NYT: Private practice doctors are fleeing to hospitals, and that is not a pro

posted at 4:41 pm on February 14, 2014 by Erika Johnsen

If there’s one thing ObamaCare has really achieved so far, it’s been the mass infliction of uncertainty onto so many aspects of the healthcare sector — and the resulting incentives, if they aren’t driving people out of the profession altogether, are driving both primary care doctors and specialists to forego the private-practice model for salaried jobs with hospitals. So sayeth the NYT, while noting that this particular shift away from “fee for service” private practices, for which certain health economists have long advocated because of the way they can incentivize doctors to oversell medical services, isn’t necessarily going to result in better or cheaper care for patients:

Last year, 64 percent of job offers filled through Merritt Hawkins, one of the nation’s leading physician placement firms, involved hospital employment, compared with only 11 percent in 2004. The firm anticipates a rise to 75 percent in the next two years. …

“In many places, the trend will almost certainly lead to more expensive care in the short run,” said Robert Mechanic, an economist who studies health care at Brandeis University’s Heller School for Social Policy and Management. …

But many of the new salaried arrangements have evolved from hospitals looking for new revenues, and could have the opposite effect. For example, when doctors’ practices are bought by a hospital, a colonoscopy or stress test performed in the office can suddenly cost far more because a hospital “facility fee” is tacked on. …

Hospitals have been offering physicians attractive employment deals, with incomes often greater than in private practice, since they need to form networks to take advantage of incentives under the new Affordable Care Act. Hospitals also know that doctors they employ can better direct patients to hospital-owned labs and services.

“From the hospital end there’s a big feeding frenzy, a lot of bidding going on to bring in doctors,” Mr. Mechanic said. “And physicians are going in so they don’t have to worry — there’s a lot of uncertainty about how health reform is going to play out.”

In a nutshell, all of this consolidation is quickly yielding more and more power and influence for already-powerful hospitals in determining prices, which in turn is likely to result in less competition and still higher prices for consumers.

Oy. As Krauthammer put it the other night, via RCP:

When you’re personally hurt, it affects your vote a lot more than that you have a disagreement over policy with a party or two. And that, I think, is why the Democrats are so scared. This is no abstract issue anymore. People are losing their insurance. They are losing their doctors. They are losing their hospitals. Some of them are losing jobs or losing hours as a result over the law, and it isn’t as if people are waiting for another disaster on the website. … When you decide to revolutionize a sixth of the U.S. economy and to issue tens of thousands of regulations on as delicate an ecosystem as American medicine, you deserve the blame for everything that goes wrong.


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Over

Bmore on February 14, 2014 at 7:06 PM

So I guess Brayam thinks obamacare is so great that he’s already enrolled…right Brayam?????

BeachBum on February 14, 2014 at 7:08 PM

Because I want to be sure bayam sees some actual data:
 

Funny how all those previously uninsured with pre-existing conditions who can now afford insurance now have access.
 
bayam on February 14, 2014 at 6:15 PM

 
+1
 
All 107,000 of them.
 
(3/100ths of 1% of the population)
 
Tell, please, what has this cost again?

rogerb on February 14, 2014 at 7:08 PM

Tell, please, what has this cost again?

rogerb on February 14, 2014 at 7:08 PM

Because bayam the wild-eyed brain surgeon likely didn’t know that states had pooled resources already in place for uninsured preexisting, they were already being taken care of. But what’s a few outright lies when you’re going for the giant hoax?

John the Libertarian on February 14, 2014 at 7:14 PM

Affordable? So a single individual making $25000 a year gets subsidized payment and only owes $100/month. Previously his deductible was $2000 and had a nice Rx plan that he paid $10/med. on his new plan his deductible is $5000 (one fifth of his pretax income) and has to pay for his doctors visits and meds in full until he meets that deductible. Tell me again how that’s affordable??

HughJass on February 14, 2014 at 7:18 PM

HughJass on February 14, 2014 at 7:18 PM

Bingo!! My husband and I make about $23k a year. The bronze plan is about $1000 a month all subsidized, the deductible is $12k. Now, if we were to take this plan, we would be sticking it to the taxpayers AND we would never use it unless we got hit by a bus. So who benefits from this? But Bayam has no idea what FACTS are, I’ve looked at the plans, so I KNOW the facts. Nothing Affordable about it.

BeachBum on February 14, 2014 at 7:23 PM

Bayam. We’re paying a small fortune for a policy with an $11,600 embedded deductible. If we meet that, then we have a 20% co insurance for most things. We can’t afford sick visits right now. Our pre Obamacare policy covered everything with a reasonable co pay. And not one of our specialists takes Obamacare. Tell me again how wonderful socialized medicine is.

hopeful on February 14, 2014 at 7:23 PM

Stating that at least people can afford health insurance doesn’t mean that it’s actually affordable or that they’ll even have a doctor that takes it. I hope providers run as far away from this as possible. Concierge medicine, bay am, that’s innovation in healthcare.

HughJass on February 14, 2014 at 7:24 PM

@bayam

It means that healthcare providers don’t profit from ordering unnecessary or duplicative tests- instead providers are compensated for healthy outcomes.

So…if the patient dies, they don’t get paid?

Solaratov on February 14, 2014 at 7:37 PM

Argue with an idiot at your own peril.

Lanceman on February 14, 2014 at 6:31 PM

I thought that I had the urge, but found out it was only gas.

307wolverine on February 14, 2014 at 7:46 PM

What are the costs of premiums and deductibles to all these people who were previously denied health care insurance? My company just dumped its insurance and told us to go on Obama care. Previously I paid 0 premium and 0 deductible for a single. Now I will be paying 435 a month with a 6k deductible. If I am paying this much ,,, what must it cost to those who have had pre existing health issues that were once denied but now as the libs say they can AFFORD it now. I don’t believe it.

garydt on February 14, 2014 at 7:55 PM

Funny how all those previously uninsured with pre-existing conditions who can now afford insurance now have access.

bayam on February 14, 2014 at 6:15 PM

+1

All 107,000 of them.

(3/100ths of 1% of the population)

Tell, please, what has this cost again?

rogerb on February 14, 2014 at 7:08 PM

Two kinds of pre-existing conditions: (1) those that are getting kicked out of an existing plan that was taking care of their conditions, that now become pre-existing conditions in the new far more expensive Obamacare policy. They are finding out also that they have huge deductibles and very poor doctor/hospital networks and a much more restricted drug plan.

(2) those that have pre-existing conditions that precluded them from traditional insurance, and didn’t sign up for high-risk state pooling programs designed for them. They ended up in this state largely because of negligence in signing up for insurance before they got sick. For whatever reason they also don’t qualify for Medicaid, which covers pre-existing conditions.

The number of people in (1) far exceeds (2).

slickwillie2001 on February 14, 2014 at 8:18 PM

Us Catholics are sitting in the catbird seat.

Over 12% of all your base are belong to us.

Thank you, Bayam.

http://www.youtube.com/watch?v=8fvTxv46ano

unclesmrgol on February 14, 2014 at 9:04 PM

OR just plain quitting. Enjoy the lines.

WryTrvllr on February 14, 2014 at 9:14 PM

You know Brayam, the Province of Quebec had just one medivac chopper.

Ask Liam Neeson how that turned out.

WryTrvllr on February 14, 2014 at 9:17 PM

So…if the patient dies, they don’t get paid?

Solaratov on February 14, 2014 at 7:37 PM

Or if they get a known 30% complication rate item.

WryTrvllr on February 14, 2014 at 9:19 PM

Marshmellow McConnell or Milktoast Bayner will not repeal this POS.

So replace the GOP to get rid of this POS.

AshleyTKing on February 14, 2014 at 9:35 PM

http://www.dailymail.co.uk/news/article-2559876/2-000-NHS-patients-records-lost-day-two-million-data-breaches-logged-start-2011.html

2,000 NHS patients’ records are lost every day with more than two million serious data breaches logged since the start of 2011
Records have been mistakenly sold on eBay or dropped in the street
Staff are also sending sensitive information to the wrong places
One NHS Trust said information had been thrown into bins
Fears they will fall into private hands – who will use them to make a profit

Bayam!

Murphy9 on February 14, 2014 at 9:44 PM

Marshmellow McConnell or Milktoast Bayner will not repeal this POS.

So replace the GOP to get rid of this POS.

AshleyTKing on February 14, 2014 at 9:35 PM

With Democrats!!!!!

WryTrvllr on February 14, 2014 at 9:47 PM

So, that POS “Bayam” did her job… she trolled this thread and generated a bunch of responses…..

Well done, A-Hole. Hope yer proud of yourself sitting in your parents basement. Or your own, paid-for and well-appointed living room.

Either way, you are a POS actively working to destroy this country, and for that you’ll have my never-ending disdain. You are pathetic.

Having said that….

This crap’s gotta stop. What’s the point of chasing after idiot trolls like Bayam, except to fill our time and make us think that somehow we’re making a difference?

Meanwhile, real shit is going down; our idiot President is being ordered by his handlers to literally dismantle this country, and there isn’t any real action being taken to oppose him.

WTF?

I wish I had the answer, it would make for a great end to this post, but what I’m thinking still can’t be said out loud….yet.

GFY Bayam, and I REALLY REALLY mean that!!! You and all the other losers advocating the end of the USA. You make me sick.

Fathom on February 14, 2014 at 9:49 PM

What’s the point of chasing after idiot trolls like Bayam, except to fill our time and make us think that somehow we’re making a difference?

Fathom on February 14, 2014 at 9:49 PM

I love your passion. Good stuff. But don’t worry about bayam. The poster is being willfully obtuse for a reason. The Dems are in very hot water and it’s all going to blow up in their collective face, and so, to mix metaphors, they whistle past the graveyard. Most times we take them on because we’ve got an itch that needs scratchin’, plus it shores up our own thoughts on the matter.

John the Libertarian on February 14, 2014 at 10:02 PM

My wife is about to start her fellowship in Sports Med this summer. She’s already talking about starting up her own cash-only practice after she’s done. No insurance, no co pays, no administrators, just two doctors in the office, and one MA who doubles as a secretary.

Going in for a knee or ankle exam will cost you less than an oil change and tire rotation.

If you need an procedure done, then you’ll be looking at a monthly family cell phone bill payment.

She has offers from a major top sports medicine clinic that treats professional and collegiate athletes, but its associated with a huge health system like where she now – and she hates it.

I also love the turd talking point about how doctors are now paid on patient outcomes and wont order frivolous tests. Medicaid/Medicare are the worst at this. Medicaid patients are in general just plain nuts. You can’t discharge them from the hospital until you’ve done 15 tests on them to make sure nothing is wrong because if they come back for a followup, the bastard government don’t pay a dime for the first visit.

Government run healthcare incentivizes inefficient, unaccountable medicine.

Defenestratus on February 14, 2014 at 10:21 PM

Hospitals also know that doctors they employ can better direct patients to hospital-owned labs and services.

I experienced this, when my 79 year-old mother broke her pelvis. She needed to stay in an acute care facility – the hospital that treated her referred her to an acute care provider that was nearly 30 miles away. There was another facility that was much closer – but wasn’t recommended. Why? It was run by a competing hospital group.

Hill60 on February 14, 2014 at 10:24 PM

Government run healthcare incentivizes inefficient, unaccountable medicine.

Defenestratus on February 14, 2014 at 10:21 PM

Yup. And I was saying this five years ago. Black market healthcare will be the prevailing standard in the country, because progressives are such monumental idiots and do not understand even the most basic of free market influences. See bayam.

John the Libertarian on February 14, 2014 at 10:36 PM

I have a co-worker that is a dyed-in-the-wool liberal.
…at least…she *WAS* until she found out what a cataclysmic lie
“FREE” “UNIVERSAL” health care is.

She can now not only not afford her monthly insurance coverage, which costs more for her and her legally adult children…the premiums are so high…she can’t afford for herself or her children to GO to a doctor.

She cried at the office the other day over this very thing.
I stopped, and said to her, “You have the power to change this. Stop believing populist lies and fairy tales, and vote with your brain, not your imagination.”

She is still thinking it over, …but I think she’ll figure it out.

…Hope she or one of her children don’t die in the interim.

Liberalism is a lie. Socialism is a lie. Leftists are evil. period.

a5minmajor on February 14, 2014 at 10:42 PM

So replace the GOP to get rid of this POS.

AshleyTKing on February 14, 2014 at 9:35 PM

Blaming the GOP for the ACA is like raping someone and accusing them of prostitution. The GOP was a victim not a perpetrator of the passage of this mess. They were denied the opportunity to communicate the contents of the bill to the public because they could not see it. The CBO hid the cost estimates until after passage and the administration lied through their teeth about how this thing would work. But now it is the GOP’s fault? Maybe it would be better to vote out the Dems who passed it and support it rather than the GOP. When Grimes wins over McConnell in KY because the conservatives stay home rather than vote for him do you think she will repeal the ACA? Of course not.

KW64 on February 14, 2014 at 11:54 PM

What’s the point of chasing after idiot trolls like Bayam, except to fill our time and make us think that somehow we’re making a difference?

Fathom on February 14, 2014 at 9:49 PM

I love your passion. Good stuff. But don’t worry about bayam. The poster is being willfully obtuse for a reason. The Dems are in very hot water and it’s all going to blow up in their collective face, and so, to mix metaphors, they whistle past the graveyard. Most times we take them on because we’ve got an itch that needs scratchin’, plus it shores up our own thoughts on the matter.

John the Libertarian on February 14, 2014 at 10:02 PM

Bayam is another damn Canadian troll, like Drywall. Nothing he says about the US is based on his personal experience, it’s all talking points.

slickwillie2001 on February 15, 2014 at 12:17 AM

bayam on February 14, 2014

…the braying jacka$s was able to be a dumba$s 12 times …on ONE thread of less than 200 comments?…isn’t that a record?…should not have been much of an effort to get a baker’s dozen!…try harder next time butt brayer!

KOOLAID2 on February 15, 2014 at 12:43 AM

ok so i recently finished school, for Medical office administration and i am currently on my extern site. So let me fill you in on what i have been doing for the last few weeks…. fighting with insurance companies… one patient in particular is being driven to extremes because even though he has insurance with BCBS his claims are NOT being paid. he was diagnosed 5 years ago and has been getting treatment from our office for 4 years. In all this time he has NOT changed his insurance policy. his BCBS policy number group number and id are all exactly the same and his claims are being denied based on pre-existing condition… yet even the BCBS rep admits its not a previous condition as his diagnosis occurred while his current insurance was active…. this is just one of many. Ocare is killing patient care.

katee bayer on February 15, 2014 at 1:10 AM

Katee, everything you described is about insurance company greed. Not Obamacare.

libfreeordie on February 15, 2014 at 6:57 AM

Funny how all those previously uninsured with pre-existing conditions who can now afford insurance now have access.

bayam on February 14, 2014 at 6:15 PM

Well, given how much the “Affordable” Care Act has driven up premiums, that isn’t very many people.

Really, it would have been so much simpler to just allow people with pre-existing conditions to buy Medicaid policies. They suck, so there wouldn’t be a big switch from the private market, but it would have given coverage to people who needed it.

Just a cost anecdote. A stress echo (a type of cardiac stress test) in a private office can be done for charges under $500. I had a patient bring me the bill from one done at the hospital-$7000!

Yup, that ACA is sure bending the cost curve. Not bending the right way, but it’s bending it.

I’m looking forward to seeing the announcement in March of the number/percent of Americans with health insurance now that we have tha wonders of Obamacare. Based on the date so far, there will be fewer Americans with coverage and they will pay more. It will be fun to see the Democrats and their media minions spin this.

talkingpoints on February 15, 2014 at 7:25 AM

Already pasted a link, can’t you read?

http://www.aetnaacs.com/what-accountable-care

It means that when coronavirus or other deadly pathogen breaks out in the hospital, infecting Grandma, the hospital can’t bill Medicare to treat her. It has to prevent virus outbreaks or pay the price.

It means that healthcare providers don’t profit from ordering unnecessary or duplicative tests- instead providers are compensated for healthy outcomes.

In other words, it’s one of the most important terms in health economics and if you don’t understand it, you don’t understand the case for healthcare reform.

bayam on February 14, 2014 at 5:49 PM

To my knowledge, Accountable care as you define it in the first statement, has nothing to do with the ACA (Affordable Care Act). Also, the first time it was suggested in the US was at Geisinger between about 2003 and 2006, (No charge for complications unless all evidence based measures were taken, I was at the meeting) so it preceded the ACA and Obama.

Also, I have not seen any data suggesting the Accountable Care (outcomes based compensation) is the standard in either France or Germany.

talkingpoints on February 15, 2014 at 7:57 AM

http://www.aao.org/yo/newsletter/201208/article02.cfm

The above is a link to a post about Accountable Care Organizations (ACOs) first proposed at a Medicare meeting in 2006. They are included in the ACA but are not really a primary part of it. They are an American concept and really don’t have anything to do with care in Europe which has a very different compensation mechanism.

I think this may have been what Bayam was referring to in the description of Accountable Care.

talkingpoints on February 15, 2014 at 8:05 AM

Katee, everything you described is about insurance company greed. Not Obamacare.

libfreeordie on February 15, 2014 at 6:57 AM

Then why was everything fine for 4 years with the same insurance company until a few weeks ago when Ocare kicked in. Does Ocare suddenly cause insurance companies’ greed to manifest itself? If so, how is that a good thing?

talkingpoints on February 15, 2014 at 8:08 AM

libfreeordie on February 15, 2014 at 6:57 AM

Didn’t see you address any of the other points made in this thread. Have you personally looked at the policies available? I have and they ARE NOT AFFORDABLE. So you are talking out of your azz which isn’t suprising since you use it for everything else too.

BeachBum on February 15, 2014 at 8:08 AM

Insurance companies are breaking the backs of doctors along with the regulations. Payments to the doctors run about three months behind the treatment and the insurance companies drag their feet about numbers and codes to delay paying, it’s called business.

mixplix on February 15, 2014 at 8:33 AM

Katee, everything you described is about insurance company greed. Not Obamacare.

libfreeordie on February 15, 2014 at 6:57 AM

 
They probably don’t even have any decent meatloaf recipes, do they, professor?

rogerb on February 15, 2014 at 8:53 AM

Who needs doctors anyway? Through the wonder of the ACA, we now have IPAB, a panel to tell us which treatments to use, or not to use! No worries!

/s

xNavigator on February 15, 2014 at 10:28 AM

Katee, everything you described is about insurance company greed. Not Obamacare.

libfreeordie on February 15, 2014 at 6:57 AM

He has some literature in his car that he would really love to show to you.

Art Vandelay on February 15, 2014 at 10:29 AM

I tore my ACL and had no insurance, so I had to pay cash. No problem. I got a 40% discount across the board, and it turned out that I would have spent far more if I had “invested” in health insurance. All this talk about health insurance is bunk. We don’t need it. Catastrophic insurance, maybe, but not general health insurance. You’re all wasting your breath.

HiJack on February 15, 2014 at 10:37 AM

I have a co-worker that is a dyed-in-the-wool liberal.
…at least…she *WAS* until she found out what a cataclysmic lie
“FREE” “UNIVERSAL” health care is.

She can now not only not afford her monthly insurance coverage, which costs more for her and her legally adult children…the premiums are so high…she can’t afford for herself or her children to GO to a doctor.

She cried at the office the other day over this very thing.
I stopped, and said to her, “You have the power to change this. Stop believing populist lies and fairy tales, and vote with your brain, not your imagination.”

She is still thinking it over, …but I think she’ll figure it out.

…Hope she or one of her children don’t die in the interim.

Hooray for fail. It leaves a mark.

As one of the physicians who made the private-to-hospital shift, the article is fundamentally correct. I was appalled at the difference for, say, a complete blood count in our original private practice in the Midwest ($25-95, subject to payor) and the hospital charge (about $200. Yes, that’s not a misprint).
And outpatient procedures? Don’t even get me started.
Private practice was/is imperfect; it was however independent, and competitive. Hospitals don’t publicly compete with each other on price—in fact, they avoid price competition at all costs. While it’s not industry style price-fixing, the net effect is the same. Meanwhile, CMS feeds higher compensation rates for certain types of care (e.g. cancer care) at hospital-based facilities, while they do everything to obstruct and ratchet down access and compensation for private practice. Because, y’know, those ‘private’ doctors are all thieving capitalists, while the hospital industry is a pack of useful, and malleable, idiots.

Weep for the loss of your medical care system. It’s underway. Thanks, Progressives.

orangemtl on February 15, 2014 at 10:41 AM

Liberalism is a lie. Socialism is a lie. Leftists are evil. period.

a5minmajor on February 14, 2014 at 10:42 PM

Leftists lie; people die. A lot of ‘em.

HiJack on February 15, 2014 at 10:43 AM

Katee, everything you described is about insurance company greed. Not Obamacare.

libfreeordie on February 15, 2014 at 6:57 AM

The high cost of college tuition is because of your greed. Teach class a few hours a week and you get paid how much? Because you spout out some very unoriginal thinking (this means you didn’t come up with anything you teach) and use your lesson plans over and over and over?

oldroy on February 15, 2014 at 10:48 AM

Weep for the loss of your medical care system. It’s underway. Thanks, Progressives.

orangemtl on February 15, 2014 at 10:41 AM

In just a few minutes libfree will tell you how wrong you are.

oldroy on February 15, 2014 at 10:51 AM

oldroy on February 15, 2014 at 10:48 AM

+1000 Exactly, it’s only greed when those evil corporations do it like Big Oil, Big Insurance etc. I’m sure the perfessor thinks he’s worth it, I doubt he is. He’s just sucking the money right out of the parents who pay him and the taxpayers who subsidize him because he’s GREEDY.

BeachBum on February 15, 2014 at 10:54 AM

Weep for the loss of your medical care system. It’s underway. Thanks, Progressives.
 
orangemtl on February 15, 2014 at 10:41 AM

 
In just a few minutes libfree will tell you how wrong you are.
 
oldroy on February 15, 2014 at 10:51 AM

 
But not why. Only how much he enjoys meatloaf.
 
Racist.

rogerb on February 15, 2014 at 11:25 AM

But not why. Only how much he enjoys meatloaf.

Racist.

rogerb on February 15, 2014 at 11:25 AM

That’s kind of creepy the way you keep track of stuff… /sarc

oldroy on February 15, 2014 at 11:28 AM

Katee, everything you described is about insurance company greed. Not Obamacare.

libfreeordie on February 15, 2014 at 6:57 AM

Insurance company “greed” is a direct consequence and outgrowth of government interference. And since you will absolutely not take that at face value, let me explain to you why.

In the immediate aftermath of WWII, industries from coal mining to steel mills to manufacturing needed to reabsorb a massive influx of former soldiers returning home. When they returned home, on a much larger scale than even WWI, the men came back to price and wage controls which had not yet sunset. Unions extracted promises for paid vacation, and health insurance in lieu of pay raises solely as a workaround of the wage and price controls.

Over the next couple of decades, several events conspired to bring American healthcare into the modern age of bureaucratic clusterfark that it is now, but none of these events had a thing to do with initiative on the part of the insurance companies. The two most prominent and far reaching of these events were the establishment of the United Nations World Health Organization (WHO) and the passage of the Medicare Act of 1965 as a revision of Title XVIII of the Social Security Act.

The World Health Organization was founded primarily to enable the United Nations to engage in statistical endemic/epidemic tracking in developing nations. Their work came to the fore in the 20th century with the discovery of hemorrhagic fever in the Ebola River valley in Zaire I think in the early 1970′s (though I’m not sure). The WHO’s statistical tracking uses “codes” for both diagnosis and treatment, and over the years as the codes are revised they tend to get more and more intricate and have expanded to conditions where endemic/epidemic spread and casual contagion are not considerations (like broken bones or nosebleeds).

With the advent of Medicare in the mid-1960′s, the Department of Health and Human Services began mandating that hospitals submit their insurance paperwork with these codes so that the information may be submitted to WHO. Diagnosis codes are generally four or five digits, with procedure codes being five or six digits. In order for reimbursement to happen at all, the codes, which are grouped together in ways that change with each biennial revision, must match a proper procedure to the diagnosis. e.g. Treating a broken bone with a colonoscopy according to the paperwork necessitates a long appeals process during which the medical office must explain to DHS what happened.

Now, here’s where what you call “insurance company greed” comes in…

Statistical medical information is severely skewed if you’re getting it only from individuals 65 years of age or older. Of course, that’s the demographic Medicare was targeted at. So DHS simply mandated that all private insurers had to submit the same information. Since then, the number of staff dedicated to insurance billing has *exploded*. And every time there is a revision in the WHO codes, every time there is a rationalization by DHS for doctors to get paid less for the same work, the bureaucratic nightmare gets worse.

In short, as goes WHO (a UN agency), so goes Medicare, and as goes Medicare, so goes private insurance. There is not a single thing wrong with the health insurance industry that can not be traced back to some sort of government misfeasance.

gryphon202 on February 15, 2014 at 11:50 AM

No worries. The Zero will force compliance with a wave of his magic pen.

If the docs here decide to retire or leave the field altogether, he’ll import the finest docs from Borneo, Zimbabwe, Turkemenistan, and the Congo to fill the void.
RN’s who refuse or drop out will be replaced. The Zero will simply deem all hair stylists and cosmetologists to fill that void.
The Zero will have them complete a simple 30 minute online course titled “The Gov’t Basics of Nursing” or “So you wanna play with needles”.

StubbornGreenBurros on February 15, 2014 at 12:08 PM

Who really trusts doctors? I feel no sorrow for their present scrambling condition. They bled George Washington to death and poor Dwight Eisenhower only saved his leg from being amputated at a hospital by having his brothers take shifts to protect him from the doctor’s hands. The game and times have changed, and doctors are more skilled, but many are still overly bossy and deadly. Let them jump about for a time.

Dave Turson on February 15, 2014 at 12:14 PM

Who really trusts doctors? I feel no sorrow for their present scrambling condition. They bled George Washington to death and poor Dwight Eisenhower only saved his leg from being amputated at a hospital by having his brothers take shifts to protect him from the doctor’s hands. The game and times have changed, and doctors are more skilled, but many are still overly bossy and deadly. Let them jump about for a time.

Dave Turson on February 15, 2014 at 12:14 PM

Oh come on! There are good doctors out there! In fact, the general practitioner I see always makes it a point to ask me if I need sample drugs before he prescribes me anything cause he knows I don’t usually have much cash. And his business office is wonderful about letting me defer payments.

gryphon202 on February 15, 2014 at 12:17 PM

No worries. The Zero will force compliance with a wave of his magic pen.

If the docs here decide to retire or leave the field altogether, he’ll import the finest docs from Borneo, Zimbabwe, Turkemenistan, and the Congo to fill the void.
RN’s who refuse or drop out will be replaced. The Zero will simply deem all hair stylists and cosmetologists to fill that void.
The Zero will have them complete a simple 30 minute online course titled “The Gov’t Basics of Nursing” or “So you wanna play with needles”.

Oh, it’s already happening. One of Eastern Nigeria’s finest surgeons is cooperating with police in New Mexico and performing forced anal exams at 2 am in the morning on innocent people;

http://www.kob.com/article/stories/s3209305.shtml#.Uv-hVPm2jCc

Narniaman on February 15, 2014 at 12:22 PM

Charles us 100% correct, and 110% correct as to who deserves the blame. Choke on it liberals.

Whitey Ford on February 15, 2014 at 12:25 PM

One of Eastern Nigeria’s finest surgeons is cooperating with police in New Mexico and performing forced anal exams at 2 am in the morning on innocent people;

http://www.kob.com/article/stories/s3209305.shtml#.Uv-hVPm2jCc

Narniaman on February 15, 2014 at 12:22 PM

You left out the part where it was all based on an invalid warrant.

gryphon202 on February 15, 2014 at 12:29 PM

on202 on February 15, 2014 at 11:50 AM

All of that is also motivated by greed. It has always been about providing lavish lifestyles for some and not others. Call it capital, call it the state, they are one in the same.

libfreeordie on February 15, 2014 at 12:44 PM

Who really trusts doctors? I feel no sorrow for their present scrambling condition. They bled George Washington to death and poor Dwight Eisenhower only saved his leg from being amputated at a hospital by having his brothers take shifts to protect him from the doctor’s hands. The game and times have changed, and doctors are more skilled, but many are still overly bossy and deadly. Let them jump about for a time.

Dave Turson on February 15, 2014 at 12:14 PM

Faith healing in your fever swamp that good?

Murphy9 on February 15, 2014 at 12:49 PM

All of that is also motivated by greed. It has always been about providing lavish lifestyles for some and not others. Call it capital, call it the state, they are one in the same.

libfreeordie on February 15, 2014 at 12:44 PM

Really, dude? So that government that you trust so much, the UN that has enforced world piece for three generations(!), they are all motivated by greed, right?

Dude, really, you sorely need a lesson in economic rudiments. There is not a man or woman alive on the face of the planet that would refuse more of whatever it is they consider wealth. “Greed” is a buzzword that libwits use to demonize people and organizations that don’t fit the narrative.

When you stop and think about it, the move to hospitals and network clinics makes sense. Not that it’s good, or in any way beneficial, but it makes sense. A private practitioner on his own has to hire half or better of his staff just to handle billing. That has nothing to do with greed, and everything to do with the practical realities of running a business. It takes some, though not all of the pressure off to have a health network or even a small individual hospital do the hiring decisions if only so that the doctor can devote less time to billing considerations and more time to actual patient care!

gryphon202 on February 15, 2014 at 12:52 PM

libfreeordie on February 15, 2014 at 12:44 PM

Just like the taxpayers provide a lavish lifestyle for you.

BeachBum on February 15, 2014 at 12:52 PM

It’s pretty ironic seeing a reprobate moron who creates no value whatsoever whine about other’s wealth.

Murphy9 on February 15, 2014 at 12:54 PM

This is also why you’re going to find more and more doctors moving to cash-only practices. It won’t happen for a while in smaller markets dominated by one or two regional health networks, but eventually most people will have the choice of going to a cash-only practitioner where the care is better, cheaper, and more timely.

gryphon202 on February 15, 2014 at 12:57 PM

Faith healing in your fever swamp that good?

Murphy9 on February 15, 2014 at 12:49 PM

I’d send you a card for your deathbed nightstand if I had the opportunity to become acquainted.

Dave Turson on February 15, 2014 at 12:58 PM

Oh good, bodily threats…

Together We Thrive™

Murphy9 on February 15, 2014 at 1:04 PM

Don’t go all Jared Loughner (D) on us.

Murphy9 on February 15, 2014 at 1:05 PM

Don’t go all Jared Loughner (D) on us.

Murphy9 on February 15, 2014 at 1:05 PM

Ha-ha, no threats here: My comment dealt with trusting doctors under the present system.

Dave Turson on February 15, 2014 at 1:10 PM

My wife is about to start her fellowship in Sports Med this summer. She’s already talking about starting up her own cash-only practice after she’s done. No insurance, no co pays, no administrators, just two doctors in the office, and one MA who doubles as a secretary.

Defenestratus on February 14, 2014 at 10:21 PM

Have you checked that state regulations allow you to take cash for medical procedures? I believe some areas specifically prohibit this, precisely because it takes the insurance system out of the loop.

But, best of luck, anyway. Hope it works.

virgo on February 15, 2014 at 2:23 PM

Have you checked that state regulations allow you to take cash for medical procedures? I believe some areas specifically prohibit this, precisely because it takes the insurance system out of the loop.

But, best of luck, anyway. Hope it works.

virgo on February 15, 2014 at 2:23 PM

Most states do not expressly forbid it. Those places that do are places like Illinois or New York, where bureaucratic regulation runs amuck in virtually every industry. The biggest obstacles to doctors being able to practice as they wish emanate from FedGov, as usual.

gryphon202 on February 15, 2014 at 2:43 PM

Defenestratus on February 14, 2014 at 10:21 PM

Right on! This is the way to go. Once more and more physicians realize that their time will be spent treating patients rather than filling out useless paperwork from useless governmental requirements they will go this route. The financial and psychologic gains from this are immeasurable. If laws could be dropped about physicians opening their own private hospital, then we’d be in business.

HughJass on February 15, 2014 at 5:05 PM

Most states do not expressly forbid it. Those places that do are places like Illinois or New York, where bureaucratic regulation runs amuck in virtually every industry. The biggest obstacles to doctors being able to practice as they wish emanate from FedGov, as usual.

gryphon202 on February 15, 2014 at 2:43 PM

As far as I know, there is no requirement anywhere that you MUST use insurance (at least until the Unaffordable Care Act) to pay for health care. If you could negotiate your price for care, all you have to do is show up with a suitcase of cash and the procedure was done. This is much easier done with outpatient surgical centers as those are privately owned and the negotiations would involve the proceduralist and anesthesiology. Doing this at a hospital is much more difficult because of all the extra red tape required. Often times the negotiated price is MUCH lower than what the billed cost would be, because that involves pricing to maximize return from insurance companies. Whereas the private physician knows his costs/overhead/etc and can do it for much less than what they would ordinarily bill. And there is no hassle of insurance company or government.

HughJass on February 15, 2014 at 5:14 PM

Doctors were already fleeing private practice, especially of general or family medicine, because of the rising costs of paperwork compliance and arguing with insurers all the time. Better to specialize, as one brilliant young researcher explained to me why he decided to go into dermatology. The money is good, the hours are set business hours, you never get called off the golf course or at 3 am for a pimple emergency.

The big problem is why taxpayers subsidize education, given its failing outcomes.

Universities should be able to hire as many leftist gender studies professors as they wish, but not on my dime. All government aid to education should come in the form of vouchers to parents and students, and not one penny directly to schools or administrators.

Adjoran on February 15, 2014 at 5:14 PM

Well we just found out that test’s that are not “preventive care” We will have have to pay for until we hit a cap of 1000 then insurance kicks in. Lots of people are finding this out. People that are just getting some blood tests they have to pay for each vile the tech uses because each one is a different test and it adds up quick. Oh and finding out what your A1AC, thyroid or cholesterol levels are NOT considered “Preventive Care”

Patricksp on February 15, 2014 at 5:18 PM

As far as I know, there is no requirement anywhere that you MUST use insurance (at least until the Unaffordable Care Act) to pay for health care. If you could negotiate your price for care, all you have to do is show up with a suitcase of cash and the procedure was done. This is much easier done with outpatient surgical centers as those are privately owned and the negotiations would involve the proceduralist and anesthesiology. Doing this at a hospital is much more difficult because of all the extra red tape required. Often times the negotiated price is MUCH lower than what the billed cost would be, because that involves pricing to maximize return from insurance companies. Whereas the private physician knows his costs/overhead/etc and can do it for much less than what they would ordinarily bill. And there is no hassle of insurance company or government.

HughJass on February 15, 2014 at 5:14 PM

The problem is, you can’t refuse private insurance while you take Medicare/Medicaid. And where government is concerned, we all get screwed over whether we do business with government directly or not.

gryphon202 on February 15, 2014 at 5:52 PM

They can’t afford the practice, Obama care or not, to set up from scratch is too costly, the overhead is impossible.

Fleuries on February 16, 2014 at 7:59 AM

The smart money, in venture capital and beyond, is betting that technology is about to disrupt and transform healthcare. Obamacare has created an opening, and the incredible innovation in healthcare going on today is completely beyond the ability of Charles to understand it. If confronted by someone like Larry Page or Marc Andreesen, Charles might think he’s encountered an alien life form.

bayam on February 14, 2014 at 5:39 PM

Some non investing advice from a fellow Lib. First, don’t quit your day job as you gave the same advice concerning “green investments”; second, if you want to give financial advice at least have a Series 7. That is needed before you can have your Series 9/10; third, in Western Europe they either have a two tier system (private pay for those that can afford it….aka the wealthy) and government provided healthcare or like in the UK you have the option to carry private insurance to supplement the Government provided healthcare. UK’s healthcare is know as a 16/60 plan. For those under 16 or over 60, not bad care……not so for the rest.

Finally, try subscribing to The Economist and from there do real research. Wiki is not your friend. I laugh when I hear the term “Smart Money” as I realize the speaker really sees it as OPM. Smart money to me is my own money, not someone else’s.

HonestLib on February 16, 2014 at 8:15 AM

A friend’s in-law is an RN who just quite nursing. She said at the hospital she worked, they had cut back so much they were making nurses clean the toilets.

She said nursing jobs, at least in this part of Michigan, are not as plentiful as they once were due to job force reductions. Since her husband has a decent job, she simply stopped working.

I don’t know if I can get my friend to find out which hospital. I don’t want the toilet cleaners to also be handling the syringes

The private practice physician was part of the greatness of our system. You could shop for one who did it your way.

As Obamacare expands, there will be less patients who are free of federal mandates in the private patient pool

Since the government has a vested interest now in the outcome of all mandated medical care, look for government control over lifestyle choices. And the new controls will flow from government idiots

Calling Dr de Blasio

entagor on February 16, 2014 at 12:37 PM

Who really trusts doctors? I feel no sorrow for their present scrambling condition. They bled George Washington to death and poor Dwight Eisenhower only saved his leg from being amputated at a hospital by having his brothers take shifts to protect him from the doctor’s hands. The game and times have changed, and doctors are more skilled, but many are still overly bossy and deadly. Let them jump about for a time. – Dave Turson on February 15, 2014 at 12:14 PM

One of the dumbest statements made on this page.

In Washington’s time bleeding was thought to be a cure. Medical science back then certainly was not the best. However, today some doctors have brought back the procedure of blood letting in certain situations. Eisenhower had a bad infection on his leg when he was just a child, before the time of antibiotic drugs. If gangrene had set in amputation would have been the only choice of the doctor at the time to save his life. While as president Calvin Coolidge had a son who got a blister on his foot while playing tennis. He died of blood poisoning because of the lack of antibiotics.

SC.Charlie on February 16, 2014 at 4:28 PM

One of the dumbest statements made on this page.
[Blah, blah, blah.]
SC.Charlie on February 16, 2014 at 4:28 PM

Where are your links that counter my comment. Eisenhower asked his brothers to protect him from an amputation and contrary to what the doctors diagnosed his leg healed. Doctors kill patients in many ways – you may have to learn this someday.

Dave Turson on February 17, 2014 at 3:48 PM

Where are your links that counter my comment. Eisenhower asked his brothers to protect him from an amputation and contrary to what the doctors diagnosed his leg healed. Doctors kill patients in many ways – you may have to learn this someday.

Dave Turson on February 17, 2014 at 3:48 PM

That’s the risk you run when you attempt to repair the very stuff that is the fabric of life. Doctors will make mistakes. Some of these mistakes will be deadly, and doctors will be held to account for them (particularly surgeons and obstetricians). As long as a doctor doesn’t condescend to me and treat me like he’s an authority figure and I’m a subordinate, I’m okay with that. The problem is, too many patients eagerly treat their doctors like authority figures and willingly cede personal responsibility for their own health.

gryphon202 on February 17, 2014 at 11:28 PM

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