DISILLUSIONMENT INVADES MEDICAL PRACTICE

"The best decision I ever made was coming to the USA for advanced training. The worst mistake I ever made was deciding to stay."


So sayeth a respected physician, a department chairman in his specialty, whose name is being withheld since he didn't give us permission to use it. The point is that this doctor's doctor expected to spend his life caring for people, healing the sick, the force behind the profession for so many neophytes in medicine. They did not expect to become nursemaids to insurance companies or to the Affordable Care Act.  But that has become their fate because taking care of patients, actually comforting them, has taken second place to the requirements of paperwork without which neither doctor nor hospital can be paid. Today after  interviewing  a bevy of doctors who spent about an hour each on computerized hospital discharge orders (it used to take 10 minutes if you wrote legibly) it became clear how disillusioned they were.


In our previous column we described how the internists found a way to mega-wealth by opting out of clinical practice and opting into the rarified world of industrialized and corporate billing ($800,000 for the board chair according to that year's IRS 990 form). But here's the other side of that coin: according to Kathy Kristof's report in MONEYWATCH,  internists see one patient every 30 minutes, put in 54 hours per week, but waste 23 percent of their time doing paperwork for insurance companies. Take home pay is around $185,000 (about a half-million less than the board chair's 800 grand). The lesson is learned: income has shifted away from clinical medicine and patient care and towards control of capital just as in business.


The new motto is "profits before patients." Keep that in mind as your doctor rushes out the door from your clinical visit. You are important, yes, but the paper trail is crucial. That's where the money is. By the way, Kristof's article is entitled "$ 1 million mistake: Becoming a doctor."


References


$1 million mistake: Becoming a doctor, MONEYWATCH, by Kathy Kristof, 9/10/13 (my editorial comment-- insurance companies are increasingly forcing hospitals and their doctors to process patients as though they were produce, get 'em in,et 'em out, and bill 'em quickly)


Obamacare enrollees hit snags at doctor's offices, LOS ANGELES TIMES, by Chad Terhune, 2/04/14 ("people are having trouble finding doctors")


LifeForSale.com,  documentary movie, Evelyn Li, MD, Medical Consultant ("Life For Sale explores dangerous nooks and crannies of healthcare that until now have remained hidden from public view" -- RLW, Editor, www.politicsofhealthcare.com)

Late addition to post, 2/24/2014: "Doctors, insurers face off over pay," SAN JOSE MERCURY NEWS, by Tracy Seipel, 2/14/14,  ("... insurers are often caving in to the doctors ... medical costs are the largest component of a health insurance premium ..."  What this otherwise well researched story doesn't tell is that physicians' share of the health care policy premium is from 17 to 18% and that the insurers get the last word in the 'face off' when they use Utilization Review to deny specialty services, e.g., consultations, or refusing to cover physical therapy or to approve expensive diagnostic studies)




 

OBAMACARE: "IF IT HASN'T CHANGED SINCE THE LAW WAS PASSED..."

By now we all know the story: "water, water everywhere, but not a drop to drink," or, in its latest revision, "words, words everywhere, but not a syllable of truth anywhere."

"If you like your doctor, you will be able to keep your doctor. Period. If you like your healthcare plan, you will be able to keep your health care plan. Period."

Ooops, not 'zackly "period," more like a comma from a president who must have been in a coma when he misspoke so badly and so carelessly on 15 June 2009 when he recklessly promised so much only to deliver so little four years later.

The new version of "period" is "if it (your health care plan) hasn't changed since the law was passed." The president's awkward attempts to shred and parse his previous language are downright embarrassing particularly to those among us who trusted him at the time.

Here's the latest horror story we have, relayed by a subscriber who has asked us not to publish his name but whose revulsion at the deception he's been offered is palpable.

Joe B, we'll call him, had an individual policy with Blue Shield in which he enrolled in 2012 and which he intended to keep especially since his president told him that if he liked his health-care plan he could keep it, "period!"

Joe B's plan was HSA compliant with high deductibles, $4,000 individual, $8,000 family-embedded. There was no so-called "lifetime maximum." Joe B recently was advised by Blue Shield that the health-care plan he liked and expected to keep would not be available after 12 December 2013. He was told that the plan he liked and had intended to keep was not compliant with the Affordable Care Act, that his new premium for a plan he didn't want would be increased by 40%,  that his deductibles would go up by 12.5%, and that his co-pays after the deductible was met would, in Joe's own words, "skyrocket."

Next Joe B  checked out CoveredCA. Too bad for Joe B, because CoveredCA did not offer him any HSA compliant plans. Joe B's conclusion, sadly on target, is that "the lies which were told that both got the law passed and got many elected or re-elected (Obama) are insidious and cause for great concern for our country."

Next, Joe B learned about the IPAB (Independent Payment Advisory Board) from our blog and finds that  provision of the ACA "cause for great additional concern."

Joe B's conclusion: "Stealthily setting up a plan to redistribute income through the healthcare system is what is resulting, and it's just not right."

Our conclusion: if the president wants to ease into a more socialized system, or a single-payer model, he should have the intestinal fortitude to tell that to the voting public.  What he is doing now is an attempt to deceive the public and re-write history. It is likely that the computer glitches in the sign-up process will eventually be fixed, but Joe B has just found out that the HSA compliant health care plan that he liked and was told he could keep is out the window -- that, my friends, is not a computer glitch. It was false when the promise that Joe B could keep his health care plan was initially floated and remains so today -- a sad commentary and severe blow to our ability to trust our president's promises on healthcare or anything else.