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Some days you just have to write what I suppose is called a stream of consciousness. The intent is to enlighten--probably myself, and perhaps to clarify my own bleak intuitions.

The doctor for whom I do volunteer work at the hospital where he is a surgeon and oncologist is a human angel on earth. Trust me, he is a rare breed.  His entire motivation for being in medicine is to render help.  As he said to me the other day, "I saw three patients today who will probably die within a year, I need to be able to focus my time and efforts on comforting them."

Then, in the next breath, he said, "take a look at this." He showed me a computer printout. It was a tally of insurance company reimbursements.  In almost every instance a service or surgical procedure was billed at one amount and this fine doctor was paid literally cents on the dollar.

Even more shocking, the printout was replete with open items from six, eight or ten months ago. All unpaid.

This is ground zero of the American healthcare system.  And my fears should be your fears.

Not only are we being scammed by the insurance industry, good doctors like my friend, are being squeezed and fucked every step of the way too.

These doctors need to survive, we need to survive. This system is so rancid it is destroying everything and everyone it touches.

So what did this noble, may I call him a heroic doctor, say?  He said, "how much longer can I give totally unreimbursed care?"

Then he told me about a patient who had a history of cancer that was, "screaming at me."  When an oncologist says, something is "screaming" you better listen up.

He said this woman needed a digital mammogram. A digital mammogram is a state-of-the-art screening procedure.  It is also somewhat more expensive than the more routine old-fashioned mammogram. This woman was unable to secure the digital mammogram. Then the doctor said, she has a terrible history, she needs a breast MRI--but the insurance company will not pay. They won't pay for a digital mammogram and they certainly won't pay for an MRI.

So what will happen to her I asked? "We'll fight, we'll appeal" he said.  "Then she should file a criminal complaint, insurance companies are practicing medicine without a license."

I have written about being in his office on countless occasions, as some of you may recall, as he pleads with insurance companies on behalf of a critically ill patient who requires a specific medication.

This is how doctors across American are spending their very precious time.  Is this acceptable?

I overhear clipped conversations among my friend and his colleagues, trading suggestions and horror stories about how to appeal or circumnavigate one insurance company denial or another.  Is this how doctors should be spending their time? Discussing criminal insurance companies or complex treatments and  surgical procedures?

I crawl home on days like these with a heavy heart and in absolute despair. I cannot for the life of me, understand why we allow such atrocities to go on and on and on. And why we allow the political class to remain so totally detached from the suffering and hardship this system inflicts on everyone?

And what about the newest generation of doctors. Why would anyone want to be involved with what is evolving into a Third World health care system.  Yes for the rich it offers untold miracles, but for so many it is a like running a toxic, sewage-encrusted gauntlet.

Without a universal, single-payer system  we'll eventually end up with a healthcare system where you can have anything you want if you're rich, and most of the rest of us can just go away and die.

If we lose doctors like my friend, we as a society will have failed as miserably as we have failed and lost in Iraq.

Originally posted to nyceve on Fri Oct 20, 2006 at 04:45 AM PDT.

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  •  This is the unvarnished truth . . . (398+ / 0-)
    Recommended by:
    clio, Magenta, Rumblelizard, Lupin, Alumbrados, Angie in WA State, Doug in SF, sj, jmart, vicki, Best in Show, pb, Sean Robertson, Upper West, MadRuth, tundraman, matt n nyc, Buckeye BattleCry, wystler, SarahLee, alyosha, laurak, roonie, AlanF, Hornito, Oregon Bear, left of center, yerioy, tiggers thotful spot, alisonk, cosbo, Pandora, flatiron, TrueBlueMajority, Powered Grace, mem from somerville, saraswati, ScientistMom in NY, emal, finnucane, MikeHickerson, JTML, walter mitty, TechBob, Stoy, Debby, KumarP, billlaurelMD, Xan, cotterperson, democat, LynnS, wastelandusa, yosho, Pompatus, d3n4l1, freelunch, acuppajo, marrael, varro, velvetdays, AustinCynic, roseba, zic, Matilda, grndrush, musicsleuth, mataliandy, exNYinTX, bostonjay, Creosote, finkstah, shermanesq, RubDMC, vinifera, opinionated, Disgusted in St Louis, monkeybiz, Miss Devore, kwinz, bronte17, lmiller42, medaka, Helena Handbag, macdust, Shadan7, Cassandra77, annrose, megs, Baldwiny, Prairie Logic, grrtigger, KibbutzAmiad, CoolOnion, biscobosco, highacidity, jules too, Xapulin, mytribe, scamp, moiv, phild1976, vmibran, high5, chimpy, roses, javelina, murphsurf, L0kI, lanellici, skwimmer, baltimoremom, Bearpaw, jandey, dchill, ornerydad, ethans mom, Rona, thingamabob, fumie, Jesterfox, splashy, jted, antirove, high uintas, celticshel, nitetalker, bato, wader, stacystace, BarbinMD, MCL, emmasnacker, oldjohnbrown, DeadB0y, lapolitichick, BmoreMD, sooner, JDPITALIA, kdrivel, TiaRachel, kevin22262, grayslady, dwahzon, attydave, hazzcon, rockhound, annetteboardman, dufffbeer, Eddie Haskell, 313to212, Dood Abides, dcookie, barbwires, bwintx, Exurban Mom, ChiGirl88, Bluefish, JohnGor0, WV Democrat, OrangeClouds115, DrReason, eco, CanYouBeAngryAndStillDream, Thestral, Little Red Hen, sweettp2063, kd texan, tipsymcstagger, vansterdam, greeseyparrot, mdgluon, Gowrie Gal, Jersey Joe, gretel, sxwarren, julifolo, rapala, SteveK, leolabeth, madaprn, joanneleon, god less force, maybeeso in michigan, Bluesee, marina, 3goldens, escapee, Jim Hill, deepintheheartoftx, denise b, liberal atheist, ichibon, MHB, el dorado gal, LakeSuperior, Alegre, Five of Diamonds, asskicking annie, baccaruda, JanetT in MD, Heiuan, zaraspooksthra, mjd in florida, ArchTeryx, Chinton, Halcyon, PBen, greasymadness, letsfight, offred, saucy monkey, Melody Townsel, tgray, clammyc, Bad Cog, Valtin, karpinsky, terrypinder, stitchmd, kaye, Hugo Estrada, viral, catleigh, KiaRioGrl79, david78209, wildcat6, thefos, trinityfly, reflectionsv37, maisie, lennysfo, buckeyedem08, Ex Con, Morrigan, EconAtheist, GreyHawk, lotlizard, blue jersey mom, Joy Busey, abbeysbooks, gkn, paxpdx, Yamara, joseph rainmound, JenThinks, el zilcho, wardlow, wulidancer, The Raven, boret, FightTheFuture, wiscmass, sbdenmon, willers, dsteffen, sleep deprived, Rogneid, playtonjr, Casper46, Detroit Mark, JanL, psyched, Dr Benway, wiseFool, zapmama, Dania Audax, danger durden, thiroy, Drocket, Paper Cup, evil twin, debedb, skywriter, taracar, occams hatchet, Appalachian Annie, jimraff, dus7, Major Danby, dsteele2, Nightprowlkitty, Taunger, Milly Watt, vigilant meerkat, DrSpalding, parallel man, virgomusic, Opakapaka, emeraldmaiden, Easterling, maren a, Russgirl, ActivistGuy, wahineslc, Ellicatt, seefleur, sessal, bikerider, Ohio 2nd, Sparkygal, Gottlieb, greenearth, Sassy725, TalkieToaster, Christopher Walker, Lashe, 4Freedom, Glorfindel, gatorcog, OneCrankyDom, DiesIrae, DSPS owl, slandurgurl, FireCrow, FreeTradeIsYourEpitaph, JVolvo, Dauphin, armadillo, bleeding heart, ThePenIsMightier, ER Doc, Andy30tx, pfeffermuse, Josh or Con or Both, sadpanda, rage, doingbusinessas, Clive all hat no horse Rodeo, buckeye blue, Lovo, toys, means are the ends, frankzappatista, Dreaming of Better Days, kurt, cohenzee, Downtowner, Bernie68, bstotts, RickBoston, kidneystones, Friend of the court, coolsub, Class of 72, Craig Burnham, slksfca, jezlin, Bhishma, eastmt, pale cold, One Pissed Off Liberal, J Royce, Boreal Ecologist, DrSteveB, Iowa Boy, grassrootsbloggerdtcom, paul d, Susan Something, dotsright, Cronesense, Cat Whisperer, SAM I am also, blue armadillo, PhantomFly, Cottagerose, Aquadragon, milkbone, kmiddle, kml0331, suburi, DvCM, Mary Mike, Muttly, Nespolo, profmom, daveygodigaditch, flumptytail, ilex, DWG, Ninepatch, Uncle Cosmo, Canyon Lefty, NoMoJoe, stratocasterman, chicago jeff, sowinso, Demi Moaned, MySharona, mudslide, jkilkullen, jhop7, circusanimal, GeorgeXVIII, TexasTwister, cloudbustingkid, tkerresq, et tu babe

    And I know, any doctor will tell you, this is but a taste of what they deal with day-in-and-day-out.

  •  This is why I keep telling dkos (16+ / 0-)

    people to take advantage of medical research being done by the pharmas. By screening for a study(you can always back out) you will get pages of cutting edge bloodwork done for free. Then you can take the bloodwork pages to your doctor. No tests need be ordered and it is all free.

    If you have a chronic disease, then it is important to search for the places that are doing the cutting edge work on drugs. Right now there is one going on for rhumatoid arthritis paying $4100. And you will get the drugs to take home.

    If you are sick, go get paid for it and get your drugs free. Wherever you are there is a facility to help you. Doctors need to know about them too. To have a list of them,to enroll a patient in them.

    I guess I must do a diary on this but I get so discouraged as they scroll off so fast.

    •  abbeysbooks, but it shouldn't be this way . . . (36+ / 0-)

      This is the United States of America, you shouldn't have to plead to be a research subject in order to obtain blood tests or medicine or medical care.

      This is a total perversion, IMO. Yes, thank God it exists, but that people must resort to this is gross testimony to the collapse of our system.

      •  Right, nyceve (6+ / 0-)

        I'm a U.S. citizen, not a damned guinea pig!

      •  But this IS America (5+ / 0-)

        The New Republican America, made over by the pea-brained ideals of Ronald Reagan and Norman Podhoretz.

        Share. Share resources, share delight, share burdens, share the healing. If we only could realize that sharing will bring us back from mass suicide.

        by MarkosNYC on Fri Oct 20, 2006 at 06:29:10 AM PDT

        [ Parent ]

      •  I agree with you. (1+ / 0-)
        Recommended by:
        DBunn

        But the reality is that at this moment in time it is the best way to get blood tests done for free and serious and chronic diseases treated and to be paid. Doctors often prescribe a new medication for a life threatening illness because it is the cutting edge treatment for you and there is nothing else. So it would be a good idea to research your sickness, find who is working on it, what hospital etc as many of these are done in hospitals under the supervision of doctors, and get paid and get the medication.

        If the doctor you go to isn't savvy about this, and your insurance won't pay, it is better than dying. The investigational medication will have been previously tested on animals before you get it. The doses have also been tested. If you are the first, the dose will be less. If no side effects, they will up it on the next group and so on.

        If I had cancer this is what I would do unless I had the best insurance coverage available.

        As for heart problems I don't know why Clinton with all his insurance never got chelation treatments just as prevention. I am assuming he knew nothing about it and was not told. Letterman the same. I have personally met people getting chelation that have avoided bypass surgery by cleaning out their arteries instead of going under the knife.

        Right now NIMH is studying it in research trials across the US. About time I say. I wish I could get in one of those trials.

        And severe eye problems, not run of the mill, the Hunckler Eye Institute in Kansas City KS is the place to go. When ever I see a child or toddler or baby with severe eye abnormalities I tell the parent they can get experimental treatment at one of the best eye institutes in the country. And they do it for free and often pay a stipend for transportation.

    •  That's one side of the coin (5+ / 0-)

      the other is that most insurance won't pay for treatments provided through clinical trails. And I'm not talking about pharma trails, I'm talking about trails run by groups like ECOG (Eastern Cooporative Oncology Group) where my husband worked for many years.

      To point out how absurd this can be, frequently a trail is to compare two treatments that are both improvements over the standard medical treatment. But because it's a clinical trail, it's not covered.

      The next step down that road is that because trails aren't covered, most doctors don't pay much attention to them, so fewer patients participate. And once a treatment takes it's place as a better way to treat a particular cancer; it can take a long time before it spreads to your doctor or mine as a viable option.

      •  I'm talking about clinical trials that are free (0+ / 0-)

        or the ones that pay you to participate. After it is over you can find out if you got the placebo. And before you participate make sure if you get the placebo that they will give you the investigational medication when the trial is over. Many do just that.

    •  i certainly don't want to be a guinee pig (6+ / 0-)
      Recommended by:
      sj, SarahLee, marrael, nyceve, Sychotic1, Heiuan

      just to get care for conditions that already have proven treatments (i.e. not research)

      I realize what you're saying is a good option to try for people in this situation, but if we're talking about using research $$$ to substitute for insurance, we're in real real trouble as a society.  

    •  it is easier (3+ / 0-)
      Recommended by:
      SarahLee, marrael, DSPS owl

      to do this if you are in a city.  Or near a medical school.  When you live in the rural part of the country you may not have access to this option.  

    •  This is at best a short-term bandaid (3+ / 0-)
      Recommended by:
      nyceve, TiaRachel, et tu babe

      I appreciate your efforts to make people aware of their alternatives and I would encourage you to write your diary with basic information on how to find and use this alternative - you can always post links to it when you comment in other posts to keep from having to repeat yourself.

      However, this isn't going to solve the deep problems we currently have with health care.  Unfortunately, the only thing that I think will solve it are:

      --Complete Democratic control of Congress and the Presidency and enough party discipline to keep the DINOs in line

      --Public outrage over a number of highly publicized deaths due to lack of insurance coverage. . ."she begged for breast cancer treatment but no one would treat her. . . all the funds for uninsured patients had run out. . ." type of stories.  Our current system actually makes that kind of hard because there are ways to get treatment if you can't afford it -- you just have to impoverish your family first and/or declare bankruptcy afterwards.  I haven't seen any studies that link premature death to lack of insurance coverage, and I haven't seen the kinds of stories that would engender the public outrage we need.

      --Public pressure from American corporations who want to stay that way but cannot compete in the global economy against workers and retirees who have national health care.

      I think we'll get there but a lot of lives will go down the tubes unnecessarily first.

      •  I agree with you. (0+ / 0-)

        I am just thinking of how to save lives now. I think it will be the corporations that usher in universal health care. God knows we should have it. We needed to bite the bullet when Clinton tried to put it in but all those entrenched dems fought over the different plans. Then along came 1994 and I think that's why they were booted out. I don't think it was completely the Gingrich revolution.

        •  I don't think we were ready in 1993. (0+ / 0-)

          I don't think it had become painful enough yet.  But a lot's changed since then and it's gotten a lot more painful for everybody - businesses, employees, the growing masses of uninsured, doctors, hospitals. . .

          •  Yes we are a culture that waits until (0+ / 0-)

            the horse is out of the barn before we act. Going to the moon was not though. But I guess Sputnik was a big incentive.

            Universal health care just makes good sense. If people are healthy they contribute more.

            It is difficult and expensive in the begining. When medicare kicks in I notice a lot of people start going a lot now that it's paid for. It's like they are trying to make up for all the years they stinted on it. So I get annoyed when I see people abusing it and they do.

            But if you began as a child going, and concentrating on prevention, then you wouldn't rush to stand in line when you were 65.

            My Canadian friend in Singapore told me that she just felt so safe having it, wherever in the world she went, she didn't have to worry about her health.

    •  Go for the free tests (0+ / 0-)

      but skip the study unless you have a fatal or highly debilitating incurable disease.  Drugs that have been through the clinical trial process and been approved end up killing people when on the market.  Imagine how dangerous it is to be a guina pig.  Why do you think they pay $4100?

      •  Only had trouble once in ten years (0+ / 0-)

        And that was the anti-dpressant study I did. It was an awful drug and came out FDA approved and all in the spring after Feb testing.

        If you have uneasy feelings about a particular drug, don't do the study. I have turned down some I didn't feel comfortable with. As an older woman I get investigational harmone replacement for post menapausal women, osteoporosis drugs, anti-biotics, urinary incontinence drugs (I like these) new morphine derivatives with a drug added to take away the high (the best part) new flu vaccine. These are the ones that come to mind right away. I guess there have been others. Oh yes a glacoma one that I liked with synthetic marijuana. I am doing one the next three weeks on a morphine derivative. One generic compared with two out on the market for 20 years. Paying $2800. I get to read books, talk with nice people, watch movies, play on my laptop, sleep, do yoga, and anything else to amuse me.

        The pay is based on a number of things: how many blood draws, how long the study is, how hard it is to fill that particular study, how frequent the blood draws are, how many returns, generic or investigational and so on.

        You screen for the ones wanting healthy subjects and get your blood work done, as they are looking for something wrong with you, and that's free. If you have a disease you are going to get meds from your doctor that also may have awful side effects. And there just may be a new one in trials that compensates for that. Or just does it better. Your doctor cannot prescribe it if it is in trials, but you can get paid and test it to see if it helps you better than the one on the market. If I were sick and or in pain and desperate I would try anything.

        And if guinea pigs don't do it then how can your old mother get a new drug she badly needs if someone doesn't test it to make sure she won't be troubled with it. Yes, some trials people throw up, have headaches,can't sleep, want to sleep all the time. That's why you stay in there while you take them so they can monitor you.

        And so on and so on.

    •  placebo controlled trials (1+ / 0-)
      Recommended by:
      abbeysbooks

      it sounds good to get into studies, but if you're in a placebo-controlled trial, you may or may not get the medication in question. Depending on how the study is structured, you could get the 'standard of care' treatment versus the study drug, or you could get a placebo. This may have some serious repercussions if you really need treatment; and you may not qualify.

      There are several different 'phases' of drug trials; some are placebo studies as I mentioned above which are typically phase 3 studies; phase 2 studies are looking at side effects and are more restricted, they may actually be conducted on people without a disease.

      Getting into studies is not a bad idea, but it's not a good way to rely upon getting your health care. It shouldn't have to be that way.

      •  No it shouldn't have to be that way and it is (0+ / 0-)

        that way.

        Usually the placebos in phase III are not 50% of the group. Usually 2 or 3 people get the placebo but you don't know unless you are tuned in to your body. Most people in the groups are not in my experience. Or they may do two dosings of a group, one placebo and one the drug but it is double blind so you and they don't know which one you are getting.

        The investigational ones are interested in side effects and blood absorption rates both. But most subjects don't bother to tell them of side effects as then they keep coming back to you and asking is it a 2 or a 3 now etc. And the followups are on a time schedule so you might want to be napping at that time and they will wake you, so the ones who do a lot of studies just keep it to themselves and say fine, I feel fine.

        The there are those who are newcomers who imagine every little thing they feel attributed to the drug. It may be their nervousness or their desire for attention. Or just their newness to the situation. Their problems may or may not be drug related but everything is supposed to be reported. So when you read all that fine print of side effects on the prescription paper slip that's where they came from.

        Studies are an excellent way to keep monitoring your health. You won't go to the doctor once a month for check-ups etc as it is too expensive, he will think you are a hypochondriac, or your insurance won't pay. But you can get it done free many times a year. You can't back out of studies too many times at a place or you will go on the shit list in the database.

        There are some things about my health that I am watching right now and studying about. They are barely noticeable at this time but I can keep an eye on them.

      •  Also if you are in a phase I (0+ / 0-)

        which means you have the disease or problem and you get the placebo, then usually they give you the medication afterwards to take home. San Antonio does a lot of these. A lot of out patient ones there with take home meds and followups sometimes for well over a year.

        There was one 3 week in house last year for diabetes paying $6500 to try a new drug. You had to be diabetic of course, and not responding well to the market medication. Now that's very nice. And it was for people 65 to 80.

  •  And, as a surgeon, he's actually better off (47+ / 0-)

    The insurance systems are set up to reimburse procedures much more than other forms of care. Surgeons who can bill for procedures have continued to do better than internists and other primary care docs who bill for office & hospital visits. The pay is much better for doing than for thinking and caring.

    I'm a salaried employee of my hospital system, so this doesn't directly affect me, but the billing code specialists in the hospital administration watch us closely, to encourage us to dictate each visit "properly" to maximize the hospital's reimbursement.

    We are men of action, lies do not become us.

    by ER Doc on Fri Oct 20, 2006 at 04:57:01 AM PDT

    •  ER Doc, this is true . . . (21+ / 0-)

      and you know what he says, lots of doctors see a patient who needs some sort of surgical procedure, then they keep calling them back because each visit is a separate payment--or something along these lines.

      Of course, I'm not a billing specialist, I'm just a civilian observer, so what I'm saying here is the gist of what I understand goes on.

      But beyond that, the reimbursement level is so low, it's a joke.  And my friend doesn't cram a million patients a day, quite the contrary, so it is becoming increasing impossible to make ends meet.

    •  If you don't document (4+ / 0-)

      properly, the insurance doesn't pay and the patient gets billed for the whole amount by the hospital. I have seen both ends of the system.

    •  what do you think of the idea of (10+ / 0-)

      single payer universal healthcare?  

      I think doctors deserve to make a good living, given the amount of education that it takes to become a doctor.  However I don't see any reason for medical insurance companies at all and I don't think hospitals should be for profit institutions.

      •  Ten years ago (5+ / 0-)

        Canadians were worried about the flow of our doctors to the US, especially specialists. At that time they could make a lot more money in the States than they could in Canada where the amounts they can make have a top limit. This hasn't happened in the last few years - this drain is rarely happening any more.

        •  Canadian Doctors here (1+ / 0-)
          Recommended by:
          ER Doc

          I'm Canadian/American. As the third largest Canadian-populated city (LA) we have lots of Canadian doctors. Of the last 3 new doctors my family was referred to by our (American) doctor all 3 were Canadian.

        •  I don't think you can make (1+ / 0-)
          Recommended by:
          ER Doc

          as much as a doctor here now.  I am sure there are doctors in Canada who want to get rich. It's human nature.  But if we go to universal healthcare doctors here are just going to have to accept the new reality.  

          •  You can't make as much (2+ / 0-)
            Recommended by:
            TiaRachel, ER Doc

            as you could, say, a generation ago.  But if you go from a universal system to, say, an elite practice (charging elite prices) in NYC or LA, you'll make a hell of a lot more.

            Yes, to some extent, doctors will just have to "accept the new reality" - but that is the worst possible way you could put it.  Remember that these are people who have taken out 200K of loans to work hellish hours for at least eight years of training.  If you don't pay decent (six-figure) salaries, it's not worth anyone's time to go through all that.  

            Politics is like driving. To go backward, put it in R. To go forward, put it in D.

            by gkn on Fri Oct 20, 2006 at 09:23:53 AM PDT

            [ Parent ]

            •  we also need to make college and med school (3+ / 0-)
              Recommended by:
              chainsaw mary, ER Doc, DBunn

              less expensive.  But in any case I think there are a lot of doctors who want to do the job because they are natural healers.  

              •  true true (5+ / 0-)
                Recommended by:
                nyceve, TiaRachel, gkn, virgomusic, ER Doc

                If you poll any class of medical students, you'll find about 10% wnt to be a doctor for the money/prestige/ego gratification. The other 90% really do give a damn about people and want to help them. At my school, we actually run free clinics for the homeless and the poor. We do this of our own free will because we reall do want to help everyone we can.

                When all is said and done, my brain will be worth around $250K. I want to specialize in geriatrics - with the govt. cutting Medicare/Medicaid reimbursements, I might have my school loans paid off by the time I retire.

                •  it shouldn't cost you so much (2+ / 0-)
                  Recommended by:
                  TiaRachel, ER Doc

                  these universities and medical schools sit on huge endowments and charge you a fortune while grants are cut year after year.  Education has to be made more affordable.

                  I think in your case Universal healthcare can be an asset.  You would have a lot less need for massive office staffs to shuffle all the insurance forms.  You could see more patients, spend less time on administration and pay your loans off faster.  There is no reason why "socialized" medicine should mean less money for most doctors.  It might mean less  for some of the highest paid big ticket specialists.  But the need for malpractice insurance would also drop.  Aren't most law suites about recovering life long medical care costs?
                  If you have life long medical regardless of employment, there is a lot less need to sue whenever something goes wrong.

                  •  The federal government has been cutting back (1+ / 0-)
                    Recommended by:
                    TiaRachel

                    on their support for medical eduacation for years. Not just the Bush administration; it's been one of the ways to help cover the cost of Medicare without asking for as much new money. College costs in general have gone up a lot more than inflation as state and federal money has been cut back, and medical school has gone up a lot more. The University of Iowa charged about $2000/year tuition for Iowa residents when I was a student (class of 1980.) Instate tuition is now $20,619, and out-of-state tuition is $40,689. Most medical students are graduating now with $150-2000,000 in loans; essentially a home mortgage, and then going into a  residency that pays about $45,000/year for 3-7 years, depending on the field they choose.

                    We are men of action, lies do not become us.

                    by ER Doc on Fri Oct 20, 2006 at 12:28:58 PM PDT

                    [ Parent ]

                  •  They charge about 35K (0+ / 0-)

                    per year, and it costs about 60K per year to educate us, so I'm not going to complain too much about the costs (of course, I wouldn't have done it if I hadn't gotten a scholarship via doing a PhD as well...)

                    Universal health care would definitely be an asset.  I would much rather spend my extra time in my lab than dealing with forms - I get more than a little irritable from that crap.

                    Politics is like driving. To go backward, put it in R. To go forward, put it in D.

                    by gkn on Sat Oct 21, 2006 at 12:07:34 AM PDT

                    [ Parent ]

              •  It has always seemed to me (2+ / 0-)
                Recommended by:
                virgomusic, ER Doc

                that med. school ought to be free to qualified applicants.  Medicine is/should be a public service.  Then physicians would have less reason to require/justify enormous incomes.  

                In exchange, they should be required to work in a (yet to be established) public system for some period of time.  Of course, they ought to be paid in the six figures to justify the extended trainig.

                This is not the ultimate solution to healthcare reform, but seems to be one, possibly necessary, step toward it.

                •  My son's at Des Moines University (5+ / 0-)
                  Recommended by:
                  nyceve, TiaRachel, gkn, virgomusic, Iowa Boy

                  in the osteopathic program. $37K/year in loans. And he wants to be a pediatrician, which is currently one of the lowest-paid specialties. Not most, but an appreciable percentage of students are currently choosing their specialty in part based on the level of loans they're carrying. We end up with more dermatologists, anesthesiologists, and radiologists that way, and a lot fewer family physicians and pediatricians. And a lot of internal medicine residents choose to subspecialize in cardiology and gastroenterology rather than practicing general internal medicine or going into infectious diseases or rheumatology.      

                  We are men of action, lies do not become us.

                  by ER Doc on Fri Oct 20, 2006 at 12:10:50 PM PDT

                  [ Parent ]

                •  Some (elite) schools (0+ / 0-)

                  are thinking about moving toward that - Hopkins considered it a few years back.  

                  Politics is like driving. To go backward, put it in R. To go forward, put it in D.

                  by gkn on Sat Oct 21, 2006 at 12:09:14 AM PDT

                  [ Parent ]

                  •  Oh yeah. (0+ / 0-)

                    And there are some ways to get loan repayment via public service, kind of like you can for law school if you do legal aid - for instance, if you work in underserved rural areas for x years, the school will pay back y percent of your debt.

                    Politics is like driving. To go backward, put it in R. To go forward, put it in D.

                    by gkn on Sat Oct 21, 2006 at 12:10:56 AM PDT

                    [ Parent ]

  •  Wow, your friend (25+ / 0-)

    seems rare indeed.  I tried pre-med my first semester of college when I learned that people become MDs because they love science.  I wanted to help but because of my math and science impairment (you want me to divide what?? Fractions??  lol) I discovered that I wasn't exactly MD material.  It seemed to me then that someone who had both talents was rare indeed but I am sure there are a lot of good docs out there.

    I've read time and again about how the time of docs making a lot of money is long gone.  Purely business now.  It is very sad how this could happen in the richest country in the world.  I smile when people wonder why I immigrated to Europe.

    The law was made for one thing alone, for the exploitation of those who don't understand it, or are prevented by naked misery from obeying it. -Bertolt Brecht

    by Jeffersonian Democrat on Fri Oct 20, 2006 at 05:01:05 AM PDT

    •  But that's exactly what happens (8+ / 0-)

      Our country has evolved to let business be the prime force in all aspects of our lives. There's no 'living' that we do, we only do 'business.'

      Pathetic. IT's all marketing.

      Share. Share resources, share delight, share burdens, share the healing. If we only could realize that sharing will bring us back from mass suicide.

      by MarkosNYC on Fri Oct 20, 2006 at 06:31:48 AM PDT

      [ Parent ]

      •  at the risk of going ot (31+ / 0-)

        I had a brief stint in the business as my first job out of active-duty military.  Back then Pharm companies were hiring junior military officers for their leadership, definitely not for my liberal arts education in my case.  I didn't do too badly and made valedictorian with a handful of others out of my sales class.

        I sold drugs, yet my drugs dealt with heart disease and stroke, ya just didn't want what I was peddling.  My route often took me up the Virginia eastern peninsula where it is very poverty stricken.  These were also the days before my enlightenment when I listened to Rush Limbaugh.

        The patients there really needed what I was selling.  They were poor, many obese with diabetes, circulatory and heart problems.  My anti-stroke drug, according to our studies at the time, was 25% more effective than aspirin and without the gastronomical complications that some patients experience.  The catch was that my drug costs $99 a month vs. 3 cents a day for generic aspirin.  My company had a program for underprivilaged people and I was faxing my limit of forms for the program.  Still many people went without.  Driving back one day Rush was babbling on about Hillary, health care, yada, yada, yada... and then the lightening bolt of reality hit me (which finally solidified my doubts that grew in my military Latin American deployment experience) that what he was saying was completely the opposite of what I just experienced.  Not only that, but I also realized that my stress level was so high while listening to him that I drove more aggressively, faster, having to pass every car and truck that was obscuring my view.  I think it was a subconscious "me first" mentality.

        I turned the dial to NPR and never turned it back to this day.  I also noticed that by driving the speed limit, not only was it safer, but I let the others stress out and pass me.  Soon enough they were gone far ahead and I had my nature view again - without stress driving.

        Shortly afterwards, I began to feel like a prostitute taking docs out to dinner and spending lavish amounts on events yet the people of the peninsula still couldn't get the meds I peddled.  I soon gave up a 55k a year job in '99/'00 to go back to school and become a poor grad student in literature.  Everyone thought that I was nuts but I think my soul lies easier with that decision.  And...I am actually happy in that regard.

        So, you are right, that was my "no living that we do, only business" moment in health care.  I guess the bright side is that I did discover that a few docs should not be put on a pedistal and probably should not be practicing medicine.  It makes me careful in choosing a provider whereas before I just had blind trust.

        The law was made for one thing alone, for the exploitation of those who don't understand it, or are prevented by naked misery from obeying it. -Bertolt Brecht

        by Jeffersonian Democrat on Fri Oct 20, 2006 at 06:56:06 AM PDT

        [ Parent ]

        •  Those few rotten doctors are also part (5+ / 0-)

          of the reason HMO's and corporations were able to divie-up the healthcare dollar while lowering the excellence of medical treatment.

          In one hospital where good doctors once reviewed the hospital treatment policies, a corporation infiltrated the board by offering dummy corporation stock with which to make a killing on the stockmarket. These doctors were, in effect, bribed to vote against best practices. I am sure the pecuniary incentive made it easier for some of these doctors to rationalize their actions as "win/win" results. I am also sure that some doctors only felt they were finally going to earn what they went to medical school for--money, for too many doctors did not see medicine as a calling. The good doctors were outnumbered by the followers of Reagans's "greed is good" ethos.

          Soon they voted in other lackeys to their committees, and the result was. . .another keystone in our present system of heatlhcare extortion.

          Peace is respect for another's rights. Benito Juarez

          by Ignacio Magaloni on Fri Oct 20, 2006 at 07:37:53 AM PDT

          [ Parent ]

          •  that does not (2+ / 0-)
            Recommended by:
            nyceve, Ignacio Magaloni

            surprise me in the least.  Living in Germany with semi-socialized medicine has really converted me, I honestly advocate universal health care as the only humane choice.  Stories like NYceve's, yours, mine, and countless others only illustrate the problem more.  The question remains what and how to do it.

            I hope the new dems do hop on this issue (cheerfully optimistic).

            The law was made for one thing alone, for the exploitation of those who don't understand it, or are prevented by naked misery from obeying it. -Bertolt Brecht

            by Jeffersonian Democrat on Fri Oct 20, 2006 at 08:07:36 AM PDT

            [ Parent ]

        •  wow (4+ / 0-)

          Great story.  Thanks.  
          How could you possibly not learn that Rush was problematic -- you are a thinking person, clearly!

          •  thanks (9+ / 0-)

            but actually, for me at least, what he say made sense.  It took me awhile.

            Let me explain myself, that is how propaganda becomes effective, by twisting half-truths and making it sound like "common sense".  I am thankful that once I got to grad school, I learned to distrust and question "common sense" (which also gets me in trouble sometimes here, but I won't give that up) and learned about critical thinking.

            I think that is why academics tend to be "liberal", part of the job is questioning and critical thinking.

            The law was made for one thing alone, for the exploitation of those who don't understand it, or are prevented by naked misery from obeying it. -Bertolt Brecht

            by Jeffersonian Democrat on Fri Oct 20, 2006 at 07:58:19 AM PDT

            [ Parent ]

        •  Remarkable story (3+ / 0-)
          Recommended by:
          nyceve, Jeffersonian Democrat, ER Doc

          I really appreciate your taking the time to share it.

          I am sending this diary on to my reps (as I so often do with nyceve's diaries.  

        •  That (1+ / 0-)
          Recommended by:
          Jeffersonian Democrat

          is an inspiring story!

          And, for the record, I don't understand how docs can accept lavish dinners from pharma reps and not feel like prostitutes.  Of course, my generation has ethics classes in which we're forced to debate these things - and the preceptors are definitely biased toward the don't-ever-take-anything-from-a-pharma-rep mentality.

          Politics is like driving. To go backward, put it in R. To go forward, put it in D.

          by gkn on Fri Oct 20, 2006 at 09:33:43 AM PDT

          [ Parent ]

          •  wow, thanks (0+ / 0-)

            I never thought of that as inspiring, just felt like the right thing to do, for me personally, at the time.  I had lots of material things, and I have pretty much lost them all, but I don't regret it now.  I felt very empty inside then, not so now, I think I've found my niche in literature.  It will never make me wealthy but I enjoy it.

            The law was made for one thing alone, for the exploitation of those who don't understand it, or are prevented by naked misery from obeying it. -Bertolt Brecht

            by Jeffersonian Democrat on Fri Oct 20, 2006 at 10:25:18 AM PDT

            [ Parent ]

        •  Radio's effect on blood pressure (1+ / 0-)
          Recommended by:
          Jeffersonian Democrat
          that is really fascinating. Someone should do a study on extreme radio's effect on blood pressure and speeding.
    •  People become MDs (3+ / 0-)

      because they love science?!?

      Not in my experience - hell, in my class, we've got everything from science majors of all stripes to music, Spanish, French, comp lit, sociology...

      You have to take the basic 4 classes to apply, but you're a lot more interesting to med schools if you're not just interested in science.  If that's all you care about, med schools do not want you - they want you to go to grad school.  Oh yeah: science professors also hate pre-meds, primarily because so many are not at all interested in the science classes they have to take.

      Sorry for the rambling - I'm doing a PhD along with med school, and I actually get irritated with classmates who don't care a whit for the science behind the facts we're pouring into our heads.

      Politics is like driving. To go backward, put it in R. To go forward, put it in D.

      by gkn on Fri Oct 20, 2006 at 09:29:24 AM PDT

      [ Parent ]

      •  lol (2+ / 0-)
        Recommended by:
        nyceve, gkn

        that was only my impression and the way that I like to put it.  I meant it as: if I am going to torture myself by taking a drink of water from a fire hydrant trying to digest this information, I better love water.  I admit, it was an over generalized statement.

        I mean, it appeared to me that my motivation was in the wrong place (I just wanted to be a damn cool trauma surgeon and save lives from the brink - yea, a little immature romanticism I know) because I really have no talent with science, calculus, etc.  I would learn something but not retain it two weeks later.  And I wasn't kidding about fractions.  I just found that I didn't have the passion nor the talent that seemed to me necessary to get through that.

        So, for my undergrad, I switched to Russian and East European Studies.  I found that I excelled in languages, since I already had Spanish from the military and I am currently trying to perfect my German, and literature and had an undiscovered passion for it.

        The law was made for one thing alone, for the exploitation of those who don't understand it, or are prevented by naked misery from obeying it. -Bertolt Brecht

        by Jeffersonian Democrat on Fri Oct 20, 2006 at 10:48:35 AM PDT

        [ Parent ]

      •  Ooh, are you in Urbana? (0+ / 0-)

        ...you don't have to answer if that's too identifying.  I guess it's apparent now, that's where I trained.

        Universal Health Care - it's coming, but not soon enough!

        by DrFood on Fri Oct 20, 2006 at 11:21:36 AM PDT

        [ Parent ]

        •  No. (0+ / 0-)

          But I have a lot of friends there...I thought about it for undergrad and then decided it was too damn cold.

          Politics is like driving. To go backward, put it in R. To go forward, put it in D.

          by gkn on Sat Oct 21, 2006 at 12:02:19 AM PDT

          [ Parent ]

  •  The Compesation (43+ / 0-)

    for Insurance company CEOs is obscene. These people increase their companies' stock value by increasing premiums, denying payments, and making sure they don't insure sick people.  They are the only segemnet of our economy that benefit from the "free market" in health care.  Remember Harry and Louise?  They convinced Americans that "we don't want the government to make our health care decisions", and a lot of doctors agreed.  Now fat, greedy businessmen are making our health care decisions, and it is a disaster for patients, doctors, and businesses.

    "He had, in fact, got everything from the church and Sunday School, except, perhaps, any longing whatever for decency and kindness and reason." Elmer Gantry

    by MadRuth on Fri Oct 20, 2006 at 05:01:37 AM PDT

  •  Calling all veterans (20+ / 0-)

    If you served in the military, and if you were discharged under any but dishonorable circumstances, you are eligible for Veterans Administration health care.

    A lot of veterans assume that the V.A. health care system deals only with service-connected conditions.  Nothing could be further from the truth.  You may have to pay a co-pay amount for prescriptions, based on income, and you won't qualify for dental work unless that's service-connected, but if you're not enrolled yet you should take the time to sign up.

    Here's a link to the page on the V.A. site where you can enroll or apply for care:

    Enroll in the V.A. health care system .

    We're all in this together.

    by JTML on Fri Oct 20, 2006 at 05:03:23 AM PDT

  •  I have had (16+ / 0-)

    several doctors tell me they would like to get out of the business as well - they can't keep the fight up against the insurance bureacrats indefinitely.

    Apparently, as long as the elite continue to receive decent care nothing will be done.  I cannot seem to make much ground on advancing this issue among Democratic candidates who seem permanently spooked by the "Hillary Care!" label.  We need a health care revolt in this nation.

    I personally would like to see all employers, including of course, the federal government, simply drop their contributions and coverage.  I cannot think of how else to wake people up.  If every single person had to fight to obtain, let alone pay for and use, health insurance the way tens of millions of us already do, I think the problem would be addressed overnight.

    •  I would hate to see business just drop coverage, (6+ / 0-)

      but it seems like business could be an ally in improving health care, since they are paying gigantic health bills. Maybe if Democrats take control, they can find a way to both provide universal care while also reducing the total cost -by eliminating the costly HMO police.

      A total cost-benefit analysis is needed for creating such a universal approach. If the costs of all the wasted time that doctors, nurses and medical administrators spend on paperwork are factored in, the savings of a universal system would make it less expensive. At the same time, it would cover everyone AND take the direct costs away from business. Businesses could pay a fair tax to cover their share in a way that would be less expensive for them, so they would be happy.

      Health care needs a total, comprehensive solution. One that ignores the desires of health care companies and only focuses on the needs of Americans and the costs involved.

    •  Thank you Kibbutz. . . (4+ / 0-)
      Recommended by:
      SarahLee, Thestral, flumptytail, MySharona

      Hammer meet nail.

      What Kibbutz wrote is the beginning, middle and end of the story:

      they can't keep the fight up against the insurance bureacrats indefinitely.

      •  2 of my doctors (2+ / 0-)
        Recommended by:
        catfish, nyceve

        had switched a couple of years ago to a non-insurance basis.  The patient pays cash upfront.  The patient then tries to navigate the insurance system by him/herself to receive reimbursement.  The doctors do not take insurance, medicare, medicaid or workman's comp.  I began to learn about diagnostic codes and physician licensing numbers to fill out forms.  Became acquainted with filing complaints to the state insurance board and learning the secret call-in numbers of the insurance companies to bypass the long wait times.

        These physicians have become the Drs to the rich and famous.  I had to drop them this year as the unreimbursed portion of the bills became untenable (despite having insurance and having most claims accepted).

    •  Example of Canadian doctor (1+ / 0-)
      Recommended by:
      jhop7

      several doctors tell me they would like to get out of the business as well - they can't keep the fight up against the insurance bureacrats indefinitely

      I met a Canadian doctor who had been enticed to some delightfully warm and semi-tropical place in the U.S. to practice. He came back after a few years. Everything was lovely except for the frustration of the patient's access to care, based on their insurance coverage. Too many insurance questions had to be resolved before he could just treat the patient.

      He liked the simplicity of the Canadian system. In emergency cases, people are treated at the hospital, even if their insurance coverage isn't known. Most will be Canadians with provincial health care. Some aren't Canadian; the hospital deals with that issue. The medical people treat patients.

      When patients see the doctor for more routine stuff, the doctors know what's covered and what isn't. The claims submitted by the doctor's office to the provincial health care system are paid faithfully, so far as I know.

      As far as wait times go: I think that many Americans have been persuaded that there are long wait times all the time in Canada.

      Within the last couple months, I've talked with two friends who had unexpected, serious, health problems. Both said that they were very happy with the treatment they got--their cases were expedited, and they were sent straight to the specialists they needed (multiple specialists in both cases).

  •  Everyone should look at those bills (26+ / 0-)

    I recently had major surgery. The hospital got $20,000, the surgeon $1200. This is what is supposed to pay for three office visits, office staff, and liability insurance. I could easily have traded the cold, greasy meal and the 11 wake up calls during the night for an extra 10 minutes in the surgeon's office before the surgery in order to allay some of my fears.

    There are many reasons that "the establishment" resists a universal health care plan. One of the main ones is that a rational system would require the corporations to negotiate fees at the same table as the professional associations.

    •  Part of what you pay goes to cover costs (8+ / 0-)

      incurred from patients that can't. These same people often do not have a regular physician, and so sometimes minor problems are allowed to grow into major ones, treated with an emergency room visit.

      17. Ne5

      In chess you may hit a man when he's down -- Irving Chernev, on Przepiorka v. Prokes, Budapest, 1929

      by Spud1 on Fri Oct 20, 2006 at 05:19:58 AM PDT

      [ Parent ]

      •  The cost of the uninsured... (2+ / 0-)
        Recommended by:
        baccaruda, gkn

        I've written about this many times before. We simply can't afford to not have national health care. Here are just a few of the costs:

        --$1200 on every car made in the U.S., making Ford incapable of competing with Toyota

        --Tens of thousands of unnecessary visits to emergency rooms, that we all pick up

        --Special education costs for babies born to mothers without prenatal care

        --An emphasis on maintenance rather than cures, that reduces our national productivity and inflates social security disability

        But why should the big money republican donors care? The little guy and gal are paying their costs, and their stockholders are saving money!

    •  My sweetie had 3 surgeries last year (12+ / 0-)

      and she was begging to be allowed to stay in the motel across the street from the hospital!  Cleaner, quieter, SAFER, and sooooo much cheaper.  

      The extinction of the human race will come from its inability to EMOTIONALLY comprehend the exponential function -- Edward Teller.

      by lgmcp on Fri Oct 20, 2006 at 05:57:23 AM PDT

      [ Parent ]

    •  MichaelMT, this is exactly correct . . . (15+ / 0-)

      These highly trained doctors are often making less than the bs driver who brings you to the hospital.

      A year or so ago, i had a mammogram at one of the top hospitals in NYC.

      The bill for the mammogram was $125.00, the insurance company paid the doctor/radiologist who read it, $16.00.

      Something is very fucked up here.

      •  nyceve, these are the kinds of numbers (11+ / 0-)

        that have been missing from the debate. I've looked for these numbers; what does a procedure cost? What does a professional's time cost for it, what does the machinary cost? The rent? the heat? The janitor?

        What we pay for a medical service is completely unrelated to what the service cost. So all conversations about care, the cost of care, the cost of insurance, are pretty much like talking about this republican administration or the latest Johnny Depp movie -- their conversations about lots of little and a few big pieces of fiction. And from what I can tell, those numbers, when they are provided, change for the benefit of the audience.

        •  Exactly (5+ / 0-)
          Recommended by:
          SarahLee, zic, Thestral, gkn, DSPS owl

          and rather than a serious analysis and debate about the subject of health care costs we get treated to what amounts to fables, with our elected officials reciting the bill they sponsored in 1996 to stop "drive by mastectomies". This is like spot-cleaning a filthy garment. I'm sick of it. My husband and I have plans to retire out of the country.

          "And tell me how does god choose whose prayers does he refuse?" Tom Waits

          by madaprn on Fri Oct 20, 2006 at 06:31:49 AM PDT

          [ Parent ]

        •  I work for a big hospital system (1+ / 0-)
          Recommended by:
          zic

          and this was just addressed in a meeting.  We are a faith based non-profit and our CFO was speaking of his desire to bring charges more consistently in line with costs, BUT he said that changes we make in our cost/fee structure could trigger an adjustment in our Medicare reimbursement rates, which are already low.

          Our CEO commented that "we" (the system) do no want single payer.  He didn't say why, just that "we" are against it.

          Our CFO expects that we will be okay on Medicare reimbursement through 2008 because of elections, but that we will see changes after that since Medicare is expected to go bankrupt in 2020.

          For what it's worth, hospitals struggle with the insurance companies and the issue of uninsured patients too.  I think the only winners in the current system are the insurers.

          Time for a clean slate.  The smart parties will start now on crafting their postion on single payer so that they can effectively lobby for a system that serves their interests.

      •  $16 for a radiologist? (7+ / 0-)
        That's far too high. Why isn't the hospital outsourcing to India? One shouldn't have to pay more than $1.

        < /insurance company snark>

        What happens on DailyKos, stays on Google.

        by Jon Meltzer on Fri Oct 20, 2006 at 07:36:23 AM PDT

        [ Parent ]

        •  No, not for the radiologist (4+ / 0-)
          Recommended by:
          Jon Meltzer, nyceve, TiaRachel, lgmcp

          You pay for the radiology technician, the equipment, the receptionist, the lights, the heat...and maybe one dollar to the radiologist in Bangalore who glances at the film.

          •  I knew somebody who sold that equipment (0+ / 0-)

            Big imaging machines for MRI, CAT scan, and sonogram ...they cost an incredible amount, so a small percentage commission on just three or four sales a year added up to a handsome annual income.

            Though I'm sure a solid technical and fiscal understanding was required to do the job, I'm pretty sure it was also required to be tall and good-looking.  With what Dilbert's author calls "executive hair" (female version).  

            The extinction of the human race will come from its inability to EMOTIONALLY comprehend the exponential function -- Edward Teller.

            by lgmcp on Fri Oct 20, 2006 at 09:57:53 AM PDT

            [ Parent ]

  •  Overhead costs (17+ / 0-)

    from fighting insurance companies make up about 15% of the health care dollar, for ZERO return in health.

    Read that again if you must, for it is an ASTOUNDING number.

    Now Hypnocrites cartoons are for sale on T-Shirts, buttons, and more.

    by dhonig on Fri Oct 20, 2006 at 05:13:44 AM PDT

  •  What is the core cause of all this? (3+ / 0-)

    Where is our medical system bleeding from?

    Most people are idiots... But don't tell them. It'll spoil all the fun for those of us who aren't.

    by d3n4l1 on Fri Oct 20, 2006 at 05:14:42 AM PDT

    •  class, he said it (1+ / 0-)
      Recommended by:
      yoduuuh do or do not

      class

      •  I don't understand (2+ / 0-)
        Recommended by:
        Thestral, flumptytail

        I don't think that is what I mean.  Where is all the money going?  To insurance company CEOs?  Is someone charging too much in the chain?  What is the cause of the rising prices?   I don't know much about this topic and lately I've been wanting to learn.  Anyone have a good start for me?

        Most people are idiots... But don't tell them. It'll spoil all the fun for those of us who aren't.

        by d3n4l1 on Fri Oct 20, 2006 at 05:43:44 AM PDT

        [ Parent ]

        •  Yes, you are correct (14+ / 0-)

          Back in the 80's, business leaders decided to make health care delivery as profitable as other industries. Overall, the industry was about 7% profitable, and they bought out and consolidated hospital ownership, insurance companies, supply manufacturers, and brought that profit up to 12%.

          The profiteering is being collected by shareholders and  chief executives of these corporations. It's that simple.

          Rising prices are just a testing of the waters by corporations to see what the market will bear (or is that bare?). Know one knows how much people will pay for health care in America, and they are testing our limits. It's pretty obvious that Americans will pay a real lot of money for health care, like the $180 cash I just paid to have my teeth examined and cleaned by my hygenist. But that's nothing. Surgeries are outrageously priced, 10's of thousands of dollars . . .

          How much will the market bear? That's what rising prices are about.

          Share. Share resources, share delight, share burdens, share the healing. If we only could realize that sharing will bring us back from mass suicide.

          by MarkosNYC on Fri Oct 20, 2006 at 06:08:13 AM PDT

          [ Parent ]

        •  I believe that... (0+ / 0-)

          the good Senator from the State of Tennessee could aid you in your quest.

          and all he requires for payment is a cute, cuddly, kitten.

          Neil Cavuto is a GOP circle-jerking necrophiliac? (-6.88, -6.15)

          by guyermo on Fri Oct 20, 2006 at 06:29:11 AM PDT

          [ Parent ]

  •  Isn't this one of the arguments against the (11+ / 0-)

    single payer system, that doctors work as if they have a regular job like the rest of us, making a salary (albeit a nice one)? That those doc's in a single payer system can't just charge what the market will bear?

    Haven't insurance companies here basically implemented that? Or am I wrong (or have I not made my point clear)?

    I know that some doctors here rake in huge bucks - I've worked on some of their homes. But it seems to me that insurers are limiting what most doctors can charge, and therefore their income. Add to that the extra staff that doctors must have just to deal with insurance companies, furthering limiting profits.

    17. Ne5

    In chess you may hit a man when he's down -- Irving Chernev, on Przepiorka v. Prokes, Budapest, 1929

    by Spud1 on Fri Oct 20, 2006 at 05:18:01 AM PDT

    •  Exactly: the evils that are imagined to come (9+ / 0-)

      from a single-payer system are with us already, and only a single-payer system can alleviate them.

      "I belong to no organized party. I am a Democrat." -- Will Rogers

      by Allogenes on Fri Oct 20, 2006 at 05:39:05 AM PDT

      [ Parent ]

    •  Another argument I hear... (16+ / 0-)

      ...is that letting the government run a single payer plan is letting "someone else" make health care decisions.  Hey, we've already got that, with insurance companies deciding what to pay for.  The government is us.  We're the taxpayers, and we should take over health care payments by pooling money into a single-payer plan (the way we do for utilities & roads).

    •  Single-payer & doctor's wages (0+ / 0-)

      Isn't this one of the arguments against the single payer system, that doctors work as if they have a regular job like the rest of us, making a salary (albeit a nice one)?

      I live in Canada. We have a single-payer system.

      There are probably quite a few doctors here who are employed by, say, hospitals. I know a doctor who was interning and now is a resident. Long hours, modest pay.

      Most physicians aren't employed in salaried positions.

      The ones who have their own private practice are self-employed, so they get paid according to what they do. Each service provided to a patient is billed to provincial health care at the prescribed rate.

      "Single-payer" just refers to the system for payment. It doesn't mean that there is a single employer.

      •  Thanx. Can your doctors charge more than (0+ / 0-)

        what the system pays? So that a patient would have to make up the difference.

        17. Ne5

        In chess you may hit a man when he's down -- Irving Chernev, on Przepiorka v. Prokes, Budapest, 1929

        by Spud1 on Fri Oct 20, 2006 at 11:29:23 AM PDT

        [ Parent ]

        •  Charges (1+ / 0-)
          Recommended by:
          Spud1

          Spud1, most medical services are covered by provincial health care. The rates that doctors are paid for those are negotiated by the province and the physicians' professional organization. The rates that they work out are then set for the year. Doctors cannot charge patients more. This is referred to as "extra billing" and it is forbidden and, indeed, downright wicked.

          Some medical services are not covered. As far as I know, physicians can charge whatever they want for those, and patients pay out-of-pocket.

          Patients who want plastic surgery for vanity reasons have to pay the costs. However, if someone needs plastic surgery because of injuries, then it is medically needed and that's covered.

          Sometimes the provincial government has the bright idea of reducing health costs by de-listing some medical service. This generally generates quite a furor if the service in question is regarded as necessary.

          One benefit of the single-payer system--that single payer being the provincial health care system--is that you know exactly whom to punish at the polls if you're unhappy with the decisions made about health insurance coverage.

          •  I was thinking of how a free market person (1+ / 0-)
            Recommended by:
            True North

            would argue against this, as it 'limits' a doctor's earning potential. Dr. Andrews, the sports doc in Alabama, would be an example: if he was paid the same standard rate for a shoulder scope, could a star athlete pay more for his services.

            I hope I'm making myself clear. Cheers.

            17. Ne5

            In chess you may hit a man when he's down -- Irving Chernev, on Przepiorka v. Prokes, Budapest, 1929

            by Spud1 on Fri Oct 20, 2006 at 12:26:11 PM PDT

            [ Parent ]

            •  free marketeers (0+ / 0-)

              As I understand the way it works in my province, physicians have a couple of options:

              1. The doctor can work within the health care system. That means that the doctor bills provincial health care for the fees for medical services that are covered. The doctor can't extra bill, so patients will not pay more to the doctor. Patients do have to pay the doctor for medical services not covered by provincial health care. Thus, I imagine that some doctors, like plastic surgeons, have many patients in each camp; others, like family doctors, are mostly billing the health care system.
              1. A doctor can opt out of the system. The doctor collects fees from patients and does not bill provincial health care for any services provided to anyone.

              I don't know how many doctors in Alberta have opted out. Not many, I suspect.

              There are no doubt some doctors who would like to practice public medicine part-time, and private medicine the rest of the time, but that isn't an option.

              Most of the Canadians I've talked with about health care have been equally keen to avoid going the American route and the British route. The Brits I know--now Canadians--are especially hostile to duplicating the British public/private system here in Canada.

              Most people I know oppose a two-tier system--one tier for publicly supported health care, and one tier for privately paid health care. The fear is that the public system will rapidly deteriorate if that happens. With one tier, we're all in it together, and we can influence decision-makers in a way that Americans, with a very diverse system of health insurance, cannot.

    •  No. Socialied Medicine, like UK is that. Single (0+ / 0-)

      Payer is one source pays all bills, in this case the government; Like Canada and Germany (I think France, too).

      It can drive down some wages, but not that much because the paper work is so reduced and all are covered.  Also, it can put pressure on the entire system, so all overall costs go down.  The insurance companies pick and choose and divide and conquer for their own bottom line.  Insurance Companies need to be pushed out of this and only insure for quicker treatments and elective surgery, like they do in Britain and other single payer-systems.

      Also, the government can help with schooling costs more easily, offsetting the largest burden of people who want to be doctors and not just get rich with a more nationalized healthcare system.

      If a doctor wants to be rich, either go into elective surgery, ala Nip/Tuck, or find another field.  Too many rich people giving too little back!!!

      I want my doctor to make a good living, of course, but I am not interested in him becoming "rich".  That is his prerogative.  I want him to practice medicine because it is his passion and his calling.  
       Not  becasue it is his get rich scheme.

  •  Im in Collections (24+ / 0-)

    Most of which are Medical bills.Every time they call I tell them Im saving for a downpayment on the Lawyer to file Bankruptcy,and they will be included.They got nothin to say to that.

  •  Devil's Advocate (6+ / 0-)

    I'm not looking to get into a war of words.  However, have you ever looked at the doctor's charges for a procedure in relation to the procedure's actual costs?

    Having recently undergone some medical treatment myself, I see that I get charged obscene amounts for utterly simple procedures.  Putting a splint on my broken finger?  Almost $100 for a 30-second procedure with about 50 cents of materials.  X-Ray?  Another $100 or so.  The total appointment - about 15 mintues.  Total charges?  Several hundered bucks.

    Doctors "rack rates" are absurd and there's good reasons that insurance companies pay a fraction of what the charges are.  The doctor you work for sounds like an honorable man.  I don't quibble with his right to earn a living.  That said, I don't care if he's the best oncologist in the US, charging thousands of dollars for a procedure that has minimal actual costs other than doctor's time is crazy.  

    You will never catch me arguing that our healthcare system isn't flawed.  However, I resent reading that it's all the fault of the big bad health insurance companies and that the providers bear no responsibility.  Health care costs are like college tuition - they increase EVERY year at a rate that has no relationship to inflation or actual cost increases.  

    Perhaps if the ABA would support reasonable tort reform, the liability costs for doctors would decrease or level-off and healthcare could become more affordable.

    Just my two cents and NO, I do NOT work for a health care insurer or any organization related to the healthcare industry.  I agree with your ultimate premise in that a national healthcare system that provides care to everybody is desireable.  However, until then, to condemn healthcare insurance companies for trying to operate as a business is unfair.  I notice in other comments in this thread - people talking about how they are trained to do things so as to maximize reimbursement - isn't gaming the system like that tantamount to fraud?

    •  you have to understand (13+ / 0-)

      that the amount billed has no relationship to the costs  incurred to provide the care, and that the amount billed is never the amount that the provider/doctor receives

      and the malpractice/tort reform meme is false and is designed to distract you from the real problem.  Malpractice costs are NOT what is driving the cost increases in healthcare.

      some doctors do make more than a comfortable living, but the CEO of UHC made 124 million last year

      Get the insurer's greedy paws out of the mix FIRST, then worry about if doctors are overpaid

      and no, I'm not a doctor or in the healthcare industry, but I studied reimbursement and it would blow you away the way that services are billed and reimbursed

      Political language is designed to make lies sound truthful and murder respectable, and to give an appearance of solidity to pure wind.- George Orwell

      by whitewidow on Fri Oct 20, 2006 at 05:53:26 AM PDT

      [ Parent ]

      •  A few more thoughts (5+ / 0-)

        On Malpractice:  Ask an OB/GYN in NJ whether malpractice costs have an impact on their costs.  There's a reason so many have dropped the OB portion of their practice - and it's not low reimbursements.

        I agree with your first paragraph - that was my point.  In nyceve's post, she talks about the doctor getting pennies on the dollar.  The doctors who bill these rack rate amounts KNOW that they will get pennies on the dollar.  It's like hotel rooms- you almost never pay the actual rack rate posted on the inside of the door to your room.  

        Agree that the CEO of UHC was ridiculously compensated.  You won't find me arguing with that one.  Yet, I also have never seen a starving doctor either.  

        As for the points below, of course I know that when I am charged an obscene amount for my procedure, I'm funding somebody else's procedure as well.  However, I don't think that is how it should be.  The whole concept of insurance is the law of large numbers.  I would argue that it is my PREMIUMS, over time, that should be funding others' care, not my medical charges.  

        •  the insurance bills have increased (7+ / 0-)

          the costs incurred by the insurance companies have not.  

        •  insurance costs are increasing (1+ / 0-)
          Recommended by:
          TiaRachel

          Because the stock market is so anemic, not because malpractice awards are rising.

          To the extent malpractice awards may rise, the vast majority of malpractice payments are going not to some "revenge money" but to cover actual medical costs that have been/will be incurred by the patient. And perhaps you've heard that the cost of medical treatment goes up every year...

        •  Insurance costs are increasing (1+ / 0-)
          Recommended by:
          MarketTrustee

          in part because the cost of medical care is increasing. And that is largely because technology (drugs, equipment, procedures) continually expands what can be done medically for a given patient. I suspect this has a lot to do with why health care cost increases regularly outstrip inflation.

          In this age of innovation, there is no natural upper limit to what could be spent on health care. But it is obvious that from a social/economic point of view, there has to be some kind of limit. At some point, the cost of keeping grandma alive for 2 more months becomes the reason Sis and Junior can't afford college.

          Startling fact: the (pathetically small) total number of jobs created during during the last six years is approximately equal to the number of new jobs created in the health care sector.

          A single-payer universal access national health care system is the best approach for rational management of health care resources and equitable distribution of care.

    •  on the one hand (9+ / 0-)

      our medical office was told to wait for the pathology reports before billing, because insurance companies would pay three times as much if it said "malignant" than "benign" even though the procedure had already been done either way, and was not more risky or time-consuming because of the diagnosis.
         on the other hand...
      I was working for nyceve's kind of doctor during the mid-to-late 1980's, when HMOs were invented. Before that, it was literally illegal to have that kind of a middleman in medicine. Our doctors resisted being herded into programs to the bitter end, running into things like being told to send a patient without a car to the nearest in-program specialist 45 minutes drive away, instead of to our usual consultant across the parking lot.
         They eventually had to crumble and join the program. Then there was the time we were suddenly inundated with medicaid patients from the state next door. We found out from the patients that everyone else around stopped "accepting medicaid" because of the pennnies on the dollar thing. We saw all these patients until we were overwhelmed too, leaving them nowhere but the emergency rooms to go, even if theirs was not a huge problem.

      all of us are pupils in the eyes of God

      by SassyFrass on Fri Oct 20, 2006 at 06:03:56 AM PDT

      [ Parent ]

    •  yada yada (17+ / 0-)

      Same old tired bullshit about free enterprise, tort reform, every man for himself, and how wonderful it is to make a profit when others are bleeding.  I'll keep it simple:  when health insurers are posting record profits while doctors can't get paid for their work and patient costs are up 44 percent, something is rotten.

      Your bill for your broken finger includes the 30% inefficiency of your doctor's office having to deal with your insurance company, the cost of maintaining office space, tech equipment (not cheap), staff, and other overheads.  You might have only seen the doc for a minute, but that doesn't mean he set 60 broken fingers in an hour and made $6,000 in that hour.  It would be impossible, and believe me, you wouldn't want someone like that to care for you even if it were.

      And med mal?  Funny how in states that have tort reform, doctors' liability insurance premiums haven't gone down any more than in other states.  You'd think that if the law gives insurance companies a break, they'd respond by making costs more reasonable.  Hmmm.

      No sympathy for the insurance carriers, sorry.  There's nothing wrong with being in business to make money, but that doesn't mean we don't have the right to rein them in when they make too much money on the backs of the rest of us.

    •  $600 for a walking cast (4+ / 0-)

      Velcro, plastic and polyester with foam.  And for that my ortho charged the blues $600.  The insurance coughed up $485 for the cast.  I was expected to pay $120 for something that probably cost $50 or $60.

      I hate to say it but some of the charges seem a bit extreme.  Still - the insurance companies have an obligation to pay even at the reduced rates.  The fact that they're denying service and tests is criminal.

      They are practicing medicine without a license by over-riding a doctor's medical recommendation for tests etc.  They should be brought up on charges for that.

      And if someone dies - arrest whoever denied coverage for murder.

      Fear leads to anger. Anger leads to hate. Hate leads to suffering. -8.75 / -6.10

      by Alegre on Fri Oct 20, 2006 at 06:18:52 AM PDT

      [ Parent ]

      •  You didn't pay for the cast (2+ / 0-)
        Recommended by:
        TiaRachel, gkn

        you paid for some other procedure that somebody else got, for some piece of equipment that they need but costs too much to bill actual cost, for the janitor's vacation, and the landscaping out front.

      •  Wheelchair purchase = for me to leave hospital. (2+ / 0-)
        Recommended by:
        Buckeye BattleCry, Sychotic1

        After a hip replacement and infection, the only way they would let me go home where I'd be alone was to have my insurance co (at the time I had that!) buy me a wheelchair. (Because I had to rely on them for transportation I had to comply.)

        What type of wheelchair? Which I did not really need and would not be able to use of course. The top of the line, $1500. So after I got home I called them and said I was returning it, didn't need it, and they picked it up.

        We will never eliminate poverty in America unless we do it comprehensively and nationally....no more incrementalism. - John Edwards

        by Gorette on Fri Oct 20, 2006 at 07:22:10 AM PDT

        [ Parent ]

    •  Americans don't take primary care residencies (4+ / 0-)
      Recommended by:
      SarahLee, TiaRachel, cosette, gkn

      Because reimbursement for taking care of sick people is so low.  There's big money in ortho because medical procedures pay well but taking care of sick people is a loser.

      The system is completely fucked up and getting worse by the day.  Insurance company executives and are skimming money from our payments to pay for their lavish lifestyles. Unlike the greedy ortho docs you refer to, greedy insurance co. execs. provide no service to anyone. They are parasites.

      Meanwhile, honest doctors who want to care for sick people are getting squeezed from every direction. So don't be surprised when you next go to the hospital that your hospitalist doesn't speak American English.

      •  In defense of orthopedists (2+ / 0-)
        Recommended by:
        TiaRachel, MarketTrustee

        and I am not one, I am a primary care doc, let me say this for orthopedists: the progress in orthopedic care in the last 2 decades is nothing less than amazing. People who would have been permanently disabled in the past are being returned to high functioning status because of the high-tech care that many orthopedists provide. It really is nothing short of amazing.

        And they do spread the costs around: take a hand surgeon, since the original comment was about a finger splint: the orthopedist does not get anywhere near as well compensated per time spent on a surgery and follow-up care for, say, reattaching an amputated digit. So, yes, they charge more for a finger splint. So does the primary care doc, BTW.

        On your other point, name me one other sector of the economy that is required to depend upon middlemen, who take, as you point out, a substantial cut.

        The actual percentage of medical costs attributed to physician's salaries is in the range of 6-7%. We are definitely not the problem here, orthopedists included.

    •  Studies have shown... (10+ / 0-)

      that tort reform DOES NOT lower healthcare costs.

      In the states where it's been passed, their malpractice insurance rates have not gone down proportionally to the loss of rights for people who are injured.

      Tort Reform is the boogie man the insurance companies have blamed for their practices.

      HotFlashReport - Opinionated liberal views of the wrongs of the right

      by annrose on Fri Oct 20, 2006 at 06:34:52 AM PDT

      [ Parent ]

    •  First fallacy... (9+ / 0-)

      The first fallacy of medical care reimbursement is that we should pay for the "doctor's time."

      Sorry, no.  You're not paying for the doctor's time; you're paying for the doctor's BRAIN.

      The power of accurate observation is commonly called cynicism by those who have not got it -- GB Shaw

      by kmiddle on Fri Oct 20, 2006 at 06:42:36 AM PDT

      [ Parent ]

    •  Tort reform is a red herring (5+ / 0-)

      Perhaps if the ABA would support reasonable tort reform, the liability costs for doctors would decrease or level-off and healthcare could become more affordable.

      If the AMA and doctors were serious about controlling malpractice costs, they would self-police themselves and get rid of the doctors that are a weight on the system. Nah not going to happen.

    •  cost explanation (9+ / 0-)

      My wife is in the health care field and has her own practice, so I've gotten a first-hand look at the cost issue. The cost of the procedure itself may not be $XX, but you are also paying for overhead items, including doctor time, staff time, admin time, building and equipment leases (much of the medical equipment is not cheap and costs tens of thousands of dollars), professional and office  supplies, computers, utilities, malpractice insurance, disability insurance, property insurance, taxes, etc.  Most doctors come out of school with huge debt, and so a lot of your payments, especially to younger doctors, are going right to the federal government or other lenders.  They've also gone 8-10 years without holding a paying (or at least reasonably well-paying) job while in school, residency, fellow-ship, and so have incurred other debt as well.  Our overhead costs are insane.  For insurance-based patients, my wife often takes 40-50% cuts on her fees (ah, right back to the insurance industry).  Of course, there are doctor's charging exhorbitant fees that go well beyond a reasonable price and that need to be cut back.  

      This isn't a "woe is me" talk.  I'm hoping we'll be pretty comfortable as the practice grows, but at the same time, we're essentially "owned" right now by insurance companies, lenders, landlords, the government, etc.  

      The reality of costs can be deceiving.

      •  Final comments. . . (0+ / 0-)
        1.  Good luck to you and your wife - I wish her the best as she builds her practice.  The insurance company gets a discounted rate over the "rack rate" in exchange for funneling patients to her.  Your wife does not have to spend nearly as much in marketing her practice because the insurance companies provide a flow of patients.  
        1.  If the insurance carriers were going to pay whatever rate the doctors decided to charge, then 1) The doctors would have no incentive to control costs themselves and 2) Fraud would be worse than it already is, and 3) premiums would be increased dramatically.  We always hear about the often valid sob stories making villains out of the insurance carrier - I'm not accusing these people of lying - but who hasn't had a bad service experience in other aspects of their life as well?  Everybody makes mistakes.  That said, WHat about the healthy person who has to pay higher premiums already to fund those who are not healthy?  If there are no limits, then the rates for the healthy would soar.  THis would lead to them deciding to go uninsured (as many youngsters already choose to do).  This leads to adverse selection for the insurance company, and would send rates through the roof.
        1.  To JoeBob below:  Tort reform does not mean letting bad doctors off the hook (in my way of implementing it) - however, it prevents undue enrichment.  Tragedies and accidents happen - the victim or family of the victim is entitled to some compensation when it occurs.  However, massive punitive damage awards that enrich the survivor do not lead to fewer mistakes - all they do is make the attorney and the survivor unduly wealthy.  
        •  Bardy (2+ / 0-)
          Recommended by:
          TiaRachel, MarketTrustee

          On your "massive punitive damages awards", I invite you to name three cases where you would willingly trade places with the plaintiff because they got such good deal in exchange for whatever happened to them. You must make sure you have numbers from the final case resolution.

          I think your initial analogy is flawed:

          The insurance company gets a discounted rate over the "rack rate" in exchange for funneling patients to her.  Your wife does not have to spend nearly as much in marketing her practice because the insurance companies provide a flow of patients.

          That is one way to look at it, but this is not a free market situation. Most patients have little if any control over their insurance carrier or coverage. The insurance companies don't funnel patients to doctors - the insurance companies lock up patients and then perhaps if the doctor agrees to their terms, the company will pay the doctor to see them. An insurance company that has a majority of patients in an area almost flirts with anti-trust issues - there simply wouldn't be enough patients remaining for a doctor not accepting that insurance.

    •  malpractice (2+ / 0-)
      Recommended by:
      SarahLee, elfling

      Personally, I think 'tort reform' is just a scheme for some people to escape accountability for their mistakes. Do you really want to throw away your Constitutional right to pursue a grievance in court to theoretically save a few bucks? The solution to malpractice insurance isn't to tie the hands of aggrieved patients and their lawyers; the solution is less malpractice.

      Lastly, the stock market is vastly more relevant to the price of insurance than actual claims are. If the market goes down your premiums go up, and it doesn't matter how careful you are.

    •  Liability reform is NOT the answer (5+ / 0-)
      Recommended by:
      elfling, nyceve, TiaRachel, DrFood, gkn

      You've fallen for their red herring touting "junk lawsuits" as a major cause of rising health care prices. Do a little research and you will find that:

      1. Some states have already capped malpractice compensation, some as early as 1975. Guess what? In those states, not only have providers' insurance premiums not fallen, they have actually GONE UP MORE than in other states. Just one example, from David Sirota's book "Hostile Takeover":

      In Texas [tort reform was passed here when Bush was governor], the nation's largest malpractice insurance insurance company, GE Medical Protective, actually raised physicians' premiums by 19% just six months after Texas enacted a cap on malpractice awards.

      1. Malpractice claims have been declining, not rising, over the past 12 years or so. Frivolous lawsuits are rare, as even the tort reform lobbying groups have admitted. Just to restate: insurance companies are paying out less than they used to in malpractice claims, yet they still keep raising premiums.
      1. In 2003, insurance company profits rose 900%. Yes, you read that right. In 2004, they rose a further 29%.

      Finally, more Sirota, quoted in full:

      At one point in 2005, the insurance industry was actually asked about its profiteering, and its unwillingness to lower rates even in states that had limited victims' rights. Their response was - surprisingly - quite candid. "We have not promised price reductions with tort reform," said the industry's spokesman. Exactly - because those reductions never come. All that comes are bigger insurance industry profits., more campaign contributions, and more proposals to further limit citizens' legal rights.

      In 2002 and 2004, the nonpartisan Congressional Budget Office (CBO) tried to explain this reality to federal lawmakers who were considering a bill to limit victims' legal rights. There is "no statistically significant connection between malpractice tort limits and overall health care spending," CBO said in 2002 when Congress debated insurance industry-written legislation. When it came up again in 2004, CBO reported that "even a reduction of 25% to 30% in malpractice costs would lower health care costs by only about 0.4%" - that is, almost nothing. Because, again, when you limit victims' rights, all you do is let the industry pocket more profits - not bring down the cost of health care.

    •  Well (1+ / 0-)
      Recommended by:
      elfling

      when the insurance company states that it will only pay xxx on the dollar, the doctors offices charge more for the procedure...it winds up being kind of like an arms race.

      Politics is like driving. To go backward, put it in R. To go forward, put it in D.

      by gkn on Fri Oct 20, 2006 at 09:40:42 AM PDT

      [ Parent ]

    •  There's a Monetary Factor You're Missing (0+ / 0-)

      There is no flat-rate cost for a medical procedure. What may cost $50 in Omaha, may cost $200 in New York City. And that's not simply because of so-called greedy doctors, but because of overhead, cost of insurance in one area vs another, and cost of living factors, among others.

      A lot of insurance companies tend to flat-rate the cost of a procedure -- they take an average based on nationwide costs, rather than an average based on regional costs. So, as a patient you're stuck with higher fees if you live in major metropolitan areas, likewise, if you're a doctor in those areas, the insurance payment received is reduced as well.

      Insurance companies are out of control, especially when they hold your life and death in their hands. There needs to be a nationwide class action suit brought against them for practicing medicine without a license. Of course with their stranglehold on Congree right now, it would probably net us a grand total of $10 each from a settlement.

  •  Excellent, heart-rending post (4+ / 0-)

    This is great information and fine writing. Thank you.

  •  insurers & big pharma... (10+ / 0-)

    prior generations of a universal insurance activists and doctors used to attack each other as the enemy. Slowly but surely organized medicine has begun to realize they should be on the same side as the people, their patients. Many do not realize that the AMA has a membership of around 40% of U.S. physicians, and that many of the professional societies have long supported some form of universal care. Just as a matter of simplifying the paperwork that physicians have to do it makes sense.

    Remember the anti-Hillary care campaign by the insurers that if you voted for it you would get a system of care without choice, yada yada yada... it sort of like the old LBJ vs. Goldwater ad... "I was told a vote for Goldwater would be a vote for mindless war vietnam... I voted for Goldwater and that is what I got"

    Check out info at www.pnhp.org

    Help make NYC Republican free; support Steve Harrison NY-13 against Vito Fossella.

    by DrSteveB on Fri Oct 20, 2006 at 05:22:08 AM PDT

  •  I work for the Canadian Health System (16+ / 0-)

    At a governmental level.

    nyceve all I can say is if anyone try's and takes this system away from me and replace it with a similar system to the US, they will have the fight of there lives on there hands.   It works, it isn't perfect but it has better results and brings equality to the system.

    •  Would you please write a few (2+ / 0-)
      Recommended by:
      nyceve, jkilkullen

      diaries explaining how things work? We would like to know more.

      •  Sure but in the meantime (6+ / 0-)

        Go to the governments Site.

        http://www.hc-sc.gc.ca/...

        Basically the Health care systems is admistrated by the provinces which are the single payers for Health Care.  They provide coverage for various services that are necessary,  If you Break a leg, it's paid for if you get a cavitity you'll probably have to pay.   Basically, everything that needs to be paid is paid.

        If you need drugs which cost 50 000 a year you'll get covered most of the time but have to pay a portion.

        There is a limited budget somewhat and sometimes innovative and expensive therapy's take time to be added by the provinces.....

        Thats probably one of the 2 biggest compaints about the system......1) Slow adaptation of innovative therapy's due to the heavy requirements of evidence to support them.   2) Wait times for specialized services.....minor surgury, sometimes slow entry into cancer treatment after diagnosis due to wait times.......This is rare but does occur.

  •  This is why I didn't go into med school (8+ / 0-)

    I hear so many horror stories about negotiations with insurance companie and HMOs.  I just couldn't imagine enjoying my career.

    Essential funk: 'Indictment' by Antibalas

    by pontechango on Fri Oct 20, 2006 at 05:32:28 AM PDT

    •  Me too. (4+ / 0-)
      Recommended by:
      SarahLee, nyceve, pontechango, flumptytail

      I chose Chinese medicine instead. I'm much more independent, which has it's pitfalls, but nothing like the devil's deals you have as a person connected to insurance billing. :)

      Share. Share resources, share delight, share burdens, share the healing. If we only could realize that sharing will bring us back from mass suicide.

      by MarkosNYC on Fri Oct 20, 2006 at 06:09:40 AM PDT

      [ Parent ]

    •  I have many physician acquaintances.. (4+ / 0-)
      Recommended by:
      elfling, pontechango, buckeye blue, ilex

      and virtually every one of them has said that they actively discourage their children from going into medicine.

      I was in exactly the same boat; I could have gone to medical school as a mid-career change and considered it very strongly. I've got the brains for it, and was really drawn to the profession for a variety of reasons.

      But then I ran the numbers.  The economics of it were just frighteningly bad. Especially since I wanted to be a pediatrician (the least paid of all of the specialities). At the time, I was earning more money than the average pediatrician.

      So my decision was to go back for 6+ years of schooling, go deeply into debt and come out on the other side with a profession where I would have been compensated LESS than what I could make in another field.

      Sorry folks. I don't think anyone's that altruistic. I know I'm not.

      The power of accurate observation is commonly called cynicism by those who have not got it -- GB Shaw

      by kmiddle on Fri Oct 20, 2006 at 06:50:08 AM PDT

      [ Parent ]

      •  Yup. (0+ / 0-)

        virtually every one of them has said that they actively discourage their children from going into medicine.

        My mother tried to discourage me.  She really didn't think I could possibly be happy in medicine.  

        Politics is like driving. To go backward, put it in R. To go forward, put it in D.

        by gkn on Fri Oct 20, 2006 at 09:53:43 AM PDT

        [ Parent ]

    •  Oh, but there's so much that's great (2+ / 0-)
      Recommended by:
      True North, MarketTrustee

      ..and gratifying, and rewarding in medicine.  Just not hugely financially rewarding.

      I'm lucky that I was part of a program that covered most of my tuition.  It took me seven years, and I worked various jobs during that time (like teaching chemistry to undergrads).  I also ate a lot of beans and rice, but I got out without huge massive debt.  It is doable, and I still recommend it.

      Universal Health Care - it's coming, but not soon enough!

      by DrFood on Fri Oct 20, 2006 at 10:46:30 AM PDT

      [ Parent ]

    •  pontechango, isn't that sad . . . (1+ / 0-)
      Recommended by:
      pontechango

      you might have been an ncredible doctor. The system is cannabalizing itself.

  •  the craziest thing (12+ / 0-)

    In the medical industry, the charges you see on your bill have absolutely  no relationship whatsoever to the actual costs that were incurred to provide the services.

    Can you imagine any other business billing and receiving reimbursement this way?

    The amount billed is also rarely the amount the provider actually receives.

    The system is so f'd up, it is beyond absurd. I was going to school to get into medical billing/coding, but I got so depressed that I dropped out.

    Coders and billers spend an unbelievable amount of time fighting payers to help patients get reimbursed.

    How can we continue to have this amoral for-profit system?  

    And I see United Healthcare's profit up 38% while Mcguire the recently fired CEO (ding dong the witch is dead!) made 1.6 BILLION on his backdated stock options.

    UHC's stock has increased 50 fold in the last 15 years.  Who benefits?

    But talk to any wingnut about single payer healthcare, and all you get back is "rationing" and "we don't want to be like Canada".  

    It's enough to make one's head explode!

    Political language is designed to make lies sound truthful and murder respectable, and to give an appearance of solidity to pure wind.- George Orwell

    by whitewidow on Fri Oct 20, 2006 at 05:41:02 AM PDT

  •  until we get the Big Money (5+ / 0-)

    out of politics, until our elected representatives don't need Big Money from special interest donors to be reelected or challengers don't need Big Money special interest donors to run a "credible" campaign, common sense fixes to our broken health care system will not happen.

    that's the bottom line. Vote yes on CA's Clean Money initiative, Prop. 89, and the next time the nurses union tries to get a health care ballot intiative passed in CA, outofstate Big Pharma won't be able to dump hundreds of millions into the election to stop it.

  •  A friend of mine (8+ / 0-)

    told me that the NASW ran a study on Social Worker's in private practice that only took insurance as payment.  Included in figuring income was the amount of time filling out forms, talking on the phone, performing reviews and meeting with the patient.  The NASW estimated that, when all was said and done, the Social Workers in private practice only earned $1.00 an hour.  Shocking?  This was back around 2000 I believe.

  •  Day 8 and still trying (10+ / 0-)

    I am stilling trying to sign up for my MediCare partD ins., to no avail. My most exp. persciption needs refilled next Fri., and I will have to go without. I have spent a min. of 4 hrs a day just trying to sign up, and some days as much as 8 hrs. What a scam, promise us coverage, but not allow us to signup for it. They look good in the newspaper, but I better never meet one of them in a dark alley.

    -8.63 -7.28 He was carrying a skateboard on his back, a red rose in his fist, and the war.

    by OneCrankyDom on Fri Oct 20, 2006 at 05:50:09 AM PDT

  •  My pediatrician told me there are no more male (11+ / 0-)

    pediatricians coming out of med school.  Its not lucrative enough.  Men are choosing other specialties.  We are creating a system that all peds are going to be woman.  As usual woman are willing to take less money in the workplace.

    •  And I suppose all the money is in nose jobs (7+ / 0-)

      and fake fucking boobs.  

      In the Pajamahadeen I'm Scooby-Doo!

      by Militarytracy on Fri Oct 20, 2006 at 06:01:34 AM PDT

      [ Parent ]

    •  It's about liability (3+ / 0-)
      Recommended by:
      TiaRachel, Thestral, chemicalresult

      The liability in pediatrics and obstectrics/gynecology are very high, and so people (men I guess) shy away from those specializations. TV advertising has so lulled American women into believing that their babies and pregnancies are so perfect that 'you' won't have any complications during pregnancy and delivery, that when things do go wrong, BLAME THE PRACTITIONER and make some money from suffering.

      Child birth is dangerous, has complications, there's nothing new about this. That's life, and modern medicine has responded greatly to alleviate and change that natural situation. But that's still not good enough for women who've been advertised to to death! No, they can't possibly be the one, the one woman who has a problem at birth or during pregnancy!!

      There should be no blame here. Human pregnancy and birth is fraught with errors. Must we sue everyone in sight for something that's tied to evolutionary issues out of our control?

      Share. Share resources, share delight, share burdens, share the healing. If we only could realize that sharing will bring us back from mass suicide.

      by MarkosNYC on Fri Oct 20, 2006 at 06:17:59 AM PDT

      [ Parent ]

      •  You are confusing peds with ob/gyn (2+ / 0-)
        Recommended by:
        SarahLee, TiaRachel

        Big difference.  I went to an ob/gyn to have my baby and and I see her annually.  She takes care of women and women's health issues into and beyond menopause.

        I take my children to see my pediatrician once a year and when ever they get hurt or sick.  At 18 we find a different doctor for them.  If my children encounter anything complicated like stiches or a broken bones we are refferred to a specialist.

        Pediatricians are important componants to family life but it is because they care for the most important thing in my life-- my children.

        Its unfortunate that my grandchildren will not know any men doctors until they grow up or get very very sick.

      •  Now, look across from the other side (1+ / 0-)
        Recommended by:
        tmo

        TV advertising has so lulled American women into believing that their babies and pregnancies are so perfect that 'you' won't have any complications during pregnancy and delivery, that when things do go wrong, BLAME THE PRACTITIONER and make some money from suffering.

        On the other hand, let's say you're a young family and your child was born with dramatic health problems.

        Suddenly, you have a pair of twentysomethings, perhaps with some savings, facing:

        • 6 figure medical bills
        • regular medical appointments that will pretty much require that one parent quit a job in order to shuttle to the doctors
        • all kinds of auxillary expenses that are never covered by health insurance - travelling to specialists, parking, special food, special therapists, special child care needs, and the like.

        I know a young family who had a son who needed a liver transplant. They had insurance, but even so, the guidance counselor advised them that they would likely need to raise $250,000 to cover their out-of-pocket expenses for their son.

        If a doctor made a mistake that had some role in causing a family to have enormous medical costs, a malpractice claim is a totally responsible choice in the current YOYO (You're On Your Own) environment.

        There should be no blame here. Human pregnancy and birth is fraught with errors. Must we sue everyone in sight for something that's tied to evolutionary issues out of our control?

        I agree with your beginning, but my question is different. Must we force families who lost the genetic or luck lottery to give up everything because of an accident that is out of everyone's control?

        I had an epiphany on this when I was made very ill by a prescription that I didn't need. The doctor is a good doctor, and he prescribed it in good faith. It is a gray area as to whether it was an error or not to give it to me, and then whether or not his nurses compounded it by encouraging me to keep taking the drug and wait until the next appointment. But the net effect was I spent 4 days in a hosptial and was disabled for a year because I followed his instructions.

        Fortunately for everyone, I had an understanding employer who kept me on, paid for my insurance and salary and accommodated me, a very good insurance plan that paid for the medical costs, and I had savings and a strong network of family support.

        If I had not had those things, I would have had a choice: bankruptcy or a malpractice action. I would've needed a lawyer either way. A malpractice suit would take money from the doctor's insurance company; bankruptcy would've deprived the hospital and the doctors who made me well of the fees they earned cleaning up his mistake. Which is more ethical? I honestly don't know.

        •  Your post is the best argument I've seen (1+ / 0-)
          Recommended by:
          MarketTrustee

          for single payor healthcare, on both points.

          4% of pregnancies will have serious genetic or other developmental defects. MarkosNYC's point is very good: this is just the bad luck of the draw.

          But your post points out the problems inherent in the system, where health coverage is dependent upon employment and the support systems in many many places are poorly equipped to deal with these situations. Furthermore, in addition to this, most of these kinds of children eventually wind up on Medicare and/or Medicaid which, of course, has its own problems.

          As for your specific issue, you were indeed very very lucky to have an understanding employer. As for the medication, when I prescribe something I always tell my patients if they have a significant problem with the medication they should stop taking it and call me, although that's neither here nor there. But had you not had a sympathetic employer, you certainly would have been out of a job, out of coverage, and pursuing some sort of recourse would have been a reasonable course. But, if your healthcare were not dependent upon this, as you point out, you would have been less likely to pursue it.

          I had a surgeon friend once say that he would be happy to have universal (i.e., single-payor) healthcare if it would reduce his liabilty. BTW, he's also now an employed doc (and still a great surgeon.)

          •  I did call, btw (0+ / 0-)

            But, thinking back, I think I sounded too perky on the phone, and the nurse... in his office, the doc never spoke on the phone, only the nurses ... told me I was probably fine and to keep taking it. They didn't ask the right questions. And then when I got really desperate, and called on a weekend, I got his partner who basically yelled at me for bothering her with something so irrelevant. When I did finally get to see him, and I told him what was going on, he blanched and clearly knew instantly we were in trouble - he made me an appointment with a specialist himself on the spot.

            I was also a victim of office hour syndrome. Every morning I felt better. By 5 pm, I thought I was going to die. But, nothing to do until morning... when I felt better, and it seemed silly to call and move up an appointment by a few days.

            So here I will also put in a plug for email. If I could've emailed my doctor at midnight when I was miserable, I don't think we would've let it get so far out of control. He knew me, not his partner and not his service, and he would've been in a better position to recognize that I had a problem before it turned so ugly.

            •  HIPAA prevents many docs (0+ / 0-)

              from using email, because security cannot be guaranteed.

              I personally have given my email to some of my patients but have made it quite clear to them that it is not secure. Also, if I use my email at work, I can't answer it unless I'm at work - and because I work part time, that can be a problem. And home email has its own difficulties.

              There does need to be a better way of communicating, agreed.

    •  Oh good grief (2+ / 0-)
      Recommended by:
      SarahLee, MarkosNYC

      My sister in law is a pediatrician.  I don't know exactly what they earn, but I'm going to guess it's six figures.  It's enough to afford a nice house, travel a lot, and my brother stays at home with their kids.

      As much as there is wrong with the health care system, it's not that doctors are making too little money.

      •  Salaries vary a lot (6+ / 0-)

        ..depending on location and patient/insurance mix.  Also how many minutes you spend with each patient/how many you see a day.

        Yesterday I spent almost an hour with a troubled sixteen year old girl, eventually finding out that she was sexually abused by multiple people between the ages of 8 and 14.  She of course had never heard of PTSD, but that is what she is suffering from.  Fifteen minutes of that hour was me on the phone setting up an ASAP appointment with someone capable of handling this, who takes Medicaid.  

        My income is notably less than $100K.  I might be able to push it that high if I put in 90 hours per week, or if I start churning through patients at a higher rate.  For me, it's not worth it.

        Universal Health Care - it's coming, but not soon enough!

        by DrFood on Fri Oct 20, 2006 at 10:39:06 AM PDT

        [ Parent ]

    •  Similar for family practice (3+ / 0-)
      Recommended by:
      nyceve, DrFood, MarketTrustee

      and to a lesser degree for internal medicine, probably because training in IM leads to possibilities for subspecialty training.

      As another example: look at OB/GYN, which is beginning to be dominated by women. Approximately 15 years ago, it was one of the highest paid specialties (as long as it included OB.) It also, about that time, began to attract more women, and I believe it was about 5 to 7 years ago that training programs became female predominant (although the practice is not yet.) At the same time, reimbursement to OBs started to drop, in some cases considerably, and I know I don't need to tell you about the increase in liability premiums since it's been a huge issue here in Baltimore. Try finding an OB, in fact. Our hospital stopped delivering babies about 4 years ago.

  •  Thanks for all your posts on health care (12+ / 0-)

    I have a friend who's a doctor in general practice.  He absolutely loves working with patients & they treat him like a family member.  He's the kind of doctor who gets invited to patients'milestone events, like birthday parties, graduations, weddings.

    He loves his job, but admits that if he had known what hell he was going to have to go through with insurance companies, he would have picked another line of work.

  •  I wish that I had something to say (6+ / 0-)

    that reassured you or even me for that matter, but I have nothing to add.  I fight an HMO that fears refusing too much because the bottom line is if a soldiers family ends up on CNN and someone is "dying" from lack of care the American people will go nuts right now.  For everyone else fighting like hell out there and not in a position where if a spotlight was shone on you that the multitudes would rise up and smite the evil doers I can't even imagine how hard you have to fight to survive.

    In the Pajamahadeen I'm Scooby-Doo!

    by Militarytracy on Fri Oct 20, 2006 at 05:59:40 AM PDT

  •  Why the Canadian system is better than yours (18+ / 0-)

    The Canadian healthcare system is experiencing many of the same issues that all industrialized healthcare is facing. These are by-and-large reducible to two subsets of issues: rationing, or cost-benefit analysis, and the lack of consensus amongst healthcare stakeholders.

    Here's why our system, needing a considerable overhaul as it does, is still hugely better than yours (and to see that it in action one only has to follow a group of typical patients through the same set of visits and procedures, compare the experience, compare the results, compare the cost and the long-term impact--NBC actually ran a documentary like this about 12 years ago or more, when there was all that talk about Clinton introducing universal healthcare. They actually used too small a sample (1 patient) but followed that one patient in the US, Canada and CUBA! Results: measured for a blended rating on care, cost, delay and so on, Canada was best, followed by Cuba, followed by the US).

    In the first case, our cost structure is greatly more efficient, meaning that a great deal less money has to be spent to achieve the same results. While rationing will forever be an issue (since who can put a value on a loved one's life?), the entire framework within which that rationing must occur is more flexible and efficient.

    In the second case, the difficulties facing long-term solutions in healthcare stem from an inability to reach consensus between the govt., hospital admin., doctors, nurses and patients. These groups all have vastly different perspectives, prejudices and needs. Absent incredibly strong leadership, it is next to impossible to act together to fix things. But at least we have two fewer stakeholder groups in the mix: the insurance cos. and the related business interests. And guess what? They are the single most powerful interest in the American healthcare industry. And, they are the single cause of the great inefficiency in the system.

    I guess that fact explains this: in Canada, healthcare is a universal right; in America, healthcare is an industry.

    Regardless of the problems we have, I'll take our healthcare over yours in a heartbeat.

    -8.38, -4.97 "...there is nothing either good or bad, but thinking makes it so." Hamlet, Act II, Scene ii.

    by thingamabob on Fri Oct 20, 2006 at 05:59:47 AM PDT

    •  thanks, thingamabob (6+ / 0-)

      I want to copy your comment, and paste it after every single one left by every single idiot who shows up on DailyKos to defend "free-market American healthcare" against the horrors of "Canada's socialized medicine."

      •  The only horror in Canada (11+ / 0-)

        Is that if you're super-rich, you still can't jump the queue. In other words, the government insists on treating all Canadians as equally worthy of respect and consideration, no matter what their bank account contains. (Well, at least as far as health care is concerned.)

        Isn't that horrible?

        And by the way, the vast majority of doctors in this country are extremely supportive of the system. That's right--the people who would theoretically have most to gain from a private system want to keep what we've got. Remember that the next time some GOPer or insurance company sells you the pap that it unfairly caps doctors' fees.

        And one more by the way, I have known Canadian doctors who lived and practiced in the US and came back because the cost of running their offices, complete with paperwork, staff to manage the paperwork and the multitude of HMO and insurance company requirements outweighed the extra money they were earning. At least as far as a GP is concerned, the benefits of the system here easily make up for a slightly reduced level of pay. And doctors still earn well into the six figures--their not hurting.

        -8.38, -4.97 "...there is nothing either good or bad, but thinking makes it so." Hamlet, Act II, Scene ii.

        by thingamabob on Fri Oct 20, 2006 at 06:28:57 AM PDT

        [ Parent ]

    •  human right (4+ / 0-)
      Recommended by:
      SarahLee, marrael, nyceve, DSPS owl

      health care should be considered a basic human right

      it should be unquestionable that every citizen in this country (on this planet, really)should have a RIGHT to have access to health care

      Political language is designed to make lies sound truthful and murder respectable, and to give an appearance of solidity to pure wind.- George Orwell

      by whitewidow on Fri Oct 20, 2006 at 06:23:53 AM PDT

      [ Parent ]

  •  I thank God that (9+ / 0-)

    my family's been very fortunate so far with respect to insurance - even though our coverage has eroded each year for the past 10 or so, and our deductibles have risen.

    The phrase "bad faith lawsuit" is one that I repeat in my mind on those days when I have had to spend literally hours on the phone to get a reimbursement processed. I have actually uttered it once or twice to supervisors at the various insurance companies, in order to goad them into action.

    "Tort reform" was mentioned upthread. I tossed out the pithy comment some months ago that "Tort reform" is to corporate theft as "states' rights" was to segregation - i.e., a code phrase that stands for callous, heartless, CORPORATE greed.

    Big Insurance loves the thought of "tort reform." Bad-faith lawsuits are, unfortunately, one of the few arrows remaining in Americans' quivers, until we have real healthcare reform in this country. We must not allow that arrow to be taken away.

    Outstanding diary, eve, as usual. Thanks for this.

    As nightfall does not come all at once, neither does oppression. - Justice William O. Douglas

    by occams hatchet on Fri Oct 20, 2006 at 06:07:50 AM PDT

  •  nyceve: It's nothing personal (0+ / 0-)

    but I am absolutely sick to death of you and your diaries. My heart falls every damn time I see you in the Recommended Diaries list.

    You are telling me horrible things about U.S. healthcare that I don't want to hear. Again.

    Yeah, did I mention I am one of those people without steady employment, who can't afford to purchase insurance as an individual subscriber because of a "pre-existing condition"? My experiences aren't all that dramatic, as bad American healthcare stories go. I just have to smile and keep my chin up, and hope I don't have any freak cases of hepatitis or slip-and-fall and corkscrew fractures, right?

    My lack of catastrophic coverage weighs on me constantly, but I don't want to be thinking about it.

    So, nyceve, wouldja please just go away?

  •  The last time the Dems touched this... (2+ / 0-)
    Recommended by:
    flumptytail, ERyd

    ...the word "Hillary-care" was born.

    And trust me, that's not an indictment of anyone except the fear-mongering assholes who used that as a weapon against Clinton's ambitions to reformulate the health care system.  The system is so beyond-recognition broke, it needs rebuilding, not just fixing.  But the solution has to start with a political entity with the courage and the conviction to see it through.  

    I wish I could be more optimistic that that person exists, and is willing to endure the pillorying that the Clinton administration did.

    www.ctforlieberman.com ...tells you everything you need to know about Joe...

    by rlamoureux on Fri Oct 20, 2006 at 06:09:31 AM PDT

  •  The Pull Quote (7+ / 0-)

    "Then she should file a criminal complaint, insurance companies are practicing medicine without a license."

    Ladies and Gentlemen, we have the Money Quote right here.

  •  Criminal / Murder (8+ / 0-)

    Like I said the other day, these insurance companies are nothing more than cold-blooded murderers if they cut off coverage or deny recommended service or tests.

    They're as good as pulling the plug on those patients.

    There are doctors and nurses on trial for murder in the wake of the evacuations in NO after Katrina hit.  Murder.  They didn't take care of their patients and for that they're on trial for their lives.

    HOW is this different from what the insurnace companies are doing to us?

    It's not.

    The folks who call the shots and deny coverage are pulling the plug and if I were a prosecutor - I'd go after them with everything I've got at my disposal to lock them up for murder.  Find a case where some poor sould died because they couldn't get the tests or treatments they needed - and put the fuckers who denied coverage in the docks for murder.

    Because that's what they're doing to folks - murdering them.

    Fear leads to anger. Anger leads to hate. Hate leads to suffering. -8.75 / -6.10

    by Alegre on Fri Oct 20, 2006 at 06:10:32 AM PDT

  •  Where is the money going? (8+ / 0-)

    I've been asking this question for several years now.  Where is the money going?  The premiums go up.  The doctors get paid less and less.  The jobs get outsourced.  The executives' compensation skyrockets.  Who is getting all this money?  Why are there not studies (highly publicized) analyzing where the all the money goes in the health industry?

    Here's an interesting tidbit from a family member who sits on the board for a local hospital system.  He told me this summer that if you go to the emergency room in this hospital system, in the middle of the night, x-rays and imaging are read by radiologists in Australia because it's cheaper to do it that way than to have radiologists on all shifts.  

    •  It gets invested (4+ / 0-)

      Insurance requires a huge pool of assets in order to be viable, but those "assets" are anything but a gigantic pile of cash sitting in a bank, waiting to be paid out on claims.  Your insurance company's assets are part of an enormous web global investments, plus captive insurance companies and reinsurers who act as sub-insurers.  The idea is, the money they don't pay out on claims can be used to earn interest on investments.

      Ever wonder why all insurance company offices look like castles?

  •  There's a percentage in pain (20+ / 0-)

    The great physician in my life was the neurosurgeon who removed a tunor from my spinal cord when I was 29. When this surgeon heard that this particular case existed, he claimed it for himself, though he heard it over the grapevine and from another hospital. It was a rare tumor, eight centimeters of it squeezed tight inside the column, and difficult, and he just felt that he was the most likely to get a result that might have me at least part way out of a wheelchair for the rest of my life.

    But what was amazing about him was how he made the time to walk with me as I was rolled from my room the ten miles of tunnels and corridors to the operating room. He did that because when we met for the first time on the Friday I was diagnosed before the Monday he had cleared the schedule to operate, he asked me if there was anything I needed or wanted.

    I told him that I'd had lots of operations, but I'd never seen the inside of an operating room because they always made me leave my glasses in the room. Lousy eyesight and high curiosity always made me wonder what the insides of those damn rooms were like.

    He said he would take care of that. It turned out that he had moved prep for the huge surgery - it involved about 40 people - back for ten minutes so that he could make sure I had a good look at everything. When we got there he explained everything in the operating room and introduced me to his team. Then he said, "I have to take them now." The last thing I saw was everyone looking at this surgeon as if each of them secretly suspected that they were the only ones to understand that this was a holy man.

    Almost every week, there came to this great New York hospital, a patient from a poor country, always a patient who would have zero chance at such care. Someone whose life he could rescue. The day after me he was to to operate on a young boy from India with a enormous, pressurizing brain tumor. Every cent of it on the doc himself. Surely he cajoled and begged and borrowed, but he managed to get the kids taken care of.

    Dr. Bennett Stein, the greatest surgeon I ever knew. A true healer, which one doesn't get to see a lot of in the US health care industry. Thanks to Dr. Stein, no wheelchairs have ever been necessary for me, and instead of paralysis I was reporting from a war in a jungle on the other side of the planet within a month of surgery. (I had editors then aka sorry for the size of this.)

    The problem is how many doctors see it as an industry and take part in it as an industry.

    This week I got a little banged up and needed to go see some doctors.  My insurance was cancelled years and years ago, and so I haven't gone to visit the medical men too much. When I need something big I'll go to Apollo in New Delhi if I can't get a room and doctor at Samitavet in Bangkok.

    Anyway, the doctors I saw this week would not see me without an insurance card. You can't walk in, even if you say you'll just pay cash. They don't want to hear about it. They tell you to go to the emergency room.

    So, just to be able to function, to be able to qualify at all in a system where you HAVE TO HAVE a plan number and a member ID, an insurance card, I bought one of those discount health cards they advertise on the radio (Air America, ironically, considering that this card is the only good thing I've had happen to me regarding American doctoring since the Stein operation, which was in 1989).

    The card is fantastic. Two and a half bucks a day, and it already saves me almost $400 a month in prescriptions alone.

    And it works as an insurance card to get in to see the doctors... but.

    Yeah, but. But there's a rub: because doctors think I have insurance, their bills are tremendous. Over two grand for not that much stuff. The health discount card will save some of it, but not much. It's still the best deal I've ever made, which may not be saying much, but I do not for a second understand how the thing works.

    And so I offer this only to say that there are all sorts of rot in the system. Most of it comes from the fact that the two businesses are so big - insurance and health.

    The other problem is that there aren't that many doctors like Stein or your onco who do not try to rip off the insurance companies. There's so much overbilling: insurance tries to rip patients off and then doctors, which become the same thing, but then the doctors have to overbill to try to get something back, and then some bastards figure what the hell, if the system is that messed up why not just go for broke and try to squeeze it dry for all it's worth... and on and on.

    Part of what's sad about it is that while the insurance companies are by definition money-grubbing monsters - they crunch numbers and to try to lather them up as high as possible, when doctors who would otherwise be good to their patients are compromised, it's awful.

    Again, the real healers are rare. Who knows - maybe someone on the business side with the same kind of ethics is working up alternatives like my litttle discount card.

    I sure hope so. Because in the meantime a lot of cheats are splattered all over every side of the system like blood spots.

    The blood of the American patient.

    We're fucked unless the legitimization of torture, in all its forms, becomes eradicated at least on a legal level. Some things, the tortuous ones especially, really could use a dose of democracy. Maybe it could start working its way out of all the places where pain is a percentage in America.

    "What did they expect?" -- Benito Mussolini, on marching 300,000 Brown Shirts on Rome.

    by Gottlieb on Fri Oct 20, 2006 at 06:20:39 AM PDT

  •  There aren't enough doctors (0+ / 0-)

    and doctors like it that way. Supply and demand.

  •  Tort Reform... (2+ / 0-)
    Recommended by:
    potownman, flumptytail

    And "tort reform" is the Republican's answer to fixing the system.

    For over 20 years now, the Republicans and the insurance industry have been belly aching that they need to limit awards to injured parties (i.e. tort reform) to fix the system.  Tort reform has been passed in many states and doctor's malpractice insurance premiums haven't gone down.  Doctors don't practice better medicine by limiting plaintiff's rights.  It's the boogey man who keeps on giving.  It allows sloppy doctors to practice bad medicine with impunity.

    I had a malpractice case against a doctor over 20 years ago.  He almost killed me.  I got some money after a 3 year protracted battle, but nothing to ever (and I mean ever) make up for what his willful negligence did to me.

    On the other hand, I work with alot of fine doctors who are constantly harassed my stupid, baseless malpractice suits meant only to enrich the patients and lawyers who bring them.

    It's a fine line.  But this also illustrates that the system is horribly broken.  Someone needs to bring sanity to our healthcare system or we will all surely be victims of it one day.

    Thanks to nyceve, orangeclouds and others for bringing this front and center.  

    HotFlashReport - Opinionated liberal views of the wrongs of the right

    by annrose on Fri Oct 20, 2006 at 06:26:32 AM PDT

    •  Universal Health Care is tort reform (4+ / 0-)
      Recommended by:
      SarahLee, annrose, DrFood, MarketTrustee

      Since torts are about damages, and in most cases the damages from malpractice are related to ongoing/future needs for medical care, setting up a situation where people get the care they need regardless of fault will naturally cause a sharp decline in lawsuits.

      Of course, the price of malpractice insurance is more closely related to stock market performance than the practice of medicine, but that's another show.

  •  From a doctor's point of view.. (17+ / 0-)

    ..and before anyone starts worrying about me, I make enough money to live on, my 2001 VW Beetle is paid for, I have some investments, and my medical school debts are paid..
     We do not "game" the insurance companies - we make sure that whatever claim is made is made under the best compensation code for what we actually DO.
     Attorneys bill by the hour - their knowledge and expertise is what they have to "sell", and a really good attorney has a really good product to "sell".
     Physicians do not charge by the hour, but they do not have any more hours in the day than attorneys have. Spending a couple of hours with a very complicated, sick patient takes a lot out of a person - and to be told that those two hours are not worth the $120.00 charged - that they are only worth $49.00 - this is NOT "gaming" the system.  This is what I face every day.
     And for this, I have to see nineteen patients a day to pay the rent, the nurses's salaries, the electric and miscellaneous supplies, and this does not include compensation for the physician.

    In a time of universal deceit, telling the truth becomes a revolutionary act. - George Orwell

    by drchelo on Fri Oct 20, 2006 at 06:26:40 AM PDT

    •  Thank you drchelo . . . (3+ / 0-)

      Tell the truth about this depraved system.

    •  Doctors and hospitals (0+ / 0-)

      can post their prices like other businesses do.

      If I could be charged $1,000 for fifteen minutes worth of work [or knowledge already on my well-stocked bookshelves and hard drive], I'll either treat myself if I'm poor or buy PPO insurance policy if I can afford it.

      Doctors are reaping the whirlwind for the unchecked greed of the past.

      Politicians are fully aware of the games insurance company play and they fully support the insurance companies because medical costs must be brought into line with lay people's incomes.

      If you want a $100 an hour income simply post a price list outside your office that will give you this income.

      Not posting prices like a proper business can cut both ways.

      Massachusetts has recently passed a law giving complete pricing power to a few insurance companies.

  •  This is exactly why (2+ / 0-)
    Recommended by:
    potownman, flumptytail

    Since now we are giving up our constitution I am looking at other countiries to immigrate to where the health care system works, welfare of the people matters more and the country is not inclined to go to war.  Somewhere for my children to escape to if need be.

    The devil can cite Scripture for his [own] purpose.

    by mojavefog on Fri Oct 20, 2006 at 06:27:19 AM PDT

  •  Doctors routinely overcharge for procedures (1+ / 0-)
    Recommended by:
    ERyd

    Or maybe overcharge is the wrong word, but their billing system is screwed up beyond belief.

    Essentially they put down ridiculous charges on the bill, knowing full well that the insurance company knows better and isn't going to pay them.

    For instance, I had an outpatient surgery two years ago.  The bill said $12,000...  The insurance company paid $4,000.

    Thank god I had insurance, cause theres no way I could have afforded $12,000.  But that is what I would have been billed.

    Check your bill next time.  For what they charge for one tynenol you could buy a whole case down at Walgreens.  It's a fricking game.  The doctors jack up the bills to see what they can get away with, the insurance companies don't trust a single thing they are sent.

    •  Is it the doctors (1+ / 0-)
      Recommended by:
      etherapy

      or is it the hospitals? I'm not sure my doctor overcharges - but I am sure that the hospital bills look totally outrageous.

    •  It all goes back to insurance (3+ / 0-)
      Recommended by:
      SarahLee, JohnInWestland, TiaRachel

      In a sense, you are being overcharged. The cost of providing unreimbursed care is folded into the costs and premiums that those of us with insurance pay. Ergo, you're not just paying for your care, you're paying indirectly for the uninsured as well. You also pay for plenty of other things, such as when a Medicare reimbursement is less than the cost to provide the service.

      Also, you're being forced to pay for a lot more than just medical services. As nyceve mentioned, it's not rare for doctors to provide a service and then not get paid for 8-10 months. So, the doctor's office basically has to finance your care until they get paid by the insurer.

      Personally, I don't think most doctors are overpaid. More than anything, I think the shenanigans we see in our medical bills are a result of the perverse incentives established by insurers.

    •  It is a game (1+ / 0-)
      Recommended by:
      frey60

      and hospitals especially are lobbing right back defensively at the insurance companies. The uninsured get crushed in the middle.

      On that tylenol, though: you're not just being charged for the pill, but for the nurse's time to get the pill, deliver it, and dispense it. The cost of the pill is negligible in that exercise.

    •  I know that (0+ / 0-)

      my local hospital bills me for a pregnacy test nearly everytime I walk through the door. However, they never actually give me a pregnacy test... nor would there be any reason for them to do so when the fact that I had a hysterectomy years ago is taken into account. (A procedure that was performed AT that hospital I might add.) So I definately know for a fact that at the very least my hospital routinely over-charges and falsely charges for care they did not provide. I don't doubt that my hospital is doing anything out of the ordinary though. I just assume this is standard operating procedure for billing departments.

  •  Who gets it, who doesn't (7+ / 0-)

    Gets it:  I have a relative who's been sick for about twelve years, about as sick as you can get and still live.  Massive surgical and medical interventions, many experimental and trial procedures.  

    Her husband was director of benefits for a private company, and no fool, and years ago he accumulated many private supplementary insurance policies.  They have money, you see; he can afford it.  

    Their out-of-pocket costs for the medical care she's received (actual costs now topping the several million dollar mark): about $120, over all these years, she says. Denials: none.

    This is the same relative who said to me straight-faced "You can't provide good medical benefits for employees, because they use them."

    Doesn't get it: My mother's cancer went very slowly for a long time, and she could handle her own affairs.  Then she crashed, and two months later, she died.  During those two months I paid her bills and opened her mail.  She got lots of notices from Medicare about procedures paid for, none with any balances; I filed them.

    After she died, I found a box full of other insurance notices, mostly from her medical insurance carrier.  Some of them referred to denied procedures.  I checked with her oncologist's office.  After many many calls, many many arguments, I finally learned that the doctor had tried to get my mother different treatment, different clinical trials, but had been unable to get her in - her insurance company wouldn't pay.

    One of her rules of life was Never, Never, Never Argue With a Doctor.  It isn't my rule, and so she never told me.  She kept it to herself so I wouldn't make a fuss.  She hated fusses.

    "Republicans are poor losers and worse winners." - My grandmother, sometime in the early 1960s

    by escapee on Fri Oct 20, 2006 at 06:33:46 AM PDT

    •  hmmm (0+ / 0-)

      Well, on the upside, I think we are seeing some reform in how companies treat individuals and how the are thinking strategically about benefits...i.e., the cost of keeping employees is way lower than the cost of high turnover and part of that is attractive health care.

      Now, when this trickles down and around to everyone aside from big companies - can't say. But the management trend seems to be focused on employee engagement and retention.

      Anyone else seeing that, or am I just lucky to work for a company that wants to be on the "one of the best places to work" list?

  •  Then we eat each other.... (3+ / 0-)
    Recommended by:
    SarahLee, nyceve, Thestral

    My corruption map:

    First we eat our children.
    Then we eat each other. <-U R Here <br>Then we eat our ourselves...

    If you dance with the devil, then you haven't got a clue; 'Cause you think you'll change the devil, but the devil changes you. - illyia

    by illyia on Fri Oct 20, 2006 at 06:34:37 AM PDT

  •  Evolving into a third world medical care system? (11+ / 0-)

    Are you kidding?

    Some of the poorest 3rd world countries have systems that are much better than the US.

    Go to the emergency room in Nariobi and the actual care is better than the US. And the $30 you pay (if able) actually covers the cost of the treatment.

    The idea is that you are supposed to take care of everybody.

  •  This is what I don't get. Dems have an easy (6+ / 0-)

    winning issue if they would take on the insurance industry.  Insurance is completely a scam.  If the medical insurance industry was removed from the equation,patients would be able to actually AFFORD healthcare and doctors would make more money.  All of our lives would be a heck of a lot simpler.  

    I truly don't understand why the insurance industry always seems to get a free pass when it seems obvious that they ARE the problem.

    Is it over yet???

    by dnn on Fri Oct 20, 2006 at 06:40:13 AM PDT

  •  I have a hunch this is linked to politics.... (0+ / 0-)

    Do doctors tend to be liberal, and vote Democratic?

    We know who is allowing the insurers to write their own legislation.  I wonder if there's an indirect GOP link to this mess, it looks like their handiwork.

  •  I am so frustrated (2+ / 0-)

    In any business fine, you need to charge enough to make your assets pay for themselves with whatever investment return you expected at the time..

    ..but after that, you're really just turning on a fucking machine and hiring somebody to analyze what it spits out (at least in terms of testing). How about we just put the obsolete equipment out on the hospital lawn for people like me to use when they upgrade? Hell, I'll learn to operate an MRI device if it saves people the $1,000 or whatever they're charging these days.

  •  A few other realities of the Medical System (1+ / 0-)
    Recommended by:
    nyceve

    I'm not going to dispute that the insurance companies are f'ed up.  I'm from Minnesota, and we were just recently rewarded by United Healthcare's CEO resigning and questions about how exactly he was worth 1.5 billion dollars to begin with.  And that's not the first one, we had another big HMO here get busted by the attorney general for buying luxury condos for it's executives and other wasteful perks.

    But, there's some other things going on...

    A friend of mine's wife is director of the physical therapy department at a major clinic system.

    So you go to their clinic, see the doctor.  He says you need therapy.  Now a normal reasonable person would say, ok, go up to the 2nd floor and down the aisle to the therapy dept.

    Nope.  Doesn't work that way.  You see while the doctor sees patients at that clinic, he and his buddies also happen to OWN a therapy clinic across town.  So you get directed to HIS therapy clinic, even though it's not convenient for the patient, and there is a perfectly good therapy dept inside the clinic you are currently standing in.  But there's more money in it for the doctor to push people to his therapy provider.  Conflict of interest?  Sure, but that's the system.

    Here's another one...

    There's a 3 month waiting list to come see the doctor.  The dept has 4 doctors right now.  An additional doctor would relieve the waiting list.  Let's have a vote, shall we?  A reasonable person would say there's enough work there for 5 doctors, they should hire 5 doctors.

    Bzzzttt!  We're not in the world of reasonable.  See in this world the doctors get to vote if they want to hire another doctor.  And their prime motivating factor?  Do I share 1/5th of the take, or 1/4th of the take?  Cause it's not like the patients are going to go somewhere else.  They can't, the insurance company won't pay at any other clinic.  Hmm, let me think.

    Besides, what's the chances of finding another doctor to work there anyway?  The AMA says only so many doctors can graduate each year, just enough to replace the retiring ones, and maybe a few extra.  Wouldn't want to many doctors in the system competing for jobs, that might deflate wages.

    The whole system is messed up, but it's not just the insurance companies.

    •  This doesn't ring true. (0+ / 0-)

      From what I've heard, income levels (net of all their expenses including insurance administration expenses) for doctors, especially primary care doctors have actually gone down in the last few years.

      I may not be right - anyone got any actual data?

  •  Malpractice Tort Reform is divide and conquer (4+ / 0-)

    Get it?

    The move to "reform" malpractice law in this country is probably a method used to divide patients and their doctors, to pit the two against one another. In reality, both are being screwed!

    (-8.88/-7.64) Flirting with Feingold. Hugging up to Edwards. Still pining for Gore!

    by Joshua Lyman on Fri Oct 20, 2006 at 06:54:38 AM PDT

  •  I have a problem with one aspect of your post. (2+ / 0-)
    Recommended by:
    FreeTradeIsYourEpitaph, ERyd

    And don't get me wrong, I'm NOT defending the insurance companies.

    The payment the doctor/hospital/lab receives from the insurance company is a number that is generally accepted by the entity based on a prior negotiation or contract between them and the insurance company, usually referred to as Something like "reasonable and customary". The fee does assure a reasonable profit or it wouldn't have been accepted by the entity.

    Three years ago, my wife had gastric bypass surgery. After extensive fighting with BCBS prior to the surgery it was determined that they would not cover it due to a specific exclusion in our companies policy that disallowed payment for weight loss procedures, even if medically determined necessary. I ended up having to withdraw $25K from my 401(k). The total cost for a "cash" patient. The surgeons fee was $10K.

    The doctor billed BCBS for the office visits, and to my surprise, BCBS paid. I asked the doctor, just for fun, to bill for the procedure and see what happened. Well, they paid it! They sent the surgeon a check for $3500, their negotiated coverage for the procedure and I believe a fair price for about four hours work.

    I asked the surgeon for a refund of my $10K. They told me that they would have to wait 30 days to make sure that the BCBS hadn't made an error and ask for their money back. Well, conveniently for the doctor, BCBS "requested" the payment back a couple weeks later.

    Anyway, the moral to my story is that the doctor would have taken $3500 from BCBS, but it ended up costing me $10K because my wife was a "cash" patient and didn't have a negotiated cost.

    Don't feel sorry for the doctors, they make PLENTY.

    •  oh (2+ / 0-)
      Recommended by:
      SecondComing, ERyd

      is that why my dentist office with 3 dentists working in it had several Porsches' in the parking lot...They got $800 for 3/4 hour of work and roughly $4k for perhaps 3 hours total work over a couple of weeks.
      $1300 an hour is pretty good pay
      If they actually 'work' 20 hours a week billed at that rate, they're raking in $111.8k a month or $1.3million a year
      No wonder why they want to commit suicide so much..

      "I would say the best moment of all was when I caught a 7.5lb perch in my lake" -gwb describing his greatest moment since becoming president in 2001.

      by FreeTradeIsYourEpitaph on Fri Oct 20, 2006 at 08:09:38 AM PDT

      [ Parent ]

  •  Eve it's gotta be discouraging to see this... (5+ / 0-)

    But the positive is, that even with how immersed in this crap your friend is; he hasn't stopped fighting... and that's remarkable... And you haven't stopped fighting... and that's remarkable...

    A lot of times it would be easier to just walk away and watch tv...

    I'm very impressed with the determination you have shown since you started your expose on the American Healthcare system...

    Your fellow Americans need you... and your friend...

    -9.13, -7.79 Adolescent Mooncalves Unite!

    by L0kI on Fri Oct 20, 2006 at 06:56:02 AM PDT

  •  NYCEVE - Breast MRIs (9+ / 0-)

    NYCEve,

    I just scheduled a Breast MRI yesterday - I have one/year. The insurance company doesn't pay for them - they would pay half I think (1500), and I have really good coverage.

    Now, I'm telling you this only as an FYI and I'm sure your doctor friend has explored all avenues but just in case......

    My Breast MRIs and other "girly part" ultrasounds are paid and done via my enrollment in the Gilda Radner Foundation program. I'm not sure what's available around the country - I know it is active in NYC. Might be worth checking into for your doctor-friend's patient.

    By the way the Gilda foundation here in my neck of the woods is meticulous about keeping its study participants scheduled, on a regular exam course, etc.

    •  michele2, thanks a million . . . (3+ / 0-)
      Recommended by:
      SarahLee, tryptamine, marrael

      Didn't know this, he may not either, he's never mentioned it. I'm going to send him your comment immediately.

      Thanks again. What an amazing place--Dkos.

      •  Tell him to check their website (2+ / 0-)
        Recommended by:
        tryptamine, nyceve

        the NYC contacts are there - I'm pretty sure they have a robust program going in your city - but honestly, I haven't visited the general website in a while. I've been part of the program for about 5 years...I have MRIs every year.

        There are organizations out there who will help - Gilda is probably just one. Maybe the Susan Komen(sp) foundation would be another one to check.

      •  ooops (3+ / 0-)
        Recommended by:
        SarahLee, tryptamine, nyceve

        one more thing...what they do is check you every six months as part of their study - they alternate mammos and MRIs - all on their dime. It is a great program...the people I've dealt with are compassionate, knowledgable, and extremely nice - and they are all located within a hospital even!

  •  Nyceve, thanks for all you're doing to (2+ / 0-)
    Recommended by:
    nyceve, Gorette

    help with this huge problem. I'm pretty familiar with the problems and I agree totally. We must do something comprehensive. It's so painful to think about how this mess has affected people we know and love.

  •  It's criminal (6+ / 0-)

    The entire idea of "insurance" has been corrupted.  That we routinely pay for medical insurance and then wait for our claims to be "approved"--is itself a crime.  Imagine if you saved money your whole life in a savings account, decided to withdraw money after ten years to buy a new car--but the bank had to first "approve" your purchase before it would give you back your own money.  

  •  good. (7+ / 0-)

    it's good to be scared of real monsters. my SO hates his life as a doc and has admitted frankly that if he knew then what he knows now, he would have never gone to medical school.

    cents on the $$, paid 60, 120, 356 days or never. then, an MD might want to litigate for payment or write off those cents owed by every insurer presented to pay for his/her patients. think about the scale.

    if one prevails in litigation that can last years (because the insurer has deeper pockets), any settlement will further reduce your claim -- mebe 50% of cents on the $$.

    the problem identified by nyceve here is not the specialist, it's not how ill the patient, as if the cost and frequency of intensive care somehow determined an insurer's fiduciary obligation, it is that private insurers do not reliably pay even an agreed minimum fee-for-service to providers.

    insurance is an industry of outlaws.

    for a private MD, this "administrative cost" -- this risk -- of doing business with outlaws will put "even" a primary care doc out of practice.

    Diversity is the key to economic and political evolution.

    by MarketTrustee on Fri Oct 20, 2006 at 07:05:26 AM PDT

  •  Take a look at MGMA survey on MD compensation... (2+ / 0-)
    Recommended by:
    SarahLee, ERyd

    ... and its hard to have a little less sympathy for at least some sets of MDs.

    To be sure, US insurance companies are evil on the order of Karl Rove.

    However, MDs aren't exactly starving.
    GPs and pediatrician average is around $150k
    Average surgeon is making $400-500k in a lot of specialties.

    Part of the billing issue at the hospital where my father worked was that greedy MDs owned the hospital and regularly sent ridiculous bills -- 10x what might have been reasonable -- to both the insurance companies and the patients, knowing that most insurance companies would not pay anything close to what was billed, and knowing that once in a while some undereducated or uninsured patient would pay the full cost, or pay in addition to what the insurance company paid.

    There may be individual heroes in the American health care system, but there are no classes of heroes -- from insurers / MCOs to MDs to pharma companies to device companies to hospitals, there is rampant evil and corruption everywhere you look.

    Anybody seen my owl?

    by Minerva on Fri Oct 20, 2006 at 07:06:40 AM PDT

    •  Corruption (3+ / 0-)
      Recommended by:
      SarahLee, TiaRachel, ERyd

      You're right about the corruption not being limited to insurance providers.  I have worked in medical bill review and have seen some nasty practices by doctors.  These include submitting the same bill multiple times both as duplicates and also by submitting the same bill for the same procedure more than once, but slightly modifying the bill.  Such as a bill for putting a cast on a broken left arm, and then submitting another bill for casting the right arm of the same patient.  Contacting the patient reveals that they only had one broken arm.  In most cases the doctors profess ignorance and "billing mistakes" but it happens so frequently, and with predictable methods, that it's obviously fraud.

      HOWEVER, with that said, you are not allowed to judge someone's propensity for evil simply because they're making $600,000 per year or whatever.  If your child needed heart surgery I guarantee you that you wouldn't care how much that rich surgeon was making.  You going to go to Fred's Surgery-o-rama, or to the acclaimed surgeon who has done the procedure many times before but is more expensive?

      There's corruption under nearly every rock one turns over, but the difference is that with health insurance the corruption is systemic rather than the exception to the rule.

      Mr. Conyers, you may call your first witness.

      by rabel on Fri Oct 20, 2006 at 07:56:09 AM PDT

      [ Parent ]

    •  A little perspective (3+ / 0-)
      Recommended by:
      TiaRachel, MarketTrustee, blueseas

      I realize that most of us don't make $150k - but if you're in urban California, a $150k household income will just about exactly cover a median house, health insurance, two ordinary cars, and enough left over so that you can go to the grocery store without worrying about whether the cheese you want is too expensive.

    •  I've seen that too... (2+ / 0-)
      Recommended by:
      rabel, ERyd

      I had surgery a few years ago, fairly routine. I had just started a new job, didn't yet have their insurance, but fortunately I had opted to keep my COBRA from the previous job. I was very careful to make sure the surgeon, the ultrasound scans, the hospital expenses, were all going to be covered, and they were.

      The insurance company paid the agreed-upon fee for the surgery fairly promptly (I got copies of all the paperwork) that showed both what his original bill was, and how much of it they covered. I forget the exact percentage they paid.

      The surgeon then turned around and for nearly six months thereafter, attempted to bill ME for the portion of his invoice that the insurance company hadn't paid. It took several calls to my insurance company to clarify that, no, I did not really owe him that amount, and yes, they would so inform him.  

      I'm sure he's not the only one who's tried that.... I wonder how many people would not know any better, not check or challenge it, and strive to pay such a bill?

      "Everyone is entitled to an opinion... What most people fail to realise is that they are not entitled to have that opinion taken seriously." --Adam Tinworth

      by JanetT in MD on Fri Oct 20, 2006 at 09:49:14 AM PDT

      [ Parent ]

  •  The public health is a COMMONS (2+ / 0-)
    Recommended by:
    SarahLee, SecondComing

    and the preversion and exploitation of this by for-profit insurance companies ( Heavy Republican Contributors, all) is unsustainable. And I'n not even mentioning the PharmCos.

    Hillary had the right idea.

    •  That's a point that many conservatives overlook.. (3+ / 0-)
      Recommended by:
      SarahLee, elfling, ERyd

      Public health (e.g. a healthy populace) is a common good from which everyone benefits.  Much like education, a well funded militia, and roads and other infrastructure (communication, etc.)

      The more people who have it, the better society.  So yes, the government should pick up some of this tab, particularly since no one would do these things on their own (nor could they/should they)

      -6.5, -7.59. Annoy a Conservative: Think for yourself.

      by DrWolfy on Fri Oct 20, 2006 at 08:00:22 AM PDT

      [ Parent ]

  •  Ok...NYCEVE... Let Me Explain What The HMO... (4+ / 0-)
    Recommended by:
    SarahLee, rabel, sockpuppet, adamsrw

    Argument is going to be.... "In Europe the Universal Health Care System doesn't pay for everything either.... While Governments pay for medicines & some procedures, the Government believes that patients are to die "natural deaths"... While we in America believe in fighting death until the very last second, Europeans believe in allowing a natural death to occur sooner rather than later... If, a patient's health will only improve marginally with extraordinary measures, then the money in their health care system should be spent on younger patients (0-55 yrs of age) as opposed to older patients, who should be prepared to die..." We saw what the Religious Rightist did on the Terry Schavio thing.... "Keep her alive at all costs... Who cares whether or not the truth of her condition matters..." I'm in my 50's now, & I've filled out my "living will", when I went into emergency surgery & I presented my "living will", a charge nurse said she wasn't going to pay attention to it... Why...??? It says I don't want extraordinary things done to save my life, but, it didn't matter to the charge nurse.... She's going to do as she damn well pleases.... The reason "Universal Health Care" won't be allowed to work in this Nation is because Religious Rightist have us afraid of dying a "Natural Death".... They have taught us to be afraid of dying.... I know this is going to piss off people.... But, I gotta tell ya's.... If I at the age I am ... Monday, I'll be 55 years old, & were to be diagnosed with breast cancer, then yes I would like to survive that, but if I were in my 70's then I would want to be able to say to my doctor, "unless you can keep me comfortable, with some idea of a normal life, then let me pass with ease..." I'm not running to die, but I won't let the medical profession use me as a test subject, nor will I use up medical resources that should be spent on someone else younger, who may deserve to live a better life.... If we could just take religion out of this issue & would use our minds, I would bet, there are more people who think like I do, than the Religious Rightist will admit....  

    Take Care All... PLHeart..

    by PLHeart on Fri Oct 20, 2006 at 07:12:23 AM PDT

    •  Well it doesn't cost (0+ / 0-)

      the drug company that much money to make a few extra doses that may keep the old bitty(?) alive longer.

      It also is necessary to train doctors. Therefore, to do surgery on a patient unlikely to survive anyway makes for good practice.

      If a person works for 2,000 hours a year for 40 years for a total of 80,000 hours, there no reason that person can't be provided with a few dozen hours of healthcare.

      We need rational people running the country, not healthcare rationing.

      •  At What Cost To The Elderly Person's Right .... (0+ / 0-)

        To choose whether they want to be kept alive that way do you think you should make them pay..>??? Look, Doctor's have plenty of opportunity to see how a drug will work on anybody... The best use of a drug on an elderly person should only be whether that drug makes that elderly person feel they can face life more easily.... If that drug physically drains an elderly person despite it's so called benefits then I don't think you should make that person take that drug just to keep them alive so you can see how fast or how slow it drains them of life.... If I become elderly & if I find myself dying I am not going to let them give me drugs to see how fast or how slow I will die.... I can donate my body after my death so they can see the progression of whatever disease killed me.... But, I won't let them fill me up with drugs at an outrageous cost to me & my sense of who I am, just to make drug companies richer, while sacrificing my right to think for myself... This isn't about whether you live or die...It should also be about the quality of that life.... & the costs HMO's Doctor's & the Government thinks it should make you pay for that quality of life....Pay Attention... Please....

        Take Care All... PLHeart..

        by PLHeart on Fri Oct 20, 2006 at 03:29:43 PM PDT

        [ Parent ]

  •  duh! (3+ / 0-)
    Recommended by:
    SarahLee, sockpuppet, ERyd

    i have been saying this for years.  the insurance companies are paying their CEO's millions to keep that profit margin fat.

    Don't fight it son. Confess quickly! If you hold out too long you could jeopardize your credit rating. --Brazil (1985)

    by hypersphere01 on Fri Oct 20, 2006 at 07:15:13 AM PDT

  •  Allow me to share my tally... (6+ / 0-)

    Back in June, I had an emergency appendectomy.  Thankfully, for my financial well-being, I have insurance.  I cannot imagine how I would have paid the entire bill myself (OK, I can, it would likely have been to refinance my house).  

    The doctors, however, are not as fortunate that I have insurance.  Here's the tally:

    • Total charges:  $13,944
    • Benefit (amount paid by insurance):  $1,397
    • Deductible:  $1,500
    • Additional out-of-pocket:  $349
    • NOT COVERED:  $10,698

    That's $0.23 of each dollar charged that the doctors actually received, of which I paid $0.13.  Amazingly, the company paid in August for the June services.  However, I am sorry for the unfortunate individual without insurance who will have to pay that full $14k to help make up for the costs that didn't get reimbursed this time.

    The quickest way of ending a war is to lose it. -George Orwell
    Aimless Reality

    by Alphadork on Fri Oct 20, 2006 at 07:21:14 AM PDT

  •  Death of healthcare by a thousand small "cuts" (7+ / 0-)

    Physicians nationwide are facing a 5.1 percent cut in Medicare reimbursement starting Jan. 1, and the prevailing sentiment is many will decide to quit accepting new Medicare patients. Others may opt to cut back on the services they provide to the 65-and-older population covered by the federal insurance program.

    Despite intensive lobbying by the American Medical Association, AARP and other groups over the summer and early fall to stop the reimbursement cut, Congress didn't act before taking a break late last month.

    The only chance now is for a stop-gap measure in late November following the mid-term elections. With some Congressional members likely to lose their bids to stay in office and more pressing national concerns, the prospects aren't favorable.

    "The answer to that is 'maybe,' " said Fred Whitson, director of medical economics for the Florida Medical Association. "The (lobbying) effort will still be ongoing. The problem is it's a lame duck Congress and those who are not coming back may have no interest in it or they may."

    The 5.1 percent cut is the first of nine years of payment reductions to physicians. Cutbacks will total 40 percent by 2015 if there is no change to the reimbursement formula used by the government.

    A survey of physicians by the AMA in March found 45 percent said they would either decrease or stop seeing new Medicare patients as a result of the planned cut. If the cuts continue in subsequent years, 73 percent of the physicians said they would delay purchasing new medical equipment, the survey of 8,200 physicians found.

    BonitaNews.com

    I'm not going anywhere. I'm standing up, which is how one speaks in opposition in a civilized world. - Ainsley Hayes

    by jillian on Fri Oct 20, 2006 at 07:24:48 AM PDT

  •  First, I was mad at the doctors (10+ / 0-)

    at my kids' pediatric office when I saw the signs at our last visit.  One sign informed us that the office had contracted with a new after-hours service for taking phone calls when the office was closed.  Each call will now cost $20, billed directly to the patient, considered by all insurance companies to be a 'non-covered benefit.'  (Don't you love insurance double-speak?  How is it a benefit if it's not covered??).

    The second sign explained that most insurance companies won't pay for some name-brand medicines without a 'prior authorization.'  The docotors will try to prescribe generics, but some medicines aren't available in generic form (there was a list of common types of meds that need prior authorization, including ADHD and asthma treatments).  Since getting this authorization requires lots of documentation, including letters and treatment notes, from the doctor, there will now be a $15 charge for all prior authorizations.  And they'll take 8-10 business days, just do without the medicine until then, I guess.

    After I took a few deep breaths, I thought about some of my EOBs and how little the providers were being paid.  Medical professionals are drowning in the red-tape imposed by insurance companies seeking to maximize profits by denying coverage.  They have to hire people just to deal with the insurers' paperwork requests.  They're working extra hours after hours and getting paid nothing (or next to nothing), but they're at the mercy of the insurers just like patients are.  I'm suprised it took this long for them to try to shift some of the costs back to their patients.  Our whole system is going under.

    "Going to church does not make us Christians any more than stepping into our garage makes us a car." --Rev R. Neville

    by catleigh on Fri Oct 20, 2006 at 07:25:09 AM PDT

  •  Doctors and hospitals (10+ / 0-)

    spend a great deal of time appealing denials.  If people want to know a major contributor to the high cost of healthcare, they can start there.  Hospitals have to hire entire departments full of people to submit claims to insurers and then appeal all the claims that get denied--a significant cost in salaries for these people, health insurance, etc etc.  

    Many of the denied claims are never reimbursed by the insurance companies, which means the hospitals/doctors have to eat that cost.  To make up for it, they raise costs for other treatments and "cross-fund" money-losing service areas like emergency care and obstetrics by insanely jacking up the price of other treatments and supplies (this is often where the $10 band-aid horror stories come from.)

    You only have to look at the compensation of people like William McGuire of United Health Group (the largest insurer in the U.S., his salary and back-dated stock options came to $1.6 BILLION dollars!) to see where all our money is really going.  They happily take our premiums while we're healthy, but when we get sick and need them to pay doctors for our care, they refuse.  

    Our system is broken beyond repair and will remain so as long as healthcare is seen as a commodity that only the rich should have instead of a basic human right that everyone in this country deserves.

    If liberals hated America, they'd vote Republican.

    by Rumblelizard on Fri Oct 20, 2006 at 07:25:53 AM PDT

  •  I suppose diagnosing the health "insurance" (8+ / 0-)

    industry as "bloodsuckers" isn't premature at this stage of the socioeconomic disease.

    It surely is long past time for a national health care program.

    The single thing in your diary that I disagree with is:

    Without a universal, single-payer system  we'll eventually end up with a healthcare system where you can have anything you want if you're rich, and most of the rest of us can just go away and die.

    No "eventually" about it:  we're already there, I'm afraid.

  •  This summer (11+ / 0-)

    My dad had a major surgery, followed by complications.  He spent over a month in intensive care on a ventilator, then died.  This was a month and a half ago.  My mom is still getting itemized lists of things (I.V.'s, blood draws, doctor's visits) each with a price.  These lists are often the size of a small dictionary.  The price is unfathomable, and we still don't know how much my dad's insurance will cover (if any at all).  

    It is absolutely overwhelming, especially for her.  Not only did she lose her husband of almost 35 years, but now she has to worry about maybe having to pay the costs of his failed attempt at recovery out of her pocket.  

    I have told her not to even look at those lists anymore, and to just wait until they stop coming... just wait for the final bill, then start fighting.

    This summer was an absolute nightmare, and now it looks like the new nightmare (of trying to pay for the last nightmare) is just beginning.

    At least we have hope that insurance will cover a good chunk of it...  What happens to the people who can't afford insurance (like me) when they get sick?

    Yeesh...

    •  Hugs Kid (3+ / 0-)
      Recommended by:
      elfling, nyceve, sockpuppet

      I hear you, I've been there. I'm uninsured too.  Hang on.  
      What happens to people who don't have insurance is that doctors sometimes say, "Oh, you don't have insurance? We can't do an MRI. You can take aspirin instead of Plavix." (This, after I had a stroke and was in the hospital. One doc said MRI and plavix, the other one said no.) So I made a huge deal out of it.  I said, "Then I guess I will die. Because I can't pay for all this, you will let me die.  I will call a lawyer to make out my will so my young teenager will have someone assigned to care for him.  I am already taking a full aspirin a day, have been for months." The nurses were pissed at the doctor. The Social Services person came and filled out paper work so that I got started on the fun-filled road to Medicaid disability spend-down, so at least for that one month, it paid for MRI.  Just incredible.  The doctor from Africa was amazed.  He said OH no, you need an MRI. Not just CT scan.  
      SO: Make noise.  Get all agencies involved.  Ask why you don't get treated with the same things people get on Medicaid or insurance.  Take notes.  Write the hospital after you leave. Write your senators and congressmen.  

      War is not an adventure. It is a disease. It is like typhus. - Antoine De Saint-Exupery

      by Margot on Fri Oct 20, 2006 at 09:10:02 AM PDT

      [ Parent ]

    •  My sympathy. (2+ / 0-)
      Recommended by:
      sockpuppet, ERyd

      My dad lasted 13 days in intensive care after major surgery, many years ago at age 53.  He didn't even die of the original problem (aneurism), but of kidney failure.  I really don't understand how mom managed.  She was a strong person.

      BTW mom remarried at just short of 60.  She's now been able to celebrate two 25th wedding anniversaries, one with each husband.  Now it is her husband who has to be strong, since she has Alzheimers.  We really appreciate him.

      The Republicans are defunding, not defending, America.

      by DSPS owl on Fri Oct 20, 2006 at 09:10:03 AM PDT

      [ Parent ]

      •  Thank you (4+ / 0-)
        Recommended by:
        elfling, sockpuppet, DSPS owl, ERyd

        My dad was also young, 56.  He went in to have an esophagectomy due to cancer, and ended up dying from Acute Respiratory Distress Syndrome, basically his lungs failed.

        My mom is 53 and very healthy, and is putting on a strong front, but I can tell she is lost.  She will find her footing though, and I will be there to help her until she does.

    •  This is just so cruel (2+ / 0-)
      Recommended by:
      nyceve, sockpuppet

      Not only did she lose her husband of almost 35 years, but now she has to worry about maybe having to pay the costs of his failed attempt at recovery out of her pocket.

      I simply cannot imagine having to deal with that - what if she didn't have you.  I would sink into depression.  

      I am so sorry for your loss and sorrier that your mother would even have to think about things like this after suffering that kind of loss.  These are the stories that really make me cry.

      •  Yes, (4+ / 0-)
        Recommended by:
        SarahLee, elfling, sockpuppet, ERyd

        And to think, I almost wasn't able to be here with her.  I was in the navy at the time dad was diagnosed, and had to fight very hard to have my discharge request properly processed.  

        Finally, I contacted my congressmen, and Senator Byron Dorgan (D-ND) came through and got the ball rolling.  His staff contacted the military, and my discharge was approved 2 days later.

        I owe him one...

        Now, if only I can get him to work a universal health care bill into law...  :)

    •  rule of thumb (0+ / 0-)

      i've seen bills like that. get out the fine toothed comb.

      4 days on ventillator is max before dependency: this from my SO's (former ER res/chief) mouth.

      i took it to the bank this summer when my moms failed by CPD and was near to being warehoused in ICU. we got her out. 60 days later, she's billed for physical therapy (PT) among other things, while she was in ICU, that medicare A does not cover.

      advocate.

      Diversity is the key to economic and political evolution.

      by MarketTrustee on Fri Oct 20, 2006 at 03:28:27 PM PDT

      [ Parent ]

  •  I used to work at a doctor's office (8+ / 0-)

    I have seen this too many times to count.

    Doctor submits for payment to the HMO and the HMO decides what it's going to pay. I spent hours following up on what the doctor and office manager thought were missing payments only to be told "No, we only reimburse that for $13" or "We don't cover that drug without pre-authorization."

    My personal favorite was when a patient had an MRI ordered for her BRAIN and the HMO told me it would take 72 hours to process the request unless it was an emergency. I got them on the phone and asked if the words "MRI of the brain" were not denotative enough of an emergency, and they said no. I spent around 45 minutes on the phone with them convincing them that physcians don't order MRI's of the brain just for fun and that this was a potentially serious matter.

    Another HMO refused to pay for a child's asthma drug because we couldn't provide a documented patient history of the child having asthma. I called and explained to them that she'd been diagnosed on her first visit, so there was no 'history' to give them. And they refused to pay for it! Was the medical secretary or doctor supposed to forge/backdate patient notes so she'd have a 'history?' I asked them in all seriousness how they dealt with it when somebody was diagnosed for the first time, and they were just like "hey, those are the rules."

  •  Yes, but having a single payer system would lead (5+ / 0-)

    to Socialism...and maybe even having our guns taken away by black helicopters...

    And it feels like I'm livin'in the wasteland of the free ~ Iris DeMent, 1996

    by MrJersey on Fri Oct 20, 2006 at 07:40:21 AM PDT

  •  Single-payer healthcare is not (0+ / 0-)

    necessarily the answer.

    Single payer will squeeze doctors just like insurance comapnies do.  Witness the current Medicaid/Medicare reimbursment fiasco.  

    What should be done (at least as a 1st step) is requiring uniformity in forms and other such things between insurance companies.  That should decrease the number of denied or underpaid claims because insurance companies won't be able to say "you forgot to check the box 52(q)(3)(a) and therefore we cannot process the form."

    Second, insurance companies must have penalties hang over their heads for delaying payment.  In many states if you don't pay your employee within a given time frame, you are liable for triple the amount.  I say insurance companies must be put in the same situation.

    Third, insurance should be mandatory.  Part of the problem is that many young (and healthy) people do not buy insurance, thus taking themselves out of the risk pool and driving the costs higher for everybody else.

    Fourth, we as a society should learn to accept risk better.  For example, appendicitis used to be purely a clinical diagnosis.  No tests (except maybe for bloodwork) were done.  It was all about history and physical.  Now everyone is sent to get a CAT-scan done before being taken into surgery.  A CAT scan costs around $1500.  But what is the value?  Before, about 5% of the people thought to have appendecitis were false positives.  So in 95% of the cases, the CAT scan is useless, because it confirms what a good doctor already knows.  The value of doing a CAT scan in the remaining 5% does not necessarily outweigh the overall cost.  Yet we do it because of CYA.  No one wants to be sued for doing "unnecessary surgery."  

    •  how can you make health insurance mandatory? (4+ / 0-)
      Recommended by:
      TiaRachel, Mike McL, ERyd, et tu babe

      I've seen others make this argument too and I just don't get it.  The whole problem is that for many of us, insurance isn't affordable.  I mean, why do you think us "young people" aren't buying insurance?  Maybe some of us are cheap, or lazy, or inconsiderate, or don't care, or whatever, but for most of us, we just can't.  If a law were passed making health insurance mandatory, I (and a whole lot of people like me) would just be SOL...there is no way at all that I can afford to get my own insurance (now, granted, I'm not "healthy", and have pre-existing conditions which make me even harder to insure, but so do many, many others).  What are people like me supposed to do in such a set-up?  I understand that costs are lower if there are more people in the pool, so having everyone in would be ideal, but there are plenty of us who couldn't afford to join the pool even if it costs went way down before we were required to do so.

      •  Cost is certainly a problem (1+ / 0-)
        Recommended by:
        nyceve

        Part of the solution is providing subsidies to people to buy insurance based on income (i.e. the more you make the less the subsidy).

      •  Here is one way (1+ / 0-)
        Recommended by:
        zigeunerweisen

        What you'd do is create vouchers that would enable you to buy a basic health plan of your choice. The vouchers would be funded by tax dollars.

        Insurance companies would agree to create, say, two basic health plans that they would provide for the voucher alone. Maybe one is an HMO type plan, maybe one is a high deductible plan.

        Every resident would be required to have insurance - but every resident would have a voucher to buy it with. They (or their employer) could choose to supplement the voucher with their own funds to buy other plans.

        The insurance companies would be given a captive audience - no people outside the market. In exchange, they would have to offer the plan to anyone, have no preexisting conditions, no cherrypicking, no denials.

        This is a way to get coverage for everyone while also leaving the insurance companies in the picture, which may be necessary politically. It would be better than what we have now (though I would in fact prefer single payer).

        In any case, any legislation that involves mandatory insurance absolutely has to eliminate preexisting conditions and obligate insurers to write a policy for anyone who applies. And, since there would be more people, and more healthy people in the pool, I would expect premiums to go down.

        But I don't think you can realistically do mandatory insurance without vouchers.

    •  Once you start charging young (0+ / 0-)

      people a few thousand dollars a year they may country shop.

      Britain may decide the NHS needs more money. A $1,000 young immigrant's rate will leave America's $3,000 rate in the dust.

      Most young people entering the future workforce will speak Spanish. The countries south of the border may decide to pick them off.

      America may be left with a change of address card after investing $200,000 in a young person's education.

      •  I seriously doubt it (0+ / 0-)

        Few people will voluntarily move to say Guatemala to live on a Guatemala salary and obtain Guatemala healthcare.  Even if the Guatemalan insurance costs only $100 to US $3000.  

        As for competition with Europe, a) that is healthy and b) I don't think we will lose it.  More professionals come from Europe to the US than vice versa.

        •  For now (0+ / 0-)

          It is true that Europe loses more professionals to the US than vice versa, but as far as I know the trend has been changing for the past ten years. Even if young professionals leave, they come back afterwards.

          And why? Europe has far more social protections than the US, a more available healthcare, better retirement plan, and far less right-wing extremism in power. While a young person might not care about such protections as you grow older and start a family you tend to begin to appreciate social protections.

          Cheers.

          Omne malum nascens facile opprimitur, inveteratum fit plerumque robustius. - Cicero

          by Dauphin on Sat Oct 21, 2006 at 04:15:36 AM PDT

          [ Parent ]

  •  Single Payer is a non starter.. (0+ / 0-)

    This is another example of corportism run amok in the US.

    Doctors can't fight it, even when they want to look out for us, they can't because of the insurers.

    I have a friend who is having serious bone problems in Canada which is affecting his vision.  While he is being shuffled back and forth between specialists (Canadian health care is great unless you're really sick), he asked me about the US insurance system (since he is looking for a job there when he graduates).

    I told him about the wonderful "pre-existing condition" clause, which means he would either a) not be covered at all, or b) not covered for his current medical problems.

    Ain't the US health care (insura-care) system great?

    I can't believe the people in Canada who want to move to single-payer cite the US as such a great system.

    -6.5, -7.59. Annoy a Conservative: Think for yourself.

    by DrWolfy on Fri Oct 20, 2006 at 07:45:37 AM PDT

    •  Whaaaat!? (4+ / 0-)
      Recommended by:
      True North, Dauphin, ERyd, et tu babe

      I can't believe the people in Canada who want to move to single-payer cite the US as such a great system.

      i am totally confused by this statement

      first off -- i have NEVER heard a canadian cite the "US as such a great system"

      secondly, canada does have a de facto 'single payer system'

      Canadian health care is great unless you're really sick

      now, while there are delays in service provision in some areas of medical treatment -- this statement of Yours is absolute bullshit

      i don't know a single canadian that would want to trade the canadian system for the US one -- and if they do, have them spend a year down here, and they will be turned around in a 'heartbeat' ... imo

      •  There are many conservatives (I have heard) (0+ / 0-)

        that want to move to a single tier (no, not even a two-tier) system based on private insurance.

        Perhaps I misunderstood "single payer".  Sorry if I did.

        And, Canadian health care does have issues, particularly with wait times and triage (which, most of the time works well).

        -6.5, -7.59. Annoy a Conservative: Think for yourself.

        by DrWolfy on Fri Oct 20, 2006 at 08:15:26 AM PDT

        [ Parent ]

        •  Wait Times (4+ / 0-)
          Recommended by:
          True North, Sychotic1, ERyd, et tu babe

          wait times for 'elective surgery/procedures' can be daunting in some cases -- primarily for orthopedic procedures

          however -- there are virtualy no substantiative delays in any 'emergency' care - including orthopedic surgery

          what possible triage problems have You heard about -- non-emergency emergency room visits can indeed result in long wait times -- taking Your son/daughter to the emergency room on a sunday night with the 'sniffles' will likely end You up waiting for quite some time admittedly ...

          i have NOT heard trading in the Universal goverment insurer system to a private insurer system at all -- however, wrt to the 2 tier system -- their are advocates for the pay to play for some of the procedures (esp elective MRI, orthopedic, etc) for those that 'can afford it'

          but i have not heard ANYONE ... and no politician in canada no matter how conservative would dare to ... suggest that the canadian system should be remade in the image of the american one

  •  Even my Dr said the system broke long ago (5+ / 0-)
    Recommended by:
    elfling, nyceve, sockpuppet, Iowa Boy, ERyd

    I'm a cash customer (so my Dr. likes me) - cause even though I can afford insurance - Insurance decided it can't afford me. the scar deepens...

    Consider; is it better to plot a strategy and wait, or set a course, and run? - BMM

    by keechi on Fri Oct 20, 2006 at 07:48:25 AM PDT

  •  poll (1+ / 0-)
    Recommended by:
    nyceve

    Who is the bigger villain--health insurers or big pharma?  That gives me a thought, Wall Street Journal would love a merger between Merck, Humana, and United Healthcare.  Put all the evil in one board room.

  •  Why do we allow such atrocities to go on and on? (6+ / 0-)

    Because a significant portion of the population makes a mint off of the suffering of poorer people. Because there's a lot of money to be made trading in death and despair.

    When was the last time medical science was able to cure anything? Seems all we've gotten for the last 50 years is more expensive "treatments."

    Is it tinfoil talk to point out that the pharmaceutical companies have the highest profit margins in history? Would it also be irresponsible to point out that they, along with the insurance companies, are at the vanguard of making sure Americans don't have universal health care?

    •  yep (0+ / 0-)

      funny how so many of the 'new' drugs out there are chemical derivatives of some other drug...kind of like financial derivatives.

      "I would say the best moment of all was when I caught a 7.5lb perch in my lake" -gwb describing his greatest moment since becoming president in 2001.

      by FreeTradeIsYourEpitaph on Fri Oct 20, 2006 at 08:19:37 AM PDT

      [ Parent ]

  •  Hey - if this insurance thing starts getting ugly (3+ / 0-)
    Recommended by:
    nyceve, gatorcog, ERyd

    I'm sure they'll just blame the trial lawyers.

    Support Will Pryor for Congress [TX-32]

    by Whiskey Sam on Fri Oct 20, 2006 at 07:55:58 AM PDT

    •  They already have in Florida (0+ / 0-)

      I believe it was 2 years ago that the repub state government ginned up this fake crisis of doctors having to leave the state because of the high number and cost of malpractice suites.  It was a faked crisis on both ends -  doctors weren't leacing in droves (c'mon - Florida?) and the cost and number of malpractice was no higher here than anywhere else.  All this to get -  you guessed it -tort reform.  Gas up Jebby's corporate buddies, screw the poor.

      It is the mark of an educated mind to be able to entertain a thought without accepting it - Aristotle

      by gatorcog on Fri Oct 20, 2006 at 11:27:21 AM PDT

      [ Parent ]

  •  The first thing is (1+ / 0-)
    Recommended by:
    tallmom

    have the procedure and duke it out with the insurance company later.  Saying they won't pay for things is what insurance companies DO.  You can usually make them pay for it, especially if you find something.  If you don't find something, then you won't mind having to pay it yourself.

    Tell the woman to apply for a new credit card, use it to pay, and sort it out later.

  •  Eliminate the insurance companies (6+ / 0-)

    and we will be able to afford very excellent single payor healthcare.  The administrative waste of the insurance companies runs into the hundreds of billions.  Single payor socialized medicine makes sense in a global economy.  We need to be able to compete against Canada, Japan and the EU which have lower health care costs per worker.

    •  GM says so (4+ / 0-)
      Recommended by:
      nyceve, Sychotic1, ERyd, et tu babe

      You're right. GM said their health insurance costs per worker in the US compared to their costs in Canada are prohibitive. Unless the big manufacturing corporations in the  U.S. get together to fight big Pharma and big Insurance for Universal Healthcare we'll see more outsourcing.

      •  This is my concern (0+ / 0-)

        under the Bushies. They'll simply tell GM to take it overseas ("and we'll give you tax breaks to do it!") rather than step up with any kind of plan for universal coverage.

        Companies like Costco, Starbucks, other large brick-and-mortar companies - they can't really pick up and take their places overseas, though.

  •  Universal coverage or single payer? (0+ / 0-)

    As I understand it, the key to the problem is that we need everyone covered by health care.  One way to do this is single payer.  Another way is similar to how we handle auto insurance (at least in my state).  Everyone is required to have the insurance but you can chose your carrier.

    I'm not qualified to critique these two approaches--anyone here who can shed some light?  (In the "pick your carrier approach" there would be both subsidized and publicly paid plans for low/no income)  

    "The Universe is change; our life is what our thoughts make it." Marcus Aurelius

    by Mosquito Pilot on Fri Oct 20, 2006 at 08:17:07 AM PDT

  •  NEGOTIATE! (4+ / 0-)

    I know I'm shouting.  Money is worth shouting about!

    A few years ago, we had a 10 day window with no insurance (switching insurance from husband to me).

    Of course, one of the kids gets sick.  

    Bill comes.  Ridiculous office visit fee.  I go in to the office and say "not okay for you to charge us the full amount, I'll pay you halfway between your reimbursement amount for our new insurance, and the billed amount."

    And they said yes.  

    My mom's husband broke his foot.  Needed surgery.  No insurance.  She meets with the hospital social worker and works out to pay about a third of the total.  Had to bring tax records, pay stubs, doc's prognosis for being out of work, but they made a deal.

    Docs get reimbursed by insurance at a negotiated percentage of their fee.  So their on-paper fee is inflated. Many will be happy to take 50% from you - they get 10/20/30% from insurance at best.  And if they don't want to deal - GO TO ANOTHER DOC, if you can.  A reasonable doc / doc's staff would rather get hard cash from you with no paperwork, than have to deal with insurance.

  •  So maybe the doctors (0+ / 0-)

    should actually ally with the lawyers instead of blaming them for something that is not their fault.

  •  You can't solve a real problem with rhetoric (5+ / 0-)
    Recommended by:
    nyceve, Ti Jean, SingleVoter, onanyes, DSPS owl

    nyceve,

    As much as I applaud your effort to expose the inner workings of the healthcare system in the U.S., I am appalled by your obvious attempt to appeal to people's fears and angers only in exposing the problems.  You're trying to make the problems with the healthcare system in this country the sole responsibility of the insurance companies.  Of course, it is easy to round them up and point fingers at the few of them instead of the vast number of doctors and hospitals.  What about looking at the thousands of over-compensated doctors and inefficient hospitals that are equally as culpable.  You make an argument stating that 'insurance companies are practicing medicine without license'.  What you're really saying is doctors are refusing treatment because insurance companies are not paying for certain services. As far as I know, there is nothing in the Hippocratic Oath that justifies such action.  I am almost certain, your ‘noble doctor’ is not in any danger of living in any fashion that is less than lavish, as most in his position are not.  Many more are waiting in line to be in similar position primarily for the over-compensation the position guarantees.  

    Also, I lived in your so called 'Third World' country half of my life.  I was born and raised to parents who provided healthcare in one of those countries.  These parents of mine are not outsiders who came to serve an impovrished mass so they can feel good about themselves.  My parents are of this 'Third World' country, and they got into medicine to make a living.  What they made instead was tons of lives better while accumulating nothing they can call their own.  Thier children are now looking after them in their late years, as supposed to them owning multiple houses in different hemspheres of the world had they been physicians in the U.S.  The infection known as greed has not spared doctors of this country either.

    In my line of work, I am tasked to solve problems.  About 75% of my time is devoted to identifying root causes of such problems I am hoping to solve.  If I played fast and loose with this root cause identification process, as you appear to be doing with the healthcare system problem, I would find myself unemployed in a hurry.

    I think your passion to fix this fundamentally broken systemin the U.S. is admirable, however your means are highly questionable.  I say this as someone who has read your diaries for a while now.  I think you as well as your readers can benefit from a well reserached and thoughtful debate on this issue.  I would like to do it myslef, but I have to many problems to solve.  I will definetly consider it if my siuation changes.  At the meantime, I encourage you to do the same.

    Man's most judicious trait, is a good sense of what not to believe. -Euripides

    by peelinglayers on Fri Oct 20, 2006 at 08:34:20 AM PDT

    •  This is a POLITICAL websight (5+ / 0-)

      ...and you're the first person of the morning who deserves to be called either a naive bumpkiss or a troll.

      Doctor bashing will quickly KILL any type of health care reform.

      Rhetoric inspires political action. Political change makes policy change. We're going to change the system.  You're "tasked with finding solutions" but you're "too busy?" Get a life.

      •  Just helping sharpen our tools (0+ / 0-)

        Call me as you may, as that makes it simple for you either to hate me(troll), feel sorry for me (naive bumpkiss, I don't know what the latter word means) or love me ( I guess I haven't given you a reason for that this morning). The addiction to emotions!

        Having said that, this is a reality based community open to debates, despite your vitriolic response.  You have a thuggish tendency to intimidate those who disagree with you.  I don’t know whether you are that way in person, or a sight of keyboards brings the thug out in you as it does in many.  Regardless, you gain no victory by intimidating little nobody me! :-)

        I am tasked at finding solutions for the work I do that pays the bills.  Had I taken a cause to advocate at this site, healthcare would be in my top 5.  But, due to my demanding schedule for the work that pays the bills, I wouldn't do justice to any cause I would take on in such forum.  That's what I meant, as I am not sure I was clear enough in stating that or you were just hating on me so bad by the time you got to that part and were a little clouded.

        Chill out my friend from the Canyon, disagreement on ideas does not necessarily mean drawing a line in the sand.  Often, it is a mere invitation for debate so that we can sharpen our tools better.

        Man's most judicious trait, is a good sense of what not to believe. -Euripides

        by peelinglayers on Fri Oct 20, 2006 at 12:05:22 PM PDT

        [ Parent ]

        •  "work that pays the bills" (0+ / 0-)

          this rubric explains why a fresh MD chooses a speciality. furthermore, one speciality over another. in any case, (gross) billable v. insurer reimbursed amount(operating income, let's say, although we're discussing individual professional fee/service), speciality presents an immediate economic advantage in the form of cash $$ consumer/patients are willing and able to pay.

          plastic surgery, anyone? anyone?

          OTOH, if you can't stomach blood, despair, administrative headaches, you can always flip your MD into a dual degree, say, JD or MBA. then you never have to actually touch another person. you'll spend the rest of your life being paid big bucks to run a hospital or dictate policy from memory.

          Diversity is the key to economic and political evolution.

          by MarketTrustee on Fri Oct 20, 2006 at 03:13:24 PM PDT

          [ Parent ]

    •  I agree with the headline (5+ / 0-)

      Sometimes on DailyKos we get a little too excited about sharing the doom and gloom stories, and not interested enough in the solutions. There are positive things in medicine, and some insurance companies are honest in their dealings. There is the reality that in some cases people get more care than is appropriate, and that paying for expensive treatments isn't always cost-effective.

      Some doctors are getting rich, but plenty struggle. I wrote a diary earlier this year about doctors in Sonoma County with established, successful practices moving to Kaiser where they could get out from under the overhead and work for salary.

      •  Money and Healthcare, poisonous medicine! (0+ / 0-)

        I read your diary with interest.  The essence of your case in your diary was that these 'poor doctors' were making $100+K as a KP employee instead of making twice, thrice, even ten times more at a private practice.

        The truth of the matter is, 100+K is an adequate compensation for physician.  Earning that much and making a modest middle-class living is not only much well of than most people in the world, but also in the U.S.  May be, just may be, the lack of flagrantly exorbitant compensation would discourage the wrong people from going into medicine and the right ones to do so.

        Don't get me wrong, I have no problem with current physicians as group of people.  Most of them are driven people, driven to achieve. In fact my closest friend is a physician.  If you ask me, should he be a physician, I would tell you 'No'.  Should he be anything that doesn't require meticulous care for human beings on a personal level?  I would say, 'hell yes!'  He is an admirable individual with qualities to match strengths of 100 people.  He went into medicine because that's where the money and prestige is, and that is what people of such tendencies are encouraged to go.

        Getting the right people into medicine is the first step in fixing the problem.  In the mid 90s, medical schools around the country attempted half-heartedly in making this idea a reality; to recruit more rounded people than mere overachievers.  When their efforts are not mirrored by the 'real world', we're only talking about about a practice in futility.

        My friend despises the practice of medicine, because he feels completely inadequate dealing with people on such personal level.  He may end up running hospitals on a managerial level sooner or later.  What a disservice to him and the world of medicine! He is not honest enough to admit this to himself right now, but he knows it, and I for sure know it.

        This, in essence, is the U.S. healthcare system today; many are in it for the money, not for the noble purpose of healing.  The ultimate solution to the problem is getting the money out of healthcare, be that be the insurance companies or the over-compensated doctors or the hospital Inc.s

        Man's most judicious trait, is a good sense of what not to believe. -Euripides

        by peelinglayers on Fri Oct 20, 2006 at 01:54:09 PM PDT

        [ Parent ]

    •  Thanks, peelinglayers for your excellent . . . (0+ / 0-)

      and very moving comments.

      As you may or may not know, I am organizing the Health Policy panel/initiative at YKos 2007.  We are going to attemot to come up with viable solutions with timetables attached.

      I would urge you to join our effort, we need as many committed people as possible.

      Please feel free to email me if you are able to participate.

      Thanks again.

  •  Serious Question About Billing (1+ / 0-)
    Recommended by:
    onanyes

    I don't have first-hand knowledge about medical financing, but in looking at my insurance claims, which are automatically handled by my doctors, the difference between the billed amount and the allowed amount can be as great as 10-fold.

    While the doctor may feel penny-pinched by the insurer, isn't the original "billed amount" a fiction, also? The price Billed Gates would pay if he walked in off the street?

    •  If you are uninsured (1+ / 0-)
      Recommended by:
      ERyd

      You are liable for the billed amount, even if you are a low or middle income worker.

      I'm pretty sure Bill has a good insurance plan. ;-)

      •  Liable for the reasonable and customary (0+ / 0-)

        charge.

        I will send the medical provider 1.4 times the Medicare amount.

        If they wish to pursue the matter further, I will sue to abolish the state employee/legislator healthcare payment system since I'm denied the equal protection of the law.

  •  Excellent diary (2+ / 0-)
    Recommended by:
    nyceve, tallmom

    You have a natural talent for writing about these issues and I look forward to your posts more than any others.

    You wrote a diary a week or so ago where you told us about your neighbor going to Thailand for dental care. The comments kind of turned into a dentist bashing free for all. Just wanted to speak up and say that there are a lot of dentists that are in it to help people and get them healthy. They're not in it for the money. Like your doctor, they're trying to do what's right. Just wanted to let everybody know.

  •  Outlaw the insurance companies. Period. (8+ / 0-)

    This has gone on long enough. Health care is not a priviledge for those can afford it, it is a RIGHT. If our government doesn;t see fit to use our tax money to provide health care for everyone, we need a new government.

    The Private Health Insurance / HMO experiment has failed, and it is high time to move on.

    You can't get away with the crunch, 'cuz the crunch always gives you away

    by dnamj on Fri Oct 20, 2006 at 08:53:31 AM PDT

    •  that is very socialist of you (0+ / 0-)

       Uhh, sorry, but you get what you pay for. We could, as a society, decide we're rich enough to provide this entitlement, but human rights stop where human effort needs to begin.

      "Religious bondage shackles and debilitates the mind and unfits it for every noble enterprise" - U.S. Constitution author and fourth President James Madison

      by Iowa Boy on Fri Oct 20, 2006 at 10:04:08 PM PDT

      [ Parent ]

  •  maybe this *is* the plan... (5+ / 0-)

    Without a universal, single-payer system  we'll eventually end up with a healthcare system where you can have anything you want if you're rich, and most of the rest of us can just go away and die.

    That's one way for Republicans to outnumber Democrats.

    I wouldn't believe Bush if his tongue became notarized (h/t to shanti2)

    by billlaurelMD on Fri Oct 20, 2006 at 08:53:37 AM PDT

  •  Yes, Another Excellent Diary, NYCEve. (1+ / 0-)
    Recommended by:
    nyceve

    Hope that everyone reading will e-mail a link to it to everyone on their e-mail list...perhaps with a subject line "Had Enough?"

  •  Docs aren't without blame (4+ / 0-)

    I don't know what type of practice the cancer doc has, whether he's on staff or part of a group or on his own. But, someone -- either him or someone representing him -- agreed to these low ball payments. Someone -- either him or his representative -- entered into a contract with the insurer/managed care plan to accept these discounted fees as payment in full.

    Until I had to stop working due to my own health problems, I worked for many years as a consultant on health care plans. So, I can tell you that we didn't get to where we are today without willing cooperation by the medical profession. For years now, the medical profession has allowed the insurance industry to usurp their control of health care pricing and health care delivery. When you look closely at the behavior of medical professionals over the last couple of decades, you can't help but conclude that they have no one to blame but themselves for the situation they are now it.

    I have had these discussions with a lot of doctors over the last couple of years. And it continues to amaze me that even those doctors who see the growing instability in the current system still deny the need for massive reform and still religiously vote Republican.

    Docs such as this cancer specialist are going to have to join with others like him to push his profession to take back control of medical decisions. They are major stakeholders and nothing is going to improve until they take a stand.

    •  Getreal246, he may be contractually . . . (0+ / 0-)

      obliged to settle for a particular payment, but a staggering and I mean staggering number of the bills hadn't been paid--and I'm not talkiing 90days here, I'm talking close to a year in many cases.

  •  Doctors bought in (0+ / 0-)

    The AMA and the various state medical societies have done the insurers bidding for at least the last two decades. No different than the Christian Right, they totally followed the GOP/Corporate line, thinking the GOP would deliver for them. They spent their money empowering corporate interests, not caring that they were stripping the injured and their families of their constitutional rights. Rather than protecting their patients from bad doctors, they protected the bad doctors.
    Now they are reaping what they sowed.

  •  Buck Stops in the Insurance Tide (1+ / 0-)
    Recommended by:
    MarketTrustee

    Doctors and everyone else on the receiving end of money from insurance corps will be getting stiffed more and more as our society unfolds.

    Katrina, tsunamis, droughts, floods, corporate collapses and liabilities, terrorist attacks, spikes in commodity prices... all these losses are covered by insurance. When they're more predictable, because there's many many events like them in the past from which to predict their odds in the future, insurance corps can spread the cost of coverage over less likely payouts to cover even the occasional big payouts.

    But as more unpredictable events, especially large ones, hit the world, ultimately most of the money comes from the insurance corps' accounts. The World Trade Center, for example, got held up in a lawsuit by Silverstein, the insurance policyholder. Not only was the total destruction a huge loss, perhaps the biggest ever to a single real estate policyholder. Silverstein's policy paid double on some "extremely unlikely" events, like total destruction by terrorists, to justify Silverstein paying real money for them, "just in case". Of course we all know that it did happen. And Silverstein managed to get the court to find that the policy also paid double again, claiming that two planes into two buildings was two events. Quadruple damages on the total value of the entire World Trade Center. To make matters worse (for the insurance corps), Silverstein had taken over the WTC only recently, so he had been paying insurance for only a short time, perhaps only in the dozens of millions of dollars. Against which Silverstein is collecting probably dozens of billions of dollars. Sure, they'll raise his rates now, but they have to get all that money.

    And then Katrina. And since most insurance corps, especially big ones, are really just marketing outfits that are themselves insured by really big wholesale "reinsurers", the demands on the insurance industry are centralized globally. The biggest ones are German, like Munich Re, and Japanese, part of those countries' post-WWII economic revival. Their payouts are to a global scope.

    At the same time, these insurance corps are ever more essential in ever more of the world's integrated economy. So they have ever more political power, even dictating policy. Policies that primarily make mandatory paying for insurance for any activity. It's the "privatized tax" for any significant action in the modern world. They hike these taxes across a global base. But the big payouts are also keeping them scrambling to cut down where they can. Their idea of "political reform" to fix the system is to prevent lawyers from collecting damages from bad doctors, which insurance companies have to pay, and all doctors have to subsidize, regardless of their quality.

    So they're screwing some doctors. Especially some who operate primarily for patients' benefit, "too nice" to screw for the system we're building. Prescribing drugs, plastic surgery, "cosmetic psychology", "physical therapy" instead of "personal trainers"... the system is rigged to keep heartless rich people pampered, even if not healthy or protected.

    "When the going gets weird, the weird turn pro." - HST

    by DocGonzo on Fri Oct 20, 2006 at 09:18:33 AM PDT

  •  Please get involved in the 50 state project (2+ / 0-)
    Recommended by:
    SarahLee, nyceve

    There is so much justified frustration with the current state of health care, let's try to channel that frustration and do something productive.  I have, in an earlier diary - , - issued a call to action.  If we can get 100 individuals from each state to register as e-members (e-membership is free) of AAESEP, I will go out and fight for group rates on quality benefits from national carriers.  Because the initial diary didn't get much attention, and on the advice of others, I was waiting until after the elections to re-issue this call to action, but please consider acting now.  We can change this bleak reality if we work together.

    AAESEP is "Improving the Way America Works" - www.aaesep.org

    by AAESEP on Fri Oct 20, 2006 at 09:28:34 AM PDT

  •  This is a perfect example (1+ / 0-)
    Recommended by:
    SarahLee

    why pay-what-you-think-it's-worth works. If doctors just put out a real physical tip jar some of them would probably do better and people would be spending less.

    This is just sitting there waiting for someone to start the movement. There's lot's of details to worry about in terms of equipment, labs, etc so maybe some have looked at it and decided it couldn't be done. But, if your doctor is not unique and you've given no hint why he would be unique then there are thousands more out there like him.

    -4.25, -6.87: Someday, after the forest fire of the Right has died we'll say "Whew, I'm happy that's over."

    by CanYouBeAngryAndStillDream on Fri Oct 20, 2006 at 09:36:29 AM PDT

  •  Yesterday (6+ / 0-)

    I had to take my mother to receive her thrice yearly transfusion of blood. She needs two units every four months because she is so osteoporitic that she hasn't enough bone marrow to make red blood cells.

    Everytime we have to take her, they type and cross match, make her wait two to three hours while they run the tests, then work for an hour or so to find a vein. The treatment is beneficial in the long run but exhausting and miserable for her. She could be admitted for the night, transfused and stablized and sent home but no. The insurance and medicare won't have it. Yesterday we took her in at 8:00am and brought her home at 9:00pm. As she got out of bed to get to the wheelchair her oxygen dropped to 80% saturation. They stuck her nasal canula in her mouth and one in her nose, watched till it came up to 95, then waved bye bye as we wheeled her to the car.

    I have no faith in the medical system. They are a profit making industry and patients are money. Her doctor has no say, she tried once to arrange for her to be admitted for this because it takes such a toll on her and was told "no" in no uncertain terms. Mom is 86, she will be 87 in two weeks, she is slowly dying and an inconvenience to hospital personel. You can see it in their faces, hear it in their talk. "She might mess her bed, she needs help to the toilet, she is just here for a few hours and a royal pain. Oh, by the way, we didn't check and the blood infused into her arm and she has a hematoma that goes from her elbow to her wrist, don't worry, it'll go away in a few months. Bye Bye"

    If you have a loved one in the hospital, don't leave them alone. Stay with them, advocate for them, you and you alone stand between real care and neglect. Insurance companies have drained the idealism from once caring doctors and nurses and turned them into automotons. They have to justify every thing that they do for your mom, dad, child, you, and it becomes overwhelming. They just stop, they do the least and that's that.

    I'm sorry, I'm really negative I know. I just brought my mother home, crying at 9:00 last night. I'm not a nurse or doctor, I don't know what her oxygen was at when I got her into bed, I don't know whether I was endangering her life while we drove her home. I do know that I got up every two hours and went to her room to see if she was breathing. I am so pissed.

  •  Only Solution is Clean Money (5+ / 0-)

    Look, friends, someone early on in this discussion said it best: our elected representatives are bought and paid for by the HMOs and insurance companies who are making out like bandits (and killing people in the process, just like bandits).  WHY do you think electing a different cast of characters who equally owe their political pasts and futures to the insurance and healthcare industry will make much difference??

    There really is only one solution: Clean Money full public funding of election campaigns at the state and federal levels.  Until we have elected officials who work for US all of our outrage is beside the point.  Haven't the last several decades taught us anything?  Individual - even class action-lawsuits are just a way for insurance companies to localize the problem and don't lead to systemic change.  What they are doing now is PROFITABLE. Until that changes, they will do what they are doing.

    Insurance companies are amoral.  They are set up to make a profit.  Until we change the rules, they will keep doing what they do.  To change the rules for insurance, we need to change the political playing field.  And simply switching the party in power is not enough.

    That's why I support Prop 89 in California.

    Clean Money now.

    •  You are 100% correct (2+ / 0-)
      Recommended by:
      nyceve, sockpuppet

      We have let Congress make it not only possible, but highly profitable, to steal from us. Fast Talking Sue is dead on: it's time to take the money out of this game. Our interests are bought and sold to the highest bidders every day.

      "There are four boxes to use in the defense of liberty: soap, ballot, jury, ammo. Use in that order." Ed Howdershelt

      by JuliaAnn on Fri Oct 20, 2006 at 11:11:13 AM PDT

      [ Parent ]

  •  it's sad to me (0+ / 0-)

    that we all have our fingers pointed to the insurance corps or the phrama corps, or the doctors.

    but folks they are not the problem. they are symptoms to the problem. The Problem Is Congress. Congress facilitates this mess. if you fix congress, all the symptoms will go away.

    how do you fix congress? not by throwing money at legislators (even if they were honest, ethical, and proposed remedies, their proposals will never make it to a vote).

    so when i see the cascade of diaries about symptoms, and rallies for this candidate, or that candidate, all i see is the flip-side of the myriad of posts in this thread.

    how do you fix congress? by holding a national convention.

    http://www.cc2.org

    if we held a national convention, all this would end. if we all got together on the same page and used Daily Kos to make america aware of Article V of the Constitution we'd go back to being a great nation.

  •  What's the difference between the billed charges (0+ / 0-)

    and the cost of the procedure? That's the key metric, not the gross versus net.

  •  Most doctors aren't like yours. Mine isn't. (2+ / 0-)
    Recommended by:
    nyceve, et tu babe

    But many are.

    And god bless em...

    If GWB had his way, only the wealthy would survive.

  •  another wrinkle (3+ / 0-)
    Recommended by:
    high uintas, sockpuppet, et tu babe

    I use cpap. The federal "gummint" via the FDA have crazy hoops manufactures must jump through to "certify" durable medical equipment (I think that's the term) If I got the unit via insurance company, I would pay 50% (back when I had insurance) of 1200.00 for the unit and be required to get it from one of the third party home care companies that charged several hundred dollars to "fit" the mask...

    When it broke down, I found out the schematic is considered a "trade secret" and it is not possible to repair them without doing your own reverse engineering.

    I ordered a newer model from Canada for 350.00. They are on the shelf in many drugstores.

    Now you can order them in the US for less over the net but a prescription is still required.

    ---
    I have a friend that is a paraplegic. He has shoes that he has to wear when in the wheel chair that require a prescription. Insurance paid 2500.00 for them.
    I looked at them when he got them. They are a pair of red wing boots in his size, with a notch cut in the heel and one leg of a military surplus stainless steel bi-pod from an m-1 bolted between each shoe.

    The biggest threat to America is not communism, it's moving America toward a fascist theocracy... -- Frank Zappa

    by NCrefugee on Fri Oct 20, 2006 at 10:24:08 AM PDT

  •  A debate started up (6+ / 0-)

    on my local papers forum about universal healthcare. A surgeon had written in supporting it. Very quickly, someone posted about blaming the insurance companies when it was really the doctors who were charging exorbitant prices. There was a lot of back and forth about this but hell, I'd rather the doctors get the money than the bean counters at insurance companies! And I can see why doctors need to inflate prices when they get paid pennies on the dollar or when half the time they don't see payment.

    I don't know a medical person who isn't caring and I've known a lot of them. My dorm floor in college was full of nursing students and I know some of them still. I have a few friends who are doctors. The base motivation is caring. I've had nurses who are a little bitchy, but they still did their job of getting me good care. I've also had nurses who have nearly reduced me to tears with their caring nature, especially in high stress situations.

    Our insurance policy is changing at the end of the year. We've had very nice insurance through the hubster's large company but they've told us they're tired of paying for it. I think we'll still have decent insurance after this shakes out but it's scary, reading the other side of it.

    Speech in this country is free, you hack!

    -5.88, -6.82

    by Debby on Fri Oct 20, 2006 at 10:25:44 AM PDT

  •  you are right! (1+ / 0-)
    Recommended by:
    nyceve

    universal health care.  period.

  •  Money Quote? (1+ / 0-)
    Recommended by:
    nyceve

    So what will happen to her I asked? "We'll fight, we'll appeal" he said.  "Then she should file a criminal complaint, insurance companies are practicing medicine without a license."

    Can this be a slogan?

    I think it could be very popular.

    This kind of clarity is never shown in the debate. It's all about dollars and cents; shopping, cost benefit, liability, etc.

    This one small phrase throws all that bullshit econ mumbo-jumbo out the window.

    Did this resonate as soundly with any of you?

    Democrats want to protect America & all Republicans want is war. No Shit Sherlock

    by k9disc on Fri Oct 20, 2006 at 10:39:57 AM PDT

  •  I am a casualty in this war on good health (1+ / 0-)
    Recommended by:
    nyceve

    Healthcare should be the leading issue in any upcoming election until the problem is solved.  Ultimately, each party's approach to healthcare defines their view of role of government.  For the conservatives, market forces are allowed to rule the insurance industry.  And I'm sorry Adam Smith, but self-interest here does not benefit the growing permanent underclass of uninsured and underinsured Americans.

    I am a disabled resident of Missouri, where we have had gut-wrenching Medicaid cuts.  I have been effectively cut off medicaid because I make more than $900 dollars a month.  And, I can't get an individual policy because of my disability.  Such a system is unconscionable ethically.  But even more frustrating is that it doesn't make sense economically, as the public is made to absorb emergency care for the uninsured, whose health gets worse because of lack of insurance, which in the end means more expense to the State.

    While I am not convinced that Medicare for All is the best system (see Slate's article), insurance does need to be reformed, radically.  As long as the open market governs insurance, then millions of Americans are going to be  punished for not being born rich, or healthy.  Some form of Single-Payer system, along the lines of England, needs to be implemented.  And for people like me, we can't afford to wait.

  •  Two things (0+ / 0-)
    1.  My company's benefit plan is changing.   They've dropped a number of options, and now we'll have to pay more out of pocket.   It sucks.    I already pay thousands per year in co-pays.   Now I'll have to pay more.   And, I haven't seen much in a pay raise in five years-  I don't know about the rest of you.    The news reports tell me the economy is good, so why does it feel like it sucks?
    1. I have noticed for many years how insurance companies are slow to re-imburse health care providers.   They sit on "their" money as long as they can -  I suppose to collect interest from some investment.   Our health care system is broken.  
    1. Did anyone else notice the libertarian for U.S. Senate in Texas has a universal health care position?   Does that strike you as odd?   How common is this among libertarians?
  •  Insurance (2+ / 0-)
    Recommended by:
    nyceve, TiaRachel

    I don't have health insurance. I don't own any property or real estate, either. If I get go-to-the-hospital sick, I have no intention of ever paying for any goods or services I recieve. I may even steal the linen supplies in my room.

  •  My own doctor (2+ / 0-)
    Recommended by:
    nyceve, MarketTrustee

    Charges $70 for an office visit, but uninsured patients are only charged $35.  Because I have a copay of $40 to see him, he allows me to pay the uninsured rate, skipping insurance altogether.  Despite the fact that I'm costing him $35 on paper each and every time I see him and pay without insurance, his secretary always thanks me for paying in cash each and every time I see them.  That's how much they hate the insurance company.

  •  Middlemen (3+ / 0-)
    Recommended by:
    nyceve, TiaRachel, MarketTrustee

    have no place in healthcare.  They are ruining the system.

    My brother who is a doc HATES insurance companies and HMOs.  HATES the fuckers.

  •  Every doctor I spoke with... (1+ / 0-)
    Recommended by:
    nyceve

    ...before the 2004 election was campaigning for Bush. They liked "tort reform." Greedy bastards. Not all are like your angelic one.

    •  The tort reform issue is huge . . . (2+ / 0-)
      Recommended by:
      nehark, Iowa Boy

      I have heard doctors say that they will throw choice, as in a woman's right to reproductive freedom, under the train and vote Republican on the tort reform issue exclusively.

      This is how strongly doctors feel about tort reform--bullshit.

      •  Roe v. Wade under train ... if lawyers follow! (0+ / 0-)

          I can't think of a better reason to vote Republican. I have a female friend who is a nurse and trained to evaluate malpractice suits, which she does in her spare time. People with bad genes and bad habits play the health care system like a lottery.

         If you're drowning in lawyers ... like every noncustodial parent in this country ... you'll vote yourself some relief. If I believed a Republican would unfornicate child custody handling in my state I'd drop every lick of Democratic support I'm giving. Yes, seriously ...

        "Religious bondage shackles and debilitates the mind and unfits it for every noble enterprise" - U.S. Constitution author and fourth President James Madison

        by Iowa Boy on Fri Oct 20, 2006 at 10:03:03 PM PDT

        [ Parent ]

  •  Your doctor sounds wonderful... (1+ / 0-)
    Recommended by:
    nyceve

    ...and I know there are many doctors out there who truly want to 'heal' people, and are primarily in medicine for that reason alone, but... not all doctors are like yours.

    Too many doctors, when realizing what a scam the insurance corpse is, do not try and protect their patients by blocking the insurance corpse, but decide instead to join the ranks of the undead effectively becoming one of their agents, and of course making a lot mo' money that way.

    These zombie doctors did not get into medicine in order to 'heal' people, or even to 'help' them, in fact the only people other than themselves they are trying to 'help' are their overbearing parents in boasting about how successful and rich their undead spawn are at the golf club.

    Forgive my snide and resentful tone, it's just that my dad was, and still is, a genuine healer.

    Never a doctor only a male nurse (which was a bitch when I was at a rural junior high) and is now a therapist.

    He is broke, and quite often broken by the system, and that's in the United Kingdom where there is still at least the semblance of a national health service.

    I cannot imagine how disheartening it must be here in the land where private clinics rule...

    .
    .
    .
    We are all atheists about most of the gods that society has ever believed in - some of us just go one god further
    -- Richard Dawkin

    by deafmetal on Fri Oct 20, 2006 at 11:42:11 AM PDT

  •  This is my top issue right now. (2+ / 0-)
    Recommended by:
    nyceve, Dauphin

    How can anyone fail to appreciate the fact that every single one of us is at risk of financial ruin if a member of our family faces a major illness?  The only way families get through it at all is due to community charity fundraisers.

    Here's something I don't understand.  If the insurance will pay for a mammogram, but not for a DIGITAL mammogram, then shouldn't they AT LEAST pay the same amount that they would have paid for a regular mammogram against the cost of the enhanced procedure?  

    If you don't get exactly the test that the insurance company likes, they don't pay ANYTHING, instead of setting an minimum amount for what they will pay towards a service.  This seems very dishonest to me.

  •  Delay, Deny, Deceive - Depraved Indifference (2+ / 0-)
    Recommended by:
    nyceve, Dauphin

    I know the first three words are the title to your last Diary, not this one, but the fourth word is about the solution to the problem.

    Depraved Indifference is the legal principle that transforms what could be an incidental death into a prosecutable homicide.

    Like Presumed Intent, which allows jury to infer intent when the result is a logical consequence of ones actions, acting with depraved indifference to human life is a similar principle that allows for homicide convictions when intent may be a grey area.

    For example when a person fires a pistol wildly into
    a crowd and happens to kill someone he never met, he can be and and often is charged with a homicide under the theory that he acted with depraved indifference to human life.

    That is what these so called "Insurers " are doing too and if some DA with balls somewhere should indict a few of them under this precept  I'll bet Delay, Deny, Deceive stops happening very quickly.

  •  Healthcare and Health Insurance (2+ / 0-)
    Recommended by:
    nyceve, TiaRachel

    All true and VERY depressing. I have spoken with doctors who have appealed to the insurance companies for specialized treatment, spcial medicines, etc. and while they waited for a decision, their patiens have died. Literally DIED waiting. It seems like the insurance companies are simply playing with people's lives at the encouragement of the government. Let's face it...people who don't have the money for private care are most likely NOT republicans. So - the less of their kind, the better. It is all pretty nauseating.

  •  General Strike!!! (2+ / 0-)
    Recommended by:
    nyceve, Dauphin

    A similar comment is buried somewhere in the thread, but It needed a better subject line.
    At what point is a general strike justified?  Something needs to be done to deliver the unequivocal message that the citizenry will not stand for this outrage one moment longer.  If all the un-and-underinsured and their friends and loved ones ans othr sympathetic, community oriented persons were to do something dramatic like that to protect their interests life and health and meager prosperity, the entrenched elite would have to respond.  50 million people have a huge voice, if only they could find it.  I refuse to believe that the system has you all so disconnected from each other that the idea is not workable.  I think we on Kos should set a date sometime in the not so distant future, and keep on publicizing it.  The viral nature of the tubes should help to spread the word.  What's the worst that could happen?  Best wishes.

    Infidelity does not consist in believing, or in disbelieving: it consists in professing to believe what he does not believe.--Thomas Paine

    by peterborocanuck on Fri Oct 20, 2006 at 01:16:41 PM PDT

    •  Yes, the situation seems to have passed the (2+ / 0-)
      Recommended by:
      nyceve, Dauphin

      ... "Let them eat cake" stage when I read what people are reporting from firsthand experience here.

      Better sooner rather than later that we turn off our media sedative drips and go out join the Popular Action Front for the Liberation of North America, or whatever it will be called this time.

  •  Insurance Payments (2+ / 0-)
    Recommended by:
    nyceve, MarketTrustee

    After almost two weeks in the hospital, my mother passed away on August 4th. She was 89 and died from complications following a fall and breaking a femur.
    She had exceptional care from physicians who had kept her going through strokes and other assorted medical problems, for almost 30 years. They cared deeply about her and her quality of life. The hospital bill for the two weks was not, in my opinion, outrageous by any means. But the Medicare insurance compensation was: $.11 on the dollar. The surgeon who repaired my mother's leg, repaired it so she could put her full weight on her leg the day after surgery, received $308 for his efforts. Our system is way out of wack and I do not know if we as a people have the fortitude to sit down and help our elected officials deal with this.

  •  if we get socialized medicine (0+ / 0-)

    the terra'ists win. commie.

    "It was a bright cold day in April, and the clocks were striking thirteen."

    by hoodoo meat bucket on Fri Oct 20, 2006 at 01:37:16 PM PDT

  •  I'm lucky (2+ / 0-)
    Recommended by:
    DrFood, Dauphin

    to work for a company that gives me (and my boyfriend) amazing healthcare, after both of us having gone without it for five years.  Now, after he had some wisdom teeth removed under my plan and I'm scheduled to have my first physical in half a decade, I realize what a true and unbelievable blessing I have been given.

    The other day I had a conversation with a school acquaintance and the notion of socialized healthcare came up, and she said, "Well, there must be some reason why it's not a good idea or no one would be against it."

    People who think like that are the reason the system can't be changed; too complacent to ask hard questions about what might be wrong, they're content as long as they don't one day wake up with a tumor or leukemia or some other ailment that their insurance company won't pay for.

    The first thing we need to do after we kick the Rethugs out is take the money we would be spending on beefing up the war or colonizing space and spend it on taking care of our own people.  It's shameful and embarassing that we pride ourselves on being such a magnificent superpower and yet we don't guarantee health care for anyone.  And much of the fortunate middle class that can afford to pay an insurance company are paying for... what exactly?  What are we paying for if the insurance company doesn't cover whatever it is we need?

    It's the biggest scam in our nation's history, and it's legal and it's happening right under our noses, and that's something nobody should have to stand for.  Thank you all for your beautiful stories of doctors who are fighting the good fight.  It's good to know they're out there, and we should work to ensure that they remain.

  •  3 years salary (3+ / 0-)
    Recommended by:
    nyceve, TiaRachel, MarketTrustee

    my doctor has 3 years salary tied up in
    unreimbursed bills.

    She said she could retire if they would just pay her.

  •  it's going to get worse after the 1st of the year (1+ / 0-)
    Recommended by:
    nyceve

    when medicare cuts into cardiac proceedure reimbursments by 7% 2007 and 28% total.... why go to school for 10 years and rack up $00,000 or more in school loans?  To make $150,000 a year.

    "Mercy, peace and love be yours in abundance (liberally)" Jude 2 Brother of Jesus

    by pinkpanther on Fri Oct 20, 2006 at 02:46:51 PM PDT

  •  And how many doctors vote for republicans? (2+ / 0-)
    Recommended by:
    nyceve, daulton

    How many? Not to be bitchy, but hey, every doctor that bitches about this should seriously take a look at who they are voting for.

    I'm not sure the Dems can fix this, but it sure is quite apparent that the corrupt Republican party won't do a damn thing to fix the problem.

    •  More Than You Know.... (2+ / 0-)
      Recommended by:
      nyceve, daulton

      Doctor's believe they ar better protected by Resmuglicans... Look at the fight for "Tort Reform".... In other words stopping US from sue-ing bad doctor's.... Instead of putting doctor's on the hot seat to help US get rid of incompentent doctors... If doctors would do that, then their insurance premiums would go down... Instead they allow doctors to f*** up & then they get that patients money to repair what the HACK did to them... Soooooooo, until doctors really crack down the HACKS then nothing will change... Prices will go up & this will drive good doctors out...

      Take Care All... PLHeart..

      by PLHeart on Fri Oct 20, 2006 at 04:08:25 PM PDT

      [ Parent ]

  •  wish I had seen this sooner NYCEve (1+ / 0-)
    Recommended by:
    nyceve

    In January, my cardiologist ordered a new type of cardiac CT scan for me. After sitting on the waiting list for months, I was told that my insurance carrier would not pay for it- period.

    So I finally get in to see my cardiolgist again (which took six weeks) So we decided "screw 'em - if they won't pay for the C-T scan, we'll send you into the cath lab." (cardiac catheterization is MUCH more expensive by comparison--riskier too.)

    So two weeks ago, they put me in the cath lab-
    result?

    Of the three cardiac arteries, two were completely occluded and the other was 85% occuluded.

    Moral of the story- there are GREAT selfless doctors out there.

    However, as a group they have had a LOT to do with creating our current health care disaster.

  •  Don't Disparage "Third World Health"! (2+ / 0-)
    Recommended by:
    nyceve, Dauphin

    People in the United States assume that health systems are worse in the "Third World" and this feeds into the meme that we should be happy for what we have, because it could be worse, 'like it is in the "Third World"'.  Even the term "Third World" encourages us to believe that everything we have is superior to everything they have.

    The truth is that, in many "Third World" countries the middle class has better access to affordable health care than we do in the United States.  For example, many diaries have been written lately reporting that in Thailand one can pay for complex surgeries out-of-pocket, paying one tenth of what such a surgery costs in the United States and seeing specialists without an appointment instead of waiting weeks or months.  Don't fall for the facile "Third World" meme, because it is a misnome that spreads misinformation.

    •  And even - gasp - Cuba (0+ / 0-)

      Has, in many ways, a more efficient healthcare system.

      Do you think I'm joking? Cuba has many extremely well-trained doctors. So many, in fact, that Cuba alone has sent more doctors to various disaster-struck areas than the wealthy and powerful US. And these doctors are prepared to work for less and in worse conditions than their US and European counterparts. In schools Cuban children are thought that international aid is the supreme ethical act possible.

      So why, then, is the Cuban healthcare program so inadequate? Well, if you can't buy enough medicines because of trade sanctions even the best system and the most sacrificing and educated doctors will not aid you.

      Omne malum nascens facile opprimitur, inveteratum fit plerumque robustius. - Cicero

      by Dauphin on Sat Oct 21, 2006 at 04:24:34 AM PDT

      [ Parent ]

    •  only one problem with this logic. (0+ / 0-)

      The prevailing incomes in the same countries also tend to be several orders of magnitude less than in US.  A cost that is affordable to a US resident with a reasonable income is just as inaccessible to a native residents as the US healthcare is to US folks.  The only difference is that the US residents now have a financially viable option of going to a different country to get otherwise unaffordable healthcare.

  •  Who do you think is paying ALL the bills?.... (0+ / 0-)

    Insurance companies. That's who.

    Please don't be deluded into thinking that the root of the problem is insurance companies. That line of thinking is what doomed Hillary's initiative as first lady.

    Why doesn't the lady with who needs the testing just pay for it herself? Likely because she cannot afford to do so. How is THAT the fault of the insurance companies?

    "I think they're in the last throes, if you will, of the insurgency."

    by Big Nit Attack on Fri Oct 20, 2006 at 09:25:33 PM PDT

  •  Serfs work. Serfs die. (1+ / 0-)
    Recommended by:
    Iowa Boy

    That is the plan.  Feudalism, and they remember exactly how it works.

    Problem is, we're still living in a post-Enlightenment mentality, y'know, Jefferson and all that...

    (And YOU get to pay for it all -- TWICE!  Unless you:

    http://www.nwtrcc.org/

    http://warresisters.org/... )

    If a thousand men were not to pay their tax bills this year, that would not be a violent and bloody measure, as it would be to pay them, and enable the State...

    by HenryDavid on Fri Oct 20, 2006 at 09:29:02 PM PDT

  •  I know what you mean -- and it's worse than that! (0+ / 0-)

    My mother, who died several years ago of unrelated causes, had three instances of pneumonia when she was in her mid- to late 80's, all of which were within about 2 years, and all of which were in the same general location.  The differential diagnosis was between the blockage of a bronchus (probably by an otherwise undected malignancy) that was causing the pneumonias, or by the mere fact of a previous malignancy in the same area.

    All of the doctors -- both my mother's treating physicians and the physicians in my wife's family -- agreed that a bronchoscopy was required to determine the cause of these recurring pneumonias.  Comes the morning of the bronchoscopy and my mother is prepped for it, extremely anxious, and the doctor who was supposed to do it learns that some routine lab work that she ordered hadn't been completed.  She tells me that the bronchoscopy will have to be rescheduled for another day.  I beg her to SOMEHOW get it done as soon as possible.  The result is that she gets the lab to expedite their work, and the bronchoscopy gets done late that evening because the doctor scheduled to do it stayed at the hospital that night to take care of a frightened old lady.

    There was no malignancy, my mother managed to recover from the pneumonia, and to have several more happy years before eventually succumbing to the ravages of Alzheimer's Disease.  The doctor who gave up her evening to do that bronchoscopy was an angel, to whom I shall be grateful every day of my life.

    What did that doctor get paid for the bronchoscopy?  ZERO . . . ZIP . . . NADA . . . NOTHING!  Why?  Because somebody at whatever insurance company actually administers Medicare in Maryland determined that the bronchoscopy wasn't "medically neccessary."  

    Of course, the prognosis and treatment options for a recurrent pneumonia based on a malignancy, and one that simply arises because of the occurenc of a previous pneumonia in the same area, are vastly different.  And I'm sure that had my mother's physician been willing to spend the time to file an appeal, she would probably have won.  But it would have cost her more money, in terms of lost time and legal fees, to file the appeal than to simply write it off.  So write it off she did.

    I would have been happy to pay her fee myself, but it would be illegal for her to accept it, at least if she continues to accept Medicare patients.  Before this fiasco, I asked this physician (who was only a few years past the completion of her pulmonary medicine fellowship) how she liked practicing medicine.  She replied that taking care of patients was better than she ever expected, but that dealing with the bureaucracy to get paid was worse than she could ever have imagined was possible.

    Our system is BROKEN.  It's broken for physicians, for patients, and for employers,  Perhaps neither Canada nor the European countries have the perfect system, but they've got systens that are vastly better than ours.  And if we're at all smart, we'll absorb the lessons that they have to teach.

    "Those who would sacrifice liberty for security deserve neither liberty nor security." -Ben Franklin

    by leevank on Fri Oct 20, 2006 at 10:25:37 PM PDT

  •  Unfortunately another side to the story (1+ / 0-)
    Recommended by:
    attydave

    I don't have scientific proof, but most doctors I know are conservative Republicans. They vote that way based on primarily hoping to get lower income taxes. Many of them are also elitist, live in the suburbs, drive a fancy imported car, belong to country clubs (you get the picture). You can't have it both ways. You can't on one hand be against taxation  but also expect programs like Medicare to have cash to pay you. Private insurance companies base much of their pricing and reimbursement on Medicare policies. Also, sadly, a lot of doctors don't accept patients who have Medicaid (state insurance for the poor). It is their hospital bed they are going to have to lie in it.

    "The United States, as the world knows, will never start a war...we shall also do our part to build a world of peace..." -John. F. Kennedy

    by bluestatedude on Fri Oct 20, 2006 at 10:39:07 PM PDT

  •  Healthcare, etc., Insurance Industry (1+ / 0-)
    Recommended by:
    nyceve

    Eve:

    You are so right it is not even slightly goddamn funny.

    But I must say "rancid" is not the correct or accurate term to the blighted malevolence and twisted mean-spirited evil that permeates and in fact defines the entire motherfucking industry that includes not only healthcare reimbursement but also healthcare liability, an area with which I am entirely and sadly familiar.

    What exactly the correct term might indeed be is, however, beyond the scope of my limited vocabulary at this hour of the morning, having just early last night concluded week one of a hotly contested medical malpractice trial featuring slam dunk, essentially undeniable liability and absolutely tragic permanent mild-moderate brain injury to a fine young man, which ruins his life, and was the result of a nasty infectious disease that was undiagnosed and untreated over the course of 6 days, 3 visits to his pediatricans, 2 visits to the local ER and an admission to the local hospital.

    Why, one might inquire am I participating in the trial of such a case, which surely could have and should have been reasonably settled by good faith negotiation, without the need for extensive litigation over the course of the last 25 months, the expendure so far of no less than $125,000 in out-of-pocket costs and expenses on my side of the case and probably 6 or 7 times that amount on the other side of the case, being the defense side which features 4 defense attorneys billing at their normal and customary hourly rate, and in whom the truth and other quaint concepts like fairness and justice have been forevermore expunged.

    Greed. That is why.

    The poor defendant doctors who for years paid high premiums for their $8 million in available liability coverage might as well be mindless oxen with rings through their goddamn noses, the way they have been ruthlessly manipulated and dragged through this unnecessary process by the jaded defense lawyer bastards and the sorry asshole shithead deciders at the insurance company in question.

    It ain't my clients who are greedy. And it ain't the trial lawyer (me), who had the unmitigated gall and temerity to actually undertake to represent their interests and file the case in a backwater hillbilly county swarming with uneducated Republican-voting rubes who couldn't find their asses with both goddamn hands.

    So, I have to go fuck those doctors and that evil fucking company up. And if and when I pop their bubble in the form of a $2 million or more verdict, the next time some unfortunate medical consumer in that county is severely damaged through an act of clear negligence by some doctor, maybe the entire process will play out somewhat differently.

    Maybe.  

    •  attydave, I.FEEL.YOUR.ANGER! (1+ / 0-)
      Recommended by:
      attydave

      I shake with rage when I write these goddamn fucking diaries.

      I shake with even more rage when i read these goddamn sad, awful, pained comments.

      Some days I envisions millions of Americans converging in cities across this land to demand change.

      I am organizing the helath policy Panel at YKos, you should become involved, we really need to debunk the Republiscum bullshit that tort reform solves the catastrophe.

      What a god awful nightmare we stupid Americans are accepting.

  •  Not at all surprising (0+ / 0-)

    And now Massachusetts -- liberal Massachusetts! -- has a law that makes buying into this corrupt system mandatory for all residents. As of next year I will be faced either with buying into a corrupt healthcare insurance system (probably to the tune of $5k a year) or a thousand dollar surcharge on my state taxes.

    Why? Because a Republican Govenor and a Democratic legislature pushed through a plan created by the Heratige Foundation.

    Wanna know why health care is so expensive? Insurance companies. Plain and simple.

    It makes Enron look like a tinkertoy.

  •  The system is truly broken (0+ / 0-)

    I work for a not-for-profit health insurance company. I also have family members who are doctors and I am a patient. I see things from all sides. All sides are broken.

    If the insurance companies accepted the charges doctors submitted, insurance premiums would be double or triple what they are now and even fewer would be able to afford them.

    This is because many doctors inflate their prices because they know the insurance companies will bargain them down in order to keep health insurance premiums low so that they can sell to companies.

    Companies buying insurance are looking for a combination of low premiums with decent service to satisfy their employees so they shop around for whoever can get a large base of providers (doctors, clinics, etc...) and can offer decent (not always great, but it's all a comprimise) benefits for less money by offering doctors certain amounts on certain percentages. It's then up to the insurance companies to make their money by reducing administrative costs.

    Most big insurance companies use about 10-15 cents on every dollar taken in in premiums to run their company. 85-90 cents from every dollar of premiums goes to pay for the actual medical expenses.

    There's only so much you can do internally to reduce administrative costs. Unfortunately, there are usually so many rules, regulations and exceptions to the traditional insurance policies that it does require a whole army of people to process claims. We can, and should do better.

    The other end of the broken equation is the patient. We don't realize that what we're paying for is insurance. This should not be insurance. Insurance is for something you'll need very rarely. We need health care on a regular basis. What we end up doing is paying into a pool where we're spreading the cost of health care down to averages. On average, the total health care cost for your company, for your demographic is X, here's your share of that cost. We don't realize how much is being charged on the other end, all we see are the copays, the coinsurance, deductables. These are high enough, I can only imagine if people were forced to pay for the full cost. Then people just don't get care.

    The doctor you describe is typical. He belongs to a hospital or a large group practice. This larger provider organization is the one who negotiated with the insurance company for these prices. The insurance company then tries to hold down prices by trying to make sure only the really sick get the really high-priced procedures. This sometimes works, and sometimes doesn't. It all sucks. It's all broken. There is so much waste through administrative overhead, excess rules, hurdles, barriers, over-compensations and too many middlemen. We have to have a change.

    Plane

    "Fight-em 'till Hell freezes over, then fight-em on the ice." David Van Os

    by PlaneCrazy on Sat Oct 21, 2006 at 04:55:35 AM PDT

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