DB’s Medical Rants

“Basic medical care is a right.”

Really not true at all. Not in theory or in practice. And it never has been, either. This notion is nothing more than a wish. Emergency evaluation at an emergency room is a right, at least in the USA, up to the minimum required standards of EMTALA, as long as that law is on the books and there are hospitals open to be coerced to comply. But no law requires any “basic medical care,” and no law defines what that means.

Your expectations are wrong. The worst and the best physicians have the same fee schedules. The only place where that is not true is acedemia, where they are salaried by the institution and so can get a higher salary for being good. We can charge all we want, but we will all get paid at basically the rate dictated by the insurers, and they do not pay attention to the quality of the doctor (yet).

It seems like DB makes a good case for P4P done right.

A look into the Future:

Very few American-trained physicians (who wants to go into medicine, anymore?) and many foreign medical graduates caring for the patients in this country. We outsource our industries, this is just the reverse. Our best and brightest will not choose medicine as a “vocation” (note - not career). How do you like the idea of a “D” average student tinkering around in your abdomen?

Los Angeles County, I know many neurologists and some psychiatrists who operate on the edge of the insurance world, charging $400-500 for new eval’n then sending a letter to your insurance PMD who orders tests, most of which will be covered by insurance, as will prescriptions. I can think right away of one very excellent physician and one terrible quack that operate this way- both are apparently doing well. They’ve both been around for decades, and both are smooth talkers. An excellent physician new to the area can’t get into this.

The difference between medicine and a restaurant or a clothing store is that no 3rd party pays for your food or clothes. Every healthcare system in the world is financially stressed; most are raising copays, narrowing the list of drugs used, etc.. Given the propensity of US docs to write for the newest brandname drugs adding $30 a month to our patient’s expenses is usually a disservice. This will only get worse because the MBAs and Wall Street control the insurance business and big PhRMA owns Congress. I have two very wealthy friends whose families have done poorly with the high priced healthcare that they got, based on advice from friends and physicians. Medical school grades of my peers have an imperfect correlation with their subsequent skills. There’s no simple answer.

PH,
Maybe I am not reading into your post correctly, so allow me to rant a bit. I am worried about your proposal that “the ONLY solution to make medicine a great profession once again is to get rid of the 3rd party payer system.” Is this solution that you propose, being of “benefit” and doing “no harm?” Shouldn’t the medical profession not only worry about reimbursement and status of healthcare in the US, but also that of the world? What will your “solution” do for the poor? Or, as it sounds, will it only pad your account (ie “if they want they can get catastrophic insurance in case things get really bad,” what does that prove/provide)? To me the ONLY solution to making medicine great is to provide services to all, addressing healthcare from Boise, Id to Al Fashir, Sudan. I understand that we need a revolution in healthcare today, but that revolution should include and embrace those who cannot “pay cash for their primary care.” If you are in fact not concerned about money (I find my frustrations with medicine have absolutely nothing to do with financial compensation) then why not provide a solution that is better for all? While reimbursement, malpractice insurance, P4P is an issue I feel that there are bigger fish to fry in medicine today (check out http://www.thelancet.com) because after all, as you said, “The truth is that the vast majority of physicians earn are in the top decile when it comes to income.”