I am a flaming moderate. Yes, I know that is an oxymoron but the fact remains that I am both passionate and moderate in my political opinions.
And I am in the mood to rant, so beware.
Living in the deep south, I often seem like a radical communist to those I see. I frequently get patients asking questions like \”So what do you think about Obama\’s plans to socialize medicine?\”, or \”I wanted to get in here before Obama-care comes and messes things up.\” I usually smile and nod, but find myself getting increasingly frustrated by this.
The house is burning down, folks. Healthcare is a mess and desperately needs fixing. How in the world can someone cling to old political yada-yaya-yada when people are dying? I am not just talking about the conservatives here because to actually fix this problem we all have to somehow come together. A solution that comes from a single political ideology will polarize the country and guarantee the \”fix\” to healthcare will be one constructed based on politics rather than common sense.
No, this doesn\’t frustrate me; it infuriates me. The healthcare system is going to be handed over to the political ideologues so they can use it as a canvas for their particular slant. In the mean-time, people are going to be denied care, go bankrupt, and die. Yes, my own livelihood is at stake, but I sit in the exam room with people all day and care for them. I don\’t want to be part of a system that puts ideology above their survival.
So here is what this radical moderate sees in our system:
- The payment system we have favors no one. Every single patient I see is unhappy with their health insurance to varying degrees.
- Stupid and wasteful procedures shouldn\’t be reimbursed. This is business 101; if you don\’t control spending, you will not be able to sustain your system. This means that we have to stop paying for procedures that don\’t do any good. Some will scream \”rationing\” at this, but why should someone have the right to have a coronary stent placed when this has never been shown to help? Why should we allow people to gouge the system for personal gain in the name of \”free market\”? I got a CT angiogram report on patient today who has fairly advanced Alzheimer\’s disease. I twittered it and the Twitter mob was not at all surprised. These things happen all the time. The procedures do no good and cost a bundle. The procedure done today probably cost more than all of the care I have given this patient over the past 5 years combined!
- The government has to stop being stupid. Why can\’t I give discount cards to Medicare patients? Why can\’t I post my charges, accept what Medicare pays me, and then bill the difference? The absurdity within the system is probably the best argument against increased government involvement. Who invented the \”welcome to Medicare physical??\” I never do it because the rules are utterly complex and convoluted. If the rules can be this crazy now, how much worse will it be when the government takes over? If my medicare patients are confused now, how much more will we all be if the government grabs all of the strings?
- The money is going somewhere. In the past 10 years, my reimbursement has dropped while insurance premiums have skyrocketed. There are more generic drugs than ever and I am no longer able to prescribe a bunch of things that didn\’t get a second-thought 10 years ago. Hospitals stays were longer and procedures were easier to get authorize. So where is the money going?? We do know the answer to this question – there is no single culprit. Drug companies were to blame for a while, but now they are going to the dogs; and yet the rates aren\’t dropping. The real problem is that there are far too many people trying to capitalize on the busload of money in healthcare. Shareholders, CEO\’s, and simple corporate greed has bled money out of the system like a cut to the jugular.
- Docs have to stop being idiots. We like our soap boxes to rant against EMR, malpractice lawyers, drug companies, and insurance companies. We stand on different sides yelling our opinions but don\’t come up with solutions. Instead of doing what is right for our patients, we join the punching match of politics. Is EMR implementation important? Duh! There is no way to fix healthcare without it. But the systems out there are designed by engineers and administrators and don\’t work in the real life. So why can\’t we computerize ourselves? Every other industry did. Why must we cling to the archaic paper chart because we don\’t like the EMR\’s out there? Aren\’t we smart people? Aren\’t we paid to solve problems? Stop throwing darts and start finding solutions. Med bloggers are terrible in this – they rant constantly against EMR, but don\’t ever say what would work. It\’s fun to criticize, but nobody wants to propose an alternative.
- We need to get our priorities right. Healthcare is about the health of the patient. Yes, it is a job for a lot of people. Yes, it is an investment opportunity. Yes, it is a good thing to argue about – whether it is a \”right\” or not. Yes, it is a major political battleground. But in the end, these things need to be put behind what is most important. As it stands, we are more passionate about these other things than we are about the people who get the care. In the end it is about making people well or keeping them that way. It is about saving lives and letting people die when it is time. If we were all half as passionate about what is good for patients (and we are all patients) as we are about these other issues, we wouldn\’t have half of the problems we have.
As a flaming moderate I get to offend people on all sides. We need to fix our system. It is broken. It is not a playground for those who like to argue. It is not a place to be liberal or conservative. This is our care we are talking about, not someone else\’s. The solution will only come when we all come to the table as potential patients and fix the system for ourselves.
Is it easy? Heck no. This rant is not meant to show I am smarter than the rest of you; it is meant to get all of us away from the other issues that make any hope of actually fixing our problem remote. Given the fact that we all are eventually patients, our political posturing and plain stupidity may come back to haunt us. No, it may come back to kill us.
You hit this one out of the park! As a pediatrician and a health journalist, I live the broken health system each and every day in the same shoes you do. It is infuriating that people seem to think that politics will fix healthcare at all. It is even more infuriating that professions like pediatrics are never recognized as being worthy for the salary level we deserve given the work we do and hours we put in. Finally, it’s infuriating that our own colleagues don’t help our cause. You are so right – let’s stop complaining for complaining’s sake and start talking solutions.
You hit this one out of the park! As a pediatrician and a health journalist, I live the broken health system each and every day in the same shoes you do. It is infuriating that people seem to think that politics will fix healthcare at all. It is even more infuriating that professions like pediatrics are never recognized as being worthy for the salary level we deserve given the work we do and hours we put in. Finally, it’s infuriating that our own colleagues don’t help our cause. You are so right – let’s stop complaining for complaining’s sake and start talking solutions.
“Stop throwing darts and start finding solutions. Med bloggers are terrible in this – they rant constantly against EMR, but don’t ever say what would work. It’s fun to criticize, but nobody wants to propose an alternative.”
Amen. More solutions, less fear mongering / anti-change banter.
“Stop throwing darts and start finding solutions. Med bloggers are terrible in this – they rant constantly against EMR, but don’t ever say what would work. It’s fun to criticize, but nobody wants to propose an alternative.”
Amen. More solutions, less fear mongering / anti-change banter.
You sure hit the mark with this one.
Thanks for the post.
You sure hit the mark with this one.
Thanks for the post.
[…] Posted by GruntDoc on June 11th, 2009 Radical Moderation | Removing politics from healthcare […]
I’m convinced that EMR is a sensible idea. The biggest downside I see is that a number of presently data structure incompatible systems have to be made to talk to each other to do what you want Rob. What you want is functionally sensible, but isn’t necessarily easy from an IT viewpoint.
Also I wonder, is part of the problem money vanishing into the “black holes” of administration, cost accounting and auditing, rather than into the pockets of investors? Certainly these roles, which have been a major growth area in the UK in the last 20 or 30 years, are more of a budgetary problem than procedure costs or drug costs are for us.
I’m convinced that EMR is a sensible idea. The biggest downside I see is that a number of presently data structure incompatible systems have to be made to talk to each other to do what you want Rob. What you want is functionally sensible, but isn’t necessarily easy from an IT viewpoint.
Also I wonder, is part of the problem money vanishing into the “black holes” of administration, cost accounting and auditing, rather than into the pockets of investors? Certainly these roles, which have been a major growth area in the UK in the last 20 or 30 years, are more of a budgetary problem than procedure costs or drug costs are for us.
Love this. I’m not a physician but work in the healthcare category and it seems like everyone is finger-pointing all day long. Everyone is part of the problem, and few want to be part of the soluion.
Love this. I’m not a physician but work in the healthcare category and it seems like everyone is finger-pointing all day long. Everyone is part of the problem, and few want to be part of the soluion.
Great topic- as a consumer, I see the fear and frustration of my coworkers, and we have a pretty decent plan. I also see the reimbursement rates for my primary care physician (who I adore and consider a miracle worker) and wonder how he can stay in business. Overall, something has to change- actually, it will change somehow. There is a chance to control the change now and make a better system hopefully- for patients, doctors, employers, and everyone involved.
Great topic- as a consumer, I see the fear and frustration of my coworkers, and we have a pretty decent plan. I also see the reimbursement rates for my primary care physician (who I adore and consider a miracle worker) and wonder how he can stay in business. Overall, something has to change- actually, it will change somehow. There is a chance to control the change now and make a better system hopefully- for patients, doctors, employers, and everyone involved.
Wonderful, thank you.
Wonderful, thank you.
I am an oral and maxillofacial surgeon; and a software developer..not a physician; but I live in the same world as you…you hit the nail on head on every count. Your comments regarding EMR’s designed by knucklehead engineers was so on point!! The EMR systems I use at our hospital were designed without any input/design and critique of any practicing physician..and it shows. If CMS uses the same strategy they will screw it up for sure ! Undoing a badly desisgned federal health care EMR will take 10 times the effort of doing it correctly in the first place.
I am an oral and maxillofacial surgeon; and a software developer..not a physician; but I live in the same world as you…you hit the nail on head on every count. Your comments regarding EMR’s designed by knucklehead engineers was so on point!! The EMR systems I use at our hospital were designed without any input/design and critique of any practicing physician..and it shows. If CMS uses the same strategy they will screw it up for sure ! Undoing a badly desisgned federal health care EMR will take 10 times the effort of doing it correctly in the first place.
Great piece! Agree with all of it…..like you I am especially worried about what is going to happen when we start the process in Congress of debating what’s best for our future health care system and all the special interest groups/politicos get involved. One thing is almost guaranteed….with our current leadership we will probably wind up with a bigger bueracratic mess than we already have.Your comments about EMR’s are so true…..lots of powerful/ expensive software out there, but none of it has any practical applications. All the software is too complex, and not intuitive at all. Software programmers and executives have no idea about work flow, coding documentation and all the other aspects of an efficient medical practice. Well, i just realized I pointed out a bunch of problems, but offered no solutions!!
Great piece! Agree with all of it…..like you I am especially worried about what is going to happen when we start the process in Congress of debating what’s best for our future health care system and all the special interest groups/politicos get involved. One thing is almost guaranteed….with our current leadership we will probably wind up with a bigger bueracratic mess than we already have.Your comments about EMR’s are so true…..lots of powerful/ expensive software out there, but none of it has any practical applications. All the software is too complex, and not intuitive at all. Software programmers and executives have no idea about work flow, coding documentation and all the other aspects of an efficient medical practice. Well, i just realized I pointed out a bunch of problems, but offered no solutions!!
Nice post..waiting for quick and dirty tips
I invite you to visit my blog.
Best wishes
Nice post..waiting for quick and dirty tips
I invite you to visit my blog.
Best wishes
[…] week before so I’m going to cheat and say it was published last week. The post, entitled Radical Moderation, can be found at Musings of a Distractible Mind. The post is basically an informed rant about the […]
You absolutely hit the nail on the head! This is the most logical and reasonable article I have read on health reform. Notice I don’t say “health CARE reform” because it is not just health care that needs to be reformed! The insurance companies need to be changed. Patient expectiations and perceptions need to be changed. Hospitals and physician perspectives need to be changed. The system is failing big time, but no because of any one thing. And, it is unfortunate, that the government is having to step in to impose more regulations.
No one has the solutions…yet. But, I think this article is a good place to start in finding solutions. I feel the solutions should be made by those involved with patient care and the financial provision of services. Representatives from all involved groups need to be sequestered in a room until a reasonable plan is developed!
You absolutely hit the nail on the head! This is the most logical and reasonable article I have read on health reform. Notice I don’t say “health CARE reform” because it is not just health care that needs to be reformed! The insurance companies need to be changed. Patient expectiations and perceptions need to be changed. Hospitals and physician perspectives need to be changed. The system is failing big time, but no because of any one thing. And, it is unfortunate, that the government is having to step in to impose more regulations.
No one has the solutions…yet. But, I think this article is a good place to start in finding solutions. I feel the solutions should be made by those involved with patient care and the financial provision of services. Representatives from all involved groups need to be sequestered in a room until a reasonable plan is developed!
Yes, yes, yes! The system IS broken. It does need to be fixed and politicians need to butt out. It isn’t a matter of who has healthcare as much as it is the enormous costs in duplicated services, lack of follow up and follow thru, lack of information, lack of time face-to-face with the patient, and on and on. As a nurse case manager I get the privilege of working one-on-one with patients to help them get the most out of their care. If only physicians were able to get this kind of time with their patients. If only all patients had someone to follow up with them for questions, problems, concerns.
As citizens we need to learn to be better healthcare consumers. We need an option that will allow us to select the plan that best works for our family and that works everywhere! Simply providing healthcare for every man, woman and child will not fix our problem.
As a small business owner I can’t afford decent healthcare for my own family. We get by with a high deductible plan and rarely seek medical treatment. I would be healthier if I could see my doctor routinely before things got out of hand. I would love an option that would cover my medications and diagnostic testing. Those on Medicare and even Medicaid have greater routine coverage than I do at a cost of $800/month.
Yes, yes, yes! The system IS broken. It does need to be fixed and politicians need to butt out. It isn’t a matter of who has healthcare as much as it is the enormous costs in duplicated services, lack of follow up and follow thru, lack of information, lack of time face-to-face with the patient, and on and on. As a nurse case manager I get the privilege of working one-on-one with patients to help them get the most out of their care. If only physicians were able to get this kind of time with their patients. If only all patients had someone to follow up with them for questions, problems, concerns.
As citizens we need to learn to be better healthcare consumers. We need an option that will allow us to select the plan that best works for our family and that works everywhere! Simply providing healthcare for every man, woman and child will not fix our problem.
As a small business owner I can’t afford decent healthcare for my own family. We get by with a high deductible plan and rarely seek medical treatment. I would be healthier if I could see my doctor routinely before things got out of hand. I would love an option that would cover my medications and diagnostic testing. Those on Medicare and even Medicaid have greater routine coverage than I do at a cost of $800/month.
I am a fiscal conservative, yet socially liberal individual. My Undergraduate work is in Information Technology, I also hold a Master Degree in business. I feel a “rant” is useless, you are part of the solution or part of the problem—a rant in my opinion is just more complaints, not solutions. .
Like your patients that ask “So what you think about Obama’s plans to socialize medicine” or “I wanted to get in here before Obama-care comes in and messes things up”. They are looking for informed information– you are on the front line “Dr. Rob” stop smiling and nodding and give them some unbiased resources to check, maybe you can help instead of just complaining
Our healthcare and practice are some of the best in the world and your statement about the house burning down is simply inflammatory. Also, the “yada-yaya-yada” that you so eloquently state are the obstacles to such an endeavor, do you not understand or do you not care and dismiss them as it appears when you call those barriers “yada-yaya-yada”
You state, “I am not just talking about the conservatives here because to actually fix this problem we all have to somehow come together”. Again, in my opinion his is not a “fix” or even a path to the “fix” its just more worthless rhetoric. It appears you feel a consensus will do the trick. Do you have any idea how hard it is to get consensus with just eight people? You will not get all the people, sorry to inform you of this and crush your idealistic intent.
Also, your scare tactics are (again my opinion) crap too, you state “In the mean-time, people are going to be denied care, go bankrupt, and die”. These things will continue to happen, regardless of health care reform.
As for what you see:
The payment system we have favors no one. Good, everyone is the same– isn’t that what those who want socialized medicine want?
Stupid and wasteful procedures shouldn’t be reimbursed. Business 101? Cut cost and don’t check under every rock and you wont have a business, you’ll loose you license to “practice”. As for the CT angiogram, I would assume a referral to a specialist was made and a cardiologist ordered that test for some reason you left out. It appears cardiology is well out of your skill set Dr. Rob. As for the statement “The procedure done today probably cost more than all of the care I have given this patient over the past 5 years combined”! A horrifying statement by a primary caregiver, I know the cost of treating advanced Alzheimer’s over five years is very high and would cost far more than the one test. But you can prove me wrong by quantifying the cost instead of stating, “probably cost more”. You also ask, “Why should we allow people to gouge the system for personal gain in the name of “free market”? Understand a “free market” will adjust and those that over charge should get weeded out over time. Consumers need to be aware of what they are paying for, always.
The government has to stop being stupid. You ask “Why can’t I give discount cards to Medicare patients”? This would be the “free market” which you complain about above… interesting. As for “Who invented the “welcome to Medicare physical??” “ I never do it because the rules are utterly complex and convoluted”. Glad to hear you are all ready giving your patients all that their coverage allows (please note sarcasm) if it is too hard for you to understand find someone to explain it to you and stop complaining.
The money is going somewhere. Yes it is, some of it is in your pocket Doc. You state, “There are more generic drugs than ever and I am no longer able to prescribe a bunch of things that didn’t get a second-thought 10 years ago”. Doesn’t this scream hypocrisy considering your statement in point #2 about “rationing”? Why is it your orders are more right than that of others. I could go to a dozen doctors and get a dozen different diagnostic approaches and most likely some of the doctors would use slightly different drug for treatment of the same ailment if needed.
Docs have to stop being idiots. Do you include yourself here? You are on a rant, giving little if anything to resolve this issue. I have been on an EMR implementation team. I am doing what I can given my position and social standing. We were very successful, however the cost of such a system will put many of the smaller healthcare offices out of business.
Yes, engineers design them and you lack the knowledge and skill set to create the millions of lines of code to make it work. When you buy an “out of the box” piece of software that is built with everything in mind, from pediatric to geriatrics you get to spend tens of thousands of dollars customizing it or adhering to the software products out of the box processes.
You then ask “So why can’t we computerize ourselves? Every other industry did.” My answer, they did not do it without the engineers, period. You also ask, “Aren’t we smart people? Aren’t we paid to solve problems”?
Well it appears you consider yourself smart, and yes you are paid to solve problems, but not these types of problems, get over yourself. As you state “Med bloggers are terrible in this – they rant constantly against EMR, but don’t ever say what would work. It’s fun to criticize, but nobody wants to propose an alternative. Thank you for this disclaimer Dr. Rob, Med blogger that seems to have no alternative.
You further state, “As it stands, we are more passionate about these other things than we are about the people who get the care.” And also “If we were all half as passionate about what is good for patients (and we are all patients) as we are about these other issues, we wouldn’t have half of the problems we have”. This seems clear to me that some (maybe a lot) of people don’t want to be included in this, as your word choices seem to imply. You use “we” “us” and “our” please don’t speak for me, I can do it for myself.
Lastly you say, “This rant is not meant to show I am smarter than the rest of you” with the number of people you call idiots such as docs, government, indirectly engineers further stating that “plain stupidity may come back to haunt us. No, it may come back to kill us”. I disagree with your statement and if it was not an attempt show that you are smarter than us, it sure appears to show you are more arrogant than most. “As a flaming moderate I get to offend people on all sides”. More appropriately called alienation, and in the collective “we-ism” you keep bantering about, don’t you need their help to accomplish this goal?
I do believe in a solution, and it will be found by compromise and the free market system. Not from government intervention and taxation.
I am a fiscal conservative, yet socially liberal individual. My Undergraduate work is in Information Technology, I also hold a Master Degree in business. I feel a “rant” is useless, you are part of the solution or part of the problem—a rant in my opinion is just more complaints, not solutions. .
Like your patients that ask “So what you think about Obama’s plans to socialize medicine” or “I wanted to get in here before Obama-care comes in and messes things up”. They are looking for informed information– you are on the front line “Dr. Rob” stop smiling and nodding and give them some unbiased resources to check, maybe you can help instead of just complaining
Our healthcare and practice are some of the best in the world and your statement about the house burning down is simply inflammatory. Also, the “yada-yaya-yada” that you so eloquently state are the obstacles to such an endeavor, do you not understand or do you not care and dismiss them as it appears when you call those barriers “yada-yaya-yada”
You state, “I am not just talking about the conservatives here because to actually fix this problem we all have to somehow come together”. Again, in my opinion his is not a “fix” or even a path to the “fix” its just more worthless rhetoric. It appears you feel a consensus will do the trick. Do you have any idea how hard it is to get consensus with just eight people? You will not get all the people, sorry to inform you of this and crush your idealistic intent.
Also, your scare tactics are (again my opinion) crap too, you state “In the mean-time, people are going to be denied care, go bankrupt, and die”. These things will continue to happen, regardless of health care reform.
As for what you see:
The payment system we have favors no one. Good, everyone is the same– isn’t that what those who want socialized medicine want?
Stupid and wasteful procedures shouldn’t be reimbursed. Business 101? Cut cost and don’t check under every rock and you wont have a business, you’ll loose you license to “practice”. As for the CT angiogram, I would assume a referral to a specialist was made and a cardiologist ordered that test for some reason you left out. It appears cardiology is well out of your skill set Dr. Rob. As for the statement “The procedure done today probably cost more than all of the care I have given this patient over the past 5 years combined”! A horrifying statement by a primary caregiver, I know the cost of treating advanced Alzheimer’s over five years is very high and would cost far more than the one test. But you can prove me wrong by quantifying the cost instead of stating, “probably cost more”. You also ask, “Why should we allow people to gouge the system for personal gain in the name of “free market”? Understand a “free market” will adjust and those that over charge should get weeded out over time. Consumers need to be aware of what they are paying for, always.
The government has to stop being stupid. You ask “Why can’t I give discount cards to Medicare patients”? This would be the “free market” which you complain about above… interesting. As for “Who invented the “welcome to Medicare physical??” “ I never do it because the rules are utterly complex and convoluted”. Glad to hear you are all ready giving your patients all that their coverage allows (please note sarcasm) if it is too hard for you to understand find someone to explain it to you and stop complaining.
The money is going somewhere. Yes it is, some of it is in your pocket Doc. You state, “There are more generic drugs than ever and I am no longer able to prescribe a bunch of things that didn’t get a second-thought 10 years ago”. Doesn’t this scream hypocrisy considering your statement in point #2 about “rationing”? Why is it your orders are more right than that of others. I could go to a dozen doctors and get a dozen different diagnostic approaches and most likely some of the doctors would use slightly different drug for treatment of the same ailment if needed.
Docs have to stop being idiots. Do you include yourself here? You are on a rant, giving little if anything to resolve this issue. I have been on an EMR implementation team. I am doing what I can given my position and social standing. We were very successful, however the cost of such a system will put many of the smaller healthcare offices out of business.
Yes, engineers design them and you lack the knowledge and skill set to create the millions of lines of code to make it work. When you buy an “out of the box” piece of software that is built with everything in mind, from pediatric to geriatrics you get to spend tens of thousands of dollars customizing it or adhering to the software products out of the box processes.
You then ask “So why can’t we computerize ourselves? Every other industry did.” My answer, they did not do it without the engineers, period. You also ask, “Aren’t we smart people? Aren’t we paid to solve problems”?
Well it appears you consider yourself smart, and yes you are paid to solve problems, but not these types of problems, get over yourself. As you state “Med bloggers are terrible in this – they rant constantly against EMR, but don’t ever say what would work. It’s fun to criticize, but nobody wants to propose an alternative. Thank you for this disclaimer Dr. Rob, Med blogger that seems to have no alternative.
You further state, “As it stands, we are more passionate about these other things than we are about the people who get the care.” And also “If we were all half as passionate about what is good for patients (and we are all patients) as we are about these other issues, we wouldn’t have half of the problems we have”. This seems clear to me that some (maybe a lot) of people don’t want to be included in this, as your word choices seem to imply. You use “we” “us” and “our” please don’t speak for me, I can do it for myself.
Lastly you say, “This rant is not meant to show I am smarter than the rest of you” with the number of people you call idiots such as docs, government, indirectly engineers further stating that “plain stupidity may come back to haunt us. No, it may come back to kill us”. I disagree with your statement and if it was not an attempt show that you are smarter than us, it sure appears to show you are more arrogant than most. “As a flaming moderate I get to offend people on all sides”. More appropriately called alienation, and in the collective “we-ism” you keep bantering about, don’t you need their help to accomplish this goal?
I do believe in a solution, and it will be found by compromise and the free market system. Not from government intervention and taxation.
I recently read a remark that was posted on another site. To paraphrase it said “without physicians, the insurance mongrels would make nothing… their profit is ours”. What will it take to make doctors stand up for themselves?
I recently read a remark that was posted on another site. To paraphrase it said “without physicians, the insurance mongrels would make nothing… their profit is ours”. What will it take to make doctors stand up for themselves?