Thank you Dr. Seigel,

My son-in-law is a doctor at Mayo Clinic. We are all worried and concerned about this horrific
holicost perpetrated on the people of the United States of America and especially our Valiant Doctors caught in the morass of this corruption and the thug force of the Obama Administration and the Democratic Party. Their lies, illegal political manuvers, smoke and mirrors to promote their POWER-GRAB and CONTROL of this country is to render OUR citizens SLAVES to the government.

THEY ARE SELLING OUT AMERICA. THEY ARE SELLING US OUT.

I will send this article to all of my congressmen and my friends. Thank you for your
very understandable coherent message and Thank you for standing up.

Lois Jesek

Dr Siegel is totally correct.

The Dems are supported by the trial lawyers, and have offered little more than lip service to tort reform. There has to be compromize here, or the whole health care bill will be hopelessly flawed.

“The growing doctor shortage – the Association of American Medical Colleges calculates we will be 125,000 doctors short by 2025 – does not leave us with the manpower to take care of an additional 30 to 40 million patients. Doctors will be more rushed than ever. “

Wonderful! We should just let those 40 million people die, that way you won’t be so rushed. While we’re at it, why not kill off another 10 million so doctors can have more time to eat lunch? Who needs patients anyway?

What a ridiculous argument.

“Wonderful! We should just let those 40 million people die, that way you won’t be so rushed. While we’re at it, why not kill off another 10 million so doctors can have more time to eat lunch? Who needs patients anyway?
What a ridiculous argument.”

Well, Gee Mr. Bordogna, Your statement makes no real sense. When you have only a few minutes to see the doctor as it is, why do you want even less time spent on your visit. Seems to me that’s more chance to miss something, less time for you to complain that your not getting your money’s worth from your “free” healthcare.

Bill Bordogna, I believe that to have opinion that validates your feelings you need to educate yourself. There are 279 doctors to every 100,000 people. That’s a pretty hard margin. Everyone in this country deserves time to eat, time for family and a life. If you belive different I would expect you are in the wrong country. Save your rhetoric for a personal blog.

Some of what a General Doctor does can be automated, some are on auto pilot now. They ask questions, they do the same tests, they prescribe the same meds. Have an online system that keeps track of your symptoms and recommends a course of action, if its to see your doctor so be it. The whole system has not had an incentive to reduce costs until now.

Dr. Siegel is dead on with this article! A small medical/dental group in New Hampshire has a framework to resolve all this issues. Obama’s healthcare reform is nothing more then remodeling the whole bathroom, when just the faucet is leaking!

“Nuisance suits can be blocked by creating boards of doctors and lawyers to review cases before they are brought ”

What percentage of all lawsuits are nuisance or frivolous suits? Is defensive medicine the result of the fear of being sued or the probability.

““Loser pays” statutes can be added (doctors win the vast majority of suits) so that liability insurance companies won’t force doctors to prematurely settle claims to avoid large legal fees.”

So only the rich will have access to the courts.

So basically the only way to solve the problem of health care is on the backs of poor people or those that do not have health care.

http://www.robertsfight.com

According to the actuarial consulting firm Towers Perrin, medical malpractice tort costs were $30.4 billion in 2007, the last year for which data are available. We have a more than a $2 trillion health care system. That puts litigation costs and malpractice insurance at 1 to 1.5 percent of total medical costs. That’s a rounding error. Liability isn’t even the tail on the cost dog. It’s the hair on the end of the tail.

Of that 1 to 1.5 percent what portion of that is “frivolous”?

http://www.towersperrin.com/tp/getwebcachedoc?webc=USA/2008/200811/2008_tort_costs_trends.pdf (Page 10)

And then of course the report from Towers Perrin that states that the total tort cost in the US is 2% of the GDP. What percentage of that is “frivolous” and of that percentage what percentage is “frivolous” corporate lawsuits. So how much are “frivolous” lawsuits driving up the cost of everything? Maybe less than 2 cents on the dollar or maybe even less the 1 cent on the dollar?
http://www.towersperrin.com/tp/getwebcachedoc?webc=USA/2008/200811/2008_tort_costs_trends.pdf

“Bill Bordogna, I believe that to have opinion that validates your feelings you need to educate yourself. There are 279 doctors to every 100,000 people. That’s a pretty hard margin. Everyone in this country deserves time to eat, time for family and a life. If you belive different I would expect you are in the wrong country. Save your rhetoric for a personal blog.”

So because we do not have enough doctors let’s not try and insure everyone. Why not try and get more doctors into the county by reducing the cost of medical school so they do not have to charge so much to pay for medical school. I thought doctors went into the business to serve not make 150,000 a year?

Doctors,

You need to see things from your patients’ point of view. You come in and usually spend a few minutes, charge a $100-200, prescribe medicine/order a test/refer a patient out (which you get paid for). Meanwhile, the patient has been paying hundreds of dollars a month for insurance that won’t pay unless it is very serious (meaning very expensive) and has to then balance paying you with rent, mortage payments, kids soccer, Christmas presents.

Your prices we know are influenced by staff, rent, insurance and malpractice insurance, but you just have to see that not only are the uninsured not able to see you, sometimes those that do have insurance can’t afford to see you (thank you high deductables). You only see patients who can afford you. Ever wonder about those who can’t get past your bouncers unless they produce cash or do you only think about your fancy car, huge home and fancy everything?

As a teacher, should I only teach the children who are rich enough to pay? We have socialized education, police forces, fire departments – is education more of a right than healthcare? Are only the rich entitled to protection and justice? Should firemen only rescue people who buy their yearly calender? What makes you so set against trying to help those with no coverage…it doesn’t seem to be you doctors, hospitals or insurance companies. So, if you won’t help, at least stop hindering reform.

We aren’t trying to punish you – we just want afforable healthcare for all.

Fox News obviously is in a better position to know what doctors want than the AMA or the New England Journal of Medicine.

Your desperation is show Liz

The attitude of your article is proven by your last comment, a dig of female doctors. This is not the opinion of doctors, its just your rant. I was interested in your facts but was overshadowed by your opinion.

As a practicing physician and educator, I think certain health care reforms ARE critical for America (see below articles by the esteemed Dr. Barbara Starfield). The need for improved access and insurance reform (pushed by the President), tort reform (NOT supported by the President), and more PRIMARY CARE physicians (rarely mentioned by anyone) are all keys to drive us in the right direction.

http://www.managedcaremag.com/archives/0806/0806.qna_starfield.html
http://bostonreview.net/BR30.6/starfield.php

As a 62 year old (with a medical background and former Federal Employee), I am concerned our Congress and Administration are polking their noses too far into the lives of We the People.
They are NOT required to over-see our healthcare and make demands on us. We still have the Constitution to protect us, until it is abolished by obama.

This administration is going far beyond the boundaries of the Executive Branch and many in Congress have become professional political seat-warmers, rather than elected officals to serve, protect and defend We The People, their employers. These people are not educated in the medical field, most are failed lawyers who inherited or bought their seats. What gives them the right to tell citizens what to eat, what doctor to see, what pills to take, and what treatments to receive?

There are many citizens who believe anything coming out of this Administration. Since 2006, the Congress has and continues to bully We the People and force us not as Citizens, but Subjects.

Where is the Transparancy? Seems it has been put on the back burner as have honesty, working together and the other “pie-in-the-sky” promises we continue to hear in campaign speeches by Organizer-in-Chief obama.

If the health care of the USA is placed in jeopardy, just to promote the Prez or provide a promise of a few million new votes in 2010 or 2012, there will be citizens litterally dying waiting for REAL Change and Hope.

We need quality care with fairness and intelligence.

Hello!
Gentlemen – intellectuals – experts – researchers

Completely random I read your views on the reform.
Very respect for you.
But:
Is not the health of the population – the national interest.
Leaving aside the financial side – only be temporary if we look wider
If I am wrong – correct me.
Impartial observer.

The American Medical Association and other doctor groups have failed to police their own members, so doctors shouldn’t complain when people turn to the court system for justice.

The same groups have carefully controlled how many students are allowed into medical schools in order to keep the profession exclusive, so they are responsible for any doctor shortage.

I don’t agree with the parts of the Obama plan that I’ve heard of, but doctors brought their profession’s problems on themselves.

To reply to some of the commenters: doctors do not all have big houses, fancy cars, etc. We do not get paid for ordering tests, medicines or referrals. We do see uninsured patients. If a doctor is on staff at a hospital, the ER has a list of on-call doctors for people who need to be admitted who don’t have a doctor on staff. The on-call doctor has to admit the patient and if they need a consultant (e.g. surgeon, pulmonologist, etc) usually the consultant will see the patient even without insurance because the referring doctor will send them paying patients also. I do not know of any other entity in the world, aside from US doctors and hospitals, that are set up to be for profit, that on a daily basis, give away their good or service to total strangers. In the situation above, the patient gets the same care as one with insurance. Yes, they will get a bill, but it often is written off by the doctor or hospital or ignored by the patient. Also, what other profession operates to the standards we hold doctors? Even when people are healed from whatever brought them to the hospital, they sue for weakness or general deterioration suffered in the hospital. Tort reform will decrease the number of unnecessary tests, thereby decreasing the overall cost of medicine. It is more than just the lawsuits themselves. Most doctors make less per hour than the workers on the assembly line in Detroit (or did before the bailouts).

Would catastrophic insurance in addition to tort reform and self-responsibility be one solution?

Tort reform would eliminate a lot of the unnecessary self-protection tests doctors have to order under today’s sue-happy citizenry. Catastrophic insurance would protect us from the devastating bankrupting costs of the really serious illnesses can get: cancer, diabetes, strokes.

Then there’s the taking-care-of-yourself responsibilites we all have. Eat less with better choices. Exercise. Follow your doctor’s orders (a biggie). I worked with diabetics who thought taking their pill would allow them to eat with abandon. I’ve friends with lung cancer who continue to smoke, one who is on her second round of chemo after successfully beating the disease a year ago BUT continued with the cigarettes and the cancer returned.

Quit abusing the system and get family members involved. A relative would run to the doctor over every little pain because it was free–Medicare and Medicaid. She wouldn’t remember what the doctor said was wrong, if anything, because she knew she could get another appointment. I started writing everything down the doctor said and when she would say, “I don’t know what’s wrong with me”, I would refer her to her typed copy of the office visit and the doctor’s advice and, amazingly, she would calm down and the visits became less and less. She died at 90 years of age!

Just “sayin’.”

Tone–The way I look at the role of our federal government, the health of the population is a national interest, but not a national responsibility. The Constitution details the powers granted to the federal government, and there is nothing in there about providing health insurance to the people.

But that isn’t to say that the government, as representatives of the people, do not have an interest in, or expectations to, facilitating measures to alleviate suffering among the people. The federal government IS granted powers of enacting monetary policy (which includes tax policy) to create a financial and legal environment that facilitates private, commercial solutions to address the broader needs of the People. Ultimately, “health care” is an industry of private commerce between private individuals, and the government’s role is to be a facilitator of private commerce, not a player.

Thank you Dr. Siegel. I am one of many primary care physicians that chose to leave the rat race and opened up a small fee-for-service micropractice. I have one employee, I spend an hour with new patients and 20 minutes with follow ups. I see fewer patients but provide them with exceptional care at reasonable fees. I don’t have a huge home and I drive a used car but I no longer miss my children’s sporting events and have regular date nights with my wife. Because I don’t accept insurance, I don’t have to pay a 3rd party 7% of my income to collect from the insurance companies nor do I need a nurse or office manager because my volume of patients do not demand it. I am relentless about providing preventive and proactive health care, something that is largely ignored in our system. Much of the maladies in our country are self inflicted. We are a fat, lazy, and selfish people who demand a pill for everything but because there is no longer any accountability in our country, I am not aloud to say such things to patients. Although I have been known to tell parents of obese children that it is their fault there kid will probably eventually develop diabetes, high blood pressure and heart disease – those patients usually don’t come back. Yes, some people have illness through no fault of their own and it breaks my heart to see ill patients who are unable to get the care they need regardless of the cause.

I spent 11 years in training (deferring retirement contributions) and have 180K in student loans. I went into medicine becuase I felt it was a calling but I will not apologize for making a good living for a profession that I paid dearly for over those 11 years. While many of my friends were making a good living, having children and building their lives, I was working 80+ hour weeks, putting off having children and eating hospital food. I chose that path and do not regret it, and becuase we live in the greatest country in the world, I am now free to make a living (for now) as a result of the sacrifices I made during my training. I do not believe any good will come out of Washington from either side of the isle when it comes to health care but I am not depending on them or anyone else for my well being any longer. I will continue to take care of a small number of patients who value exceptional care and affordable care, on my own terms which are consistent with the ideals our country was founded. Although the way things are going, I am not convinced I will continue to have that right if Obama has his way. If that is the case however, I like many physicians will move on to another profession and will do so with success because we understand the principles of self reliance, hard work and sacrafice.

Dr. Hirsh,

You guys make much more than a worker on the assembly line. The fact that if someone goes to ER and by law has to be seen says that people don’t trust hospitals to help people who can’t pay. Going to the doctor’s office, however, is different. Without insurance or a credit card, we can’t get into see you.

Don’t think for a moment that it is right for you guys to just right off people who can’t pay. A service is provided. You should get paid. But, the majority don’t go in because they like to pay their bills. They don’t like to go knowing they won’t be able to pay. Most do pay and at a terrible cost sometimes.

No fancy cars – you jest. Check out the parking lot. I’m not saying you shouldn’t be rewarded for your work and all the studying it took to get you there (you should). But to do it on the backs of people who have to choose you over their mortage/rent/food? You don’t know the whole story your patients’ finances. Why not ask them?

Those who bring frivilous lawsuits are less than 1%. Most people are honest, yet none of us live in a perfect world. Get over it. My dad was robbed driving a cab.

As for the referrals, prescriptions…okay. That is news to me. Are you saying that when you prescribe a medicine, that that company doesn’t reward you will payouts, trips, etc?

We need reform. We seriously can’t afford you guys and insurance is way too much for many to afford.

Scot, the gov can be a player/regulator if the people want it to be.

Just for the record, I admire you doctors. I really do. You are smart and help so many people. The problem in our country, though, is that many people aren’t getting helped or are getting bankrupted in the process. I am guessing you don’t know what it is like to get letters from collection agencies for months on end. To get phone calls asking when you will pay the bill. You don’t see the family with no savings because they pay through the nose for health insurance with high deductables/co-pays then can’t afford to go in unless it is really serious.

My family has to wait on things so we can afford them. Don’t assume that just because we have insurance, that health care is suddenly affordable.

Being a doctor has always been a very respected position. People respect you more than you know. Don’t turn your reputation into something that sounds more like someone who cares for the health of their patients but doesn’t mind the cost to them. I fear jokes about doctors are around the corner as they are about lawyers…(sorry lawyers…just a fact of life at this point).

To Unimpressed: Should I get a free transmission repair from an auto mechanic simply because hey, he’s a mechanic and I can’t afford it (but I need my car). Should I get my house rewired for free by an electrician because, hey, he’s an electrician and I can’t afford it (I’m afraid my house is ready to burn down.) My plumbing is shot should I get a free… you get the point. Medicine is a job. A profession. A means to earn a living. They should get paid for what they do. They keep people alive. Why shouldn’t they earn more than everyone else?

CFCJ,

You are right, they should be paid well. But, not at the cost of people going without healthcare. The questions remain: how can we reduce the cost of healthcare for everyone AND how can we make sure that everyone has healthcare? Your comment about free this and free that really misses the mark of intelligent dialouge on a topic that is very important. Thus said, fixing a car or getting an electrician to fix something usually allows you to get quotes, decide the best price, put it off if possible till the next paycheck….you get my meaning. Healthcare, on the otherhand, allows no patient to know the cost of something beforehand (can you ask a hospital how much they charge to fix a broken arm – then go to another one and ask the same?), and is urgent in most cases (broken bones can’t wait like my leaky transmission). Lets keep our comments civil and arguements logical and realistic.

Western culture really has been influenced by the good samaritan. We do good to others even if they aren’t “our own.” How can we ignore the (what is it now) 48 million uninsured and who knows how many overcharged and underinsurred. Remember too, most uninsured are working people who just can’t afford insurance. MedicAid pays for the very poor – for the most part anyway.

I’m a teacher with 7 years education. I teach kids regardless of their income levels. If a family is low income and doesn’t pay taxes – should I refuse to teach their children? Of course not.

No one seems to get it. An insurance card won’t do much good if you can’t find a doctor to take it. Ask Tennesseeans who signed up for TennCare. Their “care” ended up in the ER and it bankrupted the State of Tennessee. THE FIRST ORDER OF BUSINESS for healthcare is to attract more students to go to medical school and reduce the tuition wherein these students aren’t graduating with $250,000 in DEBT people. OUR MEDICAL SYSTEM IS ALREADY SATURATED. To add 40 million MORE patients ALL AT ONCE to an already saturated system is rediculous AND WILL NOT BE TECHNICALLY POSSIBLE. The healthcare system has to FIRST be set up to take care of this number of people . That is what this good doctor is trying to tell you.
No doctor is saying they are against health reform. They are against handing out health care cards to 40 million people who have no chance of getting a doctor to take care of them. Doctors want the system to be fixed. They all recognize problems within, but asking lawmakers to help fix this problem is like going to a plumber to fix your intestines. Plumbers know about pipes, it is true. And the intestine is a pipe of sorts.

I am a Physician at a busy for-profit private Urgent Care. If a patient comes to see me who is “self-pay”, i.e. uninsured, they are advised at the outset as to the approximate cost of the office visit. We are not an ER, and not obligated to see everyone who walks in our doors unless it is a true medical emergency (emminently life threatening).

I try to be very cost-conscious in my care of all patients, but especially those who have to pay for it themselves. I charge a lower office visit, and try to prescribe medications from the $4 generic formularies at walmart/kmart/target, from whom I get no kick back.

I often have patients seek care for a “broken bone” who refuse the xray for cost reasons. How can I help you without this information? I also will probably need to run some kind of lab tests to diagnose your urinary tract infection, strep throat or flu. It would be irresponsible for me to just “guess” even if that saves you money.

While most patients are very grateful for my care and the discount I provide, every once in a while someone will complain about how “greedy” and “money-grubbing” I am when they have to pay the bill. They usually have to put down the iPod and the iPhone and look for the keys to their car (nicer than mine) to rifle through their designer purse or wallet to retrieve the money I am “stealing” from them. For that very small minority, it is about priorities, not poverty.

A friend of mine has a family member who is an orthopedic surgeon. $500,000 a year! Many pediatricians, whom I’ve heard make the least, are around $125,000 a year. Again, I’m not saying you shouldn’t make a good living, but you have to understand how hard it is for someone making $30-40K a year when they have a couple of kids, rent, and larger than life insurance premiums that aren’t covered by their employer. A friend of mine, a teacher who is teaching your kids, makes about $40K a year and has to pay $525 a month for insurance that only kicks in if he ends up paying $2-3K in deductables. To put food on the table and a roof over their heads, they opted out of the insurance. What happens when something serious happens? They go to the hospital and are charged $500 to walk in the door. People are losing their homes over stuff like this you guys. As for the designer purse or iphone – yep. People who are poor sometimes like to have something nice. They also might have received it as a gift…hard to judge. I bet, though, that when you go to their home or look at their retirement, it won’t be so nice. My kids have an ipod…thank you grandparents. People do spend money on things they shouldn’t – no argument there. To the doctor who tells patients how much things costs – great but I’ve never had a doctor do that. What reform do you good doctors suggest that would help you and your patients? Seriously, any suggestions? You know the industry. Lets be constructive.

This discussion has really shown the ignorance of much the American public knows about how the health care system functions. In particular how much most doctors sacrifice to reach their goal. My daughter spent 15 years bcoming a surgeon before she made enough to afford a car. A used car, not a new car. That 15 years saw them go without vacations, a house, furniture etc. They have little in a material way, but oh yes, 350k + in school debts!!! They worked 80, and I do mean 80, or more hours a week for 35 to 50k a year, for a resident. You make payments on those loans while you’re a resident too. Most do not live high on the hog and the years of lost income taken up by training are very hard to recover. Specialists make more but have taken an extra five years or more to finish the training and pay very high primiums in insurance. I have seen the toll it takes on a person, would not wish it on her or anyone else for what they GET materially. She does it because it helps people and she has a gift, not for the money. She and most others could have done other things if they were after money, they are certainly smart enough. Reducing benefits for doctors will result in a loss of quality med school applicants, and a lowering of standards, not a good choice. More med schools would help to produce more doctors, there are not enough. Doctor’s fees a only a small part of your medical costs.

Did you know that who ever goes to college to be a doctor is already decided how many doctor will
graduate that year, and most doctors to my horror was only allow to treat and not to prevent illness
because of insurances. Universe insurance with preventive measure would be the way to go, because no one is always in perfect health and need some medical help. Give the doctors a break on the liability insurance that they have to pay,believe me some are still paying their college loans off. Sometime we as a nation make more problems then solving them. fight for a healthy nation and stop blaming the president for problems that were here before he was in office. We need to tackle the Big insurance company that abuse the system for doctors and patients alike with language that require a lawyer to understand.

Hello. Mark Baird does make some interesting comments, and unimpressed followed him with a good example of how patient’s do not understand what they are actually paying for. Unfortunately, the average patient cannot understand the viewpoint of the physician because they are not in the shoes of a physician. However, physicians often can understand the viewpoint of the patient for numerous reasons, one of which is because they are patients themselves. First, doctors do not see a patient for “2-3 minutes” and then stick you with a $200 dollar bill. Your primary physician actually is reimbursed based on time spent over the problem which is often longer then what they actually bill for. Second, physicians do not get paid for referring you for testing, unless of course they own the CT-scanner or lab they send you to (which is not the norm, and the vast majority of physicians are against). Also, I would like Mr. Baird to calculate for me how much money is spent on defensive medicine, since he was so kind as to deflate Tort reform to the “hair on the tail of the dog.” I believe you conveniently did not mention the many states that have lowered health care costs with Tort reform and have attracted more physicians with Tort reform, as well as leaving out the overall costs of defensive medicine.

I would also like to reiterate the notion above that medical students are often saddled with hundreds of thousands of dollars in debt, and the false idea that physicians are compensated too well (which is really the hair on the dog folks compared to what the businesspeople, pharmaceutical companies, and insurance companies make). First, I personally graduated medical school with $275,000 in debt. During residency (which is often 5-10 years of additional training), I make $7-8/hr, which is less then minimum wage in some states. I cannot afford to make ANY payments towards my loans so I defer them for the 6-7 years I am in residency. All of the while these loans are accumulating interest. By the time I am a licensed physicians making $150,000/yr my debt is $500,000+ and I am in my mid 30s (if I came right out of undergraduate school). Hence, I have spent 15-20 years of my life accumulating debt I cannot pay, 15-20 years lof lost income I would have received (if I would have went to college for two years and became a computer technician at microsoft or something), and spent my free time studying for my organic chemistry and cardiology consult service while everyone else during their 20s and 30s were experiencing life. Heck, if you extrapolate that $150,000/yr salary out to the age of 65 I may have finally caught up with all of the average college educated individuals lifetime income because they had a 15-20 year head start and very little debt in comparison.

Finally I would like to note that if you are a middle class American you have little to complain about in terms of health care costs. The average middle class American spends more money on entertainment then they do on health care. Look around your house and your kids’ rooms, etc. People spend more money obtaining their HD TV and Ipods then they do on health care. The ones who can’t afford it are rarely the ones who are on this message board complaining that it is too expensive. Just because you planned your expanded digital HD TV cable and internet package into your budget, but not your unexpected sickness does not mean you should get your healthcare for free.

Hurray for Doc and Fox Medical journalism. Tort needs more than reform—it needs defanging. Many of its costs are hidden or unmeasurable, as it intimidates medical practice at all levels by building in testing and follow-ups and hospitalizations and ED visits and 911/paramedic trips and medication use, many of which are inconsistent with smart medical training. If one admires the British NHS, why don’t you want “loser pays”, which disciplines the Tort system? Yes, we should have Grand Jury style boards (physicians and court officers) to promptly assess worthiness of suits, and to oversee the discovery phase of cases, and to hasten the arbitration and any awards. When the process drags on it can bankrupt both parties, ruin morale, destroy reputations and delimit access to care. Not to mention tying up courts’ dockets. We need Medical Courts, with judges who specialize, so the outlook is fact-finding, not adversarial. Tort has inflicted an adversarial mind-set upon the US medical environment. Doctors are not trained to be adversarial; but Tort encourages mistrust. We are unique in the world, and worst in the world, in all these things.
Do we want our best Doctors to limit their practices or to retire early? Do we want our brightest kids to avoid medical school? That’s where this is going unless Tort is overhauled FIRST, before any other reform.
Has anyone heard positive comments about US medical care from HHS, Congress or WH? Canadians love us.

How about this, healthcare should be “free” when legal services are “free”? The right to sue seems just as important as the right to healthcare so the government should set prices for attorneys services as well. How about $100 (total, not per hour) for a basic lawsuit and $500 total for a complicated lawsuit. Of course, there will be tax credits to offset this cost if you can’t afford it. Sounds ludicrous doesn’t it? Yet apply the same concept to medical care and it somehow makes perfect sense to our government. A final note, what started as access to healthcare evolved into access to health insurance. Is that because our elected officials are afraid to talk about personal responsibility? Have we become a country of people who want others to provide for us? Whenever we can’t do something we beg the government to fix it, i.e. collect more money from others to pay for our want or need.

Full disclosure: for me and my friend, no HDTVs, used (and I’m talking OLD leaky rusty used) cars, 1200 sq ft home, no cable…heck, he and I don’t even like TV. I make a little more than my friend…my wife has some serious health issues and can’t work…a special needs son and two others. Our fun – camping, coffee, sports, Boy Scouts and a dog. Now, when my wife goes to the hospital for tests for 4 days and the bill is $40K or my friend’s wife gives birth and has complications costing $175K, how can we not complain? For my friend with no insurance, a walk into the hospital could ruin him. They could be out on the streets (or in our home) if that happened. Is that what we want happening to people without insurance?

Are we wanting to saddle our dcotors with debt up the kazoo and wanting to saddle good hard working good people with debt that will run them off the face of planet?

We need reform.

Thank you Dr. Siegel. I am disabled and on Medicaid. It is so much harder to find good doctors who still accept Medicaid, especially dentists. I have only found 3 or 4 dentists between 4 cities that take it, and I have to take my son to a dentist office 45 min from my house because they are the only office that isn’t against treating autistic children, that also offers sedation, as my son is high functioning but would not be able to handle a procedure if he is seeing it done. I have been told it is due to dentists being afraid of patients suing that they are ambivalent about treating special needs kids, especially kids with autism. This is getting ridiculous-when doctors constantly worrying about lawsuits. Sure, I know there’s quacks out there, but can’t there be a line between blissful ignorance of doctors’ doings and people going sue-happy?

This is only one of many reasons I did not vote for Obama.

To have or not to have that is the question? I had the best of insurance Atena, to no insurance and was working in a hospital @ 11.50/hr, thank god! the pharmacy had payroll deduction to pay for my
medicine. To making a hundred dollars over and no state help to nothing and I have kids no Hd t.v for me , must be nice.

Oh finally by the way, nothing in life is free, it cost money to die and money to dig a hole to be put in. The best way to pay your medical school loan is to use your income tax return to pay it off . Everybody pays taxes at one point or other the . Even on the house one buy the HD tv one buys and the food and mic we need,so never think medical care is free we all pay sometime in this life

FDA= Food & Drug Administration. Notice there is no P for the People in FDA. All of that to say, the FDA is doing all it can do to make sure the food and drug companies are making all the money they can make. If the FDA was really interested in our health concerns, illnesses and diseases, they would bann all use of MONOSODIUMGLUTAMATE / MSG. Of course that takes congress to pass a law b4 FDA banns anything that would save lives and money out of our pockets, yet it is justified for food companies to use poisions and chemicals like MSG, CARAGEENANN and other toxic poisions that does do brain damage to a human brain. Anyone can do the searches of the internet to find out what MSG can do to the human brain. All neurological conditions can be triggered from M S G and nitrates from the foods in which they are in. Ice Cream unless it is pure homemade ice cream I will not eat as almost all of the brands sold now has CARAGEENNAN in ice cream. CARAGEENNAN like MSG has an addictive substance to it which makes a person eat more & more of that product. MSG and all its other forms it is deceived as, has helped drug companies while MSG has made people like me have a neurological condition. I know from personal trials & errors on these foods,that what I am talking about is true. I’m sure I am not the only person on earth that these things happen to. It is time doctors start speaking out loud against the food industry and drug industry hypocracy about what is in our food supply.

I am sadden by the responses. What I see in these notes is mostly the same thing I see in Washington.
I am totally disappointed with our congress. Both the house and the senate seem determined to pass a health care bill without real review. Why no public posting on the internet prior to voting? Where is the promised transparency? Why no debate?
Without disclosure and debate no one can identify the true cost, no one can identify what is being fixed, no one can identify what will be broken and no one can identify all the hidden pork and paybacks.
What is most amazing to me is that no one in the congress is even considering the easy and most effective steps.
• Enact tort reform to end the ruinous lawsuits
• Want competition then repeal all state laws which prevent insurance companies from competing across state lines
• Repeal government mandates regarding what insurance companies must cover.
• Revise tax forms to make it easier for individuals to make a voluntary, tax-deductible donation to help the millions of people who have no insurance.
• Enforcement of existing immigration laws.
• These and many other real solutions have been proposed by people that are your constituents.
I respectfully ask the congress to take a step back, listen to the Americans that are happy with their existing health care, and then take the time to understand what needs to be fixed before voting on any health care bill. Any urgency you think exists is manufactured and not real.

As a nurse for over 24 years, tort reform is absolutely neccessary for doctors. I see so many unneeded tests, medicines and waste of patients times more than ever. But doctors nowadays have to worry about malpractice suits, they order everything under the sun at a cost to us all.

As a geriatric nurse we waste a ton of money provided for ” skilled therapy” to elderly patients. No kidding- Medicare is charged over 300. dollars a day for a 1/2 hr treatment by a therapy. Now take a patient that has dementia, hasn’t walked in years and gets admitted to a nursing home or hospital. They get 2-3 types of therapy a day for 6 weeks, that in the end does very little to improve their condition. 600.-900. for one day, 5-6 days a week times 6 weeks. That is one patient costing medicare between 18,000-27,000 dollars in a 6 week time period. One patient that made little or no progress or was too weak or sick to benefit from it. This is the waste and fraud our government talks about and I have a ton of other examples of why medicare needs fixing.

As a working nurse my insurance premiums over the past 10 years have gone up and up with benefits going down. Again with a large health insurance company thru work we were paying 789.00 a month for a family of 4, with a 3,000. deductible. That is crazy but what is the choice. That is why another option needs to be available, when there is no competition they create a monopoly and all of us will eventually pay for it. Who can afford it anymore?

I know this copmment is a couple of days late, but I’d like to add my .02 worth, and I’d specifically like to address “unimpressed”: As a teacher, provide a valuable service. as a physician, so do I. You have 7 years experience after 4 years of college. I have 16 years experience after 4 years of college, 4 years of med school, and 3 years of residency. I have several friends who are teachers, in fact I live next door to one of them. So I’m going to guestimate that you are making in the range of 45-50,000. Since I have almost 3 times more education than you do, doesn’t it stand to reason that I should make about 3 times more than you? Actually, I don’t do that well, since I went into primary care. My (only) car is 12 years old. I didn’t finish paying off my student loans until I was 45, about the same year that my oldest son graduated from college. I am no longer allowed to accept so much as a free pen or pack of scrap paper from drug reps, so now have to purchase these items out of my office budget. I haven’t had a “lunch hour” in 16 years, nor a coffee break. There are days when I can’t even take a bathroom break. If my patients don’t pay for whatever reason, I’m out the money. If your student’s folks don’t pay their taxes, you still get paid.

To unimpressed and MarkBaird and others who haven’t had the opportunity to work in healthcare: Let me clear up some misconceptions. Doctors do NOT get paid for ordering lab tests, or for writing prescriptions or for making referrals. We often get paid less for an office visit than it costs us to provide the service in the first place. Not all of us drive big, expensive cars, belong to country clubs, take expensive vacations and live in mansions. Those people would most likely be the tertiary care physicians and the hospital CEOs. I haven’t had a “lunch hour” or even a half-hour in about 16 years ago, when I went into private practice. When we became doctors we wanted to help folks, but didn’t plan on doing volunteer work, which is what I spend about 1/3 of my day doing, since I don’t get paid for phone calls, filling out forms and doing paper (or computer) work. I also don’t get paid nearly what it costs to provide care to Medicaid patients, who I continue to see nevertheless. Medicare isn’t much better. I work 50 weeks a year, as opposed to having most of the summer off, and work weekends, holidays and evenings when my patients need me to. WhenI was a resident I figured out that I was being paid about $6.00/hr, and working 80-100 hours/wk. Perhaps you would like to change places??

As a medical student, I can tell you that the days of graduating with “only” $150,000 in debt are over. I have around $100,000 in undergrad loans, and will take on approximately $280,000 in medical school loans. Pretty bad right? Well most of these are at about 6.8% interest, and I will not start making any money at all until medical school is over. During residency (another 3 or so years) you make around $45,000 a year. That is a lot of interest accruing if you do the math. I promise you these numbers are real.

I’m not going for the pity post here, but I’m trying to illustrate that there are incredible sacrifices made by aspiring doctors and although most of us end up in a comfortable financial position by the time we are ready to retire, we spend a large chunk of our career paying back loans and living modest lives while working our asses off our whole lives.

I understand the arguments that people have made in the above posts about the cost of healthcare and general accessibility, but although it may not be apparent to someone outside of the medical community these reforms will decrease the overall quality of healthcare. Massachusetts serves as a good example…even with state-run insurance not everyone can get access to doctors and doctors are generally unhappy. There are changes to be made, but this plan is not the answer.

Enjoy your Sunday.

I’m a 34 year old woman whose father has been in and out of the hospital for the last 27 years of my life.
My father was a respiratory therapist, my mother an R.N. My father has medical bills that I will be paying off long after he dies. I do NOT complain. These men and women have saved his life, literally and his sight, at one point, they deserve, DESERVE! every penny that we, I will pay. He has almost every credit card maxxed at the end of every month just to pay for the medications to keep him alive. Do we wish these meds didn’t cost so much? Of course. Do we blaim the medical proffessional who prescribed them? NO.
There are many things that need to change, but I do not want to be told what doctor I can see, what hospital I can go to, what treatment I can get. Nothing is “free”~ever heard of taxes?!?
To those men and women in the medical field, your sacrifices are seen and admired. Thank you.

Alex – more than50% of Americans only have social security after working hard their whole lives. How about the 48 million uninsured and the burden of the cost of insurance on those who actually are insured? Are they just customers or are they sick people? What doctors need to know is that they are part of a system (also hospitals, insurance companies, drug companies) that are bankrupting not only our country but its people. We do love you all but the prices (insurance/med bills) are killing us.

Countrydoc – I wish I could take you out for lunch. You certainly deserve it, but I just have to say that sick people need to be taken care of just like your kids need an education (teachers have little free – papers, prep, clubs, cont. ed). I’m not for a NHS as they offer inadequate care, but we need reform so that we can make insurance affordable, reduce frivalous lawsuits while still remunerating those who deserve it, so that doctors are not overworked and are properly compensated, and so that drug companies can continue to come out with new drugs that help us all. A NHS would cripple all of the above. But, we need reform.

One other thing that bugs me is how you guys have different prices for people depending on what kind of insurance they have. It is like going back to the pre-60’s and having two kinds of water fountains for whites and for others. It is just plain wrong and you know it, and it is this that makes us feel like cash cows, which is what Lola seems to say

Hey Fox News!

You know, it would be good to get some reasonable people together: doctors in private practice and at hospitals, insured/unisured patients, insurance company reps, other healthcare workers (nurses, techs, business office people), a couple hospital CEOs, some drug company people…let people explain what they need, what they do, what the hardships are, and what suggestions they have (and no lobbiests). Oh, also a leading democrat and republican to just sit there and listen and then to come up with something to take to Washington. It should be respectful and productive…and could last 2-3 days even…like Cspan or something.

I bet millions would turn in and maybe instead of just being a bunch of armchair complainers, we could actually get some American reform that benefits we the people: doctors, patients, drug companies, insurance companies and hosptals! How about it Fox? I am serious.

I just fear our thoughts here will lead to no where except offer us the chance to vent.

This would be a wonderful thing to happen in our country.

Whatchathink? Fox News, please respond.

What do doctors think of just skipping a B.A. before med school – if that was an option – and going directly into med school. You’d finish earlier, have less debt…other countries do it. Of course, if you wanted a bachelors, you could then go to med school too, but why not just skip it? It would save you 4 years of your lives and probably decrease your student loans by, I’m guessing, $100K.

Why don’t you docs charge all of your patients the same fee? Forget the in-network/out of net-work bit. Just everyone the same? Government medicaid/care the same too.

How about a program to help pay for doctor’s med school if they agree to working for less than you might make in the public sector – you could work in a small town or a county hospital for 5+ years.

How about making laws to protect the patient from malpractice and protecting doctors from frivolous lawsuits?

How about tax credits for your deductable, co-pays, and part of your insurance?

How about mandating that companies have salary caps on their management unless the lowliest employee has affordable health insurance?

How about making strict laws about things that are making our country unhealty (MSG, hydrogenated oils, high fructose corn syrup, tobacco, nitrates, DUI, knowingly spreading hep B/AIDS)? Giving tax credits to those who use public transportation (1/10th), walk or cycle to get to work?

How about laws to help doctors receive payment faster from the gov and from insurance as well as individuals?

well spoken and agreed with. I have been in private practice as a general internist for 12 years.
I would not recommend this profession to anyone at this time. Medicare has set the precedent
for all 3rd party payors to treat us like excrement. I do not know of one internist who enjoys what they do and many are trying to find their way out of traditional medicine. Not much hope and change here to look forward to. I am on my way out as well. More Americans need to be aware that retirement may not provide them the healthcare they want or deserve. I think I will open up 10 strategically placed lemonade stands here and probably do just as well with alot less stress.

I saw the report Sunday morning. Your example of the orthopedic surgeon who make $900 for the surgery does not tell the underlying costs of the business to practice medicine. $900 sounds like a lot to the average person. My husband is an orhtopod. If he does collect the $900 he will be lucky to take home $225. Half (at least: if you are lucky, his is more like 60%, goes to overhead — the cost to practice– personnel, benefits, insurance: malpractice and health, rent, phone, billing, ETC. Then the $450 left, we have to save 50% for taxes, social security and medicare, both sides employee and employer – 14% and 2.9% So we can live on maybe 1/4 of what he collects. That is until taxes go up and then he will slow down or quit. Oh yes, we have to save for our own retirement somehow. I have a daughter who is a medical resident and a son who is a med student. It is not worth it and I would not recommend med school to anyone. The sacrifice is not worth it. Our youngest is pursuing a nursing degree.

“Tort reform would eliminate a lot of the unnecessary self-protection tests doctors have to order under today’s sue-happy citizenry. Catastrophic insurance would protect us from the devastating bankrupting costs of the really serious illnesses can get: cancer, diabetes, strokes.”

I would like to see a good study that can empirically prove defensive medicine. What about doctors that own their own labs?

Can anybody tell me what are the largest drivers of health care? Tort, chronic illness, people with no insurance, defensive medicine, etc.

I live in the state of Minnesota and believe the only real model is the Mayo Clinic. It is unfortunate that this model is not used by doctors everywhere. Why is that? Why is it nearly impossible for doctors to collaborate on the health care of an individual. I spent countless hours and money trying to get my wife’s symptoms diagnosed seeing countless specialist. I finally decided to take her to the Mayo and miracle upon miracle we found multiple problems that were causing her symptoms.

Also, regarding tort reform in Texas.

In 1995 then Governor Bush had tort reform passed. Part of the deal forced the insurance industry to not raise premiums for five years. In 2001 the insurance industry raised their premiums over 120%. So in 2001 doctors screamed again and guess what, tort reform again.
http://www.krld.com/topic/play_window.php?audioType=Episode&audioId=2215113

“Adding to the state’s allure for doctors, Mr. Opelt said, was an average 21.3 percent drop in malpractice insurance premiums, not counting rebates for renewal.”

It will be interesting to see in the bad economy with a fall in investments if malpractice insurance premiums go up or perhaps in Texas as in 1995 they will not be able to raise rates for five years as then Governor Bush prevented them from doing when tort reform was passed in 1995.

“Demian McElhinny, 33, a former hospice pharmacy technician in El Paso, recently settled claims against a neurological surgeon for spinal surgery that left him disabled and his family impoverished; he said he emerged with “pennies on the dollar.” His wife, Kelly, found work as a school bus driver, he said, while “I’m at home being a housewife to my two boys.”

Mr. McElhinny’s surgeon, Dr. Paul Henry Cho, later admitted to the medical board that he was addicted to a narcotic cough syrup and had written fraudulent prescriptions. Dr. Cho’s license to prescribe drugs was suspended, although it was soon restored, and he moved from El Paso to a hospital in Fort Worth. He did not return a call to his office, and his lawyer declined to comment. ”

So this doctor is at least making a decent living. Now there are those that will read this and say this is only one doctor. To that I will say the same thing regarding defensive medicine.

“After reviewing thousands of patient records, medical researchers have estimated that only 2 to 3 percent of cases of medical negligence lead to a malpractice claim.

Even if we eliminated medmal suits entirely, the cost savings would be pretty modest. Genuine reform, on the other hand, would likely cost us money. That’s why you never hear much about it.”

http://www.motherjones.com/kevin-drum/2009/09/real-cost-medmal

They have losers pay in Europe but then again when their is universal care there is not as much need to sue for lifetime care when you are injured.