Sicko was bad, this is worse

[ramapo]

Last week I saw Sicko. I left the movie angry, disturbed, frustrated. Ready to move to Canada, if only they would have me.

Today I had my annual physical. My doc has been practicing probably close to 20 years, maybe a few less. A few years ago he left a group to go out on his own and it has been a struggle for him.

I've known it is bad out there for the family doc. Here's how bad it is...

He is barely making it and doesn't know how he's going to send the kids to college. He can't afford to give his staff health benefits. He use to do electrical work in college and still has a knack for it. He's seriously considering getting an electrician's license in case things get worse, which he kind of expects.

This is the most fucked up situation I could imagine. He is a great doc and a great person. Was never in it for the money. He said there have always been year-end bonuses from the insurance companies for those with a low percentage of tests and referrals but always refused to practice medicine that way.

He said many docs are in a bad way but they have little professional freedom or power to address the situation. The lobbyists have the industry sewn up tight for the pharms and insurance companies. The little docs have no money and the lobbyists have millions upon millions. And that's why things are the way they are.

This is just so fucked up.

[supernova]

1. GPs are seriously underpaid

that's why so many in med school opt for higher paying specialities.

How we attract and pay MDs will have to be another facet of this problem if we are to enact universal healthcare.

I'm really sorry for your doc. Terribly sad. :-(

[Devlzown]

19. I was just talking about that to one of my doctors

yesterday. We were talking about the need for health care and I was telling him that I wouldn't really need insurance if it wasn't for the ridiculous amounts they charge for drugs -- I'm on five different meds. He told me that doctor's fees have been regulated much more over the years. I said I believed him. My family doctor used to charge fifty dollars per visit when I was a kid. Now my primary doctor charges me sixty-five. A fifteen dollar increase over thirty years isn't too bad!

[supernova]

20. Yes, GP consults are

fairly reasonable if you have to do out of pocket. I do that now. I go to the emergent care place that Duke runs. They do basic GP stuff. And that office visit is always about $65-75 for the visit and a little more for labwork if needed. It's very doable if you don't have insurance, like I don't right now, and really need attention.

Seeing a surgeon, otoh,l at $350/consult is typical around here.

We will have to get the hot air out of the system all down the line. Do docs in other countries carry privat malpractice insurance? Or if you get sued by a patient does the gov't pay the claim? I'm curious about that end of it.

[truedelphi]

35. I don't think there is the need for lawsuits there

Right now, if you can prove malpractice, you need a whole bunch of money to
maintain your life - For example, if the medical goof leaves you incapacitated as a quadrapelegic, you will need household help, you will need certain drugs for leg cramps etc.

If health care is nationalized, your nursing/household help will be paid by the government, and also the meds.

So it means there are less reasons to sue.

[shireen]

32. surgeons too

i had major abdominal surgery a couple of years ago. It was a pretty complex procedure, and my two surgeons did an incredible job. During one of my follow-up visits later, she showed me the payment slip for services sent by the insurance company. I almost fell off the examination table! It was a ridiculously low amount of money! I could not believe how underpaid they were for that complex procedure! This same surgeon had to give up the obstetrics part of her practice because insurance premiums for delivering babies were unaffordable. It broke her heart because she loved doing it. Her waiting room wall is plastered with photos of kids she delivered. It's sad to know that no more photos will be added.

My GP won't even talk to me about insurance companies, she gets too upset.

Good doctors don't make good money. That is a f*cked up system.

[ayeshahaqqiqa]

2. Sounds like my doc

she created a non-profit health foundation and doesn't take a salary from it. She works outside the office to get money to pay her expenses. She's said that it is ridiculous that insurance companies virtually dictate what medicines people can take and what treatments they can use. She will let someone pay out over time if they don't have insurance and has a fund that pays for laboratory tests for those whose insurance won't cover it, or who don't have insurance. Part of our fundraising goes to keeping money in this fund. It has meant that some people who were very sick and didn't know why were able to find out and to get the proper treatment.

[sam sarrha]

3. this should be the Democratic party Mantra... NO COROPORATE CAMPAIGN MONEY

[bvar22]

15. Absolutely!!

[GreenPartyVoter]

25. Great pic!!

[debbierlus]

4. I was a RN for years & have a few dr friends who left the medical profession

Precisely because of the b.s. you describe. It is sick.

[bobbolink]

5. Is he a member of PNHP?

They need all these docs to speak up.

Especially now, in the wake of SICKO.

Maybe it won't be long before most of our practicing physicians are trained in CUba.

[warren pease]

24. PNHP link: http://www.pnhp.org/ n/t

[Blue_Tires]

6. my dad the doctor

had to retire early because of escalating malpractice insurance

[ramapo]

8. Malpractice insurance is bad too

But he has been able to deal with that.

Oh yeah, his staff makes sure he limits the time spent with a patient because otherwise they wouldn't get enough cash flow.

I hate the MFs who have created this system so they could enrich themselves.

[Warpy]

7. I've been posting here for years about the speedup docs

have faced in their jobs, how most of them have to see twice as many patients as they did fifteen years ago just to keep their income steady, about a 5 minute face to face visit with a patient generates half an hour of paperwork plus several phone calls to bean counters just to get basic care approved.

Physicians are leaving, retiring early, or just opting out and going into some sort of sales or managerial work.

50% of nurses have left the profession for the same reason, brutal working conditions.

For profit medicine in this country has not worked for anyone but a few CEOs.

Your physician's story does not surprise me in the least. It's just more of the same old same old that every single person in the trenches in medicine knows is happening every single day.

[ramapo]

11. Didn't surprise me either

Just tough to hear as reality instead of the usual second or third-hand.

[aquart]

9. They let the insurance companies use them back when it mattered.

The AMA didn't want socialized medicine, oh no. Now I guess they watch Sicko, see that French doctor, and cry.

[LiberalHeart]

10. Michael Moore says he'll be on Leno tonight with an announcement.

[in_cog_ni_to]

13. Hmmm...wonder what announcement that could be????

Thanks for the heads up! I never miss a chance to see Michael. Our National TREASURE!

[Exultant Democracy]

12. There is a reason that the family doctors have such a powerful legacy in the United States.

The reasons that we revere them also happen to be the reasons that they don't thrive in this crooked system.

The GPs in the UK didn't seem to be doing too bad in sicko.

[kaygore]

14. The cards are stacked against those who have integrity

[warren pease]

16. Ever heard of capitation plans?

If not, capitation is another scheme the for-profit insurance industry cooked up a while ago so that they can continue the pretense of paying medical bills while doing everything they can possibly do to avoid such payments.

Capitation encourages a GP, primary care, family practice doc to sign up as many patients as possible. Then it rewards them for not seeing those patients.

It does this by paying the doc a fixed sum per month for each patient they've signed up whether that patient required medical care or not. Like this:

1. A given doc is an approved provider for a health plan paid at a capitation rate of $7.00 per member
2. People who have an HMO plan are required to select a primary care doc, by reviewing a list of physicians in a directory. Let's say this doc has been selected by 250 people to be their primary care provider.
3. The doc gets paid $7.00 for each of the 250 members, or $1,750.00 per month
4. The doc is then responsible for providing medical care to any of these 250 people with the $1,750.00 given
5. If the expenses are more than $1,750.00, the doc must cover the difference out of his/her own pocket

And the reasoning's obvious from the for-profit insurer's point of view: that $1,750 a month is an insurance policy designed to encourage the doc to see as few patients as possible, which keeps those patients from running much higher bills for medical services (which of course they'll try to deny, but better to prevent these costs out front).

So what's the result? Long waits and other barriers to get an appointment, which means more trips to the ER for relatively trivial afflictions; short time spent with the doc him/herself; most in-office work done by nurses or other assistants; little possibility of forming a relationship or bond with the doc, who has become an insurance-industry driven android rather than a health care provider.

You can extrapolate from that a higher number of misdiagnoses under a capitation system, more hand-offs to specialists (costing the imbeciles in the insurance game more in the long run), patient frustration leading to avoidance of doctor appointments unless the patient's nearly dead (and even then they'll have to wait for an appointment, so might as well go to the ER).

That's capitation; another menace to public health brought to you by the greedy bastards who have decided that it's cheaper to pay the occasional wrongful death suit than it is to actually do their alleged fucking jobs.


wp

[NMMNG]

26. That should be illegal

But it's not, no doubt thanks to generous donation$ from the insurance corporations to the politicians.

[warren pease]

27. Nope, it's called sound business practice...

Thing is, for-profit medicine isn't about providing health care. It's about providing as little coverage as legally possible so they can keep costs down and profits up. And that's exactly what they ought to be doing, according to the SEC.

By statute, a publicly held for-profit corporation's sole responsibility is to maximize return on investment for its shareholders. That's it. If they do, they're meeting their corporate fiduciary responsibilities; if not, investors will abandon them and, if things are really lousy, the remaining shareholders can sue the execs and board for not living up to their their end of the bargain.

Asking a for-profit, publicly held corporation to behave in a way that benefits its customers above all would be like asking a shark to go vegan. It's not the nature of the beast. Which is why, in my opinion, people need to understand the distinction between health care and for-profit medicine. They're not related, except to the extent that this suckers' game of a system has invited them into the middle, where they can skim money from docs and patients both.

Makes you feel even better next time your obscenely bloated monthly premium bill comes due, doesn't it?


wp

[ramapo]

30. They do all they can to not pay

My son had major surgery a few years ago.

The good news was he was fine. Insurance paid everything too.

But, one year later a got bills from some of the hospital doctors who hadn't been paid yet. The insurance company quickly "cleared it up" after a few phone calls but it was pretty obvious that they just put off paying for as long as possible.

I've also been through the old, bounce the claim a few times game until suddenly the time to submit it has expired.

[Blue Diadem]

33. Years ago, when we were able to choose an HMO or a regular

health insurance plan from DH's employer, I spoke to my Dr. about which would be best. He discouraged us from the HMO and explained it exactly as you described it. I never knew the name for it though..capitation.

[stirlingsliver]

37. NO Doctor Should Ever Agree To Such A Plan

No doctor should ever agree to such a stupid plan.

Any doctor who really agrees to such a plan is just as guilty as the insurance plan.

BOTH are trying to make money from sick people.

[warren pease]

38. I think younger docs, just setting up practice...

... with a massive college loan debt load, and little practical knowledge of the marvels of the insurance industry would be more vulnerable to this crap than more experienced docs. In fact, I first heard about capitation from my own doc, who's been around a very long time and loathes insurance and insurance companies probably more than I do -- which is saying quite a lot. But then again, I'm only one guy getting screwed, while he gets screwed exactly as many times as the total number of patients he sees, except the cash customers.

And unfortunately, the doctor game IS all about making money off sick people. The problem isn't the docs; the problem is an out of control, market-based Edsel of a system that has people in high positions who are actually devious and soulless enough to think of this stuff.

What non-sociopath could possibly come up with a more twisted scheme to bilk both patients and doctors simultaneously, and line their filthy pockets from both sides of the transaction?

The problem is that, once again, the complacent, underinformed US public just bends over and asks for another prostate exam -- this one performed with a baseball bat. And until every single one of these complacent fools has their own personal HMO moment, they won't give a damn who else is suffering because America's all about the individual and I've got mine so piss on you.

I'm hoping Sicko will get enough attention and galvanize enough people that the insurance industry will be forcibly ejected from the medical industry. However, every time one of these Dem aspirants yammers about "expanded insurance" or "universal coverage" or "coverage for all kids," they're speaking in code that actually means, "let's invite the single most destructive element in the existing system to completely fuck up the new one."

Get rid of the entire concept of health insurance; go to single-payer by expanding Medicare. Nothing else makes any sense at all.


wp

[peacebuzzard]

17. wow! thanks for explaining this and pointing it out.

I have seen the same general practitioner for years, and thought he really understood my particular set of circumstances. Last visit with him this week perplexed me with his minimal approach and reluctance to refer me on. You said it all here:


there have always been year-end bonuses from the insurance companies for those with a low percentage of tests and referrals

Lucky for me, I still have my group insurance from work since I am on a medical leave and am not roped into a PPO referral system. I simply referred myself on to get a 2nd opinion, and my health situation has become a real eye opener as to how the medical system is operating.

In retrospect, I almost felt sorry for my old doc, he really seems burned out himself. Which is the reason why I went to see him personally, I am burned out and wasted from my own occupation with the accompanying aches and pains. I feel for the whole medical industry: at least the ones who went into it to do a "good job".

I have not seen SICKO yet, and am trying to recruit a friend or two to go with me. Just hope it doesn't disappear from the big screens before I have a chance to go. I may just go on my own soon.

[IronLionZion]

18. "He can't afford to give his staff health benefits."

Yeah, I bet a lot of small businesses can't afford it either. That's why we need single-payer. It's pro-business...(well, businesses other than big insurance).

You can bet he probably treats a lot of people for free, especially his own staff. There are wealthy GPs out there. The ones who do what big pharma and big insurance and HMOs tell them to do often have big houses, boats, and european cars.

[lapislzi]

21. Ramapo, judging from your name, you're in NJ

Not too far from me...I'm just across the river in the Hudson Valley. In the 13 years I have lived here, I have watched my delightfully caring family doctor who treated my granny until the day she died get sucked into a monster "medical group" that has more doctors and nurses on staff than some hospitals I've been to. These medical groups are multi-tentacled, probably with huge overheads and inocuous-sounding affiliations like "Health Quest." The insurance companies steer you (the insured, the patient) towards these monster "networks." You can see your primary, your dermatologist, get an x-ray, all in one big giant building. And they have "satellite" offices all over the place. Do you think you ever see the same person more than one time? Half the time, I get lost on the way out trying to find my way through the maze of corridors and examining rooms.

Any doctor in private practice around here doesn't stand a chance against these medical corporations. That's the scene here in lower NY, and I'm sure it's much the same in NJ. Are these monster medical groups prevalent elsewhere?

[supernova]

22. Practice groups

MDs have had to do that, bundle themselves into ever larger practice groups, in order to negotiate with insurance companies for better compensation rates.

[ramapo]

29. My doctor has tried to stay out of that

His old group went that way...not a huge group but my doc didn't want to practice that way.

My parents were forced into such a plan years ago, HIP of NJ, until they went bankrupt and one day they had no insurance.

I'm afraid you're correct and we're headed towards corporate-ized medicine.

[undergroundpanther]

23. My doc is an independant

She takes medicare and medical assistance tho.
One of the few that DARES to.

And I think she has such courage and rebelliousness, I look up to her.Pharma companies come she takes the samples and she dosen't mince, she demands the samples she knows that company makes that her patients already take .All the promotional but useful crap(pens notepads ) She gives it away to patients the propaganda she throws out.She has recycling bins just for that..LOL. After less than 5 minutes she boots the reps out the door talking a mile a minute over them ushering them out,before they even begin to pitch.The door shuts and she sighs and says fucking assholes.And I laugh.She uses particular samples she asked for,for people with no insurance or ability to pay for it.
Before I had MA she helped me with those samples when I got sick.

[deaniac21]

28. I had to become my own doctor years ago.

[ramapo]

31. Please! Raise my taxes....

I am so sick of hearing this mantra....government run medicine...sky-high taxes...taxes will go through the roof, etc.

With premiums in NJ from around $16,000 to more than $25,000 a year for family coverage (still with co-pays and deductables), I would be thrilled to see my taxes go up and get rid of this monthly bill. Even if I came out even.

Every year our cost goes up (25% this year) so we have to reduce coverage to keep premiums below 20K.

And still we live at the mercy of the insurance company

[phusion]

34. Are you fucking kidding?

$20k/year?!

That's more than some mortgages...WTF?

Mine (single) is about $240/mo ($3000/yr) and I pay half of that.

[ramapo]

36. No joke

That's total cost to the company. We can only pay two-thirds now for new employees, we once covered about 90% of the cost.

But I'm essentially paying for my total cost as part-owner.

If I was to go off on my own, or lose my position, a comparable family individual plan is in excess of 25K/yr. + co-pay + deductable. Oh yeah, no drug plan either. There goes another bunch of K.

Want to save money? Get a catastrophic plan with a 10k or 15k deductable

And NJ is one of the more enlightened states. No denial of coverage, no pre-existing conditions but no rule saying the coverage needs to be affordable.

So when these assholes talk about losing choice with single-payer, guaranteed coverage, I say I have no fucking choice. No way I could afford this on my own. No way can I afford to lose health insurance.

Even funnier, is the joke of giving a tax break of a couple of thousand to help offset the premium. Or the big scam of an MSA.