What's going on in California?

[ddl]

Re:health care reference (RANT ON)

Doc
I agree the whole system is messed up, no matter where you turn, some else is tring to tell you how to do your business. If everyone treated everyone else with the respect and credit they deserve we would not have the problems we do. A Doc friend of mine back in Iowa would tell us of the fights with insur. over care given.

Someone mention Canada and their care. The people we know up there give a basket full of good and bad, A friend needed a operation of a herieria(sp) and was put on a two year wait. The taxes they pay more than pay for their care

Dan L

 

[Rch]

Re:health care reference (RANT ON)

What's "eob"

RCH

 

[cowboydoc]

Re:health care reference (RANT ON)

It's explanation of benefits. It's a paper that the insurance company sends you saying what they did, did not pay, how much they paid, how much you owe, deductible, etc. One is sent to the patient and one to the person or place that did the billing.

 

[alexcocco]

Re:health care reference (RANT ON)

i wonder if the general public knows how many hours we spend on the phone with the ins co's per week, how much time we spend fighting for them, at our own expense. your doctor doesent get paid for fighting with the ins co for you, that is just so much time lost, the patients still get the same amount of time, this time is taken from our families and our personal lives. i dont think it will take 25 years for the doctor shortage to rear it ugly head, i look for it to show sooner than that in many specialties, for the last 15 years more general surgeons have retired than have entered practice each year. i look for a shortage in the near future.

i think this is closer than you think, they have closed many surgical residencies in the last few years. i doubt these will reopen. how many people on this site have taken a 50 percent pay cut in the last five years? your doctor and hospital have. would you really want your operation done by the lowest bidder?

alex

 

[Rch]

Re:health care reference (RANT ON)

I agree with Alexcocco, in fact , doctor shortages are already here in those specialties that have longer training programs. It used to be a new doctor didn't have to pay back goverment loans til he/she finished ALL their training; now you got to start paying after the first year past graduation, effectively preventing many from continuing into the longer training programs. Believe me, an interventional cardiologist, radiologist, gastrointerologist, or sub specialist surgeon can be the person between life and death. Family Practice is necessary too, but these other guys are absolutely essential to make this new technology work. Increasingly, foriegn medical graduates are the only ones who are in these prolonged training programs because it keeps their training visa alive and their families have financial resources. The trick after these prolonged programs is to get permanent resident on the basis of a "high-tech need". This immigration status/game is absolutely necessary to prevent disaster in health care and,from what I hear, other technologically driven areas. It's America picking off the brains of the world. It has its obvious advantages but a disadvantage can be a linguisticlly and culturally "challenged" doc with the inabiliy to make the 'right thing happen' as opposed to just knowing what to do. An essential part of doctoring (the art of medicine !) is mobilizing the PATIENT and the RESOURCES to make sure the right thing happens. Don,t misread me, I know and refer to many excellent foriegn born docs (they've even operated on me- electively!) but our dependency on them is because of a failure of our system of training for our own needs. By the way, the capricousness and attitude of the Immigration & Naturialization Service is often an embarassing affront to American ideals of fair play.

RCH

 

[cowboydoc]

Re:health care reference (RANT ON)

Alex and RCH,
Yes you are both right about a shortage. I probably worded it wrong but what I meant by a shortage was that there was a shortage now predicted for the next 25 years. This is due to the fact that it takes an average of 12 years to develop a specialist and 10 years to develop a general practitioner. To account for a shortage the article was saying that you would have to go through two generations of training before it would correct itself, so at least the next 25 years you will see a shortage.

 

[Wingnut]

Re:health care reference (RANT ON)

I probably should stay outa this one, but - what the heck ,,, just got back from a loooong meeting in Houston where I managed to irritate a whole buncha sharpies so I'll just keep bulling along.
It, IMO, isn't falling apart because of any one thing ... it's a combination of everything. For one thing ... the entire "industry" - from one end to the other - is there for a profit. And they all work very hard to make sure they get a profit (especially the lawyers, of course). And those costs, of course, have to come from somewhere. That somewhere, my friends, is your pocket. Period.
Where do all the costs come from? Well, there's money to be made from new and improved and very little to be made from old and still functional ... so now even vet clinics can afford MRI machines. I believe that some 10 years ago a study was done and found that there were more MRI machines in Seattle than in all of Canada. Why? Well, we're all willing to pay insurance premiums so that if a doctor suggests that an MRI should be done ... there'll be one real close and available.
And now we're seeing that there's a cost to all this.
I was introduced to the US medical system 2 years ago (I already knew the Canadian system well - as the ineptness of the system and several doctors cost me a wife) when I managed, after 50 years of perfect health, to find a use for the emergency room. While putting the final sheet of sheathing on the roof of my shop (with a pneumatic nailgun), I screwed up bad (a moment of inattention) and ended up blasting a 3-1/4" spike into my leg, just above the knee. To cut that story short, I had my wife drive me to the hospital as I figured an x-ray was critical to determine the damage. When I saw the x-ray, I figured they'd quickly pull the nail (or I would have) and let me go home ... but no ... a trip to the ER, a general, and a pair of pliers to pull the nail. I woke in the morning ready to get the heck out of there ... when the anaesthesiologist stopped by ... and decided he should pull the drain. Now I'm not sure what a gasguy has to do with drains ... but that favor was added to the bill. My share of this sojourn was over $1000 since they did so much more than was necessary and the insurance comapny (and I'd side with them) decided that $4000 was at least $1000 too much (the gasguy billed $450 to pull a drain he had no business monkeying with).
I'm sure that not all doctors are in it - completely - for the money .... but it's for sure not the profession it used to be.
Yes, I real;ize that there's more than enough blame to go around ... hospitals, administrators, doctors, unions, HMO's and all the rest ... but "health care" has certainly become an oxymoron.
As bad as the Canadian system is ... and it can be quite bad ... I still find it much better than here. Maybe my unpleasant experiences have been atypical (although my wife seems to feel they're pretty standard and she has had enough experience with the system in South Texas), and I sure hope so ... but this push for obscene profits by the medical profession ... from one end to the other ... doesn't bode well for the fuiture.

ok, back to my cave ...

too bad that common sense ain't

 

[cowboydoc]

Re:health care reference (RANT ON)

Wingnut,
Now I agree with alot of what you say except I take offense to your comment at the obscene profits that the medical profession must make. Each year my income goes down. MRI's actually save money. If I can get an MRI of a knee, shoulder, etc. then that may save an expensive surgery. Instead of sending the patient to physical therapy and wasting the patients time and money I can get an MRI and know exactly what the problem is and the course of action to take. As far as obscene medical profits that's going a little too far. It costs me over $20,000 a month just to open my doors. You want to talk about obscene I'll send you my malpractice insurance bill and I've never had even a complaint. BC/BS in Iowa last year made over a billion dollars. Why is it that a doctor shouldn't make a decent living for spending 10-12 years of their life in school studying late every night? Why is it that a john deere tractor can go for 20 or 30k and that's a great piece of machinery and john deere makes a huge profit and not a word is said about the obscene profits that john deere makes. What about the 500% markup on parts, jewelry, clothing, etc? Anyway not busting your chops here just that most every doctor I know makes a good living yes, but it is in no way an obscene amount of money. The average salary nationwide for doctors is around 88k a year. Like I said before most of the upper management people I know in the businesses around here make more than that. Hon Industries is a big company here where I live and I have a good friend that runs their machine plant there. He is four years older than me, high school diploma, and makes half again what I do in a year. Anyway that's my last thoughts on the subject it's getting out there a ways now.

Time to talk about some funner subjects. How are the mini's doing? 55 below zero here last night with the wind chill, -14 actual temp. and snowing and I even put my horses in last night!

 

[alexcocco]

Re:health care reference (RANT ON)

i think that there seems to be a confusion about doctors charges, i charge everyone the same, but who cares the insurance companies only pay what they want to pay and call it their "ucr" usual, customary and reasonable fee. somehow it is never the same from company to company so ucr's really dont mean anything.

as far as mri machines and canada, most of the canadian population lives within an hour of the U.S., the cross border health care traffic is unbelievable, i worked in Buffalo, ny for a while. i guess when it comes to serious illlness many of the canadians would rather be treated in the U.S. a few years ago one of the provences ran out of money for their healthcare budget befor the end of the year, they grounded all their medivac helicopters. i would like to see them do that here, the public would go crazy.

the canadian system "works " because the people have a choice, they can stay, wait their turn, or go across the border and get their care. so given the number that opt out of the system i dont think you can say it works.

alex

 

[Wingnut]

Re:health care reference (RANT off)

Richard ... please be assured that I was NOT referring to yourself or even the average doctor with my rant. When I said "medical profession" and "from one end to the other", I was referring to hospitals, HMO's, the drug industry (who, IMO, are worse than the oil industry for ripping us off), specialists, unions, and all the rest ... and, of course, some doctors ... who read read about all too often - ripping off the system for millions and giving the rest a black eye.
I'm shocked, however, at the statement you made (not disputing the truth, just shocked) about the average income. I assume this is net ... but still find it very low compared to what I know about the despised health system in Canada (well, despised by the health industry here, anyway) where the average income is at or above $100k.
What fries my brain is how many people have their fingers in the pie here. Back in Alberta, when I was newly married some 3 years ago and my wife was not legally in Canada yet, she needed a perscription refilled. I took her to my family doc in the small town (Redwater) near where we lived and paid the office fee myself (since they couldn't collect elsewhere). They charged me the same they would have gotten from the healthcare system - $19.14. And, to top it off, my wife thought that the doc was the best one she'd even been too (and she certainly has more experience than I do ... but all in Texas). She formed this opinion during the 14 months we lived in Alberta before the transfer to Michigan.
Now, contrast that with my co-pay here of $25 for an office visit ...
I can't argue with you about the cost of value of an MRI ... my medical history was 3 years as a medic in the Canadian military ... 1 year in the OR and 2 years in surgical wards ... and that was way before MRI's ... if they even have them now. I can only look at the one little bit of knowledge I have .... my moment of thoughtlessness that caused the hole in my knee ... and the unnecessary costs that were tacked on and continued to be tacked on for a month afterwards.
Unfortunately, the experience here is likely very much unlike other places as this is basically a 2 company town where almost everyone is insured and the healthcare system here reflects that. New everything and costs to match.
I guess my outlook is colored a bit too much by the still-in-the-front-of-mind loss of my wife 3-1/2 years ago due almost entirely to people and not the system. I don't blame anyone else (i.e. don't blame other doctors or hospitals, etc) ... but it sure has colored my "worldview". I no longer want to live forever (if I ever did), nor do I believe in the extra-ordinary steps taken to prolong life (like replacement of everything except the wallet) ... nor do I believe that ...

nah ... we're getting way too far out there ... as you've already said ... let's leave it at my apology for making you feel I thought you were cashing in too well ... and that I appreciate the fact you were willing to gently let me know.
We all gotta share this world and there's no reason why we cannot do that politely ... and, hopefully, enjoyably.

pete (sorry, no time to create a nifty graphic)

too bad that common sense ain't

 

[cowboydoc]

Re:health care reference (RANT off)

Wingnut,
Thanks for the reply, apology, and clarification. I thought that was kind of harsh coming from you but explaining it a little more I see what your point was now. I am very sorry about what happened to your wife. You are so right about a few giving the whole a black eye. As far as salary it always amazes me the amount of money people "think" doctors make. Again you were truly gracious in your reply and it was very much appreciated.

 

[Bird]

Re:health care reference (RANT ON)

Richard, I tend to agree with just about everything Wingnut said, and SOME doctors, as well as others in the medical profession, ARE making obscene profits. And I think doctors had as much to do with creating the mess we're in as anyone else. HOWEVER, we all tend to generalize (if that's the right word), based on our experiences, when we logically know that such does not apply to everyone. Naturally, you (and other doctors) have a little different viewpoint than most of the rest of us.

To try to give you an example of what I'm talking about for a different profession. I spent a lot of years in law enforcement, and a number of Supreme Court decisions placed a lot of restrictions on police officers, such as Miranda and many others. Now, many officers blamed "liberal" courts for these restrictions (just as you now blame the insurance industry - and lawyers). But if you really study law and the court decisions, you'll find that in most of the cases, they were the result of some dumb cop doing something stupid - or even crooked, and it resulted in restrictions on all officers. Well, I'm convinced there were enough crooked doctors who gouged insurance companies that now it's tough on all doctors, and their patients.

And hopefully, we're smart enough to not believe all doctors are crooks, that most are good honest folks, just as I know that most cops are good honest folks, trying to do a good job; although I've known people (including one of my grandfathers) who were convinced that all cops are crooked.

Unfortunately, there's enough blame to go around, but instead of worrying about who's to blame, what can we do to correct the problem? And I wish I had the answer, but I don't.


Bird

 

[Wingnut]

Re:health care reference (RANT off)

Richard,
you had asked about the "little guys" ... all the horses are just fine (and back in the barn at night due to the icy conditions here ... the "mother hen" worries about them slipping and hurting themselves). I'll even try and post some pics along with this ... you can get an idea of how small these critters are by looking at the barn in the nackground. Sorry for the contrast ... lousy day for this mickey-mouse camera and my software for the digital vidcam is acting up ... so these'll have to do for now until I find some debugging time.



too bad that common sense ain't

 

[Wingnut]

Re:health care to horses

These are the littlest guys ... the barn backdrop will give you a size indication ... the barn sliding door is just over 7 feet.
Mama's the tri-color ... the little guy with her is the "baby" that was sick before Christmas ... the black in the background is the pround little daddy. He's about 28", mama's about 22" and the little on'es about 19". One of these days, I'll have to take the measuring stick out there. The little guy was 151 lbs when he left the hospital.

too bad that common sense ain't

 

[Wingnut]

Re:health care to horses

Better picture of the little guy (in the foreground). Better living through fur!

too bad that common sense ain't

 

[cowboydoc]

Re:health care reference (RANT off)

Wingnut,
Yes I know all about the little fellers, we have had a few of them and have one now. I bought them when my girls were small so that they could learn all about horses without getting hurt when they were really young and build up their confidence. They are great pets for the most part and don't eat nearly as much as the big ones!!!

 

[JATO_RaT]

Re: What\'s going on in California?

Yeah Harv, I've been hoping for a little of that Rolling blackout stuff , but nothing, full power. All the hype and still I get lots "O" power. Was hoping for some excitement.
Someone mentioned a 1000 megawatts as though that was some huge amount for a state this size. I think the folks in Washington and Oregon are a little out of touch with the enormities of this state. Shoot, little ol Rancho Seco pumped out 750 megawatts in its hay day. Oh well, I live in an 900 sq. ft. home and just can't use much electricity. I assume you and RobertN both draw off the infamous PG&E. Best of electron potential to you, Rat from Newcastle...

 

[Bird]

Re: What\'s going on in California?

The editorial cartoon in our local newspaper yesterday had:

Q.: How many Californians does it take to screw in a light bulb?

A. Eight....one to hold the bulb in place, seven to pray the power stays on....

Bird