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Helen & Harry Highwater's cranky weblog of news and opinion.
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"News that's not known, or not known enough." Helen & Harry Highwater's cranky weblog of news and opinion. |
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Greed is the problem with US medical care
I wonder if a doc could make a decent living with a cash only practice charging affordable ratesThis is a very hard discussion. Evil has been hard at work for decades to alter the practice of conventional medicine to suit its needs rather than the needs of workers and patients.
There are a whole host of concrete reasons why a cash-only practice is doomed to fail anywhere in the US, with the possible exception of some niche practices such as cosmetic surgery or dermatology. One of the main ones is that the potential non-insured, cash patients are divided into a bimodal distribution. This distribution is between the legions of the poor, who by themselves can not support such a practice, and the tiny segment of the very rich who tend to be patrons of the classy institutions such as Stanford or the Cleveland Clinic. Everywhere you look in our economy it is the same way. Small business is sucking wind, whether it is your local independent gas station or your local independent practitioner. The deck is WAY stacked against any individual economic player, no matter the business, no matter the profession. Independent business people have become just another species of prey for the two legged wolves that stalk our land. For instance, I don't know of a single independent or small medical practice that has evaded the tragedy of embezzlement and/or sophisticated confidence scams. Once a practice takes on insurance contracts, all doors to independent decision-making slam shut. Governmental regulation, which the usual right-wing ideologue doctor loves to complain and whine about, is instituted almost uniformly at the behest of large corporate interests (that fund right-wing causes) and results in a net of compulsion woven so fine that any doctor trying to go it alone, as you suggest, soon finds herself trapped and immobilized, often without any real understanding of what happened to ruin their dreams of independent practice. Mandated costs, malpractice insurance (if you want to do any hospital practice or take any insurance), high rents, the salaries and benefits for employees needed to conform to the demands of government and insurance regulation, continuing education requirements, mount up to an insurmountable economic burden for anyone contemplating private practice. Private practice on a cash-only basis, except for a few niche practices mentioned earlier, does not free you from mandated costs in proportion to your overall loss of income from going cash only. This is essentially how a mature, criminally organized economy works. You can't get to desirable destinations from where you are at.
Here is a story about a physician I have corresponded with about these issues. She has a cash only practice now. As a dermatologist she is in a much better place to be able to do this than a pediatrician or any primary care doc. I don't know, but it might be easier in Hawaii than other states. Hawaii doctor says no to insurance company partnership
Ah, we now encounter the irony of specialization. I am sure you would be happy with her, and she with you, if the question had to do with your skin. Outside of that, I'm sure she would agree, it would not be a happy relationship. If the building industry was organized along the lines that medicine in the US is now set then there would be no general contractors. The houses that resulted would disappoint everyone. But this is exactly what US medicine looks like. People are happy with their gynecologist, their gastroenterologist, their urologist, but the parts do not add up to a whole. My recent experience is instructive. After many years of going without medical insurance I was finally able last year to seek care. I had struggled for three years with left sided body pain, bad, disabling attacks of pain. The urologist cut out my bladder tumor, which was great, but I remained disabled, and he had nothing to offer about the pain. The gastroenterologist scoped my GI tract and removed a polyp that needed to be removed, for which I was grateful, but I remained disabled and going progressively downhill from debilitation due to lack of exercise secondary to avoiding the pain. I went to a physiatrist, who's specialty is musculoskeletal pain and he diagnosed me with an autoimmune muscle disease, which I may in fact have, but, in spite of intensive physical therapy I remained with daily attacks of excruciating left sided body pain. During this time I also saw three different so called "primary care doctors" and the only thing they did for me was send me to the specialists and I remained in severe pain. Finally, I put a couple of neurons to work and realized that the pain I was experiencing was classic for referred pain from gastroesophageal reflux. I instituted appropriate therapy on my own with over the counter medicines and these days I rarely have the pain problem. I am still left with a muscular debilitation, and that will take many months, perhaps years, to rectify, but basically I am cured. In retrospect I might have been better served by going to the emergency room with a complaint of chest pain. I would have been subjected to a lot of unnecessary tests, but the likelihood is that the ER doctor, since it is a routine presentation of a common problem, would have identified my pain problem as originating from the reflux rather than from an ailing heart. To make it worse, the gastroenerologist had identified a burn in my lower esophagus but failed to connect my primary complaint, left sided body pain, with the lesion. I am a pediatrician, and this is adult medicine, so I forgive myself a little for allowing myself to be led down the wrong path by so many of my colleagues. The ultimate irony is that the hardest job, the job of the primary care physician, is the least prestigious and the least well compensated and the least well trained here in the US. Consequently fewer medical students are opting for primary care specialties and the practice of primary care, what you identify as being done by a "general practitioner," is in rapid decline. The problems of medical care in the US are complex and hard to understand, but the cause is easy to identify: greed by the corporate influences that are picking over the corpse of US medical care. This is the reason why US medicine is falling rapidly behind all other industrialized countries and many poorer ones as well. You are close to Canada. Canadian medicine, in general (though it is under the same corporate assault as has ruined us) is much more competent than what you will find here unless you are lucky to find one of the diminishing number of well trained, conscientious physicians remaining in practice in the US. Many competent physicians I know have simply left medicine for some other field. Most, however, remain in deep denial. Good luck.
I just meant that being close to Canada you probably have some experience with it and Canadians. Wisconsin and Ontario, at least the southern part are pretty similar I suspect. I have traveled through both but just on the way to somewhere else.
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