Posted on 07/23/2006 2:42:46 AM PDT by Hostage
Nearly five years ago, my husband and I left a university clinic practice to explore ways to spend more time with our patients. Denied the right to provide services to my patients because the patients' insurer did not deem it necessary, we felt we were losing personal control of the practice of medicine.
Much of my practice was women's care, and the idea of providing comprehensive women's care in 12-minute visits was absurd. Furthermore, to maintain an "efficient" patient flow, my schedule was typically filled weeks in advance with physicals and Pap smears, so that acute care was frequently shunted to one of my colleagues; any possibility of continutity of care was totally lost. Believe me, when a patient is acutely ill, frightened, or in pain, there is nothing "kind" about forcing her to see a total stranger for her care.
We moved to a completely new area and started a retainer-fee practice from scratch. Unlike many retainer practices which cover "extra" sevices while charging insurance and/or Medicare for the usual covered services, our fees cover the entire cost of the medical care.
We are not on contract with Medicare, Medicaid, or any insurance company, although many of our patients still retain traditional insurance coverage for secondary services, hospitalization, medication, etc. However, they pay us out of pocket for the personalized care we provide them.
Ironically, our monthly care fees are considerable lower than the "access fees" that insurance e-based retainer practices charge for the "extra" services.
The bottom line is that we are very affordable.
Two years ago, our state insurance commissioner decided that he did not approve of the concept of "concierge" medicine and announced that he would shut us down. We pointed out that, far from serving only the wealthy, we in fact provide care for many groups of people who could not otherwise afford care of any kind, or might otherwise abuse emergency rooms for outpatient care. Even our maximum monthly charge (which is for housebound adults who require in-home care) is only $100 a month, regardless of utilization.
So, yes -- retainer-based medical care can be kind. But perhaps you can see why we take exception to the term "concierge".
I refuse to take insurance from my patients anymore. It's pay as they go mostly. Some situations require allowing them time to pay. Others require a lower fee. I have time to talk to all, answer phone calls from them and even emails.
My sister has been an RN since 1980. She complains that 90% of the "job" is now paperwork to legally protect the hospital. There isn't much real patient care going on. She works in OB-GYN. Last week she was dealing with illegal alien Mexicans arriving for "emergency" care to deliver yet another anchor baby. They were rude and demanding. When they act like that, they get the absolute MINIMUM legally required level of care. She is getting very tired of working in that line of business.
Another of my colleagues does Oracle database admin and teaches Oracle at a local community college. He is a very accomplished emergency room MD and OB-GYN. He just can't afford the medical malpractice premiums to continue to work in the field. Oracle work pays the bills just fine...especially when he doesn't have to shoulder the big malpractice insurance premiums.
My own experience with $204 extracted for every 2 week pay period and $1500 per year per person minimum co-pay is likewise unsatisfactory. We pay cash for my oldest son's ongoing cardiac care. He's off the insurance as of age 23. The PT tests run $40 every 3 weeks. A bottle of Coumedin costs $70 for a 1 month supply. Annual checks of the pacemaker run $240. If he was still on my insurance, the annual minimums would require the same expenses we currently incur as they don't exceed $1500 for him. The Coumedin would only cost $35 instead of $70. As a family, we rarely use any medical services, so those premiums are feeding a big pool to cover lots of other people. A cash only approach would be much less expensive for me...unless something really bad happened.
Do you know which town?
I'm up in Bellingham and my doctor is a 79 year old. He's terrific, and we pay cash.
For the last 25 years he's had a sign in the waiting room that reads, "Warning the doctor plans to retire within 10 years."
He quit taking new patients a few years ago. And someday I'll probably have to find a new doctor.
I'd love it if more doctors would accept cash. They look at you crosseyed if you say you don't have health insurance.
$50,000 per year? Where is this money going to come from? Getting rid of co-pays is the wrong idea, because without the patient paying a portion of the cost, he has no incentive to shop for the most effective services, and no incentive not to overuse medical services. Rather, we should move in the direction of a more market-based solution, with services that help the poor afford it--not programs that give it away for free.
Where are you in Nebraska? Grew up about 40 miles north of Omaha.
Insurance companies always pay for their clients' legal representation for a claim or potential claim.
That's a bizarre comparison.
Iceland has less than 300,000 people. We have 300 million. You cannot compare the two.
We have the best healthcare system by far. If not - then why do people come from all over the world to use it?
Of course it's not perfect - but we shouldn't throw the baby out with the bathwater.
My husband has United Healthcare Ins. and last year he was in the hospital ICU for 2 weeks. A couple of weeks ago (this is 1 year later) he received a letter in the mail from United Healthcare saying they were paying $0.00 and that the patient (my husband) owed $200,000 to the hospital. Needless to say we are appealing this, but I think it is outrageous and unthinkable that they make people jump through hoops all the time.
Suffice to say, I opted to pursue computer science and electrical engineering. In retrospect, it was a good decision. I upgraded the ham license to extra class. The radiotelephone license was upgraded to 1st class with ship's radar endorsement. Just for fun. Computers don't sue you. They don't flop on the table and tell you they have AIDS halfway through a procedure. Worst case is a supplier decides to drop a line of components and you have to redesign with a more current alternative.
The quality and availability of medical services in southeast Idaho is not very good. The demographers consistently label the area as "medically underserved". Very different from San Diego where lots of choice exists and much of it is fairly high quality. Too bad the San Diego hospitals get slammed with illegals. Emergency rooms are closing all over the area.
"I have no qualms with CEOs making a gazillion dollars for inventing a better mousetrap."
HMOs were the invention of Ted "Champion Swimmer" Kennedy, and they are definitely not a better mousetrap.
There are Icelanders that live here in Seattle that work for the fishing industry here. They are permanent residents or dual citizens. They have regular health insurance.
They go back to Iceland for serious healthcare. Why?
Now go back to your post number and look at the post immediately following. Therein lies one answer.
But note that I did not say we have a bad healthcare system. I said it is debatable. And note also that this line of discussion started with one poster saying, as so many say, "We have the best health system in the world".
Then go to your local DVD rental or Netflix, etc. and rent 'Moscow Does Not Believe in Tears' with English subtitles. In that film (made during the Soviet era) a TV producer says what they all believed "We have the best health system in the world".
Once we accept that we are not the best, that we are sometimes the best, other times good and often awful, then we can tell ourselves as Americans that we can do better.
Education begins with a humble spirit and a dose of humility.
My wife is a physician who fights United nearly everyday for her patients. She often wins but it leaves her all worn out.
I have never met any doctors like this. The main reason is that unless they are Doogie Howser, they know they will still be in residency at the age of 28, working 90 hour weeks for wages that would make a bus driver sneer.
It requires 4 years of college, 4 years of medical school, 3 to 6 years of residency, and often one or two additional years of fellowship. Then you have the expenses of establishing or buying into a practice. And most docs nowadays have more than a hundred grand in student loans to pay off, and sometimes two or three times that much.
Most physicians don't make any real significant take-home money until their mid-30's, and even then it can take a while to become established. If they didn't go into one of the high paying specialties like surgery or cardiology, they may never net more than $125,000 or $150,000 per year.
If you are in medicine for the money, you can probably do better by joining a unionized trade as an apprentice right out of high school. Work your way up to journeyman, master, and contractor. At age 35 or 40 you will be making as much money as your family-doctor friend AND have a fat pension already in the bank, while he may have a six-figure *negative* net worth.
-ccm
You're kidding, right? This is the Baby Boom generation we are talking about. (I'm right at the tail end of it).
We're collectively numerous enough and selfish enough to have all of Washington quarreling over who gets the honor of planting the most obsequious, expensive kiss on our arses. Just look at the Medicare drug bill for a small foretaste of what is to come.
We will vote ourselves a lavish gold-plated health care system even if it means poverty and indentured servitude for our children and grandchildren. It's a shocking disgrace, unworthy of the sacrifices our own forefathers made for us, but it's true nonetheless.
-ccm
I can only imagine. She's probably not my Dr., but on behalf of all patients everywhere, would you thank her for me?
Horse pucky, the money was put away tax-free at the time it was earned. It has been growing tax-free all this time. When it is taken out, the retiree will be in a much lower tax bracket than when he was working. There is not one thing unfair about it.
-ccm
My naturopath does her best to work with her patients. I think she takes some insurance, but she is always very willing to help her patients. She's straight forward and takes time with her patients. My children are very healthy, so they don't have a current pediatrician. When I called around for a basic physical for one, every place was going to charge $150 just for the consultation fee. On a last chance I called my doctor. She put his info. in my file and only charged $50 for the physical. While there, I overheard her secretary call someone and tell the patient that her check had been torn up and her appointment was free.
bump
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