There are some major changes coming down the pike for our healthcare system. Everyday there are new proposals, new costs or new controversies. Instead of the sitting on the sidelines, the American Academy of Pediatrics has jumped into the fray to debate.........the proper shape of hot dogs. Wow. That is big news. They want a new warning label, not about its nutritional content, but to stop kids from choking on the things. How about a sticker that says CHEW?
Here's some more bad hot dog press out of Kansas City. A flying wiener, thrown by the baseball team's mascot, may have caused a detached retina and the development of cataracts in a fan's left eye. Now that dude is suing for $250K. Unfortunately, he didn't choke on it or the American Academy of Pediatrics would have helped him out in his lawsuit.
I am not a big fan of managed care companies. Not unlike the Mafia, they skim from the top and charge incredible vigs. It isn't organized medicine, it is organized crime. That being said, I am not sure that I am favor of President Obama taking control over them. It sounds very Hugo Chavezish. Here is what is being reported in the NYT:
The president’s bill would grant the federal health and human services secretary new authority to review, and to block, premium increases by private insurers, and it would create a new Health Insurance Rate Authority, comprised of health industry experts that would issue an annual report setting the parameters for reasonable rate increases based on conditions in the market.
Don't get me wrong, these huge rate hikes are a joke and are just posturing to get a smaller increase (as I said in a previous post). There just has to be a way to make these insurers bring their rates down through competition. Here are some:
Let people shop online for the best rate like they do for car insurance. This would be done ACROSS STATE LINES.
There has to be some limits on the mandates placed on these insurers so people can choose the best product for them (bare bones vs. Cadillac). In turn, you get what you pay for.
Stop letting lawyers and lawsuits determine what services a managed care company needs to cover. Let competition do it.
Those that are self-employed should get the same tax benefit as those that get health insurance from their employer. This insurance product would be portable.
Cut out the paper work so that doctors can easily be paid by the insurance companies . The bureaucratic coefficient of friction would be reduced thereby decreasing the amount of bureaucrats needs (administrators). This saves lots of money.
Here is a tough equation to figure out. More and morestates are cutting more and more from Medicaid. For example, they are lowering what is offered to Medicaid patients or paying even less to doctors. Physicians don't mind, by the way, as fewer are even accepting Medicaid. Knowing this, the Democrat Healthcare Bill still wants to put more Americans on Medicaid. That number could exceed15 million. Can someone help me figure this math out? I sucked in calculus so maybe I am missing something.
People lose many items in almost every conceivable place and the doctor’s office is no exception. It may even be more common than you think. The normal scenario goes like this - as the patient is about to leave they suddenly find that they have lost something. Common on the list of lost items are sweaters and jackets, easily found objects which are simply the result of the patient’s desire to flee the doctor’s office as quickly as possible. The list of items people lost in my office is quite long, but some instances bring back memories. One of the worst tragedies was the patient who had lost her dentures. We disassembled the office without success. After a prolonged period the patient looked in the last place she could think —her mouth. One other instance that comes to mind is the problem of the lost automobile keys. The patient had left the office only to return quite agitated. She could not find her car keys. She had driven to the office without a problem, but on returning to her car she could not find her key. She was sure it was lost in the office. We searched the examining room, the waiting room, the bathroom and finally after all else had proved fruitless we were able to determine that she had used the bathroom and had flushed the toilet. After considerable procrastination we donned rubber gloves and delved deeper into the toilet. There, the key was found, and after much rinsing and washing we were able to return the keys and the patient left intact.
Recently there was a controversial article called "Health and Wealth" in our little local paper that investigated how much money is made in the hospitals in Maine. It actually went around the country via the AP. In order to keep my job I will bite my tongue on how much some of the administrators make. To be fair, I was also blown away by the amounts certain physicians make. A neurologist doing epidural steroid injections making $800K a year? You are kidding me. Anyway, this puts all docs in a bad light. Patients don't understand that we all don't pull that kind of cash in. Not even close. In a related story, the WSJ just shed some lighton the burden of student loans by illustrating the case of one family practitioner, Michelle Bisutti. She started out needing $250K and now it has ballooned to $550K. To be honest, it looks like she screwed the whole thing up herself but even so, the story is a sad one. I know guys in primary care who owed around $200K and were getting some student loan repayment from their jobs and STILL owe a lot of money 15 years later! It takes forever to climb out of that kind debt. Add to this that you have lost your youth to training for this career (which are prime earning years) and the fact that you probably have a young, new family, and you can see why most medical students choose NOT to go into primary care.
On a personal note, I was truly naïve about earning potential when I was a medical student. I really knew nothing. No one in my family was a doctor. No one gave me advice. It came down to physiatry (physical medicine and rehabilitation) or family practice. I chose the latter because I wanted to be the Marcus Welby kind of doc. It turns out the former type of specialty is the one that does all those epidural injections. Doh!!!
We are in the middle of finishing our April issue. If you have any ideas or stories that you want to share please send them my way. There is a section on line where you can submit a story.
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Anthem recently announced that it was going to hike its rates to about 700,000 California customers on an average of 25% with some going as high as 39%. We are in a recession, you know. The executives at Anthem have families to feed and they claim the company is losing money. Anthem, if you didn't know, is a subsidiary of WellPoint who recently reported a $4.75 billion profit in the last quarter of 2009. After a public outcry, they are postponing the increase until it is further reviewed. By the way, the same things is happening here in Maine.
What people forget is that this happens every year. The insurance companies, who have us all by the balls, announce big rate hikes. The public goes wild. There is a big "investigation" by the individual state regulators and then a lower rate hike is approved. The public is happier because the big, bad managed care company didn't get that huge increase. The state regulators look like heroes. What people don't know is that this was Anthem's intent all along. They knew they would never get the amount they asked for. It is the oldest negotiating tactic in the world. The only constant is that the rates keep going up and no one is doing anything about it.
Nearly two dozen new medical schools are opening up in the country. The reason? The NYT points out that it is in response to the imbalance of foreign docs coming in the the US while many qualified kids here get rejected or go out of the country to go to med school. The problem is that these same students will NOT going into primary care until the pay disparity is fixed. And the biggest need we have right now is in primary care. The article goes on to say:
Many of the developing medical schools are well aware of such arguments, and are billing themselves as different from traditional medical schools, more focused on serving primary care needs in immigrant and disadvantaged communities. Administrators say that they expect that approach to be buttressed by a shift in state and federal reimbursements from specialists to primary care doctors.
How about this for ridiculous - a new website that matches potential lovers up depending on their ailments. Go to http://www.prescription4love.com/ to check it out. I do understand how some cancer survivors can truly understand each other like no one else can. I get that. However, this really can match up some very "interesting" patients as well. Can you just see a gaggle of "somatization disorder" patients getting together?
The physician once was expected to wear a white coat. Something, since those days, has changed. I am not sure why or how this change occurred but it did. The coat and tie disappeared somewhere along the way.
The white coat I guess was to imply that the physician was clean and did not spread disease. In the attempt to prevent infections from being spread by physicians or hospital workers the white gowns masks and booties were required as appropriate for the operating room. Underneath these white gowns, green scrubs were developed so that all outside clothing was kept out of the operating room. The nurses traditionally wore white uniforms but with the need for functionality these were gradually supplanted by clothing that permitted rapid action and easier mobility. Hospitals in attempting to simplify dress codes brought the green scrubs into existence. Once started these green scrubs developed quickly into standard garb for all hospital workers. (Although most are green they also come in red and blue).
The scrubs priced favorably between 5 and 20 dollars soon found favor with healthcare workers and proliferated. The scrubs became ubiquitous. Seen not only in hospitals they soon began to appear in many other places. Some of the medical personnel seen on the television screen even appeared as guests on some shows in their tailored scrubs. (Either they were tailored or they fit them much better than most of the scrubs I have encountered).
I suppose this desire to display a uniform that displays his or her occupation has always been around and many craftsmen felt it was representative of what they do and constituted a subtle form of advertising. The butcher wore a blood stained apron and the mechanic his grease stained overalls as well as many others. Doctors are really no different.
