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In a recent New England Journal of Medicine, Dr. Howard Brody argues that physicians and organized medicine (physicians' professional organizations) have not stepped up enough in the health reform arena.

He makes some good points, but as someone who, with many committed colleagues in Doctors for America, have been trying to make the voices of physicians heard, the majority of physicians who favor health care reform, I disagree.

NEJM -- Medicine's Ethical Responsibility for Health Care Reform -- The Top Five List

The medical profession's reaction has been quite different. Although major professional organizations have endorsed various reform measures, no promises have been made in terms of cutting any future medical costs. Indeed, in some cases, physician support has been made contingent on promises that physicians' income would not be negatively affected by reform.

It is appropriate to question the ethics of organized medicine's public stance. Physicians have, in effect, sworn an oath to place the interests of the patient ahead of their own interests — including their financial interests. None of the for-profit health care industries that have promised cost savings have taken such an oath. How can physicians, alone among the "special interests" affected by health care reform, justify demanding protection from revenue losses?

Dr. Brody makes some interesting points about physicians' role in health care reform, including the general unwillingness of organized medicine to step up and make concessions on income or to vigorously work on the problem of practice variation.

He is only partially correct in his assessment of organized medicine's advocacy role this time around. I think it is a real accomplishment, an unprecedented consensus, that the ten largest physician organizations have come out in support of the House Bill, which includes many very important reforms including the public option.

What amazes me is that this has NO currency in the media. Does anyone know this fact? Does anyone realize how monumental this should be? So regardless of whether organized medicine has made the right offers or concessions in this current debate, the fact that they have stood up, in many cases with much pushback from conservative members and advocated for health reform is a big deal.

Secondly, even if organized medicine's endorsement of reform has not taken the form some of us would like (single payer, Bismarkian insurance), individual physicians, in surveys published in the NEJM have indicated overwhelming willingness to make a deal (i.e., accept a public option) and accept concessions.

a large majority of respondents (78%) agreed that physicians have a professional obligation to address societal health policy issues. Majorities also agreed that every physician is professionally obligated to care for the uninsured or underinsured (73%), and most were willing to accept limits on reimbursement for expensive drugs and procedures for the sake of expanding access to basic health care (67%). By contrast, physicians were divided almost equally about cost-effectiveness analysis; just over half (54%) reported having a moral objection to using such data "to determine which treatments will be offered to patients.

...the 28% of physicians who consider themselves conservative were consistently less enthusiastic about professional responsibilities pertaining to health care reform.

So i would differ with Dr. Brody's assessment that physicians and organized medicine have not stepped up adequately.

The problem, as I see it, is that the media and the pro-reform contingent in Congress, have done an abysmal job of letting the public know that the people whose opinions they value most in this debate - physicians - are overwhelmingly in favor of reform.

What we see in the media are the conservative physicians in congress (Sens. Coburn and Barrasso, Congressman Boustany) who are ridiculously out of touch with mainstream physicians. Though in touch with the angry tea partiers and the admittedly sizable contingent of conservative American physicians (not accidentally all of these physicians practicing in high income specialties - ob/gyn, orthopedics and surgical subspecialties ), they do not represent the thinking of most physicians.

Furthermore, as Dr. Brody rightly points out, physicians have a higher duty to our patients than to our own narrow self interest. But here, again, physicians have acknowledged this in a formal way in the Charter on Medical Professionalism, published in 2004 by the American College of Physicians and endorsed by more than 50 major national and international medical organizations:

Principle of social justice. The medical profession must promote justice in the health care system, including the fair distribution of health care resources. Physicians should work actively to eliminate discrimination in health care, whether based on race, gender, socioeconomic status, ethnicity, religion, or any other social category

It seems pretty clear that physicians have answered the call, but somehow, in spite of opinion polling showing how highly the public values our opinion, nobody has noticed.

Originally posted to cmhmd on Mon Mar 01, 2010 at 07:02 PM PST.

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Comment Preferences

    •  Drs like need to search deeply about their roles (8+ / 0-)

      in this mess. What are they doing about the crap that Big Pharma is peddling? As scientists, are they running independent drug trials? Have they pressed back against the drug pushing? If not why?  Have they moved against the for profit hospitals? Have they moved against fee for service? Have they sought to set up alternative insurance co? In short, just as teachers can be blamed for bad schools, and bad policing policies for crime increases, since health care is in essence the purview of MDs, I would love to have seen them far more active in this.  

    •  Unscientific survey (2+ / 0-)
      Recommended by:
      denise b, Fall line

      In my job I talk to physicians almost every day. Because I am a political junkie, and I know most of these people well enough to ask, I inquire about their view of the current HCR bills. Virtually every physician I talk to does not favor the bills. Their biggest gripe is that members of Congress do not seem to understand the difference between cost and price. The politicians seem to think that if the price of a service or procedure is lowered by legislative or agency fiat that the cost is lowered. The price at which Medicare or Medicaid is willing to reimburse physicians has, in their mind, no relation to the actual cost of providing the care. What they would like is for HCR to focus on how to reduce the cost of care, not the price of care. They feel that the policy makers in DC are tone deaf regarding the costs of a medical practice. This is not about the cost of complying with insurance providers. That's expensive, but even net of those costs private insurance is far more favorable to the practicing physician than government programs. Second biggest gripe is that there is no tort reform. This alone is a real gating item for most physicians to support HCR.

      "let's talk about that"

      by VClib on Mon Mar 01, 2010 at 07:57:37 PM PST

      [ Parent ]

      •  well... (2+ / 0-)
        Recommended by:
        Kitsap River, Larsstephens

        Tort reform does not mean the same thing as caps:
        http://cmhmd.blogspot.com/...
        So there's lots we can do without caps that actually benefit patients, and not just insurers.

        Second, dealing with private insurers costs a lot:
        http://cmhmd.blogspot.com/...

        My theory is if you subtracted the unbelievable amount of resources required to comply with private insurer BS, you'd be ahead with medicare pay in almost every region of the country.

        Finally, if you go read Dr. Brody's original article, he can make the case to you about where savings might be found that have nothing to with the cost vs. the price of services: it is the necessary vs unneccessary stuff we have to get a grip on!

      •  I laugh at cost and price (0+ / 0-)

        For docs they think costs are fixed, their costs.

        But of course they aren't, lower the price and all of a sudden you lower the cost. Of course docs think medicare medicaid is too low. I think the cost of high quality wooden fences is too low.

        Docs are part of the problem, not the solution. When someone dies for lack of money it's not only for the price of drugs. Docs cost a lot! How many die for lack of a doc?

        Docs, hospitals, and pharma are next.

        "Don't fall or we both go" Derek Hersey

        by ban nock on Mon Mar 01, 2010 at 09:39:17 PM PST

        [ Parent ]

        •  yes, and the medical device manufacturers (1+ / 0-)
          Recommended by:
          ban nock

          too...like, they say, "We need to give people fewer MRIs because they cost so much...", but they don't mention how an MRI here costs TEN TIMES what it does in Canada or any other country.

          The government just needs to regulate the prices of these things.  There is no equilibrium that can be established otherwise.  Necessary services just can't be so out of line with peoples' incomes.  And when there is as much income inequality as we have in the USA, regulation becomes esp important in making the services available/affordable.

          •  are you insinuating.... (1+ / 0-)
            Recommended by:
            VClib

            that more MRIs are ordered in Canada?  Even at the elevated cost I would bet there are FAR more MRIs ordered in the US.  

            •  Yet in Japan there are far more MRIs (1+ / 0-)
              Recommended by:
              ban nock

              and also lower prices.
              It isn't just availability (econ 101 - widespread availability correlates with lower overall prices), it may also be the type of machine. Japanese Hospitals often choosing the model with fewer bells and whistles.

              But, even if the same machine is ordered, in Japan the machine might cost half (not a tenth, a half) of the same model in the US.

              NPRhad an interesting discussion on this a few months back.

              Professor GERARD ANDERSON (Health Policy and Management, Johns Hopkins University): I'm talking about the MRI machine. When you go and you buy it from Siemens or General Electric or any of the manufacturers, you will be paying about twice as much in the United States for the exact same machine.

              Japan has the greatest density of MRI machines found amongst OECD countries.

              no remuneration was received by anyone for the writing of this message

              by ItsSimpleSimon on Tue Mar 02, 2010 at 04:48:11 AM PST

              [ Parent ]

            •  Hind2 - you are right (0+ / 0-)

              There are far fewer MRIs, per capita, ordered in Canada. In part because they have no concept of medical malpractice litigation. I heard a physician at a conference last week state the well over half of the MRIs ordered in the US are exclusively for defense purposes should the physician be sued. People have no idea how the concept of defensive medicine has infected the minds of our physician community and the hundreds of billion that are wasted because of it.

              "let's talk about that"

              by VClib on Tue Mar 02, 2010 at 09:01:21 AM PST

              [ Parent ]

  •  In Oregon, there's a group called (9+ / 0-)

    "Mad As Hell Doctors" touring the country for a public option.

    "Looks like we got ourselves a Reader" - Bill Hicks

    by blueoregon on Mon Mar 01, 2010 at 07:07:00 PM PST

  •  For the life of me (8+ / 0-)

    I truly do not understand why doctors would be fond of the current insurance system, which must be as frustrating for them as providers as it is for patients?

    •  Well, right now (5+ / 0-)

      they're sure as hell pissed at Jim Bunning.  That's a start.

      Real conservatives are conservative. They like rules governing everything. American conservatives only like rules governing other people's pleasure. Digby

      by MadRuth on Mon Mar 01, 2010 at 07:15:25 PM PST

      [ Parent ]

    •  Grassroots single-payer activism (3+ / 0-)
      Recommended by:
      TiaRachel, trashablanca, Larsstephens

      in California has traditionally been fed in no small measure by medical students, who arrive by the busload for critical rallies and show up in Sacramento for legislative actions and the like. This, despite the fact that the California Medical Association won't endorse single-payer healthcare (or at least wouldn't until recently).

      Now, just what's going to happen, once these guys end their training and start to build their own practices? I can see it now: "Gee whiz, I didn't know ANYTGHING back when I was a med student. I actually LOVE for-profit health insurance. I am so delighted that I have to haggle on the phone with them, to get them to cover procedures I recommend for patients. I feel so indebted to them, because I need to hire people, specifically to work out their arcane billing..."

      I know this diary isn't discussing single-payer healthcare, but legislation currently under consideration in Washington, D.C.. But you see my point.

      •  So far... (4+ / 0-)
        Recommended by:
        Marie, Gooserock, karmsy, Larsstephens

        what we see are that younger physicians and women tend to be more progressive. If this trend continues, the numbers I quoted above could get better over time.

        FWIW, I think that the reason most physicians buy the crap the right peddles about how horrible helath care is outside of the US and that they would be paupers if reform passed is because, unfortunately, they either are ignorant, or just are true red meat conservative true believers.

        The former can be persuaded, the latter cannot.

      •  That's "ANYTHING." My proofreading sucks. n/t (1+ / 0-)
        Recommended by:
        Larsstephens
      •  There is a lot of fear and uncertainty (1+ / 0-)
        Recommended by:
        Larsstephens

        among the physicians I work with.  They're unsure on how reimbursement may change, how they'll be paid, or even if their current practice structure can survive whatever type of HCR is passed. And if physicians are unsure of what's to come, no wonder many Americans can't get behind any specific proposal.  Oh, they may be for a PO, but once they see the specifics many change their tune.

        Most are sitting on the sidelines waiting for something to happen.  

        That's why I would like to see some real leadership on HCR, instead of alot of the pandering that I'm seeing right now.  Make an effecient, straight up healthcare bill with a strong public option, and then pay for it with a specific tax, just like Medicare and SSN, and people will get behind HCR.

        •  I agree with this: (1+ / 0-)
          Recommended by:
          Larsstephens

          "Most are sitting on the sidelines waiting for something to happen."

          But, again, to the credit of the leaders of the 10 largest physician organizations, they have stepped up and committed to reform.

          Now if we could get the media and the public to notice.

          •  the AMA only supported the house bill (1+ / 0-)
            Recommended by:
            ban nock

            when they were assured that the PO wouldn't be tied to Medicare rates.  They also, along with the hospitals, lobbied hard against the Medicare expansion when that was proposed for people over 55.  I think the doctors are going to have to take a real haircut sooner or later, because the reimbursements they expect are just not sustainable.  But meanwhile, they are terrified of Medicare rates, even though those rates are generally much more than similar services are reimbursed in Europe and other places (where the government sets fees).

            I sympathize with your position somewhat, but I haven't seen doctors coming out strongly for reform.  They are mostly afraid of a pay cut or any government oversight over their fees.  I remember reading stories in the huffpo about how they were warning patients "I could no longer treat you if Obamacare goes through, etc..." but I saw no stories about them arguing for reform.

            It would have a big effect if they did, since people respect them a lot.  I think there is a difference between endorsing and /or allowing a reform package (as the AMA is doing now), and arguing for it strongly.  They have not come forward and argued for it strongly.

    •  Primary care physicians aren't -- (3+ / 0-)

      but specialists have done very well with this system.  Much better than they would have under single-payer or socialized medicine.  

      "Dulled conscience, irresponsibility, and ruthless self-interest already reappear. Such symptoms of prosperity may become portents of disaster!" FDR - 1937

      by Marie on Mon Mar 01, 2010 at 07:43:08 PM PST

      [ Parent ]

    •  newdem - it pays better (0+ / 0-)

      Because private insurance, with all it's hoops and ladders, pays so much better than Medicare and way better than Medicaid that physicians have no trust that if the only payer was government that they would still be in business. I don't know a physician who will take Medicaid patients and who does not lose money on Medicare.

      "let's talk about that"

      by VClib on Mon Mar 01, 2010 at 08:02:30 PM PST

      [ Parent ]

      •  right, (1+ / 0-)
        Recommended by:
        Larsstephens

        but under the House Bill, medicaid goes to par with medicare. that's a big deal when in many states, medicaid only pays 30 cents on the dollar.

        And medicare pays reasonably well. If 14% of revenue weren't being expended fighting with private insurers, you wouldn't need the higher reimbursements of the private insurers.

        And while some areas of the country have insurers paying far more than medicare, in many areas, they are significantly closer to par, and in some areas a bit lower (SE PA, Nevada).

      •  "lose money" (0+ / 0-)

        I bust a gut laughing. They just make less money. Medicaid is still much higher than in any other country.

        Docs are safe for now, relatively safe, but the days of hundred thousand dollar cars and multi million dollar houses while 45K people die a year are coming to an end.

        To all you docs out there, you're next.

        "Don't fall or we both go" Derek Hersey

        by ban nock on Mon Mar 01, 2010 at 09:48:03 PM PST

        [ Parent ]

        •  ban - supply and demand for MDs (0+ / 0-)

          As we contemplate reducing the compensation of physicians we should have done some planning decades ago to increase the supply. Real investment and focus on increasing the supply of physicians will take a decade to show any meaningful impact and there is no current will to spend the money to accomplish that, even now. How will reducing physician compensation increase the supply of health professionals? We have too few primary care physicians now. The physicians with the fancy cars and houses are often in specialties that command high fees and take extra years of training. We also have a large number of physicians who are Boomers. As they enter their sixties they can play an important role in providing care to many people who will be obtaining insurance through HCR. If we squeeze them they will retire, thereby changing the supply demand characteristics even more. Nationally only 50% of physicians will see Medicaid patients, in my community even fewer. A growing number of physicians will not take new Medicare patients and lose money on those that they do. Physician practices are rational economic entities. They have a limited amount of physician time to bill. When demand exceeds supply they drop the lowest paying accounts. In medicine that is Medicaid followed by Medicare. You cannot require physicians to work for compensation they are unwilling to accept. How will you plan of reducing physician compensation work and what are the possible unintended consequences?

          "let's talk about that"

          by VClib on Tue Mar 02, 2010 at 08:56:05 AM PST

          [ Parent ]

          •  How will reducing physician compensation increase (0+ / 0-)

            the supply of health professionals?

            We have a pretty fair number of doctors, but the economic incentives are so grossly weighted towards procedure based subspecialists, that we have far too many of them too few PCPs. Rejiggering the incentives (higher PCP pay, lower specialist pay) will alter the mix.

            Physicians, in spite of the complaining you hear, will not retire as they threaten. We're generally a workaholic bunch. We don't even take sick days, let alone retire because our reimbursement goes down.

            A few will. So be it.

            •  I certainly respect your view (0+ / 0-)

              As a practicing physician I certainly respect your view. As a boomer who works in healthcare I have a lot business relationships, and friends who are physicians, who are also boomers. These physicians worked through the golden age of medicine when they were able to make a lot of money and have the financial flexibility to retire, if they want to. I realize that I have a small sample, but what they tell me is that if they see further erosion in their income they will wind down their private practices. They may continue on a part-time basis, or do pro bono work, but they will see fewer patients and enjoy a more relaxed life.

              "let's talk about that"

              by VClib on Tue Mar 02, 2010 at 10:19:24 AM PST

              [ Parent ]

              •  so you are saying that if the (0+ / 0-)

                government regulates what they can charge (as happens in almost every other country), that our doctors will retire?

                I am not attacking you, just pointing out that we have a real problem with the type of people who have gone into medicine because it was sold to them as a cash bonanza...

                Why do other countries not have to deal with this attitude?

                •  Not exactly (0+ / 0-)

                  What I am saying is that physicians in their 60s, who have had very successful 30 careers, will likely retire if their income is significantly reduced. These are people who can very comfortably retire and should they feel their work is not valued, will spend more time pursuing things other than medicine. If government becomes the exclusive regulator of what physicians can charge, other physicians will also leave clinical practice to do other things, but not in significant numbers. It is the doctors who are close to retirement age who will leave early.

                  "let's talk about that"

                  by VClib on Tue Mar 02, 2010 at 05:56:10 PM PST

                  [ Parent ]

                  •  Uwe Reinhardt has an interesting take on this... (0+ / 0-)

                    Check it out here:

                    http://economix.blogs.nytimes.com/...

                    Let me know what you think.

                    •  cmhmd - interesting story (0+ / 0-)

                      First, I too am amazed that we have not invested in the expansion of medical education. Each year we have thousands of young pre-med college graduates with great grades and test scores who don't find a slot in our limited number of medical schools. One way to change the long term economics of anything is to increase the supply. Specifically regarding radiologists, I think it is simple. As Medicare drops its prices radiologists will treat fewer Medicare patients until that point when they have enough private pay patients to drop Medicare all together, or make a change in their cost structure or personal compensation, or decide that time to do other pursuits has more value to them than reading Medicare images. However, during that time period Medicare patients will find it increasingly difficult to see an experienced radiologist.  

                      "let's talk about that"

                      by VClib on Tue Mar 02, 2010 at 06:29:10 PM PST

                      [ Parent ]

    •  The ones I know say it is. (1+ / 0-)
      Recommended by:
      Charles CurtisStanley

      They universally like Medicare.

      Living kidney donor needed; type B, O, or incompatible (with paired donation). Drop me a note (see profile).

      by Kitsap River on Tue Mar 02, 2010 at 12:11:51 AM PST

      [ Parent ]

  •  asdf (6+ / 0-)

    The problem, as I see it, is that the media and the pro-reform contingent in Congress, have done an abysmal job of letting the public know that the people whose opinions they value most in this debate - physicians - are overwhelmingly in favor of reform.

    What did doctors expect? - talking heads to be hunting them down and shoving microphones in front of their faces?

    I've been following the debate pretty closely and I have no idea how doctor's think on the subject other than a few anecdotes here and there. All other pressure groups have made their feelings known in no uncertain terms.

    Sure there is plenty of blame to go around but, if the doctor's story hasn't got out, the buck has to stop with the doctors.

    Harry Reid's lack of backbone is an act, his obstructionism isn't.

    by stevej on Mon Mar 01, 2010 at 07:27:39 PM PST

    •  I don't think that is fair. (3+ / 0-)
      Recommended by:
      TiaRachel, Larsstephens, Deathtongue

      that is the point of the post.

      My group Doctors for America, along with many other advocacy groups such as the National Medical Associaction, the American medical Students, the Hispanic Association, Physicians for a National Health Program, as well as the largest Nursing Associations are out there trying to get the media to pay attention.

      Just the fact that the 10 largest organizations support the House bill should be very news worthy. Those organizations have PR, they send out press releases and contact the media.

      But it goes against the narrative, doesn't it? Doctors are conservative, doctors are against health reform, story over.

      That is my point. This should be amajor news story and if the media were really trying to be even handed, our groups would be on TV and radio and being interviewed for newspapers.

      We try. I have been on local TV and radio, written letters to the editor and op-eds and on and on. We have tried to get the national outlets attention. They are generally not intersted. Even MSNBC - we have reached out to Rachel and Keith and Ed. Crickets.

  •  big up (1+ / 0-)
    Recommended by:
    Larsstephens

    for the physician's viewpoint.

    maybe you speak for many, or a selective few, but yours is a valuable insight

    Love is the source, substance and future of all being. --St. Francis

    by ksingh on Mon Mar 01, 2010 at 07:40:32 PM PST

  •  Hospitals are losing money... (3+ / 0-)
    Recommended by:
    denise b, cmhmd, Larsstephens

    according to many reports, including "In Hard Times, Hospitals are Bleeding Money": (emphasis mine)

    Troubling economic times in Michigan and stalled state and federal health reforms are causing historic losses at Michigan hospitals left with soaring uncollected patient debts and bills for care from a growing number of uninsured people, a report expected to be released today concludes...

    The report concludes that state and federal regulators "need to resolve the state budget crisis and pursue health care reform without cutting Medicaid and Medicare funding to hospitals." Any further cuts will hurt not only uninsured people and Medicaid recipients, but hospitals that provide care while reforms are stalled, Schonfeld said...

    and Pa. Hospitals Losing Money in Recession. Also, Economy Sickening US Hospitals.

    I'm not sure if hospitals have been lobbying Congress to pass health care reform.  I hope that Congress wakes up soon, or we may find it difficult to find a hospital if we need one, regardless of whether or not we have insurance.

  •  Here's the main problem (1+ / 0-)
    Recommended by:
    Larsstephens

    It is not that docs become less progressive when they leave med school.

    They have a lot less time on their hands.

    I have time to do this because 90% of my free time is spent on it, and I still miss many rallies.

    And my wife is ticked at how much time I spend on it.

    Yes, we all have busy jobs, but most of my colleagues still work 80 hour weeks.

  •  One thing that would make a big difference is if (3+ / 0-)
    Recommended by:
    VClib, cmhmd, Larsstephens

    We subsidized medical school for highly qualified people. It's kind of hard to be too progressive about healthcare when you graduate with over $100,000 in student loans. This would be great for the country because we would entice more bright people to become doctors instead of going into corporate america and wall street(and if we want to cover 45 million uninsured we will need more doctors). It doesn't surprise me that the media has ignored doctors. When you think about it, when was the last time you saw someone on cable news that wasn't a politician, a "strategist", or a member of some think tank. They are completely disconnected from people doing real jobs.

    •  There are various ways to have debt forgiven.... (0+ / 0-)

      and graduating physicians rarely take the government up on it...  So I honestly don't think this would work.  Also the reason a lot of brilliant minds were flocking to the financial industry was not because they were afraid of having a few hundred thousand in debt but they knew they could make a normal physicians salary in a christmas bonus at Goldman.  

  •  exactly, physicians have an oath (2+ / 0-)
    Recommended by:
    Larsstephens, evangeline135

    and i don't recall an exemption for not accepting a patient if it's not financially the best benefit.

    Other countries have turned to managed care and licensing more MD's to lower costs. The conservative MD's forget that it's the strict licensing rules (thanks to regulatory capture) that keep them a scarce commodity. Plenty of MD's, even in North America, would be glad to work for half what average US doctors get.

  •  I don't think it's the pay (2+ / 0-)
    Recommended by:
    ban nock, evangeline135

    a lot of doctors think of medicine as a business rather than a vocation.
    IMO, it's immoral to extort money from sick people.
    I'm not saying they don't deserve a very good income but profit-driven care is disturbing.
    That's why need a national health service.

    •  That's the core of the problem (1+ / 0-)
      Recommended by:
      evangeline135

      If a doctor can make 35K off that guy with the cadillac insurance why fix me who walks in the door and wants to pay only a thousand which is still twice as much as I'd pay in Bangkok.

      "Don't fall or we both go" Derek Hersey

      by ban nock on Tue Mar 02, 2010 at 04:58:05 AM PST

      [ Parent ]

  •  There's a huge primary care/specialty divide here (4+ / 0-)

    Primary care physicians like myself overwhelmingly support drastic reform, because we live with the dreadful toll of unnecessary suffering and death due to the uninsured/underinsured crisis every day of our lives.

    Surgical subspecialists? Not so much. In my region the ophthalmologists have been very aggressively campaigning to strangle reform in the cradle, arguing dishonestly that it will "harm access to care for seniors". They attend these meetings and then drive home in their Porsches. Honestly, I don't understand how they can look at themselves in the mirror.

    Maybe they don't have a reflection.

    •  Doctor I'm glad you care (0+ / 0-)

      But remember, you don't see a fraction of us. Most of us don't make it past the front desk, we don't get past the phone call, heck we don't even call. Because we know that without insurance we'll be charge double, triple, or more.

      "Don't fall or we both go" Derek Hersey

      by ban nock on Tue Mar 02, 2010 at 05:02:02 AM PST

      [ Parent ]

      •  Not in my office. (1+ / 0-)
        Recommended by:
        evangeline135

        Patients lacking insurance are seen for reduced fees, not infrequently for free. It's more important for the health of my soul that everyone needing care is seen, than for me to make a few more bucks.

        This probably explains why young docs graduating with a half million dollar education debt look at our pay and the hours we work and start laughing, before moving on to an affluent suburban practice.

  •  Wonder if Bunning made them "more progressive" (0+ / 0-)

    when his hold also caused a 21% drop in Medicare payments?

    I've never found the AMA or many of the state medical associations to be progressive.  

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