Tuesday, November 09, 2010

The Effects of Obamacare... (a must read from John Mauldin's "Investor Insight" newsletter)


This whole article is a must read. For those of you who follow this blog you have heard me say that we have already created an environment in which choosing to go to medical school is a very bad idea, so here's a pull quote from the article from the perspective of an economist/lawyer...
With the increase of covered patients, there will be a shortage of 150,000 doctors.[30] Doctors are already overworked. Patients will have to wait longer to can get an appointment to see the doctor.
Starting in 2011, Medicare reimbursements will be reduced. Medicare already reimburses doctors at an amount equal to only 81% of private payments.
Between 18 to 20 million new Medicaid patients will flow to doctors. Medicaid coverage pays doctors 56% of the private payment amounts. Federal funding will pay for parity to Medicare for 2013 and 2014, and then it is up to the states to figure out how to pay the Medicaid doctors.
Doctors will face more federal agencies, boards, and commissions, including the Independent Payment Advisory Board in 2012, a nonprofit Outcomes Research Institute, and the Physician Quality Reporting Initiative.
59% of doctors think the quality of medicine will decline in the next five years and 79% are less optimistic about the future of medicine. 69% are thinking about dropping out of government health programs, 53% would consider opting out of treating insurance-covered patients, and 45% have considered leaving the profession altogether. [31]


  1. "The insurance giants’ profits reported by HCAN are indeed breathtaking. The study provides data on the top five for-profit health insurers: UnitedHealth Group Inc., WellPoint Inc., Aetna Inc., Humana Inc., and Cigna Corp. Four of the five saw earnings increase in 2009, with CIGNA’s profits jumping by a stunning 346 percent.

    While the insurers raked in massive profits in 2009, four of the five companies insured fewer people through private coverage. At the same time, all but one of the five insurers increased the number of people they covered through public insurance programs, including Medicaid, Children’s Health Insurance Plans (CHIP), and Medicare. This is part of a long-term plan by insurers to shift responsibility for covering millions of sick, older, or lower-income customers to taxpayer-funded government health programs. These programs have, in turn, been increasingly hiring the big insurers to manage their care.

    While their profits have soared, the proportion of dollars earned through premiums that is spent on health care expenses went down at three of the five firms, with ever-larger relative sums being funneled to administrative expenses and CEO and shareholder profits. The medical loss ratio (MLR)—the share of premiums used to pay health care providers—decreased or remained flat at most insurers.

    The top five insurers continue, as well, to manipulate their capital resources carefully to benefit their Wall Street investors and corporate executives. The majority of companies report waiting six to eight weeks after receiving claims to pay doctors, hospitals, and patients, utilizing the cash to build up company reserves and boost their balance sheets."
    But then again this is capitalism which I gather from what I've read you support.
    You take on socialized medicine, Obamacare, medicaid patients and stay very silent on this.
    As Bill O'Reilly would say "what say you?"

  2. 9-11,
    Your just depressed cause the Omniscent, Obsolescent, and all Powerful Cam Newton(There is no God but Cam, and Gus Mahlzahn is his Servant) is gonna run through the Georgia Secondary like a laboratory mutant clone of the T-1000 Terminator/OJ Simpson/Edward Scissorshands...
    You don't know how good its gonna make me feel to watch March Richt cry.....


  3. "Mark" Richt I mean...
    and he won't really cry, there'll just be a single tear sliding down his cheek, slo-motion, like "Iron Eyes Cody" in that old "Keep America White, I mean Beautiful" commercial..
    You remember "Iron Eyes Cody"? who was about as much an Indian as Moe Howard, his real name was Espera Oscar de Corti, from that Indian hotbed of Kaplan, Louisiana...


  4. Dear Paul Krugmam,
    As I continue to tell you it's better to keep silent and be thought a fool than to open your mouth and prove it. The insurance companies are merely trying to survive with the Obama smiper's bullet already fired. I hope they DO survive and I will answer more fully when I can get to an actual keyboard, but, since this is my blog how about answering the critique on Obamacare without changing the question?

  5. I'm not changing the question...I'm expanding it.
    If private insurance was affordable and re-imbursement equitable you would suffer less impact of medicaid or medicare reimbursement and the accompanying hoops you are required to jump through.
    The insurance companies are making money hand over fist but it does not trickle down to more affordable premiums.
    Does this not mean anything to you or irk you just a bit...."The medical loss ratio (MLR)—the share of premiums used to pay health care providers—decreased or remained flat at most insurers." Or this..
    "The majority of companies report waiting six to eight weeks after receiving claims to pay doctors, hospitals, and patients, utilizing the cash to build up company reserves and boost their balance sheets."
    Like I said this is free market at it's best and the winner take all.
    Obamacare is less than perfect but you cannot exclude the impact of private insurers and the existing status quo on the increasing workload and general dissatisfaction of physicians.
    And I would need an elaboration on exactly how physicians feel medicine will decline in the next five years.
    Hit me with your best shot.

  6. Dear Professor Krugman,
    Oh, I'll hit you with my best when you 1. Refute the data presented, and 2. Tell me how Obamacare will improve our situation. "Expanding the question" is it? That's not changing the question? Pull the other one.

  7. Annual Spiral CT's gonna be the "Standard of Care" pretty soon, especially considering the President(Peace be upon Him) and new Speaker of the House are Eeeee-Ville Smokers.
    Figure 50million Spiral CTs at $1,000/per when you factor in all the biopsies, MRIs and thats not even counting how much the cancers they find are gonna cost...
    I'd put my disposable income in CT scanners if I hadn't just bought a New(Used) 08' ZO6 Vette.
    Might even start smokin again...


  8. frank,
    it would be just terrible if the dawgs beat Auburn this weekend. just terrible... in the meantime check out this little bit on cam-cam and do not miss the Lou Holtsch youtube bit at the end... it ends with a top ten cam-cam list... it kills, it's comedy gold.

  9. Reimbursements to doctors by insurance companies? That's a government invention. Let the lovers of government resolve that. Sorry, Anonymous; some of us were around before government stuck their noses so deeply into medicine. We paid modest premiums to insurance companies, for large deductables and catastrophic coverage.

    I could not possibly care less how much the government reimburses doctors for Medicaid or Medicare patients. That's a question for the devout followers of Lyndon Baines Johnson. People that grew up actually PAYING doctors for services that were routine want to know why we can't have that norm, again. People that actually pay their OWN medical insurance premiums want to know why we now are required to buy policies for coverages we do not want.

    If Anonymous wants to buy a policy that provides coverage for mental illness, I do not object. Why should I be required to buy such coverage? See, that's actually the opposite of expanding the question. Let's just boil this down to where the real problems came from; expanded coverage, reduced individual choice, increased coverage of individuals that require me to pay for their coverage.

  10. Aw you pervs and your football. Y'all just better be glad your teams are afraid to come east of Lousey-ana. The Mighty Horned Frogs of TCU would 1) spit blood in your eyes 2)run roughshod over your d-fences 3)keep Cam "I wrote that paper!" Newton bottled up like pickled okra 4)roll the tide back out and 5)spit blood in your grave after running up a cool 44 pts on your asses

  11. hey Oldfart,
    i got nothing but love for your frogs my brother... i'd love to see 'em win it all. come down to the SEC and bring A&M with you and there will not be the 'they didn't play anyone' argument anymore... hell, come take Vandy's place, they suck... hard. hell, i like this idea a lot... since texas is all that and a bag of chips and almost split for the left coast keep the aggies and TCU in the heartland where football is king.

  12. People that grew up actually PAYING doctors for services that were routine want to know why we can't have that norm, again. People that actually pay their OWN medical insurance premiums want to know why we now are required to buy policies for coverages we do not want.

    Well said. I got a flu shot recently. The insurance paid for it. Why??? I'd rather save it for the big ticket items. I'd also like to have a much higher deductible if it meant being able to pocket the savings on premiums and buy long term care insurance for later.

  13. nobody's holding a gun to your head...opt out of your current insurance, get catastrophic and pay as you go. Since prices aren't transparent I think you'll be in for sticker shot.
    Covering screenings and vaccinations hopefully would prevent more complicated issues down the road.
    And no I can't refute the data..I'm not an economist.However, 59 million people uninsured is the ultimate piece of data.

  14. 9-11...
    was that a Charles Barkley reference/slam??? (the "terrible,just terrible" bit, although the true Alabamian drawl is "turrible, just turrible")and I don't think I've actually watched an Auburn Basketball Game since "The Round Mound of Rebound" was playing...
    Thats not true, I didn't watch em even then...
    and go ahead and laugh, just like Ron Goldman did when OJ showed up...
    Might wanta leave UGA in Athens...its gonna be Turrible, just Turrible...

    Frank, "if you ain't cheatin' you aint tryin'" Drackman

  15. Old Fart, Jeez-us, get those panties un-wadded...
    TCU's got a fine team, can't wait till they make the move to Division 1....


  16. so, anonymous, 59 million uninsured is the ultimate piece of this data? you speak as if people are unable, for whatever reason, to comprehend the need to either maintain their health and get catastrophic coverage, or, purchase insurance, or, get a job with insurance included. for the last five years my full time job as a physician has not included medical benefits and i know exactly how much it costs for me and my wife and kids, and do you know how much that is a month? it's twice what our cell phone bill is, about $450. Running my numbers through the esurance website i see i can get a ppo plan with a $2600 deductible and no copays for $217 a month. the reason that so many are uninsured right now is not because it's not affordable or available, it's because millions or our citizens and millions of illegals choose not to budget for it and simply go to the ER. they can not be turned away. this simple fact has caused the cost of health care to skyrocket because these very same freeloaders do not pay their bills. the money is made up with increased insurance premiums, with hospitals max billing the currently insured, and with american medicine being on federal subsidy life support. our current system is as far from a free market as the east is from the west... no, my mistake, it's very far from a free market, but not nearly as monolithic as obamacare.

    simply name for me one area of enterprise where increased government involvement has led to decreased cost and increased efficiency and excellence. name one.

    and it's curious to me, anonymous, that you rant and rave about insurance companies and how EVIL they are and you hinge your argument on obamacare on the fact that it will increase the number of 'insured'. and you think, i bet, that if the government is running that insurance, that it will be more fair and efficient. i'm trying to keep this civil, but, in all honesty, are you high?

  17. frank,
    that damn good dog, Uga, is even now being trained to rip cam-cam's trachea out during warmups. it will be deemed a malicious hit and Uga will be ejected and fined, but he will dine on the finest kobe beef back in his air conditioned mansion in athens. it will be an honorable death for cam-cam, and should make this whole payola, cheating, computer thing vanish... i mean with all pictures of a bloody, dead, cam-cam etc... call it vick's revenge.

  18. You are correct that an individual plan would cost us personally more up front than the group insurance plan provided through my husband's workplace. However, I remember several years back when the group plan we had through his former employer did not cover "well care" ... the deductible was about the same, and the premiums were substantially lower. We paid out of pocket for routine office visits and immunizations. The biggest difference, though, was that the bill for routine care was substantially lower as well. An annual checkup for one of our kids at the pediatrician's office is now more than double what it was back then. There is, of course, the copay on top of that. My observation has been that the more the billing and payments are removed from the purview of the person receiving the services, the less conscientious people are about controlling the expense. At times, I've gotten an "explanation of benefits" from the insurance company with no itemization of the costs incurred. I have requested the information, and a couple of times there were errors. They weren't large ones, but it all adds up! There have also been instances of duplicate billing, which I have heard is not uncommon.

    I have to pay out of pocket for car repairs and home repairs, and some of these are kind of painful AND necessary! Yet, I wouldn't want my homeowner's insurance to start covering the preventive costs of painting or reroofing. Not having that covered doesn't mean I am going to be so short sighted as to skip that maintenance - and it's a far sight more expensive than immunizations and most preventive health screenings. Your assumption that people will neglect their health to save the cost of a flu shot is in error, I think. There will be some people who do. There will also be others who avoid it (as they do now, even though they can pay for it) because they think the shot will make them ill or because they hate setting foot in a doctor's office. There are many factors that motivate these personal choices, and simply providing universal insurance coverage will not fix that.

    I am in favor of subsidizing basic health care for people who are truly destitute ... but that shouldn't be a function of the federal government. That duty should fall to individual state and local entities. As to my "opting out" of the plan my husband has through work, yes ... I could do that, and I acknowledge it would likely be more expensive for me outside of a group pool, but that wasn't my point! My point was that escalating costs would be better controlled even for those group policies offered through employers if the emphasis was placed on insurance as a means of paying for the large, unplanned expenses.

  19. National "Health Care" will just be the existing condition, writ large. 20 years ago I was able to run down a checklist of desired coverages and every unchecked item reduced costs to me, to the point that I actually had extra money in my paycheck, compared to my co-workers. As costs rose, companies were forced to eliminate those options in order to subsidize the "high-coverage" co-workers (lots of dependents, or chronic health problems). I can "opt out" of the benefit, but no more money drops into my pay check; my subsidy is still required to support those co-workers that are big users. These are my contributions under the existing system. Imagine what our "contributions will become when we are no longer just subsidizing our co-workers and their dependents. Due to Medicare, Medicaid, and the numerous other tax extractors for "Health Care", I am already subsidizing the other masses, but nobody ever asked me if I wanted to do that. Medicare, Medicaid, and all the other entitlement schemes are already bankrupt and unsustainable. Turning the entire "Health Care" system into an entitlement will be an epic disaster in the making, (another) for which our descendants will despise us. And you know, just as with every other entitlement that has been created, getting rid of it in the future will be as impossible as sacking Peyton Manning without drawing a flag.

  20. 9-11,
    You say "Cheating" like its a bad thing...
    and One Man's Cheater is Another Man's Saviour, I mean Most Dominating QB of the last 50 years, and if anyone's trachea's gonna get ripped Saturday, my Money's on #3...
    umm actually it's probably in his Dad's pickle jar or whereever he hides the Payola...
    But hey, the Auburn Vet Skool's, just a few Cammie 90 yard runs away from Jurdan-Hair, and they've got plenty of Pentothal...
    Which y'all might need yourselves when Cameron Maximus Smites Thee with Furious Vengence and Righteous Anger.....


    Frank "Proud Cheating Graduate of the 2010 BCS Champions" Drackman

  21. frank,
    i actually hope the whole cam-cam thing goes away. i don't care. it also seems that if there's anybody to get pissed at it's some shady second tier bag-men and cam-cam's daddy. when i went to school everyone knew about the cash tossed around the locker room. that was when the russians were bad and being a physician was still pretty cool. but you ARE counting some chickens there my friend. perhaps a friendly wager between blogs?

  22. "I Don't Care"?!?!?!?
    About FOO-BAWL?!?!?!?!
    Dammit, 9-11 your Commie-Niss is showin, and I bet you have a Viet Cong flag in your Den instead of a Confederate Flag like I do..Yeah, right I wouldn't care either if MY football team lost to South Carolina, Ark-an-Saw, Florida, MISSISSIPPI STATE!!!!!!!!!!!!!!!!!!!!!!!
    HAHAHAHAHAHAHAHA y'all lost to the "Other" Bulldogs in the SEC...where was I??,
    Oh yeah, Confederate Flag, and take my advice, DON'T fly it in public...
    oh yeah, I wouldn't care either if My team was even more irrelevant in the SEC race than Tulane...
    Did you know Tulane used to be in the SEC??? wierd.

    OK, a little Wager...lets see...

    Loser has to write a 500 word essay admitting there Gay/Voted for Obama(Peace be upon Him)/Bear Bryant was the Greatest Coach of All Times/Voted for Jimmuh Carter...

    And since I'm feelin charitable, I'll even give you 2 points...wait thats not fair..
    make it 2 and a half...



  23. frank,
    you mistake me... i don't care about the cam-cam 'controversy'... i'm sick of hearing about it... football is more important than most things in life and always will be. so let's confirm this... you are giving me the line plus two extra points on top of that? i can't agree to the wager, we need to change the bet... i could never agree to the stakes you have in mind... i would only be able to comply, if i lost, with sarcasm and dirty tricks, but i guess, if you lost, you would do the same. how about a post with the other team's logo for the loser... the logo only...?

  24. Ummm 9-11, I've only heard this from my Bookie...I mean, Annonymous Sources..but Vegas took the game off the board...almost like the "Fix" is in or sumthin...
    But my mornin' Atlanta Urinal & Constipation says we're only gonna beat y'all by 8 points, which we both know is rediculously low, so I'll be a Big Man and give you my Penis Length, I mean 10 Points...
    OK, 9 1/2...
    and that's cool, Tigers/Wareagles win, and you post a pic of Aubie(The guy in the Tiger suit)/Tiger(the Eagle)
    Bulldogs Win, and I'll post a pic of whateva UGA y'all are up to, and then I'll kill myself.

    just kidding, y'all got as much chance of winning as David Duke...


  25. as David Duke appearing with Conway West on the BET Rap Awards I meant to say...


  26. frank,
    you might find this mildly amusing. and i take the bet, in case you didn't see, but will say that if auburn wins within the confines of 9.5 points it's a wash. you post up on Uga only if we actually win, I post up on Aubie if you guys beat the line. okay?

  27. I'm Your Huckleberry...

  28. 911, where do surgeons fit into this Obamanightmare? Are they going to be screwed as well? If so, how?

  29. dear priceless 1,
    apparently, the american college of surgeons thinks the gubmnt is the answer... *sigh*. it's so screwy i understand the temptation to pawn this off onto a large entity, but again, the solution lies at the level of the individual. unshackle the surgeons from burdensome government regulations, quit shorting them on their fees, and allow them to practice without falling under mandatory ER call. the fact is, being a surgeon sucks ass right now unless you are in a large group and that usually means at a large hospital. the small town general surgeon is an artifact and people are just now getting what that means... it means you shouldn't crash your car outside a big city.

  30. no I'm not high, you arrogant SOB, and if business ran as it should government wouldn't have to get involved and muck it up. Case in point my widowed friend self paid her insurance for herself and 4 kids...one developed systemic lupus requiring cemotherapy because it was shutting her kidneys down and the other child developed juvenile diabetes. She started out around 500 bucks a month and after her 2 kids' illnesses was paying 2500. Don't get behind a genetic 8 ball or you're screwed.
    Gee was it possible they were trying to squeeze her out? or my co-worker with severe sclerodermna that had litereally frozen her facial muscles and was denied corrective surgery because it was deemed "cosmetic"?
    I hate government getting involved with all it's beauracracy but private health insurors contributed to this stinkin' mess.

  31. you mean bad things happen, often to good people, and it's not fair? i agree. well said. why not simply have the government make unfairness illegal, or one better, outlaw lupus AND cancer. your solutions are all paper solutions. the reality on the ground is that bad things and bad diseases happen to all kinds of folks and the only question is whether people should be responsible for taking care of themselves or whether the government should force others to do it. but right now, the case of your unfortunate friend is, again, directly a result of a law called EMTALA, passed in 1986, where the government made it illegal to refuse care to anyone in an ER. they didn't fund it. therefore my three day hospital stay for dehydration last year cost my insurance company 18 thousand dollars instead of the $1800 it would have before we were forced to give things away to regular folks and illegals. you are emotional and angry about what happened to your friend. your anger is misdirected and your solutions are worse than the current problem.

  32. 911 said:
    apparently, the american college of surgeons thinks the gubmnt is the answer...

    ach, I don't give a rat's patootie about what those guys think - I mean individual surgeons - the working stiffs. Are they on board with Obamacare? Do they see a restriction in their ability to perform surgeries the way they see fit, or are they immune to all this garbage and can practice medicine the way they want?

  33. dear priceless1,
    you have in your possession a document in which your question is answered. find the chapter entitled 'the trauma code' and start reading... just sayin' girl! here's an excerpt...

    Many rural trauma centers closed or dropped their trauma capabilities with many general surgeons opting out of trauma care. Why take on the liability especially when the standard of care is now that of the MECCA? And trauma surgery skills are perishable, so now we have huge swaths of our fine country where, aside from the danger of being in an MVC, being shot, or being stabbed, you are also now faced with the reality that to get prompt, excellent trauma care, you may need to be flown by helicopter (which is risky as well) or fixed-wing transport to the nearest ‘trauma center’ which may be 400 miles away.

    surgeons are irreplaceable and they are 'opting out'.

  34. it's not what you know, it's who you know, or, to make it more modern, it's not what you know, it's who you slip money to under the table...


  35. http://money.cnn.com/2010/11/12/news/economy/postal_service/index.htm?section=money_topstories

  36. EMTALA cause my OBGYN to charge me $250 for a visit that took less than five minutes? Well, maybe I was charged room&board for the 30+ minutes I waited naked on the table. Hmm, I don't recall eating anything but my time. Bullshit, dear doc. Doctors see cash patients as little lambs, and it has nothing to do with any government programs. Consumers who pay cash, need, dare I say it-yep, government intervention to get the hell out of this insurance conundrum. BTW, no successful government programs is a- well did you go to public school? Public university for your undergrad? Public medical school? By your own logic, If you participated in any of these gubment programs, you are not a successful physician.

  37. dear SINVILLE,
    I know the public schools suck. I'm sorry you had to endure them but take heart! I know you can't read well so I'll type this slowly. Good thing you were able to snag a rich dude to support you and yours in the manner you, no doubt, deserve. I mean Botox and plastic surgery's cash money. Good for you though sunshine... I bet you are still hot from a distance. Really super-cute blog too. Mind not to break a nail with what, I'm sure, is going to be an estrogen fueled rant... The kind that makes hubby drink so much and stuff.

  38. Dear 911,

    Did I touch a nerve? I forgot to genuflect, and address you as my Lord! Dang it! Hmm, my husband emigrated with $200 in his pocket, and I’m pretty sure he didn’t have any other money hidden on his person. Yes, I attended public schools, and really, is that an insult?

    Long nails are tacky, but then doctors have notoriously crude taste. Did you forget to address my argument? Holy shit, another doc with an attention disorder! How does EMTALA effect rates is private practice?

    For your convenience, I corrected your grammar. I know how hard it is not to read and write in one's maternal language.

    [D]ear SINVILLE,
    I know the public schools suck. I'm sorry you had to endure them but take heart! I know you can't read well so I'll type this slowly. Good thing you were able to snag a rich dude to support you and yours in the manner you, no doubt, deserve. I mean Botox and plastic surgery's cash money. Good for you though sunshine... I bet you are still hot from a distance. Really super-cute blog too. Fragmented sentence Mind not to break a nail with what, I'm sure, is going to be an estrogen fueled rant... The kind that makes hubby drink[s] so much and stuff

  39. Dear sinville(OMG are u dreaming? And speaking of dreaming, how is that hopey/changey thing workin' for ya'!) I've taken the liberty of correcting you grammar since you are so intent on getting it correct as in..
    "Yes, I attended public schools and, really, is that an insult?" I'm sure you just misplaced that comma being that you are a publik school educated bitch. Oh, and there is your spelling. "How does EMTALA effect rates is private practice?" "Is"?? I think that's spelled "in"..Oh well, you got a computer to grandmer czech aend speill czech don't you?

    And the answer to your question is that EMTALA has no impact on private practice prices except thru the impact on malpractice co$ts. Which, I'm sure you know, varies with the specialty. The impact is on Emergency Department volumes and those of us who sighned up to take care of your EMERGENCY 24/7/365 Make sure you know what constitutes a medical emergency because 80% of ED pts don't but because of EMTALA legislation we, the EM docs, have to donate our skills, time, and space to deal with your fuckin' sore throat. This impacts not only what it costs you, but on how rapidly you or your loved one will be seen, evaluated, and treated with your "true" emergency.

    So get off my blog, bitch. Go drive your green car to the park and eat some fuckin' bark after you pray to it or burn some incense or something..

    I'm too old to put up with you any loner. 911.. Ban the Bitch!!!

  40. That should be "longer" not "loner". Maybe I should use speill czech 2!

  41. dear SINVILLE,

    you come to my blog, rant about a bad day at the OB, and throw a few stones. i threw 'em back. me, thin skinned? i have to take care of simpering dolts like you all the time in the ER and have been called every name in the book so really, sell it somewhere else.

    you come here all on about proving big government works by citing the public school system??? really?? BUT YOU WON'T SEND YOUR KIDS THERE!!! YOU SEND 'EM TO CATHOLIC SCHOOL BECAUSE YOU WANT THEM TO GET A GOOD EDUCATION. you vapid, hypocritical dolt.

    how does EMTALA cause increased costs? hmmm, let me see... almost a thousand posts on the blog and over a hundred or so on EMTALA, ....

    1986, EMTALA passed. de facto it makes it against federal law to turn anyone away from the ER anywhere in the country for anything end of story. it is not funded. so costs must be shifted. illegal aliens crashing their cars get the best care, but we get the bill. people who previously budgeted for health care or insurance now do not do it anymore because you can always 'just go to the ER... it's free'.

    and to practice surgery in a hospital you must be on ER call, just like your dastardly OB that hurt your feelings, and must take the 'self pay' ectopic pregnancy to the OR at 4 in the morning (while you are snug on your tempur-pedic dreaming dreams about Cher, or Oprah, or whatever idiot celebrity douchebag you idolize).

    and that same OB, or orthopedic, or surgeon, who gets stuck with the 'no pay' ER patients now loses his paying cases for the day, a double whammy. so they start seeing more clinic patients, 40-50 a day to pay the staff, their malpractice, and themselves. and hospitals shift costs to those with insurance or money or both, and premiums rise, and costs go up, and no one knows anymore how much tests cost because it's all super secret... it's all a fucking pick-pocket to serve the 'indigent' and underinsured, who, invariably, roll into the ER clasping the latest iphone.

  42. and it all rolls downhill. docs are quitting, service sucks, and it's all because people now expect that their medical care should be 'free' which will amount to this, and is the point of this post, the quality and availability of excellent health care will plummet with obamacare, and the main reason is that people will think it's 'free' when it's all OTHER PEOPLE'S MONEY and OTHER PEOPLE'S TIME. it will be MORE FUCKING EXPENSIVE AND LESS AVAILABLE. and i know, i work for the government health care system right now. it's a fucking joke, but i get to sleep and see my family now, just like you!

    i don't need any genuflecting, i don't care a shit for what you think about me, but there are three board certified ER docs who write on this blog (i'm one of them) who have quit ER medicine mid career BECAUSE OF THE EFFECTS OF EMTALA, and two others who are only part time now BECAUSE OF EMTALA, and whole towns are without trauma surgeons now BECAUSE OF EMTALA.

    but what the fuck do i know, i've only been doing this for a fucking decade, and you, you had a bad day at the OBs office, you self-important little diva. i've saved more lives and seen more tragedy and delivered more bad news than anyone should have to in a lifetime, and you bitch about customer service and draw conclusions based on your experience in your sheltered little world.

    you wanna see my life. go volunteer in the parkland ER and see the shit that rolls in there and see my wonderful colleagues in medicine bust their humps for every one of them and then get spit on, kicked and punched, and see the screaming drunks and the bloody messes pulled in off the street and smell the poverty and then come back and let me know how your next OB appointment went.

  43. Jeez, 911. Come live in our neighborhood. Work out of your house and be our personal neighborhood physician. In betweens, you can do your online thing. I've got great neighbors ... we'd hardly ever wake you up at 3 am, and we'd bake you pies and stuff. No spitting, hitting, or cursing, and no EMTALA ever again.

    Well, ok, you probably wouldn't make a living off of that, and I'm sure it would violate some home occupation ordinance ... but wouldn't it make for a better life if things could work that way? I remember a time when my dad saw the occasional patient after hours at our house ... they didn't seem to understand that 9 to 5 thing! Crap, I feel old!

  44. Sinville, if you pay a guy $250 and he only looks at your snatch for 5 minutes..sounds like a hygiene issue...

  45. peggyU,
    when you build the compound in Montana let me know. me and the gang will come up there and work for food.

    and this is interesting... EMTALA from KevinMD's site.

  46. It will prolly be Idaho, since my family has a nice self-sufficient setup there. My mom and my sisters-in-law just processed a whole mess of chickens, and there is also plenty of game in their freezers. Mom's got a good garden and orchard as well ... so if the shit really hits the fan, I'm going HOME!

  47. "So the hospital eats the costs and the physicians provide free care." Did ya notice a medical student wrote that little piece of fiction? The next paying patient picks up the tab. I'm pretty sure hospital administrators are receiving their bonuses. Doctors get screwed but y'all made a pact with the devil. Dump insurance companies, make your patients sign arbitration agreements (ADR), and charge cash; I'd pay. Of course, I'd never use ya cause only my kids can call me illiterate, comprehension challenged, gold digging, hot to the nearsighted, hormonal, simpering dolt, sales woman, vapid, hypocritical (which one day I will explain why this word is incorrectly used) bitching, self-important little diva and sheltered. Holy cow, I thought I was having a flashback to last Thanksgiving's dinner party.

    Oldfart, "bitch", spelling challenged, and that gem of an error-I like you :-)

    It's called post post-op but maybe the the ME takes care of those visits for ya ;-)

  48. Uh,
    Like I said above, for me and anyone with hospital privileges, doing what you suggest, while eminently reasonable, is illegal, and would get me or any docs that I involve in an ER case arrested, fired, fined, sued, or all of the above because of EMTALA.