Now the Doctors are coming for your feet; (lobbyists, lobby, economy)

[KevK]

Originally Posted by hawkeye2009

I think KevK would like to ban all medicines and the practice of medicine, as he really hates physicians.

Simple solution- don't go to doctors. You don't have to do so, particularly if you sincerely believe we are not trying to help anyone and believe all of medicine is a scam.

Nobody in my family goes NEAR a doctor unless we have to or for the semi annual mommagram for my wife. I don't need to run to the doctor everytime I see a new ad for prescription drugs on TV (which also should be BANNED) and tell him "I think I got restless leg syndrome" so I can get that new drug I saw on TV. And the thing of it is I have excellent healh insurance- only pay $40 co pay.

[KevK]

Originally Posted by DC at the Ridge

You need to think about how much medical school costs. And that during their internships and residencies, they aren't raking in the dough. They have financial pressures as well. While there are doctors making millions, there are also doctors working pro bono in charity clinics and doctors volunteering their time and talents for various charities. The problems in healthcare aren't because doctors are evil, or because insurance companies are evil, or because lawyers are evil. There may be bad apples, and money is part of the problem, but we don't accomplish anything with broad generalizations. We need to fix problems, not create problems.

OK well maybe I was a bit general in my condemnation of the medical profession but it is so full of greed and crooks, it is hard to see the good people in it!

[PNW-type-gal]

Originally Posted by azriverfan.

Overall, the idea is just a little insulting. It's assuming, we are not already doing our job. We don't need financial rewards to improve patient outcome. That is our job. No physician would ask or expect extra money to want to see a diabetic not have their foot amputated.

And you are deliberately missing the point here. Nowhere did Obama say that it's a profit issue for doctors. What he said was that it was a reimbursement issue for reactive rather than proactive medicine (I have no idea where he got those dollar amounts and I will say that his knowledge of the ins-and-outs of diabetes is not very good).

But say you have an patient with diabetes. How much time can you spend with her?

Now let's say that the system is changed so that you can refer that patient and family to an RN that can spend an hour with her explaining the ins and outs, to a dietitian, to a physical therapist, to a home health aide - without the need for referrals, without the need to get approval, etc. The patient is able to quickly get a full understanding of the disease and the issues and is more likely to be compliant, especially with quick follow-ups.

Would that really be such a bad thing?

[mimimomx3]

Originally Posted by azriverfan.

I'm a physician and disagree with Obama's statements. All physicians have experience treating diabetics. Those who have experience treating them can tell you that diabetics with complications resulting in amputation is often due to socio-economic and lifestyle issues. Those patients are non-compliant with their medication and lifestyle. Many of them are alcoholics, depressed and have other issues. Many simply refuse to eat healthy, exercise and limit their intake of alcohol.

I don't understand how offering financial rewards for improved outcomes will affect outcomes. Primary care physicians already have incentive to see their diabetic patients improve. They make nothing from referring the patient to a surgeon for an amputation. They actually lose money when they refer a complicated diabetic to an endocrinologist because the patient then follows up with the endocrine specialist instead of the PCP.

Furthermore, it won't improve patient care because many physicians will discharge or refuse to treat complicated patients because it could prevent them from getting bonuses or compensation if their pay is based on outcomes. They will prefer to see less sick people who are compliant with their medication and lifestyle knowing their "outcome rate" will be positive. All that will do will make it even harder for diabetics with complications to be seen and it's not going to lower costs because those patients are still going to be sick.

Overall, the idea is just a little insulting. It's assuming, we are not already doing our job. We don't need financial rewards to improve patient outcome. That is our job. No physician would ask or expect extra money to want to see a diabetic not have their foot amputated. As I mentioned, the surgeon only sees the patient after he has been referred by his primary care physician or endocrinologist. Again, I would like Obama to explain what incentive the primary care physician and endocrinologist would gain from referring the patient to a surgeon for amputation?

As Dr. Sanjay Gupta stated on CNN last night, President Obama's means of recovering costs through improved outcomes is nebulous. Just because physicians will be rewarded for improved outcomes doesn't mean patient morbidity will be improved because the frank truth is diabetics and patients with heart disease are not compliant with the medication and lifestyle changes. I'm not belittling these patients. It is very difficult to maintain a strict regiment of giving yourself insulin at a set schedule and watching your weight and exercising. It's not easy and I do sympathize with those patients. At the same time, there is only so much a doctor can do when diseases like diabetes is largely attributed to lifestyle and compliance with medication.

Thank you for your post. Very interesting.

[Katarina Witt]

Originally Posted by KevK

Maybe you and the doc should show some damn courage and tell the patient NO! Ever tried that?? NO you don't need this drug, that drug and every other drug you see on TV! No! No! No! Try it! And if they don't like it, tell them to go to some other flunky doctor and try to get it.

Good Lord! Where did you get your MD and your right to micromanage every physician practice in the country?

You completely misunderstood what I said, that we only prescribe a brand-name if the patient insists on the brand name. Maybe I have to spell this out for people with no health care background, but that meant that IF the drug the dr prescribed for the pt's condition is available in generic and the pt. does not want generic, the doc will say "do not substitute". The doc does not prescribe something just b/c the pt. wants a prescription, though we see plenty of pts who want just that.

Maybe you should show some damn courage and apologize to me!

[Jill61]

Originally Posted by Katiana

Good Lord! Where did you get your MD and your right to micromanage every physician practice in the country?

You completely misunderstood what I said, that we only prescribe a brand-name if the patient insists on the brand name. Maybe I have to spell this out for people with no health care background, but that meant that IF the drug the dr prescribed for the pt's condition is available in generic and the pt. does not want generic, the doc will say "do not substitute". The doc does not prescribe something just b/c the pt. wants a prescription, though we see plenty of pts who want just that.

Maybe you should show some damn courage and apologize to me!

Not to mention, it doesn't benefit you in any way, shape or form, whether the patient is willing to spend more money on the name brand vs the generic, and whether their insurance will cover it or not.

[KevK]

Originally Posted by Katiana

Good Lord! Where did you get your MD and your right to micromanage every physician practice in the country?

You completely misunderstood what I said, that we only prescribe a brand-name if the patient insists on the brand name. Maybe I have to spell this out for people with no health care background, but that meant that IF the drug the dr prescribed for the pt's condition is available in generic and the pt. does not want generic, the doc will say "do not substitute". The doc does not prescribe something just b/c the pt. wants a prescription, though we see plenty of pts who want just that.

Maybe you should show some damn courage and apologize to me!

Then you tell that patient "we always prescribe the generic when it is the SAME as the TV drug and when it cost LESS. That is our policy. If you don't like it, hit the road". It is practices like this that are driving cost for the rest of us sky high. Because that patient is most likely NOT paying for that drug. His insurance company or HMO is.

[old_cold]

Originally Posted by KevK

Then you tell that patient "we always prescribe the generic when it is the SAME as the TV drug and when it cost LESS. That is our policy. If you don't like it, hit the road". It is practices like this that are driving cost for the rest of us sky high. Because that patient is most likely NOT paying for that drug. His insurance company or HMO is.

Patients care very much.
The co-pay on brand name drugs is usually more than the generic

[Nomander]

Originally Posted by DC at the Ridge

You bring up a case where the system worked. Other people bring up cases where the system didn't work. Is it your argument that since it worked in your case, the system always worked, and that these other cases are not failures of the system? Or is it your argument that since it worked in your case, that you don't care about the people the system fails? As long as it works for you, the rest of the people can suffer? Your argument has echoes of "they have no bread? then let them eat cake!"

I am not claiming there isn't problems or using a single experience to make a generalization. My wife worked in the health insurance industry for over 6 years and she has seen what "actually" goes on with the claims in both the government and private sector.

The claims being made about doctors cheating, insurance companies denying, and other abuses do happen, but are they the majority as you seem to think? Are these cases to which fancy movie scripts could be written the norm? Only a fool pushing propaganda would think so and only a fool would attempt to claim that a government system would be the solution to the issue if it were even true. My wife has seen more of your "horror" stories with government claims than she has private.

I can say, that in my small contact experience combined with my wife's (which involved millions of claims a year), the claims being made by the UHC proponents is nothing short of manipulation and deceit.

Health care has an infection, it needs treatment. For the most part, it is working, but needs some adjustments. We should treat it in order to preserve individual freedoms to choose and avoid excessive taxation. UHC is nothing short of amputation administered by a physician who has no clue of what they are doing.

[DC at the Ridge]

Originally Posted by Nomander

I am not claiming there isn't problems or using a single experience to make a generalization. My wife worked in the health insurance industry for over 6 years and she has seen what "actually" goes on with the claims in both the government and private sector.

The claims being made about doctors cheating, insurance companies denying, and other abuses do happen, but are they the majority as you seem to think? Are these cases to which fancy movie scripts could be written the norm? Only a fool pushing propaganda would think so and only a fool would attempt to claim that a government system would be the solution to the issue if it were even true. My wife has seen more of your "horror" stories with government claims than she has private.

I can say, that in my small contact experience combined with my wife's (which involved millions of claims a year), the claims being made by the UHC proponents is nothing short of manipulation and deceit.

Health care has an infection, it needs treatment. For the most part, it is working, but needs some adjustments. We should treat it in order to preserve individual freedoms to choose and avoid excessive taxation. UHC is nothing short of amputation administered by a physician who has no clue of what they are doing.

Actually, I don't think the majority of doctors are irresponsible in how they conduct their practices at all. I do think that we often expect doctors to be super-humans, and they are not. If the problem were just about a few bad apples, then may some adjustments would be all that's needed. That's not the big problem, though. This reform doesn't promise UHC, it simply expands certain options for people currently unable to afford insurance. The big problem with the healthcare system is that we already have a public option, called Medicare, and that as the baby boomers retire, they are going to sign on to that option. At the current cost levels for care, our country will not be able to financially support that program, and transferring those baby boomers to private programs will also not be financially viable for those retirees. The healthcare industry is poised to break the US economy, unless healthcare costs can be controlled. That's the problem. We already devote far more of our GNP to healthcare than any other country in the world. We have a huge segment of the population approaching an age when health problems begin to present themselves. Which would lead to government and individuals expending even more resources on healthcare, an even greater percentage of our GNP. The pie is only so big. If healthcare takes more and more of that pie, there's less pie to go around. Some of that pie goes to things that are about maintaining the size of the pie. Electrical grids, water supply, education, transit systems, are all parts of the pie that are investments to keep the pie from shrinking in size. If the pie shrinks from a 12 oz pie to a 10 oz pie, but healthcare doesn't shrink from 3 oz, then it takes an even more significant portion of the pie. The urgency is that baby boomers have already started to retire. The next 25 years is going to test the limits of our healthcare system. It's not going to be like the last 25 years when retirement levels were fairly steady. It's a bubble in the pipeline, and a big bubble. Healthcare reform is about having some measure of control on costs in order to maintain the country's economic well-being.