From: email@example.com(Steven B. Harris)
Subject: Re: Medicare and Bret's Reality (was: Disappointed and confused--don't
Date: 20 Jun 1999 08:44:05 GMT
firstname.lastname@example.org (Richard M. Poniarski) writes:
>In article <37612B7A.84F27373@aol.com>, email@example.com says...
>> Are billing complexities and red tape and second-guessing clinical
>> decisions by government payers (Medicaid and Medicare) worse, better or
>> the same as that by managed care organizations? I've heard both ends of
>> the spectrum from different physicians and it seems to me that
>> physicians who tend to be on the right politically say the government
>> is worse and those on the left say managed care is worse. Could it be
>> that it's all in the eye of the beholder and depends on whether you
>> hate government to begin with or hate managed care to begin with?
>I am an equal oportunity hater, I really don't like either of them. The
>government because it is too powerful and is trying to have my patients
>send me to jail (i.e. the Medicare billing piece) and HMO's because they
>make decisions based on money, not on the needs of the patients I treat.
> I am just wondering; is there a third way? Something that would
>avoid the pitfalls of medicine as a business yet not fall into the
>medicine as another government "mandate".
Why, yes. It's called "fee for service medicine." Without
government intrusion, it's not much more expensive than veterinary
care, and amazingly like it.
No, you don't actually have to put granny to sleep (though if you
could see what modern hospice programs actually do, once on the case,
you'd wonder why I make the distinction). But if your 90 year old
granny is demented and needs to go on dialysis or die, and you don't
have the money, you'll have to pass the hat at your local community
chest or church, where you'll be competing with the kid who needs the
heart operation, just like 70 years ago.
But you cannot do this half-way. You've got to get the government
(state, local and fed) OUT. They regulate expenses up to the point
that you CANNOT pay for such a thing, except by taxation. They
regulate and change things in ways which nobody can imagine, because
they are too complex.
In my hospital a new wing was built, but the floor spacing was
different than the old wing. The floors were connected by ramps, but
due to the uneven spacing the grade of ramp steadily increased.
Eventually, at one floor, they simply left out the connection, and
above that they started DOWN. So one floor stayed isolated on one
side. They could have put in a ramp with a fairly easy grade, but it
still exceeded code, due to wheelchair access. In a rational society,
they'd have simply closed it to wheelchairs, and pointed out that
people in wheelchairs would then be no worse off then if they hadn't
built the thing at all (which is what happened). But that wasn't
important. What was important to people in wheelchairs was that if
they couldn't do it, nobody else could either. The politics of envy.
What about lives which might hang on the balance of somebody getting
quickly from one wing to another? Too bad. Lives don't weigh heavily
against the politics of envy.
So we'll put up with our present system. It's very expensive, and
the expense does kill people. We know that. We'd all like to change
it-- there's hardly anybody who wouldn't. But we won't, even if our
lives depend on it. And you know why not? Envy.
From: firstname.lastname@example.org(Steven B. Harris)
Subject: Re: Doctor-bashing
Date: 2 Mar 1999 07:31:39 GMT
In <36DB5495.D7755EC6@servtech.com> Ed Mathes <email@example.com>
>We have a local controversy brewing here. We have a large deaf
>population. A physician refused a new deaf patient's request to have an
>interpreter present during office visits. The patient is suing the doctor
>under the Americans with Disabilities Act. The only problem is, the
>doctor did not refuse the atient, he only refused to pay for out of his
>pocket for n interpretor, as did the patient. The patinet now has a
>doctor who signs but the lawsuit goes forward.
>An average office visit is reimbursed at a rate of $35.00 here, minus the
>with-hold (15%). An interpreter costs $50-60.00/hr, starting from the
>time they leave their house/office until they arrive back. It does not
>take oong to realize that the doctor will take a loss on each visit.
>Should it be counted as "overhead" and the cost split-up amongst all the
>physician's patients? Or should the deaf person pay?
Why, the cost should be split up among everyone else, who isn't as
needy. Or so you presume. Though it can be hard to tell, strange to
say. When the government finally agreed to pay for a service in which
deaf people could use a teletype and have a government employee in a
central office translate the typed messages into a voice phone call to
anywhere, it was considered a good thing. Suppose a deaf person needs
the paramedics? Alas, when they looked at the statistics, they found
the most frequent use of the service was deaf people ordering pizza.
Well, deaf people need pizza, too. The only question is, should you
the taxpayer pay for that when your own kid needs braces and the tires
on your wife's car are bald? Intangibles. How to assess one person's
need against another's? And do it from Washington, thousands of miles
away, when you don't know either person?
At our small private research laboratory in an industrial area, we
have just 6 parking spaces for as many employees. This would be fine
if it weren't for the fact that we can't use two of them due to their
handicap set-aside status. So, we park in the driveway. Every day,
somebody has to move a car to let someone else out. Turning distances
are very cramped. Not long ago, a scrape from somebody getting out
past a car that way resulted in $2000 worth of damage total. These are
the expenses which are not seen. So far as I can tell, we've yet to
have a handicapped person visit the lab. If we ever did, we'd
certainly know about it in advance (as we do all visitors), and could
certainly move cars out of the handicapped slots THEN. But that's
For that matter, due to the handicapped slots being present but
empty, somebody is often forced to park in the driveway nearest the
front door, where in reality it would be easier for an honest-to-God
handicapped person (should one ever show up) to park (and where the
mailman and delivery people sometimes park when they have a delivery).
Any handicapped person would naturally park there, anyway, and if a car
was there (which is likely at some hours, due to the unavailability of
parking) would have to wait while someone moved a car, in any case.
Ah, Congress. We thank thee for seeing our troubles and passing
laws of equality to make things better for us, thy servants. Thou art
our partner and our guide, forever and forever, amen.
Steve Harris, M.D.