Quote of the day—Bill

Medicine only works when those in the job WANT to work harder to help people, and that happens most consistently when both those served and the server receive benefit from the service. Medical providers aren’t mercenary per se, but when almost every decision you make gets parsed by multiple, NON-Involved people, the only compensatory mechanism is financial reward.

November 8, 2010
Comment to Following the U.K. medical model.
[Wife Barb works in the medical field as well and what Bill says both here and in the rest of his comment matches her experience as well. Government involvement in health care does not improve it. It subjects it to review by people that weren’t there and don’t have near the training that you do. It makes it time consuming and frustrating dealing with the bureaucrats rather than working with the patients. This increases the cost. This drives away those that are passionate about improving peoples lives. This retains people who can tolerate pushing paper and drives away those that find providing good quality medical treatment rewarding.—Joe]


7 thoughts on “Quote of the day—Bill

  1. Also a Doctor’s job is a BRUTAL one. Medical School is stressful just to get into, and that’s where the stress just BEGINS, then residency, finally many are on call 24 hours a day. My Wife’s surgeon spent 6.5 hours working with her brain, can you imagine how stressful that is.

    After all that, and all we gain from them is it too much to expect them to drive a luxury car home to a very nice house, and maybe take and expensive vacation a few times a year?

    If people were willing to subject themselves to the rigors of such a job the Medical world would look like the Marine Biology world. As a Marine Biologist I got paid less than comparable physical scientists, and my job pool was vastly more brutal and physically challenging work. Why? Well because jobs where scientists swim with dolphins in tropical waters, or run tests on samples on large comfortable research vessels, or better yet to entry work in a land-based lab, those jobs are flooded with interns and volunteers. People are willing to do it for free, so a living can’t be made in large parts of the field. (Tho the PhDs who run the program are compensated very well…they didn’t get their Doctorate to work the night shift at Wendy’s!)

    Same with Gun Bloggers, many of us work VERY hard at what we do, and ALL of us have “Day Jobs”, because working to restore our rights and bring new people into our hobby is rewarding in itself, that we’re willing to do it for free, or whatever we can cobble together from advertisements.

    Doctors are NOT Gunbloggers.

  2. Your point can also be made for those of us in Education, government intrusion vastly diminishes the quality of the courses I teach. When a Judge in Salem with less scientific training and understanding that I have in the tip of my little finger can tell me what I can and cannot teach…well, that’s when retirement finally began to be something to look forward to. Furthermore, my sibling who is a Mensa member and has his PhD, looked into taking his talents into the K-12 education world after a rewarding career elsewhere where he’d managed far more people and had far more budgetary responsibility than pretty much any school district had to content with and he didn’t because of the inane hoops the governmental (read Dept. of Ed)wanted him to jump through. My gut tells me he’s not the only one that’s opted out.

  3. Government intrusion in other professions is certainly an issue. BUT…generally you know the rules ahead of time. No one changes the rules while you go along, and then says, “BTW, those hospital admissions you made, they should actually have been 24 hour observations”. And then fines you for making them admissions instead of observations patients.

    Real Case: A long time practioner admits 3 patients to the hospital over a 6 month period of time. All are elderly patients with suspected pneumonia. 2 of the 3 actually do have pneumonia and end up in the hospital for approx. 1 week each. The 3rd improves within 24 hours and is discharged. 2 years later, Medicare is doing a routine screening and comes across the cases. Since the 3rd patient was discharged within 24 hours, they decide that the doctor was in error. The patient should have been an observation patient. Since they now have an error by the practitioner, they pull all his admissions in the past 3 years, and find the other 2 pneumonia cases. They deem that he should have put them in as observation patients, and then converted them to admissions after he was sure they had pneumonia.

    So, what to do, what to do? Here’s there solution. Fine the doctor and the hospital. The doctor is fined 24,000 dollars for EACH patient, 100 times the charge he submitted for doing the Admission history and physical. The hospital gets off light, they only are fined $50,000!

    The doctor appeals, loses. The hospital appeals, loses. There is no insurance coverage, this is not malpractice, it is a violation of Medicare guidelines, so no insurance coverage exists.

    Guess what the doctor did? You got it, closed his practice, paid the fine, and walked away. Roughly 1500 patients had to find a new doctor.

    Here’s where it gets fun…Guess who does the investigations? Not Medicare, not a government agency…an outside agency contracted by Medicare. Guess how they get paid? Wrong, not by Medicare…They get paid by recovery. Their fee—wait for it—1/3-1/2 of the recovered amount.

    Next time your parents need admission to a hospital, and the doctor talks about Medicare guidelines for admission–now you know why!

  4. “Government intrusion in other professions is certainly an issue. BUT…generally you know the rules ahead of time. No one changes the rules while you go along, and then says, “BTW, those hospital admissions you made, they should actually have been 24 hour observations”. And then fines you for making them admissions instead of observations patients.”

    No, you don’t. All sorts of government agencies produce so many rules, it’s generally impossible to keep up with them; additionally, bureaucrats are continually changing rules right under our feet.

    I can’t help but wonder: When are we going to stop putting up with nonsense like this?!?

  5. Alpheus,

    Notice I said, “generally”. But the proliferation is ridiculous.

    I’ll give you an even easier one to show that. The town I live in had a dog attack, the city council was discussing banning certain breeds of dogs. I pointed out, as a member of audience, that the issue was not bad dogs, but irresponsible owners, who allowed their dogs to roam without leashes or restraint. Invariably it was those dogs causing problems.

    I then pointed out that if we simply enforced the already existing leash law that most of the issues would go away. The mayor at the time (who favored the ban) pointed out that we couldn’t enforce a law we didn’t have and a couple of the other members of the city council chimed in the same. The look on my face must have been fairly incredulous, because the city manager jumped in to point out that we DID have a leash law in the city, and had for many years. The Chief of Police was there and confirmed it.

    Just like those who believe that we need ANOTHER gun law, these guys were willing to pass ANOTHER law, when they already had a serviceable law in the first place.

    Another example, ask the IRS for advice…The FIRST thing they tell you is that their advice isn’t binding!! If they don’t know the tax laws, what are the chances anyone else does?

    It’s a good point, but very few occupations rely on government payment to exist. Medicine, because of Medicare and Medicaid, and the laws passed to guarantee care to those two groups, has no choice. AND the payment is rendered after the service, if they deign to pay at all. My practice averages about 55% recovery on Medicare charges and about 20-25% on Medicaid adult patients. Its a little better for kids, and pregnant women.

    Is there another business anyone here knows of that accepts 55% reimbursement on their most difficult group of business? How about anyone who will do business for 25% of the charge?

    I wish I could buy weapons with those kind of discounts!!

  6. As an intern working in a busy southern VA and a charity hospital, driving a beat up SUV, paying off loans, and looking at 3 to 6 more years of training ahead of me, with no expectation of reimbursements allowing me to recover my opportunity costs when i actually get out into practice, yeah, I agree, the government is screwing up medicine.

  7. Bill, you’re right about Medicare and Medicaid forcing themselves into the issue; I overlooked that.

    “I wish I could buy weapons with those kind of discounts!!”

    Unfortunately, the standard practice for doctors to price their services to make up for the difference–so that a $25 service becomes a $100 service, instead; and doctors can’t charge a “Medicare” price and a “Patient-without-insurance” price, because the Government then says they are being defrauded money.

    Thus, everyone else has to pick up the tab, and, indeed, those of us who pay for private insurance have to pay higher rates…and those of us who have no insurance get hit the hardest for this.

    And then Government has the gall to claim that medical prices are too high!

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