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	<title>Comments on: In which I consider Graham&#8217;s critique</title>
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	<link>http://www.medrants.com/archives/3425</link>
	<description>Internal medicine, American health care, and especially medical education</description>
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		<title>By: &#160; Health, Wealth and Happiness in New 2008 ! [Ecademy Speaker Bureau &#8230;&#160;by&#160;Health Tips</title>
		<link>http://www.medrants.com/archives/3425/comment-page-1#comment-514987</link>
		<dc:creator>&#160; Health, Wealth and Happiness in New 2008 ! [Ecademy Speaker Bureau &#8230;&#160;by&#160;Health Tips</dc:creator>
		<pubDate>Mon, 31 Dec 2007 13:37:11 +0000</pubDate>
		<guid isPermaLink="false">http://www.medrants.com/index.php/archives/3425#comment-514987</guid>
		<description>[...] Comment on In which I consider Grahamâ€™s critique by Insurance and &#8230; [...]</description>
		<content:encoded><![CDATA[<p>[...] Comment on In which I consider Grahamâ€™s critique by Insurance and &#8230; [...]</p>
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		<title>By: Bad Medicine &#187; On Retainer Medicine</title>
		<link>http://www.medrants.com/archives/3425/comment-page-1#comment-514795</link>
		<dc:creator>Bad Medicine &#187; On Retainer Medicine</dc:creator>
		<pubDate>Fri, 28 Dec 2007 05:03:22 +0000</pubDate>
		<guid isPermaLink="false">http://www.medrants.com/index.php/archives/3425#comment-514795</guid>
		<description>[...] interesting discussion between DB and My Med Body on the ethics of retainer medicine &#8212; a model of primary care medicine where [...]</description>
		<content:encoded><![CDATA[<p>[...] interesting discussion between DB and My Med Body on the ethics of retainer medicine &#8212; a model of primary care medicine where [...]</p>
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		<title>By: Tor</title>
		<link>http://www.medrants.com/archives/3425/comment-page-1#comment-514792</link>
		<dc:creator>Tor</dc:creator>
		<pubDate>Fri, 28 Dec 2007 04:19:18 +0000</pubDate>
		<guid isPermaLink="false">http://www.medrants.com/index.php/archives/3425#comment-514792</guid>
		<description>I don&#039;t see what&#039;s the big deal. you worked hard to get where you are, you provide an advanced service, you should expect proper compensation...simple math really.

If we reframe this issue then perhaps the powers that be should also schedule car prices (or any such important good) so that every person that can or can&#039;t afford a car can go to a dealer and still walk away with one.

It really baffles me that people (or the insurance industry) use this &quot;morality&quot; veil as the reason why doctors shouldn&#039;t expect appropriate compensation for their services.

And if that be the case, then equalize the playing field...don&#039;t make us go to school 10+ years so that upon entering practice one can watch some insurance company dude laugh all the way to the bank with money that he didn&#039;t work for.
I say 4 years to become a doctor if that&#039;s the case (4 years total).

a duck is duck, man! and if they have the right to treat it as a &quot;good&quot; why can&#039;t doctors?</description>
		<content:encoded><![CDATA[<p>I don&#8217;t see what&#8217;s the big deal. you worked hard to get where you are, you provide an advanced service, you should expect proper compensation&#8230;simple math really.</p>
<p>If we reframe this issue then perhaps the powers that be should also schedule car prices (or any such important good) so that every person that can or can&#8217;t afford a car can go to a dealer and still walk away with one.</p>
<p>It really baffles me that people (or the insurance industry) use this &#8220;morality&#8221; veil as the reason why doctors shouldn&#8217;t expect appropriate compensation for their services.</p>
<p>And if that be the case, then equalize the playing field&#8230;don&#8217;t make us go to school 10+ years so that upon entering practice one can watch some insurance company dude laugh all the way to the bank with money that he didn&#8217;t work for.<br />
I say 4 years to become a doctor if that&#8217;s the case (4 years total).</p>
<p>a duck is duck, man! and if they have the right to treat it as a &#8220;good&#8221; why can&#8217;t doctors?</p>
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		<title>By: over my med body! &#187; Retainer Medicine Rally With Dr. Centor</title>
		<link>http://www.medrants.com/archives/3425/comment-page-1#comment-514780</link>
		<dc:creator>over my med body! &#187; Retainer Medicine Rally With Dr. Centor</dc:creator>
		<pubDate>Thu, 27 Dec 2007 22:07:03 +0000</pubDate>
		<guid isPermaLink="false">http://www.medrants.com/index.php/archives/3425#comment-514780</guid>
		<description>[...] starting with piece by Dr. Centor, an internist I high respect. I fired back this piece and now Dr. Centor has responded. I must give Josh at KevinMD some credit for getting the debate started (but please Josh, post [...]</description>
		<content:encoded><![CDATA[<p>[...] starting with piece by Dr. Centor, an internist I high respect. I fired back this piece and now Dr. Centor has responded. I must give Josh at KevinMD some credit for getting the debate started (but please Josh, post [...]</p>
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		<title>By: Candace</title>
		<link>http://www.medrants.com/archives/3425/comment-page-1#comment-514774</link>
		<dc:creator>Candace</dc:creator>
		<pubDate>Thu, 27 Dec 2007 20:36:32 +0000</pubDate>
		<guid isPermaLink="false">http://www.medrants.com/index.php/archives/3425#comment-514774</guid>
		<description>This is a lovely post.  And, as a previous academic internal medicine subspecialist (with friends who designed retainer practices), you articulate the reasons physicians go this route very nicely.  I&#039;d like to underscore the point about physicians in today&#039;s climate not being able to meet their own level of comfort in patient care. This was something I dealt with chronically, even in an academic institution. There was never &quot;enough time&quot; or &quot;enough resources,&quot; and the person in the end who suffers the most is the physican who loses his time (and all that goes with that --&gt; = family, spouse, hobbies --&gt; life).  As a previous clerkship director, I found that medical students enjoy discussing the inadequacies of our current system; yet, their framework for the personal sacrifices on the part of the PHYSICIAN was lacking.  They simply hadn&#039;t yet experienced the dissonance that arises in IM patient care today.

I would like to ask why, in today&#039;s world where &quot;two consenting adults&quot; can have any variety of relationships, why then can two consenting adults not establish a medical one?  If a physician delivers excellent care, and a person pays for that care, why is that somehow cheating others?  I&#039;d like to challenge those who believe this to be true to devote their entire future careers to academic medicine, because to do otherwise is hypocritical--as any sort of private practice health care is &quot;medicine for money.&quot;  And they will be very unlikely to care for a large indigent population in private practice.

Jared&#039;s point is spot-on regarding a physician&#039;s ability to behave philanthropically at any such time as he desires to do so.  And, upon further reflection of my own life, I am far more inclined to do when when I see a need for it, as opposed to be forced to do so by a single party pay system (which is only arguably philanthropic anyway).</description>
		<content:encoded><![CDATA[<p>This is a lovely post.  And, as a previous academic internal medicine subspecialist (with friends who designed retainer practices), you articulate the reasons physicians go this route very nicely.  I&#8217;d like to underscore the point about physicians in today&#8217;s climate not being able to meet their own level of comfort in patient care. This was something I dealt with chronically, even in an academic institution. There was never &#8220;enough time&#8221; or &#8220;enough resources,&#8221; and the person in the end who suffers the most is the physican who loses his time (and all that goes with that &#8211;&gt; = family, spouse, hobbies &#8211;&gt; life).  As a previous clerkship director, I found that medical students enjoy discussing the inadequacies of our current system; yet, their framework for the personal sacrifices on the part of the PHYSICIAN was lacking.  They simply hadn&#8217;t yet experienced the dissonance that arises in IM patient care today.</p>
<p>I would like to ask why, in today&#8217;s world where &#8220;two consenting adults&#8221; can have any variety of relationships, why then can two consenting adults not establish a medical one?  If a physician delivers excellent care, and a person pays for that care, why is that somehow cheating others?  I&#8217;d like to challenge those who believe this to be true to devote their entire future careers to academic medicine, because to do otherwise is hypocritical&#8211;as any sort of private practice health care is &#8220;medicine for money.&#8221;  And they will be very unlikely to care for a large indigent population in private practice.</p>
<p>Jared&#8217;s point is spot-on regarding a physician&#8217;s ability to behave philanthropically at any such time as he desires to do so.  And, upon further reflection of my own life, I am far more inclined to do when when I see a need for it, as opposed to be forced to do so by a single party pay system (which is only arguably philanthropic anyway).</p>
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		<title>By: Jared</title>
		<link>http://www.medrants.com/archives/3425/comment-page-1#comment-514772</link>
		<dc:creator>Jared</dc:creator>
		<pubDate>Thu, 27 Dec 2007 20:23:24 +0000</pubDate>
		<guid isPermaLink="false">http://www.medrants.com/index.php/archives/3425#comment-514772</guid>
		<description>Correct me if I&#039;m wrong, but let me re-set the frame of the thought experiment.  If I, as a physician, choose to not accept Medicare, who artificially sets my costs to my patients, then I am able to set my costs for my patients at will.

And if I choose to do a retainer service, doesn&#039;t that also mean that I probably have the right or privilege to produce a number of &quot;scholarships&quot; for the retainer to patients as I choose?

And, if I am a shrewd businessperson as well, wouldn&#039;t I be able to then spread this out over the course of each visit such that I actually don&#039;t have to ask for a retainer up front?  Where does the injustice occur in those tweakings?

It sounds like my 7 year-old niece&#039;s complaints about trying a new food because &quot;It&#039;s weird.&quot;  We know that the current social experiment is failing spectacularly.  So, when does the presence of mind to appreciate those brave enough to try something different come to bear?</description>
		<content:encoded><![CDATA[<p>Correct me if I&#8217;m wrong, but let me re-set the frame of the thought experiment.  If I, as a physician, choose to not accept Medicare, who artificially sets my costs to my patients, then I am able to set my costs for my patients at will.</p>
<p>And if I choose to do a retainer service, doesn&#8217;t that also mean that I probably have the right or privilege to produce a number of &#8220;scholarships&#8221; for the retainer to patients as I choose?</p>
<p>And, if I am a shrewd businessperson as well, wouldn&#8217;t I be able to then spread this out over the course of each visit such that I actually don&#8217;t have to ask for a retainer up front?  Where does the injustice occur in those tweakings?</p>
<p>It sounds like my 7 year-old niece&#8217;s complaints about trying a new food because &#8220;It&#8217;s weird.&#8221;  We know that the current social experiment is failing spectacularly.  So, when does the presence of mind to appreciate those brave enough to try something different come to bear?</p>
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		<title>By: anonymous</title>
		<link>http://www.medrants.com/archives/3425/comment-page-1#comment-514762</link>
		<dc:creator>anonymous</dc:creator>
		<pubDate>Thu, 27 Dec 2007 16:24:59 +0000</pubDate>
		<guid isPermaLink="false">http://www.medrants.com/index.php/archives/3425#comment-514762</guid>
		<description>&lt;i&gt;Single payer systems do not provide social justice.&lt;/i&gt;

What????  I almost choked when I read that.  The whole &lt;i&gt;motivation&lt;/i&gt; for a single-payer system is social equity, fairness, and, yes, &quot;justice.&quot;  Granted, it&#039;s an uphill battle to get there (and the proposals set forth thus far are fraught with problems), but as an ideal, a single-payer system is the fairest way to provide necessary medical care to all who need it.

Unless by &quot;justice&quot; you mean &quot;high compensation to doctors.&quot;  Judging by the rest of your post, I would not be surprised if this was your implication.</description>
		<content:encoded><![CDATA[<p><i>Single payer systems do not provide social justice.</i></p>
<p>What????  I almost choked when I read that.  The whole <i>motivation</i> for a single-payer system is social equity, fairness, and, yes, &#8220;justice.&#8221;  Granted, it&#8217;s an uphill battle to get there (and the proposals set forth thus far are fraught with problems), but as an ideal, a single-payer system is the fairest way to provide necessary medical care to all who need it.</p>
<p>Unless by &#8220;justice&#8221; you mean &#8220;high compensation to doctors.&#8221;  Judging by the rest of your post, I would not be surprised if this was your implication.</p>
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		<title>By: Health Insurance &#187; In which I consider Graham&#8217;s critique</title>
		<link>http://www.medrants.com/archives/3425/comment-page-1#comment-514759</link>
		<dc:creator>Health Insurance &#187; In which I consider Graham&#8217;s critique</dc:creator>
		<pubDate>Thu, 27 Dec 2007 16:12:45 +0000</pubDate>
		<guid isPermaLink="false">http://www.medrants.com/index.php/archives/3425#comment-514759</guid>
		<description>[...] Here&#8217;s another interesting post I read today by DB&#8217;s Medical Rants [...]</description>
		<content:encoded><![CDATA[<p>[...] Here&#8217;s another interesting post I read today by DB&#8217;s Medical Rants [...]</p>
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		<title>By: Graham</title>
		<link>http://www.medrants.com/archives/3425/comment-page-1#comment-514757</link>
		<dc:creator>Graham</dc:creator>
		<pubDate>Thu, 27 Dec 2007 15:25:02 +0000</pubDate>
		<guid isPermaLink="false">http://www.medrants.com/index.php/archives/3425#comment-514757</guid>
		<description>Great response, Dr. Centor. Expect my rebuttal shortly.</description>
		<content:encoded><![CDATA[<p>Great response, Dr. Centor. Expect my rebuttal shortly.</p>
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		<title>By: Insurance &#187; In which I consider Graham&#8217;s critique</title>
		<link>http://www.medrants.com/archives/3425/comment-page-1#comment-514754</link>
		<dc:creator>Insurance &#187; In which I consider Graham&#8217;s critique</dc:creator>
		<pubDate>Thu, 27 Dec 2007 15:10:52 +0000</pubDate>
		<guid isPermaLink="false">http://www.medrants.com/index.php/archives/3425#comment-514754</guid>
		<description>[...] Here&#8217;s another interesting post I read today by DB&#8217;s Medical Rants [...]</description>
		<content:encoded><![CDATA[<p>[...] Here&#8217;s another interesting post I read today by DB&#8217;s Medical Rants [...]</p>
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