Hey Massachusetts! Coakley or Brown?

[DrDemento]

Re: Hey Massachusetts! Coakley or Brown?

Mookie-I was lucky enough to start practice during those good old days you mention. Patients were actually responsible for most of their own bills-which were modest. I charged $15 for a first office visit and $10 for a follow up. Tests were ordered when really needed and not just to cover my behind against possible lawsuits. If someone had a headache-a careful history was taken and if nothing serious was suspected, given some aspirin and advised to call back if not better quickly. Nowadays that same headache necessitates at the very least a neurology consult for CAT scan and MRI and an ENT consult for sinus films and a complete ENT exam. (even if it resolves quickly)
Medicine is different today and is practiced under totally different conditions. We will never see those days again. 9 years ago I semi retired because I could no longer deal with the Insurance companies, the HMO's, and Medicare-all telling me what I could and could not do for a patient.

 

[huskyfan]

Re: Hey Massachusetts! Coakley or Brown?

house calls! I remember house calls!

 

[Patman]

Re: Hey Massachusetts! Coakley or Brown?

Mookie-I was lucky enough to start practice during those good old days you mention. Patients were actually responsible for most of their own bills-which were modest. I charged $15 for a first office visit and $10 for a follow up. Tests were ordered when really needed and not just to cover my behind against possible lawsuits. If someone had a headache-a careful history was taken and if nothing serious was suspected, given some aspirin and advised to call back if not better quickly. Nowadays that same headache necessitates at the very least a neurology consult for CAT scan and MRI and an ENT consult for sinus films and a complete ENT exam. (even if it resolves quickly)
Medicine is different today and is practiced under totally different conditions. We will never see those days again. 9 years ago I semi retired because I could no longer deal with the Insurance companies, the HMO's, and Medicare-all telling me what I could and could ot do for a patient.

The general issue is that people don't like the fact that they have to deal with the unintended consequences... a lot of reaction we see now is a reaction to things done meant to help us in the first place.

Everybody's heart is largely in the right place... but this isn't an easy simple thing we're working with given what people ask for... and its reasonable that people want to ask for it. They want to be healthy and safe... and similiarly they want others to be healthy and safe.

 

[Old Pio]

Re: Hey Massachusetts! Coakley or Brown?

Mookie-I was lucky enough to start practice during those good old days you mention. Patients were actually responsible for most of their own bills-which were modest. I charged $15 for a first office visit and $10 for a follow up. Tests were ordered when really needed and not just to cover my behind against possible lawsuits. If someone had a headache-a careful history was taken and if nothing serious was suspected, given some aspirin and advised to call back if not better quickly. Nowadays that same headache necessitates at the very least a neurology consult for CAT scan and MRI and an ENT consult for sinus films and a complete ENT exam. (even if it resolves quickly)
Medicine is different today and is practiced under totally different conditions. We will never see those days again. 9 years ago I semi retired because I could no longer deal with the Insurance companies, the HMO's, and Medicare-all telling me what I could and could not do for a patient.

My father was a prominent cardio-thoracic surgeon in Chicago (professor of surgery at Northwestern) and nobody was ever turned away from his office for inability to pay. In those days, Docs used the sliding fee to make it possible to provide services for folks who had no money. He always charged five times the going rate when the occasional mobster showed up at his office, and they always, willingly paid.

 

[Shirtless Guy]

Re: Hey Massachusetts! Coakley or Brown?

The big thing that needs to happen is tort reform so we can reduce malpractice insurance, and get back at least some of what was lost th drdemento mentions.

 

[Old Pio]

Re: Hey Massachusetts! Coakley or Brown?

The NY Times, drinking deeply from the Kool aid, provides this analysis of what Tuesday's results weren't.

"To our minds, it is not remotely a verdict on Mr. Obama’s presidency, nor does it amount to a national referendum on health care reform — even though it has upended the effort to pass a reform bill, which Mr. Obama made the centerpiece of his first year."

More beatings to follow, surely.

 

[Patman]

Re: Hey Massachusetts! Coakley or Brown?

The big thing that needs to happen is tort reform so we can reduce malpractice insurance, and get back at least some of what was lost th drdemento mentions.

I think i'll agree with others that tort reform, while it would probably be helpful, is not the critical item of impact in terms of health care costs.

What tort reform will do is bring people back into wanting to be doctors. I knew one guy at Uconn in my class who decided not to go down the medical route just because of those issues. You have to wonder how many talented people we lose to those issues. Add to that if we are losing talented persons then we're losing in on possibilities by bringing down costs due to an increase in the number of doctors (supply and demand).

 

[Jon]

Re: Hey Massachusetts! Coakley or Brown?

I just want to get blown... Like right now!

Who here doesn't?

 

[LynahFan]

Re: Hey Massachusetts! Coakley or Brown?

I find it interesting that there's actually starting to be some rational health-care discussion on this thread from posters of various political leanings and we're even finding some common ground, now that the Senate is split more-or-less evenly again. Hopefully this change will be reflected in the national debate as well!

Hugs, anyone?

 

[walrus]

Re: Hey Massachusetts! Coakley or Brown?

The NY Times, drinking deeply from the Kool aid, provides this analysis of what Tuesday's results weren't.

"To our minds, it is not remotely a verdict on Mr. Obama’s presidency, nor does it amount to a national referendum on health care reform — even though it has upended the effort to pass a reform bill, which Mr. Obama made the centerpiece of his first year."

More beatings to follow, surely.

It reflects the frustration of voters, not the last one or 2 years but the last 8 years, whats the matter with you

 

[leswp1]

Re: Hey Massachusetts! Coakley or Brown?

Start with the easy ones. Smoking for starters. Morbid obesity being another. In each case you could give the person a couple of chances to change their lifestyle (for example insurer covers smoking cessation or weight loss classes). If after that the problems continue, pay up.

For the fatties, I don't want to start hiking rates for people 20 pounds overweight, because opinions can differ for proper height/weight/body mass ratios. However if you're 100 pounds overweight its safe to say you blew away any reasonable scale (no pun intended).

I agree. That would be awesome. I can see the wars now tho (they have already started in other settings/lawsuits were people blamed their actions on their nicotine addiction against the tobacco industry) that these are addictions, people have a genetic disposition toward.

Mookie-I was lucky enough to start practice during those good old days you mention. Patients were actually responsible for most of their own bills-which were modest. I charged $15 for a first office visit and $10 for a follow up. Tests were ordered when really needed and not just to cover my behind against possible lawsuits. If someone had a headache-a careful history was taken and if nothing serious was suspected, given some aspirin and advised to call back if not better quickly. Nowadays that same headache necessitates at the very least a neurology consult for CAT scan and MRI and an ENT consult for sinus films and a complete ENT exam. (even if it resolves quickly)
Medicine is different today and is practiced under totally different conditions. We will never see those days again. 9 years ago I semi retired because I could no longer deal with the Insurance companies, the HMO's, and Medicare-all telling me what I could and could not do for a patient.

Great post. When I started it was the same. Also no HMOs, no co-pay. You paid upfront. I never saw the 1 hour sore throat then. People didn't come back 5 times to tell me they didn't do what was recommended because the culture was different and they couldn't afford it.

house calls! I remember house calls!

I did those and rounded nursing homes. Can't afford to do those now. Stopped 10 yrs ago when they were reimbursing 12$ for a visit. Lost about 80% of what I could make in the office for every hour I was gone.

My father was a prominent cardio-thoracic surgeon in Chicago (professor of surgery at Northwestern) and nobody was ever turned away from his office for inability to pay. In those days, Docs used the sliding fee to make it possible to provide services for folks who had no money. He always charged five times the going rate when the occasional mobster showed up at his office, and they always, willingly paid.

Now if you want to slide a fee or waive one (we used to do that all the time) you need to have proof the person is financially distressed or the insurance companies come after you because you give the service away and the argument is we are commiting fraud because we are overcharging them what we give away for free. (or something to that effect. I just know they legally advise against it) Really stupid.

I find it interesting that there's actually starting to be some rational health-care discussion on this thread from posters of various political leanings and we're even finding some common ground, now that the Senate is split more-or-less evenly again. Hopefully this change will be reflected in the national debate as well!

Hugs, anyone?

HUG!

 

[Old Pio]

Re: Hey Massachusetts! Coakley or Brown?

It reflects the frustration of voters, not the last one or 2 years but the last 8 years, whats the matter with you

Just stupid, I guess. Just repeat after me: Everything, everywhere is George W. Bush's fault. There, I feel better already.

 

[goldy_331]

Re: Hey Massachusetts! Coakley or Brown?

After the discussion of Oberman's comments on here, I watched a little of him the other night. I don't watch much of the cable news networks, unless there is a big breaking story. And I don't watch their opinion shows. I expected Oberman to be like Hannity, only on the left. Wow, what a fruit loop! That guy makes Hannity look like a rational centrist by comparison. He's more like a lefty version of Michael Savage - totally over the top. At least based on the little bit I've watched.

 

[geezer]

Re: Hey Massachusetts! Coakley or Brown?

After the discussion of Oberman's comments on here, I watched a little of him the other night. I don't watch much of the cable news networks, unless there is a big breaking story. And I don't watch their opinion shows. I expected Oberman to be like Hannity, only on the left. Wow, what a fruit loop! That guy makes Hannity look like a rational centrist by comparison. He's more like a lefty version of Michael Savage - totally over the top. At least based on the little bit I've watched.

I enjoyed Jon Stewart's comeback. "Hey! That's my job!"

 

[Shirtless Guy]

Re: Hey Massachusetts! Coakley or Brown?

Just stupid, I guess. Just repeat after me: Everything, everywhere is George W. Bush's fault. There, I feel better already.

Here in Minneapolis, they are running mock commercials starring Hugh Topian...my favorite is this one. Remember, If your greedy corporate boss bothers you about something, remember its George Bush's fault

 

[DrDemento]

Re: Hey Massachusetts! Coakley or Brown?

Great post. When I started it was the same. Also no HMOs, no co-pay. You paid upfront. I never saw the 1 hour sore throat then. People didn't come back 5 times to tell me they didn't do what was recommended because the culture was different and they couldn't afford it.

I did those and rounded nursing homes. Can't afford to do those now. Stopped 10 yrs ago when they were reimbursing 12$ for a visit. Lost about 80% of what I could make in the office for every hour I was gone.

We first stopped rounding at nursing homes when medicaid reimbursed me $6.62 per patient. Having Jenny in the office with me made us far too efficient there to leave for Hospital vists, home visits, or nursing homes. I oly saw people who actually needed to be seen-and it was exciting and fun. I loved going into work. 35 years later we were earning more but enjoying it far less.

 

[The Sicatoka]

Re: Hey Massachusetts! Coakley or Brown?

Q: What does $300 million in "health care" spending for Mary Landreaux and freebies on health care for Ben Nelson really buy?

A: A Senate seat for Scott Brown.

 

[The Sicatoka]

Re: Hey Massachusetts! Coakley or Brown?

When Olberman buys a car he has the dealer remove the directionals from the starboard side of the vehicle before he takes delivery.

Why?

He never turns right.

 

[SPIN CONTROL]

Re: Hey Massachusetts! Coakley or Brown?

After the discussion of Oberman's comments on here, I watched a little of him the other night. I don't watch much of the cable news networks, unless there is a big breaking story. And I don't watch their opinion shows. I expected Oberman to be like Hannity, only on the left. Wow, what a fruit loop! That guy makes Hannity look like a rational centrist by comparison. He's more like a lefty version of Michael Savage - totally over the top. At least based on the little bit I've watched.

Olberman makes Glenn Beck look sane.

 

[Jon]

Re: Hey Massachusetts! Coakley or Brown?

Olberman makes Glenn Beck look sane.

Charles Manson is the only person who fits there.
I love Glenn, but he lives where the buses don't run...