 form, now referred to as the CMS 1500, is used to file insurance claims and receive payments for medical services provided to patients. All forms are government approved CMS/HCFA-1500 to serve federal programs and private insurers as a universal claim form.