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Tuesday, June 16, 2009

Ignoring history-doomed to repeat it ?

President Obama recently spoke to the American Medical Association and offered in part some reassurances that the public choice option would not lead to a single payer and his Secretary of HHS assured NPR listeners that their plan is not a Trojan horse with a single payer lurking inside.Various administration spokesmen have promised a plan that will increase coverage, save money and improve quality of care.

Sometimes insight may be gained by sitting back and reflecting on some recent (1965) past history.Here is food for thought from the Medicare bill.

I quote from section 1801:

"Nothing in this tittle shall be construed to authorize any federal official or employee to exercise any supervision or control over the practice of medicine..."

So how has that worked out?


MedicalSoundProofingSolutions said...

I'm sure you know how it has or hasn't worked out, but why don't you share for the rest of us. Or is this blog only for the insiders?


email me and I'll quit bugging you.

james gaulte said...

By 1992 Medicare had changed from its policy of paying physicians the customary,reasonable and prevailing fees to wage-price controls.So much for the "promise" of not interfering with the physician-patient relationship.The effect of those controls has been a decrease in primary care available to Medicare patients,a decrease in quality and an increasing dissatisfaction among primary care physicians and patients.The Medicare price controls have greatly influenced other third party payers as well as they follow their lead.Simply put what the government said it would not do, it did and things have worked out very badly,


Ellen Kimball said...

James, I've morphed over to your blog from Sid Schwab's Surgeonsblog.blogspot.com which links to yours.

I am interested in your viewpoint because my husband and I are in our 70s, with Medicare active and also part of Kaiser Permanente's Senior Advantage plan. Medical premiums and uninsured dental care are always the highest item in our budget.

We have been medical consumers since birth, but of course, there have been some really rough spots.

Pay per visit, or insurance payment was always operating in the past (1960, 70s, 80s, was always employment based and seemed reasonable. Most early care of our family (five kids, two adults) was by an internist in Concord, Massachusetts whom I considered a part of my personal life. If I had to be seen that day, I'd get in. He had a couple of nice secretaries. If I had a question about a prescription, the doctor would call me in the evening after rounds and we'd discuss it like a couple of colleagues. We left Boston, came to Portland, OR, in 1998. Still covered by Aetna or Prudential or whoever at the time.

That all changed in 2001 when my husband's employer, Egghead.com, went bankrupt in California. Hubby was 67, I was ONLY 62. Not only did the company abolish its medical plan, it told us that there would be NO COBRA BENEFITS as of August 31. Why? The company was SELF-INSURED. My husband went right into Medicare and we picked up Kaiser coverage.

Luckily, I made it into something that existed as Oregon's Medical Insurance Pool (OMIP) because I was turned down by four private insurance companies for low thyroid, a slight tendency to hypertension, some medications... Let's face it, I wasn't the youngest pea in the pod!

At OMIP, I had to pay $500 EVERY MONTH for just MYSELF as part of a PPO plan that was at best, just OK. We paid those high premiums until I qualified for Medicare at age 65. Thank goodness we had the money to do it.

Kaiser is OK, but as a medical consumer, the HBO that I am now navigating is filled with busy and usually competent caregivers who are younger, more transient, and who frequently know less about medicine than I do (I can't help that. I worked as an insurance investigator for large Conneticut companies on worker's compensation and medical malpractice claims). I don't know what the Kaiser doctors get paid and can't really transfer around to "choose" a doctor.

So, in your opinion, how would changing payment to a single-payer system benefit either doctor or patient? What combination of things can be considered? I don't know enough about the subject and have only a passing memory of Medicare when the laws were under consideration.

So, what is the answer? I'll read on to gain your insight.

Ellen K in Portland, OR

james gaulte said...

The relationship you enjoyed with your internist in Concord is the type of relationship my partners and I once had with our patients.The closest thing to that available today is with a doctor who has a retainer practice but even there it may be the case that if you are hospitalized you may well be treated by a hospitalist you have never seen and did not choose.

As the single payer issue (which both President Obama and his HHS secretary assure us they are not trying to bring about) I'll try and put together my thoughts in a later blog posting. Thanks for your comments.

Ellen Kimball said...

Thank james gaulte,

Erratum to above:

HBO, of course, should read HMO. I am, after all, a radio and TV entertainer. Excuse the typo and my inability to easily edit for this error.

I will look forward to learning from you. As explained on surgeonsblog.blogspot.com, I am a former radio talk show host now age 70 who had an early interest in medicine. I ended up as one of the first female talk show hosts with a call-in show in Miami and Boston. I talked to many doctor/authors in the 1970s & 1980s.

More recently, Dr. Sid Schwab was my guest on Oregon Public Broadcasting here in Portland where I was a volunteer from 2000 to 2008. He participated via telephone to talk about his interesting self-published book, "Cutting Remarks." He is a delightful writer. I am constantly amazed by his writing, and I know there is much disagreement among you doctors about how we Americans can ever unravel this Gordian knot of health care.

At one point, I did a radio interview with doctor here in Portland in who planned to open a private practice in which you could get personal service, including same-day appointments, email access to the doctor, etc.

The expression at the time was "boutique" medical practice. He would place a surcharge on his services to gain access to him and his associates. I can't remember the fellow's name, but if I come across his contact information, would love to know if he ever succeeded. I'm just now organizing documents from my OPB affiliation which ended in April 2008.

On another topic: What DO we do with all the things we have accumulated in our lives? Something began to tick in me as I crossed the border into "three score and ten" on 5/31/09. It is a flurry of activity as I try to decide what to keep and what to do with the rest before the flame of life is extinguished.

I have typed radio reviews of hundreds of movies, Broadway plays, recordings on audio tape and cassettes going back to 1971. My dear husband, an electrical engineer, has put some of my work on CDs, but those are also obsolete now! I don't have a library. I won't write a book -- no time, no patience. Nobody wants this career stuff, but it seems a shame to let it all go to a landfill.

Question: What do doctors do with their personal accumulations after retirement? Sometimes I think we're just here to move some cosmic molecules around for a few decades and that's it. I even have a name for it: Ellen Kimball's Theory of Molecular Dispersion. Kind of catchy, don't you think?

Warm regards,