I really wanted this blog to foray afield a bit more widely than healthcare, and maybe I will but for now, we’re stuck on this general topic, although I may take a few swipes here and there. I try to reply, politely, to commentary but my response to this one really requires a more comprehensive approach
Well, duh, there IS a relative shortage of physicians in certain specialties and geographic locations. Resources are not evenly distributed. Population shifts are occurring all the time, and the populations growing as well
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And you can intuitively deduce that we have a looming problem. Compounding that, a number of new graduates gravitate to medical specialties and not primary care, and by default those specialties gravitate to urban and suburban locations.
I’m guilty. I could not practice my CHOSEN specialty in a small town in the manner and volume I do now. I focus on what I do to elevate the QUALITY of service I provide, a topic we will delve into later on. It’s a trade-off, really: a lot of mediocre care with hopefully acceptable, but average, outcomes, or specialization concentrated in certain locales with better, improved outcomes. Did you know that 50% of breast cancers in FUSA are operated upon by surgeons who perform 6 or fewer such cases annually? Americans, though, have consistently, increasingly preferred the latter for most of their concerns.
Let’s move on to a “carefully guarded monopoly. Fewer doctors, bigger fees”. Organizing medicine is like herding cats. The government and its friends at CNN, MSNBC, ABC, CBS and, yes, even FOX like to point to the AMA as the frontline organization representing medicine. Hogwash. In 2011, ELEVEN years ago, the AMA counted about 15% of American physicians as its membership, down from 75% in the 1950s.
And this was written by a CANADIAN! Why has this happened? Many reasons, being felt by every group in organized medicine, but largely the perception among physicians that organized medicine sold them out in 2009, to this glib Marxist
These same organizations fell under the spell of the Covidiocy and contributed to the largest public decline of confidence in science and medicine in recent history. Hell, we’re down there with attorneys, Boy Scout leaders (I’m an Eagle Scout, as full disclosure, with a certificate unfortunately signed by Jimmy Carter) and Catholic priests, and DESERVEDLY SO. Add in a hefty dose of DEI (Diversity, Equity, Inclusion) mania and large numbers of individuals trained in a profession based upon meritocracy instinctively are repulsed. Organized medicine has become focused only upon money, plain and simple, and we're not talking about money for its membership.
Bigger fees? Laughable. When I started practice 25 years ago, our collections as a percentage of billings hovered between 65-70%. Ten years ago, it was 40-45%. Now, it’s in the thirties, and practice overhead has NOT declined. It’s the same for hospitals, although in the last two years they’ve done quite well with federal pandemic funding, fueling the ability of some to expand and acquire. How else can you explain the continuation of policies known to cause harm? From a friend to my daughter
Shameful, but big bucks. Money talks, you know. More black eyes. Here are some graphics to peruse for your viewing pleasure
The curve represents rising annual REDUCTIONS in reimbursement to providers on top of cumulative reductions over time.
Yes, that was 2008. It’s worse now. More and more private specialists will not take Medicare or Medicaid, and some are dropping insurance altogether, like plastic surgeons. They can live on cash; I, however, cannot. Concierge primary care is growing. I have a concierge family physician; $65/month with unlimited visits and really inexpensive labs and generic drugs. His labs are less expensive than my insurance copayment (there’s a story for you, another day).
Things are, as expected, even worse now, dramatically accelerated by the policies of those pulling the strings of the Brandon Administration. Gawd, I feel like I’m watching Max Headroom when he gives a presser
https://youtu.be/cYdpOjletnc
Moving on, true totalitarians? Shutting down other schools of thought? My Deep South location has loads of chiropractors and naturopaths, plenty of sources of alternative care, and with the internet, it’s available to just about everyone. Hell, we have Eastern Medicine available here. Osteopathy had gone full mainstream alongside allopathic medicine. Shutting down things? Growth of osteopathic medical schools is growing. and more are planned. This is a good thing, especially for competent, eligible white males.
https://osteopathic.org/about/aoa-statistics/
Expanding numbers of nurse practicioners, who will eventually have universal independent practice, and physician assistants that provide satisfactory primary care and extend the reach of medical specialties continues, largely unimpeded.
Yes, my profession has opposed independent practice for nurse practicioners pretty consistently in my State, but they'll win the battle eventually. Concerns exist largely over disparities in training program quality and consistency (at one point during the Covidiocy, clinical rotations were done virtually by some; sorry, it’s just not the same), but medicine unfortunately has similar issues these days.
Quality concerns have also underscored concerns about optometrist and pharmacist prescribing privileges, which exist but are limited. Hell, we have dentists and just about everyone and their dogs administering facial injectables like Juvederm and Botox these days. Our community had a former NEONATOLOGIST doing such at one point. They may still be….take a weekend course and Viola!, you’re qualified. So, the argument of a carefully guarded monopoly doesn't hold water. If it exists, the guards should be shot.
I agree with critics that medicine is currently an unmitigated disaster, and each one of us bears a little sliver of responsibility for its decline. But that falls on the public policymakers as well, as SOMEONE put them in office. Why is it that we consistently elevate the VERY WORST among us to positions of authority and responsibility and are surprised when it all turns into a steaming pile of crap? FDR gave them the framework upon which to construct their disaster, LBJ wounded health care, and The Anointed One stabbed it in the heart in 2009. Don’t think so? Look at the 800lb gorilla EMR system, EPIC Systems. Obamacare gave it a massive shot in the arm and propelled it to the behemoth it is now, with $2.9billion in annual revenue…
Who else benefited from the 2009 mortal wound to health care? Besides pharmaceutical companies (we won’t even go into COVID, Pfizer and Moderna, that’s another topic, but do a little research on the history of Moderna. It’s eye-opening), health insurance companies. Blue Cross is a giant black box for which virtually no information is available as they operate under a special federal charter (go ahead, look it up), but look at these graphics on Cigna and United Health Care.
United Health Care has a number of subsidiaries that offer lower-cost (and lower benefit) plans, UMR, for example that can be confusing to average folks. It also acquired Optum Health, a huge Pharmacy Benefit Manager (PBM) and is acquiring pharmacy chains in droves. Aetna merged with CVS Caremark, another PBM and pharmacy chain. PBMs are simply middlemen adding no value to the consumer. Patients aren’t their consumers; health insurance plans and the government, as well as their shareholders, are the recipients of that added value.
None of these things bode well for patients. Your system is collapsing around you, and many, while frustrated, remain blissfully unaware of scope and magnitude of the rot and decay. As I said in an earlier post, don’t get sick.
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Thanks Henry. While I must say that I understand what your commenter was saying, your response adds clarity and understanding about a completely broken system. I do not envy you.
Once upon a time in the mid '80's, I was, shamefully, a life and health insurance salesman, then a broker. If I believe something, I have the gift to help you believe it too, therefore I was successful. On the flip side of that gift for me; is this: If I find out it isn't true, I do not have the ability to lie to you; just cannot do it .... not virtue signalling, that's just the fact. After a couple of years I began to see the crime of selling medicare supplements to old people and even worse; selling term life combined with annuities to young families and presenting them as investments. Was cruising down a country road one day with one of my agents who was sitting there with a Texas Instruments LED calculator in his lap. He abruptly announces, after running the numbers all of the way out for the duration of the plan, that if interest rates fall below about 9%, at the end, the plan will be worthless. I pulled into a grocery store parking lot and for an hour or more we ran the numbers; I became nauseated, returned home, cancelled the appointment. I had already questioned the medicare supplement business, realizing that the healthcare system was artificially inflated by insurance money that add nothing to actual care of patients. All of this came crashing down for me; we went from a comfortable degree of affluence to my beautiful young wife getting food from her Mother's pantry to feed our children. Personally, I was able to get back on my feet, landed a job with a company that actually manufactured the best product in their field, on earth. I only left there four months ago after 32 years. Have wondered all of this time why no one will state the obvious; that health "insurance" is a gigantic criminal hustle. Insurance executives and the stock holders in large insurance companies are the ones making the money; and they add ZERO to actual healthcare. How do you think they pay the big bonuses to the yacht owning executives? How do you think they build skyscraper building for their headquarters? The health insurance industry is a criminal enterprise and should not exist.
The Favor of a Reply
Thanks Henry. While I must say that I understand what your commenter was saying, your response adds clarity and understanding about a completely broken system. I do not envy you.
Once upon a time in the mid '80's, I was, shamefully, a life and health insurance salesman, then a broker. If I believe something, I have the gift to help you believe it too, therefore I was successful. On the flip side of that gift for me; is this: If I find out it isn't true, I do not have the ability to lie to you; just cannot do it .... not virtue signalling, that's just the fact. After a couple of years I began to see the crime of selling medicare supplements to old people and even worse; selling term life combined with annuities to young families and presenting them as investments. Was cruising down a country road one day with one of my agents who was sitting there with a Texas Instruments LED calculator in his lap. He abruptly announces, after running the numbers all of the way out for the duration of the plan, that if interest rates fall below about 9%, at the end, the plan will be worthless. I pulled into a grocery store parking lot and for an hour or more we ran the numbers; I became nauseated, returned home, cancelled the appointment. I had already questioned the medicare supplement business, realizing that the healthcare system was artificially inflated by insurance money that add nothing to actual care of patients. All of this came crashing down for me; we went from a comfortable degree of affluence to my beautiful young wife getting food from her Mother's pantry to feed our children. Personally, I was able to get back on my feet, landed a job with a company that actually manufactured the best product in their field, on earth. I only left there four months ago after 32 years. Have wondered all of this time why no one will state the obvious; that health "insurance" is a gigantic criminal hustle. Insurance executives and the stock holders in large insurance companies are the ones making the money; and they add ZERO to actual healthcare. How do you think they pay the big bonuses to the yacht owning executives? How do you think they build skyscraper building for their headquarters? The health insurance industry is a criminal enterprise and should not exist.