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Old 11-02-2009, 10:27 AM   #81
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My mother's doctor retired recently, and she had an incredibly difficult time finding another doctor in her small city area who would take a Medicare patient. It might be easier in bigger cities, I don't know. But the reimbursement issue is going to be huge (if it happens).
Imagine how difficult it is from someone with no insurance at all. A single group protecting themselves at the expense of others doesn't have much of a high ground on which to stand.
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Old 11-02-2009, 10:40 AM   #82
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Old 11-02-2009, 11:06 AM   #83
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Ben Franklin pulled it off at the age of 42 without pensions or healthcare, and made his portfolio last another four decades. Admittedly he picked up the odd free-lance writing job along with some research contracts. So maybe a better term would be ESR.

I think ER is wildly popular in the last couple years of every bull market, and extinct after the first year of every bear market...
Well Ben Franklin had a few folks help him along the way, as well as being one of the smartest men to have ever lived........
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Old 11-02-2009, 06:46 PM   #84
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I'm speaking from the experience of three recent town hall meetings (two of which were held by local congressmen). To a person, the ones screaming were senior citizens. And they were screaming loudly. The most common refrain was literally "Leave my Medicare alone!". I seriously doubt that any of them actually knew anything at all about any proposals.
My response was intended to illustrate that it's entirely possible that your screaming seniors DID know something about the proposals. Just because they don't agree with you doesn't mean they are ignorant of how it will effect their situation.

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Imagine how difficult it is from someone with no insurance at all. A single group protecting themselves at the expense of others doesn't have much of a high ground on which to stand.
It is good to know that there are some out there willing to throw their own self interest under the bus for the greater good. Keep up the good work.
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Old 11-03-2009, 08:07 AM   #85
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It is good to know that there are some out there willing to throw their own self interest under the bus for the greater good. Keep up the good work.
Not everyone is selfish and heartless. Some people willingly sacrifice so others can survive. Others simply don't give a squirt about anyone other than themselves. I know both types.
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Old 11-03-2009, 08:34 AM   #86
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Not everyone is selfish and heartless. Some people willingly sacrifice so others can survive. Others simply don't give a squirt about anyone other than themselves. I know both types.
We all do, but most of the folks who want to reign in the spending want to help those who truly need the help. Not those who chose not to help themselves. Right now it is a tough job market as many know all too well. But, even when there is not a tough market many seem to prefer to ride the welfare train. I do not mind paying taxes to help the seniors and truly disabled. I resent monies and services for lazy and cash under the table working people who choose to game the system. Many of us know these people as well.
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Old 11-03-2009, 10:04 AM   #87
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I do not mind paying taxes to help the seniors and truly disabled. I resent monies and services for lazy and cash under the table working people who choose to game the system. Many of us know these people as well.
I don't think any of us do. But the amount of actual abuse from the consumer end is pretty limited (or so I was told bya former district attorney who prosecuted Medicaid fraud). What is more salient is that a family of four living on a working wage depends on their employer's ability to pay health insurance premiums. In my state, these would run about $15k per year. The point is not abuse, it is runaway costs of a healthcare system, a cost which has been outstripping inflation and wages by a large margin. The elephant in the room is that while there are inefficiencies and abuse in the current system, the dollars we all spend on healthcare (from both taxes and premiums) eventually make their way into someone else's pocket. While it is popular to paint insurance companies as the big bag wolf, the fact remains that doctors and dentists can make $250k per year, nurses $90k, and x-ray techs $75k. As in most businesses, the majority of costs are in the staffing. Next time you go see your doctor, count the number of people drawing a salary in his office. Doctors are lamenting the Medicare reimbursement rates while driving Bentleys.
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Old 11-03-2009, 10:56 AM   #88
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Randy, there is a fairly large underground cash economy where I live. When the cleaning services for household chores offer "CASH" discounts and the cleaners admit to living in subsidized housing and being on AZ State funded insurance I know what they mean. I called for estimates on yard work for some tree removal just a few months ago. During the bid process I asked if they were insured and had 3 of them tell me they do not need insurance because I have homeowners and it will cover them if they get hurt! I think NOT. Taking everything you can from the government and working for cash is rampant. Many of the sign wavers advertising on the side of the road are paid in cash daily, survey takers in the malls, yard mtc, house cleaners, dog walkers are just a few that pop into my mind. They get the cash with no taxes and get subsidized housing, utilities, groceries and health care and pay no more than sales taxes. This is what is irksome to me. Then when they hit an age of being able to collect SS that is skewed to benefit the low earners. If the low earners have stayed "on the clock" and contributed ok. But I think there needs to be a crackdown on the under the table workers.

PS My Dr drives a 4 year old Honda
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Old 11-03-2009, 11:48 AM   #89
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I'm not sure why people believe the Medicare crowd hasn't thought this through. Both the Senate finance committee proposal and the newly announced House proposal call for very large cuts in Medicare reimbursement rates for doctors. These seniors already know it's getting harder to find care providers that accept Medicare because of the low reimbursement rates. Maybe they have good reason to doubt that these plans will improve their situation.

Interestingly, they might be the only people in America who believe the government will actually do something to reduce Medicare expenditures.
I've been Googling around trying to find something about "very large cuts in Medicare reimbursement rates for doctors". Medicare reimburesments are a complicated issue, here's an article that seems to make some sense Health Reform Threatened by Doctors' Reimbursement Rates - TIME

But it doesn't say anything about the Health bills cutting reimburesments. Maybe you can give me a link?
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Old 11-03-2009, 11:57 AM   #90
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I think we'll have a physician supply crisis if more and more patients are seen with Medicare's current reimbursement rates -- to say nothing of dropping them even more. I think many doctors (especially the older and more experienced ones) would simply retire or find another way to keep active rather than accept Medicare rates for more and more patients.

The only other way around this would be to prohibit the practice of not accepting Medicare patients, but that seems to have huge legal problems with it.
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Old 11-03-2009, 12:08 PM   #91
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God forbid we have doctors wanting to enter practice because they want to heal people. The AMA has assured a shortage of doctors educated in the US by limiting educational resources. We import an awful lot of (great) doctors from countries whose medical lobby is not quite so strong - look up one of the original aims of the AMA: to enhanace doctors' salaries.

The French model - which costs about 2/3 the US' - employs more doctors and fewer nurses with average salaries dramatically lower than those in the US. In fact, a French GP is said to average $55k per year. Admittedly they don't have to deal with the malpractice insurance costs or the legacy debt of education. While I believe everyone who works hard, betters themselves, and makes sacrifices should enjoy a comfortable life, it should not come at the crippling expense of others.

As far as low Medicare reimbursement rates, my last doctor had a lot of senior patients, and would have them stacked up like cordwood in the waiting room and occupying five exam rooms at the same time. He was billing for each of them, spending an average of 3 or 4 minutes per patient.
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Old 11-03-2009, 01:30 PM   #92
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I think we'll have a physician supply crisis if more and more patients are seen with Medicare's current reimbursement rates -- to say nothing of dropping them even more. I think many doctors (especially the older and more experienced ones) would simply retire or find another way to keep active rather than accept Medicare rates for more and more patients.

The only other way around this would be to prohibit the practice of not accepting Medicare patients, but that seems to have huge legal problems with it.
The same argument was made in 1948 when the NHS started in the UK. In fact British doctors were more opposed to a "single payer system" than US doctors today. However, pay should not be the only motivation for becoming a doctor, vocation must also be considered. The NHS has its problems, but it works well for the vast majority of those concerned. The doctors are well paid and the BMA negotiates their working conditions with the Government. Importantly doctors are salaried, not paid for procedures or the number of patients they see each day. As a consequence the PCP spends more time with each patient and doesn't order unnecessary procedures. PCPs earn about $100k/year and senior surgeons etc earn upto $300k. and don't have the issues with personal liability or educational expenses thaat US doctors do. It is a system where costs can be controlled and that delivers quality health care to 100% of UK residents at half the per capita cost of the current US system. The US really does trail the rest of the world when it comes to the delivery of health care.
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Old 11-03-2009, 01:56 PM   #93
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God forbid we have doctors wanting to enter practice because they want to heal people. The AMA has assured a shortage of doctors educated in the US by limiting educational resources. We import an awful lot of (great) doctors from countries whose medical lobby is not quite so strong - look up one of the original aims of the AMA: to enhanace doctors' salaries.

The French model - which costs about 2/3 the US' - employs more doctors and fewer nurses with average salaries dramatically lower than those in the US. In fact, a French GP is said to average $55k per year. Admittedly they don't have to deal with the malpractice insurance costs or the legacy debt of education. While I believe everyone who works hard, betters themselves, and makes sacrifices should enjoy a comfortable life, it should not come at the crippling expense of others.

As far as low Medicare reimbursement rates, my last doctor had a lot of senior patients, and would have them stacked up like cordwood in the waiting room and occupying five exam rooms at the same time. He was billing for each of them, spending an average of 3 or 4 minutes per patient.

Sounds great. Let's all have doctors working on secretary salaries. Sounds like we can all expect great service. Al least it's nothing important...just your health. Who do those doctors think they are anyway? Just because they went through many difficult years of schooling followed by several years of internship. Just because they have skills and abiliites that are in demand and exceed the skills required of most typical jobs. So what. They should accept their pay of less than a plumber or roofer and be happy about it. After all, we all went into our respective professions for nobler causes than to expect great pay for great work. Salary is so overrated.

America needs to more like France. That should be our goal. Aim high.
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Old 11-03-2009, 02:03 PM   #94
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Sounds great. Let's all have doctors working on secretary salaries. Sounds like we can all expect great service. Al least it's nothing important...just your health. Who do those doctors think they are anyway? Just because they went through many difficult years of schooling followed by several years of internship. Just because they have skills and abiliites that are in demand and exceed the skills required of most typical jobs. So what. They should accept their pay of less than a plumber or roofer and be happy about it. After all, we all went into our respective professions for nobler causes than to expect great pay for great work. Salary is so overrated.
Because everyone knows we all have the ability to comparison shop when we're in the ER. And if it means people live longer, live healthier, commit less resources to healthcare, and don't live in fear of medical bankruptcy, maybe we should be like France. Or Canada, Japan, or Switzerland perhaps. No doctor is going to cause me to shed a tear for their financial hardship. There are plenty of people to have committed their lives to other causes in the service of others for far less compensation. I don't think anyone thinks that those who commit effort and ability and make sacrifices should not be compensated, but on whose back? And since when has money been the sole measure of a person's worth?

The simple fact is that in the areas of healthcare and education the rate of increase has double or tripled
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Old 11-03-2009, 02:08 PM   #95
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The simple fact is that in the areas of healthcare and education the rate of increase has double or tripled
And what do health care and education have in common? The true costs of both are mostly hidden from the consumer of the services, so we have a tendency to overconsume them because to us, they feel "cheaper" than it really is. This can lead to a situation where demand constantly exceeds supply and the result is rapid inflation.
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Old 11-03-2009, 02:10 PM   #96
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Yeah, I guess my father in law overconsumed his share of cancer treatments. Selfish bastard.
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Old 11-03-2009, 02:13 PM   #97
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Yeah, I guess my father in law overconsumed his share of cancer treatments. Selfish bastard.
Wow, that was a prompt and impressive non sequitur.
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Old 11-03-2009, 02:16 PM   #98
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Wow, that was a prompt and impressive non sequitur.
Yeah. What on Earth does that have to do with this Forum becoming extinct?
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Old 11-03-2009, 02:22 PM   #99
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Yeah. What on Earth does that have to do with this Forum becoming extinct?
The cost and consumption of health care is one of the things that stops people from ERing, so it seems to be very relevant to the future of ER, and by extension, this forum
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Old 11-03-2009, 02:30 PM   #100
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