The insurance and government dominated system is failing our patients. A physician friend of IP4PI shares this shocking example about the system claiming another victim:
A 59 y/o man presented to my last employed practice, with an almost elephantiasis swelling bilateral legs. He had pinpoint marks on the skin of his legs. He held up a jar with what looked like a couple of tiny maggots. He said, these come out of those holes every so often. I said how long has this been going on?? He said 1.5 years. “I’ve mentioned to several doctors, they just shrug and don’t do anything.” I said we would do something, and called the hospitalist immediately to admit for workup and treatment. I was directed to the nurse gatekeeper for approval for admission. What’s wrong, she asked. “4+ edema in both legs, which are also full of maggots.” Hmmm, she said. There is no medicare admissible diagnosis of ‘maggots in legs’. What about his rising creatinine of 1.7? Not bad enough to qualify under guidelines. Call us back if it gets worse. I did try to do some outpatient workup, but I think the man was disgusted. He never followed up. He was dead within the year.
Friend of IP4PI Charles “Chip” Smutny, DO writes in:
Does anyone think about or have we even tried to come up with our own physician based contract proposal to insurers that could be a way of negotiating our independence as an alternative to their railroading contracts? Since we know that DPC works, cost less and provides better care more efficiently and that insurance will morph to continue to keep its revenue stream, perhaps we should offer up a contract of our own.
Since we don’t like their offer should we have a counter proposal that requests what we want in a legal document that can be validated and support legal recourse in “a partners agreement” instead of the current “employee-employer contract” and that the insurers must be accountable to in court to this new contract?
Simply stated it might read something like this (with 11 pages of legalese from our lawyers that structures the responsibilities and supports the clarity of the following):
- patients come first
- physicians have a right to receive pay for services rendered.
- insurers pay patients according to their contracts, not physicians
- patients pay physicians directly
- patients have the right to decide what they will accept as personal risk in their health and in their financial circumstances.
- insurers may not interfere in any way with the decision making of the patient in concert with the physician.
- insurers may not set pricing restrictions on physicians. They may however set limitations in their service contract with the patient on what they will cover in their contract.
- physicians have the privilege and the right to support their patients in their efforts to obtain quality healthcare delivery and insurance coverage
- physicians have the right to personal privacy and protect patient privacy by only allowing data stripped of unique identifiers to be collected and stored centrally. Centralized charting must not contain any unique identifiers other than the physicians delivery of care office information.
Please add on or discuss as you see fit!
This discussion might lead to some sort of standardized counter offer to insurers since so many physicians are afraid to leave that system which has steadily moved toward indentured servitude.
Friend of IP4PI Dr. Rico writes in:
Just ask yourself who loses out in a true free market solution – Insurance cos, Elites of academia and Quality/Certification cartel, and administrators and it’s clear why these special interests object so strenuously. It’s no secret there will always be millions of people who can’t pay for insurance, but let’s identify those costs clearly so taxpayers will understand the impact, as they are the ones paying for it. There can’t be a worse method of shifting costs to taxpayers than the current ACA subsidies. To state that current system works great as long as subsidies are maintained is ridiculous.
-Edward Rico, MD, MBA, FACE
Dr. Robert Villare responds to the AMA’s continued support for Medicaid Expansion and ACA:
To K B O’Reilly on AMA wire. Better question to ask is why so many Ohioans (700,000) are on Medicaid.
It is well documented that these populations reproduce with abandon and lack a mother and father family presence, are irresponsible and non-compliant, and practice poor health habits. You write nothing about their need to get responsible or the need for Ohio to create jobs to resolve this root cause problem of the need for Medicaid. Safety nets, while appropriate in some cases, should not become a chronic need for residents.
The rant about covering everyone, with no contingent duties and responsibilities is old. You note nothing about how you think this should be paid for–the real dilemma over the last 30 years. Easy to say “cover everyone” but not easy to pay for it without burdening hard-working people that you will mandate the taking of more monies out of their pocket to give to others who feel entitled and may well lack appreciation for the handout.
Solve that problem. Give them jobs to earn at least some of their medical care, and terminate the costly regulations and liability issues facing providers in this litiginous population.
While IP4PI appreciates the efforts and goals of the Republican Affordable Healthcare act, it is far from the “full repeal” that was promised over the last two election cycles. As independent physicians, we believe that it doesn’t go far enough in repealing the failed ACA, protecting patient choice and permitting the free market to produce excellence, efficiency and economy. We recommend that big money special interests like pharmaceutical industry, hospital industry, health information technology industry and insurance industry not have undue influence in the process as they have for decades but physicians and patients.
1. Full repeal of ACA/Obamacare by reconciliation.
2. True inexpensive high deductible insurance plans competing across state lines for maximum choice, efficiency and economy.
3. Medicaid block granted back to the states where each state can provide flexible solutions for their citizens.
4. Health savings accounts HSA us should be expanded for use for all medical needs so that patients can select any care or items related to health with their own value systems.
5. Primary care and basic specialty care paid directly to physicians by the patients who selected them. Prices to be posted whether per incident or monthly membership model like DPC Direct primary care.
6. Executive, legislative and judicial for branches of government must abide by this law for their own healthcare.
14 Principles for healthcare freedom
Articles critiquing GOP ACA change bill
“You can’t fix a turd.”
“And like a turd,” explained one physician a few years ago, “we had to pass ObamaCare before we could find out what was in it.” Remember Congresswoman Pelosi’s infamous quote?
Sorry to be so blunt but ACA Obamacare is so filled with theft by taxes, giveaways to hospitals and insurance industries, and theft of patient rights and physician autonomy, that it would be unwise to leave any of it on the books. If it were re-activated and funded at sometime in the future, because we failed to repeal it on total, we would be at fault. Will our children face the true consequences of paying for it and being bound by it?
Best wishes for good health,
Craig M. Wax, DO
National Physicians Council on Healthcare Policy member
A friend of IP4PI shares the story of another victim of government and insurance run medicine:
A 40 year old female, patient of mine in a previous practice, returned to me in my DPC practice. Her husband once had a good job and insurance, now with cardiomyopathy, and she is on medicaid. She returned to me with a 1.5 year history of intractable nausea and vomiting. I reviewed 800 pages of records. She had been to the ER 40 times, admitted 20. At 90% of these visits, she was misdiagnosed as having cyclic vomiting syndrome, given IV fluids, Reglan and antiemetics, and sent home. Buried in the 800 pages I found a markedly positive gastric emptying study. She has now been to the Cleveland Clinic, has received the correct treatment for her gastroparesis, and is finally improving. I guessitmate over $300,000 was spent on her (mis)care, when the proper care could have been given for well under 1/3 of that.