Healthcare

Obamacare shutters D.C. family practice

Obamacare shutters D.C. family practice
Dr. Andrew T. Lee

A Washington physician, whose father founded his practice in the late 1960s, is shuttering operations because of the burdens created by federal health care reform, in addition to Medicare and insurance company hassles.

Health care regulations and laws created by President Barack Obama’s 2010 Patient Protection and Affordable Care Act are the biggest problem, said Dr. Andrew Lee, a general practitioner who has treated more than 10,000 patients since he opened his business.

“I think all citizens in America should be provided with some access to health care,” he said. “But, I am not sure this is the right way to shovel a massive law through,” he said. “My anticipation is that it will be modified, some.”

Lee said he and his wife, who is also a doctor, took over his father’s practice in 1999 at the same address in the capital’s Chinatown, where his father started it. “He actually grew up in the house next door.”

The doctor was born in D.C., at the former Columbia Hospital for Women, now a condominium complex called The Columbian. “When I walk by with my kids I tell them: ‘You know, I was born there, I could retire there,’” he said.

“My wife and I would have this discussion for years, but it was not until three years ago, did I realize we are really fighting a losing battle,” he said.

“I am not sure if it is 100 percent related to government, as much as it is also the health insurance companies,” he said. “They tend to have a lot of factors in there that make you do things like pre-authorizations, which increase your administrative time.”

Joining Johns Hopkins

Regardless of who controls the White House and Congress, Lee said the business will close some time next year. “We are going to close our practice and join Johns Hopkins University,” he said.

Johns Hopkins is a Baltimore-based institution that is expanding its operations into Washington, he said. The school does not buy practices or have private practices inside its own business, so the couple will actually close the business and become salaried employees of Johns Hopkins, although they will take their patient records with them with the intention of treating them at their new home.

“I’ve told our patients we will be just seven blocks away and that Hopkins is committed to practicing very good medicine,” he said.

One of the considerations he and his wife dealt with was the transition from running their own business and being their own boss, he said. Initially, giving up the “ownership” of one’s job was difficult, the doctor said. But, in another way, Lee and his wife are glad to be freed from the hassles from the government and insurance companies, he said.

“My wife and I look forward to it because we can just focus on being a good physician, not worrying about the administrative headaches,” he said. “We really looked at the benefits versus the risk and we were really unsure about what is going to happen with the Affordable Care Act,” he said.

“In my view, the two winners for the Affordable Care Act are the insurance companies, because more people will have to purchase insurance, as well as the pharmaceutical companies because many more people will be buying medications—they are the two lobby groups that have fared pretty well from this.”

For Lee’s Medicare patients, the problem is not the reimbursement rates, which in some cases is more generous that what private insurance companies pay, he said. “What really hurts us—with Congress unable to come to a budget, and the fiscal crisis in January—they have always talked about cutting 27 percent if this thing goes through,” he said.

“They usually come up with a stopgap for another six months, but we are always under this threat,” he said. “The last one that happened last year, and the year before, our Medicare clearing house tells us: ‘Just don’t submit anything for one month—and then after the stopgap comes through, then send the billing in again.’”

The result is that the practice loses its Medicare revenue for that month, he said.

No tort reform

“Another problem is that there is no tort reform on the table,” he said. “That is a big problem here in D.C.—there is no cap on the personal injury portion of malpractice—all these things add cost, and our costs are going to run us out of our practice.”

Without tort reform, malpractice insurance keeps going up, he said. Lee pays $25,000 per year, and his wife roughly half that, for $1.5 million per occurrence, with a total coverage of $3 million, he said. “There is no deductible, and the premium is non-tax deductible.”

The doctor said the tort situation makes it very difficult for doctors to find an insurance company and that in turn makes it an unwelcome environment for doctors to practice in the city limits.

In the end, the neighborhood doctors like him are going away, said the graduate of the New York College of Osteopathic Medicine, Old Westbury, N.Y.

“What people really like is the access to their doctor,” he said.

“We deliberately run this as a very small practice. There are no nurse practitioners, no physician’s assistants, we just have the two staff people up front and me and my wife,” Lee said. The practice does not accept new patients, unless they are friends or related to existing patients.

“We have used electronic record keeping since 2006,” he said. The government is forcing doctors to use computers to cut down cost and electronic records to cut down on paperwork, he said. “What that does is put the onus of the cost on the individual physicians.”

Under the federal government’s “Meaningful Use” programs, if computer equipment was purchased in 2011, the practice could put in for reimbursement, he said.

The problem is that Lee and his wife bought their system in 2006, he said. New regulations require completely new computer systems in 2013, which for the Lees would cost $15,000 to $20,000.

Because they are shutting down their operations in 2013, they are ignoring the law for now, he said.

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  • TanongSak

    I wish all healthcare professionals, including doctors and nurses, would go on an extended strike. The next time a liberal politician gets sick, he can call his lawyer.

  • Ancient_Pollyanna

    This is BS. Obamacare hasn’t even started yet.

  • Bildo1

    Au contraire, mon fraire (?). The incremental nature of its implementation is like an infection that keeps spreading. My wife works for an optometrist and the regulations already require about an additional 20 mins. per patient. Starting Jan. 1, if someone comes in and it is learned that they smoke or are overweight, or have high blood pressure, they are reqiured to do a counselling session concerning their particular issue. At the eye doctors!

  • Bildo1

    Not the first, won’t be the last. Shameful. But the good Drs. Lee can clse the doors to this practice because he knows that his Daddy didn’t really build this practice…

  • Melvin Leppla

    Wake the hell up you idiot, yes it has.

  • Melvin Leppla

    Obama care aside, we as a Nation have the incredibly rotten tendency to over regulate ourselves with onerous and oppressive rules and regulations all in the name of safety. I guess as Americans get so called, “smarter,” the need for more rules and agencies to enforce these rules becomes an obsession.
    Americans have absolutely no frigging clue what is about to slam to come front in center of them and slam them directly into reality. This story is about a man who has carried on his father’s medical practice for years and years. These doctors the span of these doctors has witnessed the birth of many of their patients, and signed the death certificates of many of they’re patients.
    I don’t know about the rest of you, I get extremely sick and damn tired of seeing a different doctor every time I have the need to see one. I’m seeing a person who doesn’t know me, who doesn’t know my history other than what is on a computer screen in front him or her.
    I feel extremely uncomfortable with a doctor I just met for the first time, asking me to bend over all the while he or she snaps the rubber glove, and I’m quite sure it is the same for the women. But if I have a doctor of whom I have known for years, I feel more comfortable and secure with that person.
    Our elected Congressmen and Senators will they get to see they’re doctors of whom they have known for years, You betcha they will, because people in all candor, there is now in place a health care system that separates us on class lines. In other words there is now a health care system for us, and a health care system for the elites.
    Good luck on getting that specialty appointment. I heard that there is about a year’s waiting list to get on the another list.

  • sabrose

    Obamacare intends to herd doctors into big groups as employees. That way when the government makes those large groups fail it will be easier to take them over. This country was based on freedom and individuality. A good doctor working for himself can control his own environment. Not so when he subjugates himself to a big conglomerate.
    As a physician who is self employed for 27 years I value that freedom and I will retire before i let some socialist take it away from me.

  • denbren52

    My doctor just sold his practice and has told me that if Obama is reelected and there is no chance of repeal, he will leave the field of medicine because there will no longer be any financial incentive to practice medicine.

  • DanB_Tiffin

    Remember Dr. Granny on The Beverly Hillbillies? That is the future of medicine in our country. Oh, I am sure many doctors will be “certified” by our government, especially through affirmative action for certain types.

  • dnha14

    I can’t keep my doctor either. He’s shutting down 1/1/13. So Obama lied…again.

  • 2Anglico

    The author says the two winners are insurance companies and drug companies. I totally disagree. I know they THOUGHT they would make good but they bought the LIE. This is just an interim step in the march to TOTAL GOVERNMENT CONTROL, therefore, there is only ONE winner, the FEDERAL GOVERNMENT.

    Obamacare is all about government power, end of story.
    BTW, ancient one, MANY parts of Obamanationcare have already gone into effect, its just that the worst is yet to come.

  • AgTrotter

    Only the care part of it won’t start until 2014. However, the taxes and regulations have already begun. Please educate yourself before commenting.

  • anothercrawfish

    He isn’t alone.

  • anothercrawfish

    Something I’ve not heard before is the drug companies. If the obamataxcare is supposed to be cutting costs (that’s the plan anyway), who is going to pay for drug research. If drug companies have no incentive to make a profit on new drugs, why do it. I suspect, if obamataxcare isn’t repealed, this issue will come crashing down on us all in the next 5 – 10 years, if not sooner.

  • Ed_USA

    It’s both funny and sad that HE paints this as some sort of tragedy. Dr. Lee is joining Johns Hopkins, one of the most prestigious medical institutions in the country. He expresses his grief about that in this way “My wife and I look forward to it because we can just focus on being a good physician, not worrying about the administrative headaches”. Oh yes, what a tragedy.

    But despite the HE spin, there are some genuine things to be learned from this:

    1) One of the worst aspects of US medical care is lack of coordination between providers. Once Lee starts to “just focus on being a good physician” within the Hopkins organization his patients will get better care overall.

    2) The byzantine maze of insurance forms in the US makes our admin costs the highest in the world and frustrates doctors. That’s the source of the “administrative headaches”.

    3) Lee points out that Medicare reimbursement is “in some cases is more generous that what private insurance companies pay”, yet Medicare holds down costs far better.

    4) Lee cites the major problem with Medicare this way: “What really hurts us—with Congress unable to come to a budget, and the fiscal crisis in January”. Now tell me, which party has been obstructing a budget deal?

    I wish Dr. Lee well in his new position and I hope that it makes his practice more rewarding for him, for his family, and for his patients.

  • http://www.facebook.com/kbarrich Kristen Barnes

    One of my doctors is very good but he is not allowed to spend any real time with patients, so I go to nurse practitioners and physician assistants who I really trust.

  • Ed_USA

    Dr. Lee speaks the truth: “In my view, the two winners for the Affordable Care Act are the insurance companies, because more people will have to purchase insurance, as well as the pharmaceutical companies because many more people will be buying medications—they are the two lobby groups that have fared pretty well from this.”

    Unfortunately, lobbyists own our gov’t. Obamacare was the best that a corrupt Congress could do while staying in the good graces of their paymasters. The insurers are none too pleased at Romney’s recent resurgence.

    news yahoo com/insurers-nervous-over-prospect-romney-victory-115914066–finance.html

    You’ll note that the article points out what a crock Romney’s promise to scrap the individual mandate is: “the industry fears people literally could get health insurance on the way to the emergency room”. As with most things Romney says these days, it doesn’t add up.

  • JayC777

    1) Not true
    2) The reason we have a byzantine maze of insurance forms is because of government involvement where it doesn’t belong.
    3) Some cases. Very rare. Medicare doesn’t hold down costs, they hold down the amount of medical care people can receive because most doctors won’t accept it due to the fact that they DON’T ACTUALLY pay out as good as insurance companies.
    4) Democrats. This is a fact that only mindless buffoons deny.
    Jay
    Riiiiiiggghhhhtttt.

  • Dustoff

    Affordable Care Act

    ******************************

    Really… yet most have already jumped by 2.000 dollars.

  • Dustoff

    And this little nugget too
    2009
    Senator Max Baucus, A Leading Architect of Health Care
    Reform, Received More Industry Contributions Than Any Other
    Congressional Candidate
    WASHINGTON, DC — Health insurers and drug companies gave a combined
    $6.1 million to the top ten recipients in each house of Congress since
    2005, according to a study released today by the non-profit Consumer
    Watchdog.

  • Ed_USA

    Sorry, but this is just more proof that you don’t know anything about the health care system in this country. Medicare is funded by FICA taxes and, thanks to Ronald Reagan, taxes on SS income. Medicare is funded out of federal income tax and state taxes. So, how does cutting payments by Medicare take money from Medicare? How does it do anything except slow the rate at which the Medicare trust fund gets depleted? The Ryan plan keeps those very same Medicare reimbursement cuts and Ryan has claimed that those cuts extend the life of the Medicare trust fund.

    Here’s those commies at Bloomberg Businessweek explaining this same thing. I hope you’ll do your best to understand it.

    www businessweek com/articles/2012-08-30/hey-paul-ryan-obamacare-doesnt-steal-from-medicare

  • JohnGalt

    Sign in a local colleague’s (neurosurgeon) waiting room:

    “If you are a trial lawyer or relative of a trial lawyer, please leave the office and obtain care elsewhere”

  • Ed_USA

    1) Is true according to most experts. Here’s an example www nytimes com/2012/09/11/opinion/waste-in-the-health-care-system.html
    You are an idiot.

    2) Then why is Canada’s paperwork so much simpler and cheaper? Because their gov’t stays out of medical care? You are an idiot.

    3) “Medicare doesn’t hold down costs,” Actually, they do. You are an idiot.

    4) Let’s look at who’s blocking it with a minority filibuster. You are an idiot.

  • JayC777

    From your article( written by AP, ROTFLMFAO ):
    “Things could get grim for the industry if Republicans succeed in repealing the Affordable Care Act’s subsidies and mandates, but leave standing its requirement that insurers cover people with health problems. If that’s the outcome, the industry fears people literally could get health insurance on the way to the emergency room, and that would drive up premiums.”
    So, tell me, how can pre-existing condition part stand if the law is repealed? If it is repealed, all of it is repealed. They’d have to write a new law and get it passed through congress and signed by the POTUS for this to happen. As with EVERYTHING from you and the current occupant of the White house, nothing adds up.
    Also, for your article:
    “Although the industry hates parts of President Barack Obama’s health care law”
    The industry hates parts, huh? They hate the whole dang thing.
    Jay
    AP = Always Pathetic

  • Dustoff

    ) Then why is Canada’s paperwork so much simpler and cheaper?

    *****************************

    YEAH SURE, So that explains all the people I see from Canada at my hospital (Harborview)

  • Dustoff

    Sure ed.

    First, where it comes from. On July 24, the Congressional Budget Office sent a letter
    to House Speaker John Boehner, detailing the budget impact of repealing
    the Affordable Care Act. If Congress overturned the law, “spending for
    Medicare would increase by an estimated $716 billion over that 2013–2022
    period.”

    As to how the Affordable Care Act actually gets to $716 billion in
    Medicare savings, that’s a bit more complicated. John McDonough did the
    best job explaining it in his 2011 book, “Inside National Health Reform.” There, he looked at all the various Medicare cuts Democrats made to pay for the Affordable Care Act.

  • Dustoff

    The Medicare health program’s annual financial report reveals a
    system that is healthy at the moment, but has a bleak long-term
    prognosis.

    The report, released Monday, is
    sure to touch off a political firestorm due to recent actions that
    compel the federal government to address the problem.

    At the moment the trust fund that pays for hospital and nursing
    home care has enough money to last until the year 2019. That’s a year
    longer than last year’s projection.

    hat “warning” is part of a mechanism created in 2003 by congressional
    Republicans. They wanted a way to keep closer tabs on the portion of
    Medicare that’s funded by general taxes and Medicare premiums. Known as
    “Part B,” it covers doctor visits and other outpatient care. (Other
    funding for Medicare comes from payroll taxes.)

    The
    warning is triggered when, for two years in a row, Part B — and other
    Medicare funding from general revenues — are expected to exceed 45
    percent of total Medicare spending within seven years. This year is the
    second year that has happened.

    I can look up and post to dummy.

  • FlyoverMike

    I have friend whose father had a practice in Fresno, CA when Medicare was enacted. Before the law came into force, he had one person in his for paperwork. To comply with Medicare, he had to hire three more. So ObamaCare isn’t about providing health care to American, it’s a jobs program! For bookkeepers, lawyers, and other paper pushers. But not for health care workers…

  • MRCFRASER

    thanks Obama!! more WILL follow

  • MRCFRASER

    where have you been? It has started!

  • Frank Wacaser

    My Dr. quit and left town……..had to get another. How long ……..????

  • http://www.facebook.com/people/Erik-Osbun/100001215333702 Erik Osbun

    Shuttered for reason of insurance mandate and lack of tort reform in Obamacare. Solve the problem: repeal Obamacare.

  • Dustoff

    New Obamacare Tax Form Mandates Americans Report Personal Health ID Info to IRS

    Here’s why the IRS will require Americans to disclose their personal health ID information starting in 2014

    When Obamacare’s individual mandate takes effect in 2014, all Americans
    who file income tax returns must complete an additional IRS tax form.
    The new form will require disclosure of a taxpayer’s personal
    identifying health information in order to determine compliance with the
    Affordable Care Act’s individual mandate.

    As confirmed by IRS testimony
    to the tax-writing House Committee on Ways and Means, “taxpayers will
    file their tax returns reporting their health insurance coverage, and/or
    making a payment”.

    YET the dem’s want no ID to vote. Go figure

  • extyrequeen

    the democrat party have pushed for a single payer system for years and to
    believe that the govt. won’t control your health care is just fantasy..that’s what a single payer is going to the govt for all your health needs and no more doctor
    patient privicy….all of your records will be public record….this will be a disaster
    for all of us americans…obama has to be stopped on tuesday…

  • http://www.facebook.com/people/Robert-Ferrell/100000320220630 Robert Ferrell

    Unfortunately, another casualty of “Obama-Lack-of-Care”!!!!!!

  • RenegadeScholar

    there will no longer be any financial incentive to practice medicine
    Of course, according to the leftists, he is not allowed to leave the field of medicine. “The People” have a RIGHT to healthcare, so that means HE HAS to provide his skills to them.
    Yes; that is what it means. Someone else has the RIGHT to your skills and knowledge.

  • RenegadeScholar

    Obamacare was the best that a corrupt Congress could do while staying in the good graces of their paymasters.

    Ahem.

    ONLY democrats voted for this disaster. ONLY democrats are serving their paymasters.

  • Kauaicat

    Somewhat OT – I’m not sure who is doing Dr. Lee’s tax accounting, but the premiums he pays for liability insurance ARE deductible as a necessary and normal business expense.

    With respect to the “Affordable” Health Care Act, the HMO premiums for my wife and I just went from $777 per month to $901 per month, nearly a 16% increase – gotta pay for that free birth control for my 59 yr old wife – LOL. Prescription coverage of birth control started August 1, and it’s free under my HMO.

  • BLH557

    As a doctor who recently closed his doors after 25 years of practice I want to address your four “points”.

    1. Not all doctors can step into a spot at Johns Hopkins. I practiced in rural Texas. I now work for a company performing employment physicals and see about 40-100 personal patients per month on the weekends for cash. I can assure you, Dr. Lee’s PATIENT’S will be the ones confronted with the mass of paperwork under the managed care system of Johns Hopkins. They will get care that is limited, constrained and Dr. Lee will be told what to do, when to do it and how many prescriptions to write based on only one factor; reimbursement. I don’t call that better. Ed, obviously doesn’t know better from a dead Ambassador. (BTW, the Canadian system is headed for another round of care reductions coming up soon.)

    2) Managed care, along with its attendant plethora of paperwork, was nearly unheard of (except in Californication) until 1993 (thank you, Hillary) when the government decided to stick its nose in everybody’s business… kind of like a midget at a nudist colony. This led to (a republican) congress siding with a democrat administration to amass that “Byzantine Mass” of regulations which has only been piled on since then. That, of course, was back when 80% of healthcare outlays actually went to pay for healthcare instead of the contemporary 80% going to pay for administration. Healthcare cost less and the US had the best in the world.

    3) Medicare reimbursement is, in some cases, reimbursed at a higher rate than some managed care programs (except for gigantic healthcare corps like Johns Hopkins, Kaiser-Permente, etc. who actually get higher rates than anyone else) that is true. But when you factor in the risks associated with treating Medicare patients it is almost not worth it. Few in the lay population understand that in CMS’ eyes a simple innocent mis-coding is fraud and you WILL PAY with your freedom and hard-earned money for anything CMS decides to go after you for. Even if you win your case in a tier II adjudication or with a District Court Judge your legal expenses can amount to 2-5 X the “suspect” fraud charges, but you have to do it because otherwise you end up in jail or completely broke. Dr. Lee’s explanation appears to be a political move on his part to stay on the good side of CMS, rather than a truthful explanation of the problem.

    4. There’s plenty of guilt to go around without pointing fingers at either side of the aisle. This obstruction has been going on since the mid-90s when the Clinton administration’s bean-counters came up with the bright idea that “in the future it will cost less to practice”… duh! So, Congress (thanks Newt) placed that pesky little yearly accounting efficiency tax in assuring us all that costs would go down and therefore that improved efficiency was factored in to our yearly fee improvement (read reduction). However, with the Democrats running a supermajority the first two years of the Obama admin and a bipartisan dismissal of the Obamao’s “budget” proposals thereafter your point about obstructionism is moot.

    If you want to comment about things you know absolutely nothing about, please use a disclaimer.

  • RenegadeScholar

    1) Is true according to most experts. Here’s an example www nytimes com/2012/09/11/opinion/waste-in-the-health-care-system.html

    There you go again, Ed.

    “Most Experts….?”

    NOT.

    That is a story based on ONE report that is the conclusion of a CONSENSUS (not unanimous) view of ONE COMMITTEE of ONE organization, IOM.
    At best it could be “a few experts.”

    You need to end this one-dimensional thinking and broad brush simplicity.

  • Ed_USA

    ” If it is repealed, all of it is repealed.”

    You might want to break that to Mitt Romney. On Meet The Press Mitt said this:

    “I’m not getting rid of all of health care reform. Of course there are a number of things that I like in health care reform that I’m going to put in place. One is to make sure that those with pre-existing conditions can get coverage.”

  • DanB_Tiffin

    Sorry, doc. ED_USSR is a collectivist who knows more than any of us lesser people.

  • Dustoff

    Sandra Fluke, she’s a busy woman. (-:

  • Ed_USA

    First, that’s not the only report that’s cited uncoordinated care as a problem. Second, it’s a bit rich for you to criticize me for citing only one panel of experts when you go on to say

    “I’m citing no expert other than myself and my own experience”

    Nothing raises the bar for credibility like that, eh.

  • http://www.facebook.com/healthnut1 Fernande M Rivers

    What’s so sickening about that whole obamacarenightmare crap is that those in Congress….their families their friends…the unions…the muslims…and all those rich people have nothing to worry about it….either, they are EXEMPTS or have enough money to pay for it….What’s worst is that millions of “illegals” and their “illegals” friends will pay ZERO…We, the tax payers will pay for them…Again….today…Emory Hospital in Atlanta restated that if one with Neuro problems requiring surgery will be denied under this nightmare…unless and until the Death Panels decide to review your case…It will not happen because we all know that surgery required for neuro trauma must be done within the first 30 minutes or there is no hope regardless…We will never see a government employee within 30 minutes…so…like…Obama said…just give them a pill…and let them die on a stretcher in the ER….the same way Obama believes that if this little baby dares to live post abortion…and voted for….to let he/she die on a shelf in an abortion clinic…Imagine an Obama 4 more years…

  • TanongSak

    John, is this for real? And are you a doctor?

  • fisheraudrey

    The “I have a physician” stories are perhaps shading their comments. You seem to be missing the part where this physician blames Congress ( yes GOP led for the past 2 years) to even consider the raising the reimbursement limits for physicians who accept Medicare patients. Sorry to burst your balloon, but when you write about details of which you have none and somehow want to link everything to ACA legislation – it only proves that you have jumped into the rabbit hole and are digging as fast as possible.

  • JohnGalt

    Yes and yes.

    I am an Optometrist.

    Additionally, I not only did not build my own practice from the bare ground up, but have my highly vulnerable ass firmly in the sights of the DC Communists, and assorted unrestrained trial lawyer scum.

  • TanongSak

    Now, what’s the matter with you, John Galt, you know “you didn’t build that!” :-)
    Thank you for the reply. You have my deepest sympathy, admiration, and encouragement. And that goes twice over, if you live in D.C. Here in California, we get taxed to death, but I don’t think it’s as bad as where you are; and the climate is much better.

  • JohnGalt

    No, I practice in St. Louis, a much more reasonable and sane place than thieving, dictatorial Leningrad on the Potomac.

  • Ed_USA

    I think that the elephant in the room that you don’t address is the cost problem that has been facing the US since at least the 1980s. Managed care did not emerge in the ’90s at random, and it was mostly a private insurance effort. Managed care was an attempt to stop runaway cost inflation.

    Look at the graph on page 7 of this report
    www nasi org/sites/default/files/research/Medicare_Finances_Findings_of_the_2012_Trustees_Report.pdf

    The only time that private insurance spending grew more slowly than Medicare spending was during the heyday of managed care. After the insurers lost that battle private costs went back to rising faster.

    Since you are from Texas, you are probably aware of the study comparing McAllen, Texas to El Paso.
    www newyorker com/reporting/2009/06/01/090601fa_fact_gawande
    McAllen has some of the highest costs in the nation, and there’s no good reason why it should. It all came down to bad practices by the physicians. That’s the sort of thing that needs to be corrected.

    The reason that costs are the elephant in the room is that the current rate of rise unsustainable. The US is totally out of line with the rest of the OECD in its costs, averaging nearly twice as much per capita. Other countries prove every day that costs can be held down, but the US is failing to do it. That will change because it must change, or our entire GDP will be consumed by medical costs. Anyone discussing health care policy w/o addressing the cost issue is just wasting time.

  • Ed_USA

    The GOP didn’t want to do anything at all to deal with our broken system. No surprise there, apart from Medicare Part D, with its prohibition on negotiating good prices for drugs, the GOP did nothing the entire time they had control of the gov’t. One of the main reasons Obamacare got structured as it is was that it’s a GOP idea that’s identical to what GOP governor Mitt Romney did in MA.

    But, I don’t want to claim that Dems are not in the pockets of lobbyists. They are. And so is the GOP.

  • kbcab

    After Tuesday , Obamacare will be on its way out…

  • http://www.facebook.com/mjb1951 Michael Burch

    GOD BLESS YOU,SIR….

  • caskinner

    You poor thing….not very informed. You probably won’t even notice when you can’t find a doctor.

  • JohnGalt

    I didn’t mean to imply that I am currently in litigation. Thank God, I’ve escaped that to this point.

    I only have to peruse my professional journals, view a typical sample from the moronic, attacking popular media (your Dr. is out to get you and is also an incompetent boob), and talk to colleagues to see how these manipulative, nothing to lose ShysterVermin operate.

    Practice VERY defensively (and thus expensively) is the maxim.

  • http://www.facebook.com/mjb1951 Michael Burch

    WOW,I am speechless…what an intelligent, informed response.Thank you Doc…….

  • http://www.facebook.com/jeansjinks Jean A Wilson

    i HOPE THERE WILL NOT BE MORE DOCTORS CLOSING OFFICES BUT AM AFRAID IF OBAMACARE CONTINUES, MORE DOCTORS WILL NOT BE ABLE TO CONTINUE.

  • http://twitter.com/stephenmstrplmb stephen wilson

    My healthcare switched to medicare.Medicaid spent $1,300,000 in my fight against cancer.I worry like he!! if i get sick again,they’ll send the “end of life” clowns to my house.I’m only 51,with 12 grandkids.

  • http://twitter.com/stephenmstrplmb stephen wilson

    Any suggestions for a cancer fighter with $1,300,000 already spent?I’ve been winning for 3 years,but if i relapse am i gonna get screwed?Will the end of life people show up.I’m 51 & have 12 grandkids i’d like to watch grow up a little longer.

  • caskinner

    God willing and the idiots staying home.

  • okieflash

    Read the other day where doctors will all be paid the same, no matter if they are cardio or md’s….will have to report their real property and how many homes they own……hmmmmm, quess I would quit too.

  • JohnGalt

    First and foremost you have my prayers.

    I would assume since you are in the US, you are receiving exemplary care from your doctors AND nurses (Too often nursing staff is not mentioned, yet they are CRITICAL in the care process).

    By “screwed” I assume you mean cut off/capped from future care?

    I don’t know.

    At this point I don’t believe that anyone does except some useless Ivy League attorneys inside the Beltway.

    In my opinion, if your insurance company does have some sort of ceiling on expenses per disease incident, you should be allowed to opt to pay additional costs on your own.

    Reasonable, right? However, I’m not sure our Commissar masters are going to allow good old American free choice, any more.

    Get ready for an ENORMOUS Black market in health care if Obama’s collectivist disaster is not incinerated in the blast furnace of history.

    We need to PRAY about that as well.

    God Bless you, sir.

  • http://twitter.com/stephenmstrplmb stephen wilson

    Single payer has always been their stated goal,not enough people listened& our reps didn’t give a chit.

  • http://twitter.com/stephenmstrplmb stephen wilson

    Healthcare premiums under Obamacare are not tax deductable,neither are prostetics or any medical device.

  • http://www.facebook.com/people/Bev-Morse/100001973766549 Bev Morse

    wrong. because insurance companies will be more competitive, costs WILL come down. just like the big box stores.

  • John A . Demers

    I have lost 2 of my best Doctor’s one in the last week.My pain Doctor which I have been seeing for years due to the same reason as stated by Dr,Lee and his wife.My Doctor is a very well known great pain Management Doctor that cares for whom he treats.He had to close his two office Locations and will Lay Off all his Staff .The letter I receive from him said it all. To All My Patients, It has been a Challenging and rewarding experience providing care at my Fitchburg,MA and Ayer,MA Offices for over 6 years. However,Due to the economic realities,Including the recent Federal and State Regulations imposed on Health Care,I Can No Longer maintain a practice at these locations.He go’s on to tell me he will have to practice or should I say work for a Pain Management Care Center near Boston. Now for those of you out there that need to have a great Doctor that cares about you and nearby and he must close his doors because of no fault of his own,who even sold his house trying to keep his offices open is truly a great Doctor that cared for those he treated.He will be relocating from Central MA to a practice near Boston and when your a pain patient the ride out to his new location will just cause more pain on myself but if at all possible I will follow him .The point here is because of Obama Care People are not understanding what hardship this Rammed in Law has Cause the down right disabled people like myself. Wake Up People You Too can lose your Doctor .We Must Repeal this law and Give the Power of Health care back to the pros’s The Doctor. Not The Government. Good Luck to a Great Doctor DR,E Wong you will be missed in are community. John A.Demers

  • JohnGalt

    Thank you sir,
    God Bless us ALL if the Communists nail down the Executive branch for another four years of blatant racism, attacks on the productive, “green” corruption and the generally relentless destruction. of America

  • http://twitter.com/stephenmstrplmb stephen wilson

    I’m on medicare & you are the idiot.The quality of care suffers.I went a proctologist & told him what my problem was.he said

    “What you want me do?”I left & didn’t go back.You don’t get a cadillac for the price of fiat,idiot.Harry Ried is the one holding up legislation,it’s called tableing,idiot.Did you think the dems were going to ram more left wing bills through unfettered? I don’t think so.That’s precisely why they got hammered in the midterm,idiot.
    Paying less for chitty prison doctors isn’t the same as keeping cost
    down,idiot.If this goes into full force,the next time i get sick,the end of life folks will pay a visit.I’m only 51 & i’d like to watch my 12 grandkids grow up a bit more.

  • TanongSak

    Ditto.

  • TanongSak

    I used to live in St. Louis, for about 20 years. The climate sucks, and finally I couldn’t take it anymore, so I moved to the People’s Republic of California (LA area). What part of town (St. Louis) do you live?

  • Dustoff

    Welcome to Gov care.
    remember when O-dumber said about the old. Just take a pill instead of the operation.

    11/1/12

    The majority of NHS hospitals in England are being given financial rewards for
    placing terminally-ill patients on a controversial “pathway” to death, it
    can be disclosed.

    Almost two thirds of NHS trusts using the Liverpool Care Pathway have received
    payouts totalling millions of pounds for hitting targets related to its use,
    research for The Daily Telegraph shows.

    The figures, obtained under the Freedom of Information Act, reveal the full
    scale of financial inducements for the first time.

    They suggest that about 85 per cent of trusts have now adopted the regime,
    which can involve the removal of hydration and nutrition from dying
    patients.

    More than six out of 10 of those trusts – just over half of the total – have
    received or are due to receive financial rewards for doing so amounting to
    at least £12million

  • TanongSak

    You have my esteem, and sympathy. Being a self-employed doc is tough. Nowadays, most join one of those conglomerates. In fact, as far as I can tell, someone just out of residency can’t possibly just hang up a shingle and get patients. He or she almost has to join some group. And too, if the group is large enough, it can more easily deal with the bureaucrats.

  • http://twitter.com/stephenmstrplmb stephen wilson

    Well i’m an expert because i’m living through it.I could give a rats rear
    what some panel of people who clearly like this garbage.He!! for all
    i know these dipchits can’t run a regular practice.I do know fighting
    stage 3c lung cancer is expensive.Ed,i’ll put my personal experience up against yours any day of the week.Maybe it would
    get your rocks off having “end of life monster” knocking on your door, but at 51 for me,not so much.

  • BLH557

    If cost is the elephant, then tort reform is the rhinoceros. If you look at the long steep slide in Doctors’ disposable income vs the increases in malpractice costs (and claims) you should come to an understanding of why these costs have gone up as the number of lawsuits rises. The truth is most of the “essential” tests run for diagnostic purposes are actually for CYA purposes. Doctors of all professions have to cover themselves… HAVE to cover themselves. The increased costs come mainly from things like MRIs, CAT scans and exotic functional tests that are just performed so “Joe Blow” doesn’t sue because it wasn’t done. Texas has taken a giant step by making the cases “Loser Pays” and the number of frivolous suits has dropped significantly (and malpractice costs have not risen). I think if one compared the number of Lawyers in McAllen to El Paso you’d likely come up with a good indicator of the cause of increased costs. In the mean time reimbursement has dropped significantly. My fees, in 2012, are reimbursed at a rate that is lower than it was in 1985 when I opened my practice. Add to that the increased costs associated with documentation, staffing, taxes, accounting… not to mention waiting for months, sometimes years, to get paid the reduced amount…

    Classifieds: Wonderful, fulfilling job paying less now than 27 years ago, long hours, high risk of legal woes as well as government entanglements… sounds appealing, does’t it?

  • Ed_USA

    Unless you’re in damned poor shape for a 51 year old then you’re a long way from end of life. But if you’re on Medicare at 51 then you must have some serious problem, since normal people don’t get it until age 65. If you live a normal lifespan then you’re on Medicare for the next 25 to 30 years. It seems to me that you’d best be concerned that it doesn’t go broke from overspending.

    As I’ve repeatedly pointed out, every other OECD country gets care for 2/3 to 1/2 what we pay. Their care must be OK, because they have better outcome stats than we do. I lived in Canada for a while, and the care my family got was quite good.

  • http://www.facebook.com/people/Sandy-Whitlow/100001376587397 Sandy Whitlow

    My Doctor of 25+ years said the same thing right b4 re retired. He complained that between the Government and Insurance Companies, it is a almost “Win”/Lose. Then, malpractice makes the situation a 100% Lose/Lose. And, “that is not why I wanted to be a doctor!” I agree that we are way over regulated and the inflated hiden costs from Nonsense Labels, to attorneys advertising, call me if you, or a love one, dead family member, next door neighbors’ friend who married a etc., etc. Everyone appears to be happy with the gov’mint says you can’t smoke here in this bar. And everytime we enlist the gov’mint to fix behaviors, we invite the situation that: THE GOVERNMENT THAT CAN YOU GO THINGS, CAN TAKE AWAY “THINGS” AS WELL. Eventually, they’re coming for each and everyone of us. It may start with a cigarette or sugar tax and the next thing you will know is IRS is auditing your butt because of insurance.
    Welcome to the takers America!
    “Crime Doesn’t Pay, But Not Working Sure Does”

  • http://twitter.com/stephenmstrplmb stephen wilson

    Thank you doctor.When Obamacare rapes $720billion out of medicare to pay for obamacare,people like me will pay with their lives,literally.At 51,i
    hardly feel like giving up a $1,300,000 fight with cancer,but fear i’ll have no choice.What about the doc fix? Is it possible that it is like a bribe to keep treating seniors?

  • DanB_Tiffin

    Old ED_USSR bleating yet again about the OECD. Those initials are his “holy words”. The high cost as ED_USSR denies is explained in the 1994 report by the CATO institute, (for those who wish to actually know)

    CATO Policy Analysis report No. 211 or 1994. Why Health Care Costs Too Much.

    True then, it is true now. the people like ED_USSR caused this cost problem, now they have the nerve to tell us how to fix it. With CONTROL! Typical liberal.

  • redwolf6911

    Obamacare will destroy rural healthcare totally. Then what will people do? I feel for the Doctors who will retire rather than deal with Obamacare. Seniors on Medicare will also be getting the short end of the stick since the plan appears to be to kill off as many as possible. In fact, they will literally be at the back of the line to see any type of medical provider, since Obama is cutting payments to hospitals, doctors, and other providers commonly used by Seniors. A lot of Seniors will die alone wherever they live.

  • disqus_36UYscYqUt

    SEEMS to me A-HOLE, that you are a commy nut from NEW JERK CITY seeing how you keep quoting that COMMUNIST RAG NYTimes

  • Ed_USA

    I’m not opposed to some form of reform of the malpractice laws. The usual proposal is some form of standardized practices that, if followed, immunize against most suits. It’s likely that medical expert systems will soon be available that can do even better than that. IBM’s computer Watson that won at Jeopardy is now being trained at Cleveland Clinic Lerner College of Medicine of Case Western Reserve University to serve as an expert system for medicine. Such a system could easily provide a baseline standard for practice.

    “I think if one compared the number of Lawyers in McAllen to El Paso you’d likely come up with a good indicator of the cause of increased costs.”

    I think not. Texas, as you point out, had the “loser pays” law and also had caps on malpractice damage awards. That didn’t fix the costs in McAllen, which were much higher than places that did not have the TX tort reforms. McAllen’s problem was not law suits, it was overtreatment. The most likely culprit in the overtreatment is fee-for-service billing.

  • http://twitter.com/stephenmstrplmb stephen wilson

    Fork your graph ed,all i have to do is lift up my shirt & look at the

    16 inch scar that i had two sugeries in 5 weeks.2 tumors,2 lobectomies,8 lymphs in the 1st & 5 in the 2nd,800mls of 2 staphs&

    1 strep infection.Had a pet scan & found 2 more lymphs,4 sittings

    of 500mls of cisplatin & 750mls of taxotere.Technically it could’ve
    been staged at 4.My 2 Drs. argued loud enough for half the treatment center to hear.That much chemo would kill 95% of the population,at least.The amount of infection was enough to kill
    10 otherwise healthy adults.Go troll somewhere else ED.

  • http://twitter.com/stephenmstrplmb stephen wilson

    Go to he!! Ed.

  • Ed_USA

    “I do know fighting stage 3c lung cancer is expensive”

    Then you’re pretty damned lucky that we’re all chipping in to pay for it. I suspect that if it had to come out of your pocket then you’d be dead now.

    Interestingly enough, Ayn Rand also used Medicare to pay for her lung cancer treatment. I guess that, no matter what your politics, the public purse looks pretty good when you are the one who needs the help.

    I hope that your treatment works and you get to see those grandkids grow up.

  • http://twitter.com/stephenmstrplmb stephen wilson

    Like he!! it is.It’s paid by the medicare deductions on your paycheck.You ly ED.

  • Ed_USA

    “It’s paid by the medicare deductions on your paycheck.”

    Nope. The expensive cases, like yours, tend to cost more than you put in. But hey, that’s what insurance is all about, risk pooling. Medicare is not a savings plan, it’s insurance.

  • Ed_USA

    “Go to he!! Ed.”

    And even an easygoing guy like you finds fault with the care that our national health insurance program provides for you. Oh dear.

  • blh557

    If we take Canada’s system as any example; once Obamacare hits you won’t have to worry about cancer treatment because you’ll be delegated to the back burner (unless you are a union member or one of the elite). I had a friend who was living in Canada and her ductal adenocarcinoma (breast cancer) was considered a minor inconvenience and her MRI was scheduled for 12 months later. She came to Houston, found out what it was, and how aggressive it was and was treated immediately. She’s still alive and has not moved back to Canada.

    Keep fighting. Fighting is good. Voting is good. Vote for the good guy.

    The so-called “fix” is simply to bring Medicare fee determinations in line with normal accounting practices. Without the “fix” ALL services will drop 27% immediately. Most doctor’s can’t justify spending $10 to make $9.50, which is what it will come down to. If you call barely making a profit a bribe, then, yes, it’s just a bride… and the sun is just a ball of fire in the sky.

  • Ed_USA

    Ah yes, why wouldn’t I believe the theories of the libertarian ideologue nut-cases at Cato over years of actual real-world data from all of the countries in the OECD that get care for 30% to 50% less than what we pay? The OECD consists of: AUSTRALIA, AUSTRIA, BELGIUM, CANADA, CHILE, CZECH REPUBLIC, DENMARK, ESTONIA, FINLAND, FRANCE, GERMANY, GREECE, HUNGARY, ICELAND, IRELAND, ISRAEL, ITALY, JAPAN, KOREA, LUXEMBOURG, MEXICO, NETHERLANDS, NEW ZEALAND, NORWAY, POLAND, PORTUGAL, SLOVAK REPUBLIC, SLOVENIA, SPAIN, SWEDEN, SWITZERLAND, TURKEY, UNITED KINGDOM, and yes, they all get care for that much less than we do.

  • Vadale

    Why can’t people understand that this whole insurance thing is just a fraud designed to fail…Then they intend on taking over every hospital for national safety reasons…After just a few years, all doctors and nurses will be government employees…Does anybody really think people will go through that much work for a gov job…Get ready for long long lines at the last few doctors offices that will see you…..You stupid liberals did this to us.

  • JohnGalt

    Believe it or not, many of us actually PREFER the variability of a true continental climate. Our Springs and Autumns are especially spectacular.

    I would go nuts in the “paradise” climate of SoCal.

  • JohnGalt

    Don’t forget the hideously expensive, insanely extended, rigorous course of study to qualify for this wonderful job in the first place.

    Excellent post regarding tort reform.

    My firsthand experience says you are on the nailhead.

  • Dustoff

    I sure hope so Carol.

  • Ed_USA

    “rich people are supposed to pay more for everything”

    Oddly enough, you’ve hit on one of the reasons often cited for our expensive care. However, it neither justifies nor pays for the actual difference. Take Germany for example. Our gross per capita personal income is about 18% higher than that of the Germans. Our per capita medical care spending is about 90% more than that of the Germans. Even if you consider just disposable income (German taxes are higher), we get about 40% more but, need I remind you, we pay 90% more for medical care. Switzerland is pretty much the same as Germany for those figures. And the real kicker is that Switzerland and Germany are ranked #2 and #3 after the USA in personal income.

    So another ill-conceived “conservative” theory bites the dust. You should consider checking these ideas against the facts before you post them. It would save you some embarrassment.

    “NYTimes estimated at least of 30% of all US medical spending is on unnecessary services and procedures.”

    So that would imply that an organized effort could cut our spending by 30% without making care one bit worse. Amazingly enough, that would get our costs close to those of Norway. Still not as good as Switzerland or Germany, but it would save us $300 billion per year. If you “conservatives” actually gave a damn about fixing our fiscal and economic problems then you’d support taking the usual steps that other OECD countries have taken to successfully cut medical costs.

  • Ed_USA

    Why don’t you run for office on a platform of eliminating Medicare? I’d enjoy watching that.

  • DanB_Tiffin

    “Save you some embarrassment”
    God you are a strange one. I am never embarrassed stating the truth.

    Germany, Switzerland, Japan?
    The citizens of these countries are some of the most socially cohesive on planet earth. The Japanese, for instance, have a great work ethic and this thing called shame. We used to have that shame thing in the USA, too. A parasite on society is considered a shameful thing, there. Such is no longer the case in the USA thanks to liberal degenerates like you. Japan does not have entire segments of their population trained as “poor victims” – separate from the other Japanese – to whom the world owes money just because they are alive. They do not have such a high percentage milking their government safety net system. Their government safety net is still probably a safety net instead of a hammock-to-live-in-for-generations like millions do in the USA.

    The citizens of those other countries are still very very socially cohesive and take pride in their lives, work, countries, and their common ethics and values. Any government safety net in a country like those is not going to be floooooooooooded with parasites like in the USA and with our sick liberal entitlement culture. We are already supporting an incredible number of parasites with our entitlements, and nut-case liberals want even MORE entitlements doomed to the same fate!

    So, another ill-conceived “ED_USSR” theory bites the dust. You should consider checking these ideas against the facts before you post them. It would save you continuing to look like the liberal fool that you obviously are. So much for your hero worship of OECD countries. They are NOT the USA. Their distribution of costs among their societies relies on the good ethics and mutual respect of their citizens.

    Liberal have actively destroyed any of that ethic in the USA by their love affair with phony victim parasites milking any government system they can. Don’t you get it? Those socialist solutions can not work here. The entitlement-head liberals have seen to that, already. Just another thing they have screwed up.

  • DanB_Tiffin

    You seem to believe the voters will always have a choice in these things. Maybe they can vote for 1+1 to equal 3 while they are at it. This is how whole countries fail. Wishes of the people will not save it.

  • Ed_USA

    “The citizens of these countries are some of the most socially cohesive on planet earth.”

    Cohesive? Switzerland? You certainly are ignorant, aren’t you?

    Switzerland is a federal state formed in 1848 from cantons that were independent countries prior to that. Today the 26 cantons do not even all have the same official language (most have German, some have French and one has Italian). Because its small size and international character, 20% of the people living in Switzerland are resident foreigners, compared to only 13% of people in the US who are even foreign born, much less non-citizens.

    You seem to be pretty long on ignorant prejudices and very short on facts.

  • DanB_Tiffin

    You accuse someone else of ignorant prejudices and short on facts? This is not 1848 ED_USSR and the Swiss are not anywhere near as polarized and parasitic as the “poor victim citizens” of the USA. You are such a transparent phony!

  • Ed_USA

    You don’t seem to like the people of these United States very much. If you view 46% of them as moochers, like Mitt does, then maybe this isn’t the best place for you to live.

  • DanB_Tiffin

    Only certain people of these United States that I do not like very much. I don’t believe a full 46 or 47% are the actual moochers. But if one adds the percentage of actual moochers with their liberal enablers, then I think the total of the two is close enough to that percentage.

    At the present, I don’t believe the USA is that good and its fate is darker every day. I and others will be voting for a change in direction, and we will all just have to see what happens.

  • Ed_USA

    “we will all just have to see what happens”

    Indeed we will. But even if Obama loses, which I don’t think he will, I’d predict that Mitt won’t be much different. Romneycare, plus his many fee increases and his signing of a permanent assault weapon ban in MA don’t really mark him as a “conservative”. The people who agree with you didn’t make it out of the GOP primary.

    But we shall see.

  • TanongSak

    I’m losing my mind here too, but not because of the weather. :-)

  • TucsonTerpFan

    This is an example of an increasing situation. Over a one month period, I had to find a new family practice doctor. My “original” doctor, I was a patient for five years, closed his practice and joined a hospital. His office, before closing, referred me to another GP and I became his patient. A few weeks later he sent a letter telling me he too was closing his office and joing the staff of a hospital. I was only able to find another doctor after a specialist was able to refer me to another GP. So far, he has not closed his office, but he did say that what happens under the new health law (Obamacare) may “make me [him] change his mind.”

  • blh557

    What? It’s not FREE???? Where HAVE I been?

  • blh557

    If you know where McAllen is, I think the likely culprit is Medicaid qualification for the extra thousands of illegals crossing the border and getting those “free” services that those of us who pay taxes also have to pay for. (despite the fact that care is cheaper in Mexico for those who can pay) Yes, there are many unscrupulous practices in all aspects of health care that wouldn’t have been thought of 20 years ago. One reason I left practice was due to the increasing “acceptance” by the rank and file of these less than ethical practices; however, although I do not condone them, SOME individuals will use whatever means is necessary to counter the intrusion/interference/amoral practice by both insurance companies and the Fed to cut, reduce, de-legitimize and otherwise restrict ANY physician’s ability to make a profit.

    NO ONE, even you, Ed, wants to work harder for less money and greater risk. YOU can’t argue that point.

    Standardized (read best practices) protocols have never been instituted across the board in any of the healthcare disciplines because they only lead to less and, in my opinion, bad, cookie-cutter care. In addition, standardized practices, in the REAL WORLD, do not protect anyone. In fact, standardized practices may be an “excuse” for poor practices. Standardized practices are standardized by the OPINIONS of a group of doctors. They are normally not based on actual data, but rather from “accepted” protocols. An example of the apparent weakness of this system was revealed last year in a study comparing standard medically directed care for back pain vs. acupuncture and sham acupuncture. Standard, accepted, medically directed care was found to be less effective than sham acupuncture in the treatment of simple back pain. In fact, another study found NO TREATMENT to be more effective than standard medically directed care. Does that mean the “standard” has been changed? FAT CHANCE.

    The application of these standards require a significantly controlled environment… that is the basis of any tyranny; total control.

    If you want to know why costs are so high, just look at the difference between how healthcare is administered now vs. the ’80s. In the ’80s we typed a code on a form, mailed it to the insurance company and they paid it. Now we utilize CPT targeted coding, applied by a coding specialist, transfer it electronically to a clearing house where it is electronically and in accordance with HIPPA rules sent to the insurance company where a claims specialist or computer sees that it is entered into the companies’ extremely expensive computer system where it is analyzed for “discrepancies” or inaccuracies and it is either kicked back (a frequent occurrence) or forwarded to a claims administrator for review. If the CA finds any problems they may also kick it out (no detailed explanation from the CA is necessary, BTW) if the claim is clean then it is placed in line for payment, if not, well you get the point. This is a very simplified version of what actually happens, BTW. In addition, if the company decides, a year or so later even, that they overpaid you get to write them a check for the difference or pay a lawyer and several specialists to help recover your money from the dreaded post-payment audit.

    So, let’s see; two steps vs. infinity steps… can’t imagine why healthcare costs so much. Must be that fee for service thing. And I am certain there was no involvement by the government in all this.

  • JohnGalt

    Silly me. I’ve been out of the social pathology that is the academic system for too long.

    You know what?

    For certain privileged demographics, a full medical education just might be free, or at least greatly discounted.

  • Ed_USA

    “the likely culprit is Medicaid qualification”

    No, it isn’t. The study was specifically of Medicare spending, so it had nothing to do with Medicaid. Anyway, I doubt that it was illegals who were getting all those MRIs etc. in rural Texas.

    There have been two followup study that again puts TX, LA, and FL on the list of big spenders. www kaiserhealthnews org/stories/2009/december/02/medicare-spending-medpac.aspx

    “standardized practices, in the REAL WORLD, do not protect anyone.”

    With tort reform they would protect doctors from lawsuits. I thought you were in favor of that. You are not going to get a system where any doctor can do whatever he pleases and be immune from liability. Thats a bit one-sided, don’t you think?

    Your complaints about standards don’t fit with the facts of the world. Every other OECD country has care standards, often centrally administered by the gov’t, and their costs are 30% to 50% LOWER than ours. Also they get better overall health outcome stats. You may not like standards for the work you do, but they seem to be effective for about 800 million people in over 30 OECD countries. The uniform billing in single payer systems is also far sumpler and cheaper than the maze of different insurance forms in the US. You are just on the wrong side of the evidence in this matter.

  • blh557

    “You are just on the wrong side…” Yeah and every other doctor who has closed their practices and I have been since then.

  • Ed_USA

    “NO ONE, even you, Ed, wants to work harder for less money and greater risk. YOU can’t argue that point.” …. “My fees, in 2012, are reimbursed at a rate that is lower than it was in 1985 when I opened my practice.”

    No one wants to, but most people have to these days. I can assure you that engineering is not the sure ticket to plentiful and relatively lucrative employment that it used to be either. Most jobs now have higher pressure and lower security than was the case 30 years ago.

    It’s nice for you that you are in a position to retire from your practice after 27 years. That probably puts you in your 50s. Most people cannot retire in their 50s nowadays. Few working people outside of Wall St. have seen their real incomes rise in the past 30 years. If you find that the financial rewards of the practice are not what they used to be, well join the club.

  • blh557

    Did I say I retired after 27 years? NO. I did not retire. I put everything I had into my practice in the past several years, hoping the economy and the industry would turn around. Now I work. At least I get paid for what I do and don’t have to worry about prosecution every time I see someone.

    Your “argument” that everyone has had to give up a little is diminished by the fact that you didn’t answer DIRECTLY. Would you continue to do a job, the same job with greater requirements and overheads, for the same amount, in contemporary dollars, not 1985 dollars? I dare say not. And yet you and your ilk seem to think it’s all tit-for-tat that these rich docs have to give something up (as if 8-12 years and hundreds of thousands in education expenses isn’t enough). How about my employees and patients? What did they give up? How about the community I poured thousands of dollars yearly into local charities and helping poor people? What did they give up? Who will pay the electric bills and grocery bills for the people I tried to help throughout the year? You? Mr. Obamao? Joe, the Grinner? Hell, at about 15% of his salary I gave more money yearly to charity and church than Mr. Obama and Biden combined.

    Gave, being the operative term.

    Your pathetic arguments fall on deaf ears, Ed. Your statist, collectivist ideals are drenched in historical failure and defeat. Your arguments are moot.

  • Ed_USA

    Oh, I misunderstood. I thought you were discontinuing practicing medicine. If, as with Dr. Lee, you are just switching to working as part of a larger organization then, quite frankly, it’s probably better for your patients.

    The individual practice family doctor is likely to go the way of the mom-and-pop grocery and the small family farm, and it will likely be an improvement. Examples of this in action are Cleveland Clinic and Mayo Clinic, whose main inovation was team based care.

    Think about it in normal capitalist terms. Capitalism is all about applying capital to improve the efficiency of work. Medicine has been hampered by very weak information technology, and I’d bet that small private practices are at the very low end of the scale for IT. Checkers and WalMart have better IT support than some doctors. Larger organizations can invest more capital in better technology. That generally results in improvement.

    You might say that medicine can’t benefit from information technology. If so then I’d say that the changes in the world over the past 15 to 20 years have passed you by.

  • blh557

    Wrong again, old Ed. I embraced computerized documentation back in 1993 when I invested about $25K in one of the first electronic documentation systems available. I think the digital age could be one of the saving graces of healthcare if it is used for healthcare information dissemination and not just to keep tabs on patients or intrusion into our private lives. Don’t really want to elaborate on that one.

    The dilemma is too complex an issue to embrace or solve in such small spaces. People, too, are too complex to lump into categories, which is the weakness in the old “Best Practices” scenario… but I digress.

  • blh557

    One more comment and then I’ll lay this egg to rest.

    “Medicine has been hampered by very weak information technology, and I’d bet that small private practices are at the very low end of the scale for IT. Checkers and WalMart have better IT support than some doctors. Larger organizations can invest more capital in better technology. That generally results in improvement.”

    Generally I’d agree with the initial sentence in your statement, here… just not in my case. I built, managed and maintained my own private LAN with a bit of help from the local privately owned telephone company’s IT guys.

    Technology doesn’t apply healthcare. For the most part doctors, especially contemporarily trained MDs, have lost the arts of patient interaction and face-to-face assessment skills. The weakness in “Best Practices and Protocols” is that the personal human element is lost in favor of pure data and numbers. Doctors have lost the ability to manually, physically assess their patients. If it isn’t on the labwork it must not be there, right? Not even close. I personally thing reliance upon data has negatively effected the effective practice of medicine in the US. Just my opinion, but after 27 years of placing my hands on my patients and having a positive percentage of outcomes, I think I am quite an authority on the matter.

  • Ed_USA

    I was going to say that you were admirable in your forward looking adoption of technology, but that I wasn’t very confident that your peers were keeping pace.

    For the rest of it, I look at IT in medicine in two ways. One aspect is in helping doctors manage information. A lot of time and effort can be wasted in messing with paper files. A lot of those files also get left behind as patients move from provider to provider. IT can help with that.

    The second way that IT can help is in providing a second opinion. Even good doctors have bad days, and bad doctors probably rarely have very good days. In the future, a lot of more routine doctoring is probably going to be shifted down the education scale to PAs and nurses just because of the shortage of primary care docs. In all of these cases a medical expert system can help catch things that a human misses. And, of course, the human can catch things that the expert system misses. I wouldn’t want Watson as my only primary care doc.

    I still think that larger organizations will have greater resources for capital equipment like IT. So I suspect that your patients aren’t going to get inferior care because of your switch to being just a doctor instead of a doctor and a small business owner.

  • hankster6

    In my opinion, Obama is acting just like a dictator. Secretly destroying America in more ways that we can count. His mentors or top advisers, as they are called, either communists or Marxists or both, are keeping him in line. They chose him because he was easy to brainwash and will march to their orders. That is why he can not change his ways. He is, also, carrying out his father’s wishes, which is not well known in the public forum. If you think of him as a closet radical Muslim, you will understand him better.

  • Nubian

    UM, YOUR HEADLINE/TITLE DOES NOT COMPORT WITH THE CONTENT OF YOUR ARTICLE.

    It looks like uncertainty about what the government will do around Medicaire expenditures and how Affordabl Care Act will be implemented/changed caused them to move their practice to Johns Hopkins.

    Also, its unclear if entrepreneurial doctors are as valuable to the economy as entrepreneurial businesses. I’m sure the insurance rates for the two is also much lower when they are affiliated with John Hopkins.

    Good article – though deceptive headline and left out many factors that makes the doctors being at Johns Hopkins actually better for their patients (and them).

  • chfnelson

    1) I would not believe the NY Times, especially an editorial, if they said the sun rises in the east. You are an idiot.
    2) My sister lives in Canada, and I know the paperwork she had to deal with when her husband became terminal. You are a blind idiot.
    3) Medicare fraud costs the government billions, and there is little crackdown. Occasionally a bust is made and makes the headlines for a few days, then it is back to fraud as usual.
    4) The Democatic majority can override any attempt at a filibuster. You are an igorant idiot.
    Are you sure you are not Ed from MSNBC? You seem to be spouting the same drivel.

  • Ed_USA

    Let’s work through your points backwards, since that’s the way that your logic seems to be.

    “4) The Democatic majority can override any attempt at a filibuster.” Not unless they change the filibuster rules, which both sides call the “nuclear option”. As the rules stand, w/o 60 votes it is not possible to override a filibuster. The Dems have only 51. You owe me one apology.

    “3) Medicare fraud costs the government billions, and there is little crackdown.” Actually there is rather a lot of crackdown. In fact, in this thread you can find a doctor complaining about the strictness of Medicare on the simplest of coding errors. Make that two apologies.

    “2) My sister lives in Canada, and I know the paperwork” But you don’t know what it would have been in the USA. Canadian physicians have half the admin and clerical staff of those in the US. Do you think that indicates that they have more or less paperwork? Make that three.

    “1) I would not believe the NY Times, especially an editorial,” They start off by citing their source, which is a report from the Institute of Medicine of the National Academy of Sciences. You could follow their link and read the original report, if you were not too lazy, ignorant, and stupid to do so. Call this one even.

  • disqus_z3OoxjcN08

    AND my son wants to go to medical school after graduation…NOW what to I tell him?

  • ErieBigDawg

    AND my son wants to go to medical school after graduation…NOW what to I tell him?

  • Zach Cone

    This is exactly the same thing we have in MA. Under Romeny’s health care plan. You are not giving the IRS your health info. All it is is a form your insurance gives you that shows the exact dates of coverage. You send that in with your taxes to prove you have coverage.

  • Ed_USA

    “My sister lives in Canada, and I know the paperwork she had to deal with when her husband became terminal.”

    There are a few more things to consider about this.

    First, I have lived in Canada. I found the paperwork for getting routine care for my family to be far simpler that the sheafs of documents that I get from my insurer and providers in the US. Obviously, far more people have to deal with routine care than terminal care so, no matter how complex Canada’s terminal care paperwork might be, the total burden imposed by the routine paperwork in the US system makes it trivial by comparison.

    Second, did your sister get bankrupted by her husband’s illness? In the USA that happens all the time. Which do you suppose would be worse for your sister, the paperwork (which would likely have been greater in the US anyway), or dealing with the money issues in the USA, maybe going bankrupt, possibly losing her home, etc.? A great many people in the US would happily take on some paperwork if they could be free of the financial problems that serious illness brings in the US.

  • amongst_it

    If you read what the interviewee said in this article, it was not Obamacare that was the issue, it’s the administrative requirements of health insurance companies.

  • amongst_it

    You’re not giving the IRS your personal details, merely providing evidence that you had appropriate health insurance. The other alternative is to have an additional form which you need to complete at another time of the year and the government would then have to spend additional hundreds of thousands of dollars in administrative costs to collect the data. Makes more sense to get it at tax time as there is already the infrastructure to collect this kind of data.

  • Hillary 2016

    Get over it people Justice Roberts decided for you all – The Health Care Law is the law of the land and the massive Democratic win keep in. Will all the Republicans Attorney Generals that spend their states money in legal fees refund it to the people of those states?

  • ravenhair49

    I lost my OB/GYN last year because of obamatax. He said he wasn’t going to put up with it.

  • http://www.facebook.com/martin.witney Martin Witney

    Whilst the title of this article is misleading, I see the point being made. We have the same thing in Australia as Obamacare just with less restrictions and bureaucracy. For example, we have the choice of paying for health insurance or paying what is known as a ‘medicare levy’ on your taxes. Usually it ends up being cheaper to have health insurance AND in many cases you can claim the cost of health insurance, or a portion of it, on tax. The problem I see with Obamacare, and the US health system in general, is that in Australia if your health insurance doesn’t cover you for whatever condition you have (not altogether unlikely since health insurance companies are scum bags, (yet another problem with Obamacare) and if they don’t cover your condition you are generally covered under the public system (which is wildy inefficient and costly). The other problem over here is that Family Doctors are paid $34.50 for a consultation by the government that roughly lasts 20 minutes. The average Family Physician (GP) keeps 45% of that with the practice keeping the other 55% so they are essentially being paid $46 an hour. This doesn’t seem too bad but when you consider 8 (ish) years of University education with associated fees and a few years of poorly paid post-grad training it’s not much. End result: Doctors are just pumping patients through as quickly as possible to make a decent salary, usually in the aforementioned ‘Super clinics’, sometimes run by companies OR they are simply choosing not to accept people who get their consultation paid for by the government (read: lower socio-economic groups) in which case nobody wins anyway. In the state of Queensland, Australia, the government there has recently capped medical salaries so that graduating medical students will not see a pay increase in 3 years, so they will be paid as much as an intern for that time.

  • http://www.facebook.com/martin.witney Martin Witney

    We have the same thing slowly happening in Australia and as a future Doctor it worries me. We’re heading for the path of the NHS in England where you need a licence to open up a new Clinic and if you can’t get one, as they are controlled by the government, you simply have to work for someone else or in the public system where you are screwed over by a pathetic government bureaucracy.