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Yup. Paranoia can serve us well these days. (I am not being sarcastic.)
You have been accurately describing the frustrations of my life between 1992 and the present.
That’s interesting. Thanks for the tip.
I noticed in last years annual check up the nurse took more time taking my blood pressure than the doctor did in the whole visit. He just chatted pleasantries and never even listened to my heart or lungs. I was so startled being shown the door that I didn’t object. This year I will make a note to be more demanding.
I suppose most older docs were in it for being part of a healing art. When we changed from artists to business people our profession lost something.
The history of medical care over the past fifty years is of a system that has evolved to have confused allegiances and priorities. The result is a declining quality of care. No one assumes responsibility anymore because moral responsibility has been replaced by financial responsibility, and that is actually harder to work with.
I wouldn’t mind the change to putting people to sleep the way we do our pets if we were paying a lot less for that type of care. The care veterinarians provide at a relatively low cost would make sense to me at this point. My daughter is veterinarian, and when she was in vet school, she had to have a complete blood count (CBC) test for herself for some reason, and when she got the bill, she called me to say that it was $500. She said that veterinarians run the same test on exactly the same machine, and it costs $20. She could understand that it would cost more for a test for a human being, but not that much more. What creates that differential in price? Layers and layers of useless liability insurances.
I want to go back in time to when it was just me and a doctor and the lab down the street. And when it made financial sense.
And just to add to my note in comment 5:
I saw the change to “managed care” happen. I had a fantastic pediatrician for my kids, and a “sick visit” used to cost $14. There was in the office one doctor and one nurse/receptionist. There was another doctor on call on some weekends, but I mostly only saw Dr. Dankner. My kids and I adored her. Managed care came in and with it, a second nurse and two people out in the office. Almost overnight, a sick child visit went up to $48 dollars. It was dramatic. And it was the beginning of the end of health care as I had always known it. My kids grew out of the pediatrician’s care (not until she threw my last kid out at 18! because he refused to see anyone else), and two years later I ran into Ellie at the grocery store one night. She tearfully told me she had closed her practice. She just couldn’t practice the “new way” anymore. (We both looked after our mothers–that’s what we had in common and why we were such good friends.) She was the best doctor on planet earth.
The system is sick. It needs a team of doctors to look it over, make a diagnosis and fix it.
It needs that, and more. What individual patients can best do to protect themselves, in my opinion, is to find a doctor they pay themselves — someone like DocJay, who you pay yourself, and who answers to your individual needs.
Unfortunately, in order to discourage this practice, current regulations generally prohibit docs from accepting direct-pay patients, if they also accept any insurance or Medicare payments from any other patients.
It is very scary for docs to do what DocJay has done, and hence there are relatively few of him. But if you want a classic dr-pt relationship you should strongly consider finding his like.
We could adopt the Soviet system. They had the best health care system in the world. (If you don’t believe it, go back in time and ask them.) And it was free. If you or your kids needed any important treatment in a timely manner, you’d slip the doctor an envelope with money in it. They’d somehow manage to let you know how much.
Maybe it was more of a free market system than we have here in the U.S.
I had a friend make a trip to Cuba before the Obama reopening, and her tour guide was a doctor. He made more money as a tour guide, because he could collect and hide tips from the Castro regime.
Another good post from Dr. Rich.
If we get single payer health care, I think the medical profession will get what it deserves. While there are many doctors that oppose government run health care, all the medical interests (which are mainly run by M.D.s) were for Obamacare. Do they really want to be government employees?
This is no joke. If a Soviet official found you accepting such a “gift,” he might demand a cut of the proceeds. If a U.S. regulator discovered such a thing you would lose your career, your life savings, and you would go to jail.
The younger ones mostly do. Some out of complacency and others out of immense frustration.
It’s strange to me that so many of the liberal docs I know still place all the blame only on “greedy insurance companies” and are unwilling to confront the real array of distortions and corruptions that have led us to this current mess.
Blaming the problems on the greedy companies is the default position of Progressives with all issues of controversy, since it justifies more government control as the solution to the problem. And in most cases (and certainly in healthcare) it is government regulations that created (or encouraged) most of the distortions and corruptions in the first place.
This, again, is one reason why the historical tendency toward ever more Progressivism tends to be a great, ponderous, one-way, gear-and-cog mechanism.
There’s a heap of blame for every aspect involved.
The problem dates back to the foundation of the American Medical Association in 1847. It was founded in reaction to the economic threat posed by the homeopaths, who had formed a national medical association two years previously. At this time, there was no reason known to what we would today consider valid in the science of the day to prefer “regular” medicine to homeopathy.
The regular profession struggled. The most garish advertising permitted by professional journals of the day were “tombstone” ads, which were a framed announcement something along the lines of “Eli Lilley proudly announces the release of the finest laudanum available to the profession” or “After a shortage, we are happy to announce new supplied of xxx.” Another “ethical” stricture was the AMA’s ban on professional association with “sectarian” practitioners such as homeopaths.
This resulted in some very bad publicity when an AMA affiliated local medical society expelled a physician for discussing a patient with a colleague, who was a homeopathic physician – and his wife. (Since one had to be a member in good standing of the local society to have hospital privileges, this was a serious penalty.)
It was considered to be unethical to advertise “patent” medicines through most of the 1800s. The financial incentive was too great, and in about 1897 (the records of the discussion were lost in a fire at the AMA headquarters) patent medicines were permitted to be advertised, provided that the patentholder submitted the formula to a committee of the AMA
JAMA’s revenues began to climb, which in turn financed new political activity. This included a long, ultimately unsuccessful attempt to prevent first chiropractors and then acupuncturists from gaining state licensure, and an ongoing campaign to deny licensure to naturopathic physicians wherever possible.
Having failed at the state level, the AMA undertook a campaign to “contain and eliminate” chiropractic. This came out in a lawsuit, Wilk v AMA et al. The leaked documents in which this goal was stated featured prominently in the plaintiffs’ case and also made it clear that whatever the public rhetoric might be, the primary motive was to eliminate an economic competitor. (One charge the AMA leveled at chiropractors was that they advertised. The AMA came out with its own practice promotion materials and advertising guidelines starting around 1990.)
This led to the Appeals Court ruling, on which the Supreme Court refused certiorari, finding that the AMA had engaged in illegal restraint of trade.
Among the things that led the plaintiffs to sue:
•Refusal of MDs and hospitals to release X-rays and other medical records to a chiropractor despite a signed release from the patient; such refusals, enen in violation of state law, were common well into the 1990s and only began to stop when the ruling went against the AMA.
•A hospital threatening a neurologist with loss of privileges if he continued to evaluate multiply handicapped children as part of a multidisciplinary medical/chiropractic/rehab/educational charity started by a Kentucky chiropractor.
Since its founding the AMA was promoting the economic interests of its members even to the detriment of patient care.
The problem actually dates back to the Fall of Adam.
What’s new is that that, in the past, the profession of medicine at least “professed” to hold itself to a certain standard of behavior, regarding the relationship between doctors and their patients. That standard is now gone.
Americans. of all people, should know how important standards are. The Declaration of Independence asserted a standard that was manifestly unmet at the time but which, over a few generations, ultimately produced a Big Fight that removed the major impediment to that standard.
Even when unmet, standards create a certain check on behaviors, and may create a tendency, over time, toward their actual fulfillment. That is now gone for the medical profession, and that’s what is new here.
If your point is that the AMA sucks and does things against the public interest, you will not get an argument from me. You will also not likely get an argument from the more than 75% of American physicians who have refused to join, and who largely disdain the organization.
Hypocrisy may be the homage vice owes to virtue, but it’s one thing to aspire to virtue and another to use it in a con – as the AMA did from its inception. True, there were many, many dedicated physicians who were proud members of the AMA; one of whom was my grandfather, A”H. The CPUSA did, of which at least one of my grandfather’s sisters-in-law was a proud member did the same. (His mother-in-law was a follower of Emma Goldman.)
I wonder what it would take to just change that particular prohibition …
Ah, but this prohibition is the SJW’s work. They want a single payer system whose main feature is not quality but egalitarianism: if everyone can’t have it at government expense, you may not buy it with your own money. This rule is but a way-station en route to the finished product.
The AMA’s declining membership and power is one of the few positive developments in the politics of American medicine in the last several decades.
ON the other hand, the CPUSA is a shadow of its former self yet one of its protegés occupied the White House and its ideology now dominates education and the media. The government’s trend is for a monopoly in medical care… which is pretty much what the AMA was pushing, though it wrongly assumed the perpetuity of private practice.
This is the key. And this is a main reason why (Dr. Publius argues) we should consider supporting Ryans’s plan. (See Number 5.) The plan resurrects HSAs, which will assure that patients are allowed to, and encouraged to, pay their own way, to at least some extent. Re-establishing the principle that individuals have a right to use their own resources for their own healthcare is critical. Doing so and making it stick would ultimately be fatal to the Progressive program.
To quote from the Medicalist No. 5: HSAs are to Progressives as the crucifix is to vampires.
Agreed: Monopolies are a bad thing, no matter who runs them. It was the rise of monopolies, after all, that originally gave rise to the Progressive era.
I want HSA.
I’m not sure I agree with this. As a small business owner, I paid more attention to the details of the doctor patient relationship (actually a course in medical school) than most of the young physicians I know. Recently, my wife who has COPD developed pneumonia and the pulmonary specialist I have known for 30 years sent her to the hospital ER where the ER docs, who are in a contractual relationship with the hospital ownership, decide if she should be admitted. When I asked him about this detour, he told me, “These are not the days we knew. I cannot admit a patient without their approval.” We have not been back to him or that hospital.
Actually, I would modify this to state the AMA was promoting the interests of its Board of Trustees. The story of the RVS code and its morphing into the CPT code is an example. Another is the birth of the RBRVS.
Patients did their part in this too, when they demanded to be treated as “customers”.
What they didn’t realize is the customer pays the bills, be he individual, insurer or government. What they want and what the patient needs may be very very different…