From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: sci.med
Subject: Re: Medical crisis -- the real one.
Date: 10 Apr 1999 15:51:35 GMT

masonc@ix.netcom.com wrote in message
0d3c54.4908594@nntp.ix.netcom.com>...
>
>  The medical crisis that has existed for many years is simple.
>
>    *** Doctors don't care about the health of their patients.***
>
>   Dentists care--some of them--they send a six-month reminder.
>   Doctors never do that.  They prescibe a drug and never bother
>   to find out if it worked.  Maybe the patient died.  Maybe the
>   patient switched to another doctor.  They don't care.


  This guy thinks sending a postcard indicates caring (rather than an
industry where it's a lot easier to ignore your need for care).  He
must be easy to please when it comes to birthdays and Christmas.



>>   And preventive medicine?  Doctors couldn't care less.


    Golly.  That's why nobody out there is checking blood pressures,
cholesterols, HbA1c's in diabetics, doing stool guaiacs and
vaccinations and pap smears...    Again, somebody posting from a
different universe than the one I live in.  In the one I live in, the
hospital lab makes a lot more money than I do.  And it's illegal for
them to give me any.

>>   Have you ever heard of a doctor making a simple follow-up
>>   phone call to learn how his prescription is working?


  No, it happens all the time in our universe. Though sometimes office
nurses get assigned routine stuff (and triage if there's trouble).

>>   How many doctors schedule and remind for check-ups where
>>   there called for -- as with chronic illnesses?

    All of them schedule the next visit at the end of the last one (or
try to).  Most remind with a phone call the day before, as this vastly
decreases no-show rates.

>>
>>   What needs to be done to end this crisis?


   Hire more business middle-managers and human resources people, who
are known for their kind and caring attitudes.  Put them in charge of
doctors, in order to make sure doctors learn how human beings SHOULD
behave.


                                       Steve Harris, M.D.


P.S.  If you live in my universe, the above paragraph is devastatingly
sarcastic.  Though I realize not in some alternate timelines.  You'll
just have to trust me.

From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: sci.med,sci.med.cardiology,alt.activism,talk.politics.medicine
Subject: Re: Backlash against HMOs: a declaration of war (was Doctor-bashing)
Date: 10 Apr 1999 16:17:40 GMT

In <7el381$bgj$1@nina.pagesz.net> henryj@nina.pagesz.net (George
Conklin) writes:

>   The whole fight is whether a doctor can scare up his own
>patients on his own or its there and awaits for a HMO to
>deliver them for a fee.



   No, the whole fight is about whether or not we have so much
regulation in the health care field that doctors require monster
organizations to handle the paperwork, since doing it individually
kills them by the economics of scale.

   And the second factor is whether or not we let people take small
risks of very nasty outcomes, in exchange for going the cheap route.
And whether or not if they lose the gamble, they'll shut up and take it
like a man-- so to speak.  And this, in our bring-out-your-inner-child
no-personal-responsibility tort-happy culture.

   Answer to both questions seems to be "no."  But they're
interrelated, and not entirely uncontradictory.  What the average
person wants is all the medical care he likes, for the price he wants
to pay.  This will satisfy both liberals and conservatives, it seems.
Barely.  That it's not possible in this universe doesn't seem to occur
to them.  Their inner child just won't take it.

                                    Steve Harris, M.D.

From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: sci.med,sci.med.cardiology,alt.activism,talk.politics.medicine
Subject: Re: Backlash against HMOs: a declaration of war (was Doctor-bashing)
Date: 10 Apr 1999 16:24:01 GMT

In <clw-0904990809060001@i48-37-14.pdx.du.teleport.com>
clw@teleport.com writes:

>Just betting on the come.  The policy holders (and everyone else) hope
>they do not get sick. (In Vegas, they hope they win or not lose much) But,
>if they do get sick, thats when the HMO loses interest in their welfare
>and looks for ways to not provide services.



   It's not as though how willing an insurance company is to pay off,
or HMO to treat your bad disease, can't be discovered beforehand.
There's no way to keep it a secret if they've been around enough to get
a reputation.  There are ratings services for all of them.  It just
takes a little work and money and moxie to find it out.  Most people
are too lazy.  Or feel too lucky.  One or the other.

   Which were you?  If you claim you were the very first person ever to
be swindled by your HMO, please tell us which one it was, and how you
were swindled.  It'll be a great story.  But if your facts don't check,
prepare to be embarrassed.

From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: sci.med,sci.med.cardiology,alt.activism,talk.politics.medicine
Subject: Re: Backlash against HMOs: a declaration of war (was Doctor-bashing)
Date: 10 Apr 1999 16:33:13 GMT

In <370E42DE.71CCE13C@emory.edu> Andrew Chung <achung@emory.edu>
writes:

>most doctors are as efficient as humanly possible.  we could become more
>efficient if we were fixing machines rather than people.  talking to
>patients can be very inefficient.


   You should try geriatrics, where everything takes three times as
long and the pay is half as much.

   Some doctors won't take any Medicare at all.  Other in geriatrics
make it up by treating patients they don't have to talk to (demented
folks in nursing homes, managed by way of nurse practitioners and lots
of lab tests).  That leaves the rest of us inefficient folks who treat
the elderly outpatient, in the lurch.  I'm personally cutting back-- I
have no choice.  I can do vetrinary medicine on people, medicine on
younger people, or no medicine at all.  Thanks, Medicare.

From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: sci.med,sci.med.cardiology,alt.activism,talk.politics.medicine
Subject: Re: Backlash against HMOs: a declaration of war (was Doctor-bashing)
Date: 10 Apr 1999 16:53:52 GMT

In <7em4ss$tsb$1@nina.pagesz.net> henryj@nina.pagesz.net (George
Conklin) writes:

>In article <clw-0904991700320001@216.26.63.171>,  <clw@teleport.com> wrote:
>>In article <7elnui$chi$1@nina.pagesz.net>, henryj@nina.pagesz.net (George
>>Conklin) wrote:
>>
>>>
>>>   This all an in-house fight over who makes the most money
>>> over the American patient, already paying twice as much as
>>> he/she ought to.
>>
>>I guess the final decision is who is more concerned about the patient, the
>>HMO or the physician.
>>
>   The physicians already have shown us what they can do,
>give us 43 million uninsured and costs twice as high as the
>other developed nations.



   But not twice as high as in Utah.  Or Wisconsin.  Same medcine in
both states as elsewhere, but medicare finds it necessary to pay
gigantic differences for patient care, from state to state.  And some
states cost half as much as others, even on an age adjusted basis.
The problem is not American medicine, the problem is Americans.

   I'm reminded again of Milton Friedman going to Sweden and being
told, "You know, we have no poor scandinavians."  To which he replied:
"That's interesting!  In America, we have no poor scandinavians
either."

From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: sci.med
Subject: Re: Medical crisis -- the real one.
Date: 10 Apr 1999 16:56:40 GMT

In <370e8832.5898513@nntp.ix.netcom.com> masonc@ix.netcom.com writes:

>  I propose to start a campaign to get doctors to follow-up and to remind
>   (to prove that they care).  Get your flame-throwers ready.



   Let us know how many volunteer hours you put in last week at your
local city free health clinic on the phone doing just this.   Just to
let us know how much YOU care.

From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: sci.med
Subject: Re: Medical crisis -- the real one.
Date: 10 Apr 1999 17:11:58 GMT

In <370fd1b2.1095140@nntp.ix.netcom.com> masonc@ix.netcom.com writes:

>    I fear I treaded on a sore toe.  But I can't help but
>    wonder how the practice of medicine would change if doctors were paid
>    only by *healthy* patients. In principle, health insurance and/or HMO
>    (health MAINTENANCE organization) should be more aggressive about the
>    health of their subscribers: "get in here for your check-up or I'll
>    double your premiums" -- but that doesn't seem to be happening to any
>    significant degree. These companies simply adjust their premiums to
>    suit the ill-health of their customers.
>    
>    Question: Assuming no time or money constraints, *would* there be a
>    significant improvement in national health of doctors, insurance
>    companies, and hmo's were aggressive about demanding that patients do
>    whatever is needed to improve their health?
>    
>    Read that again. *Could* a doctor raise the health of his/her
>    patients by more aggressive follow-up and check-ups?
>    
>    This is the nub of the matter. A genuine medical-practice question?
>
>            Mason C


    The rub of the matter is that it's a genuine legal question.  And
the answer is that the law will let you as an insurance company or HMO
charge less to your patient who don't smoke. So most do.  Because not
only do unhealthy patients not pay HMOs (all things considered), they
actually fine them (by costing more to treat than they pay in
premiums).  That's a net loss, which is worse than no pay.  It's not
that the HMO wouldn't like to test your blood to make sure you're
complying with your blood pressure meds, and simply boot you out if
they don't show up in your urine.  It's that nobody will let them.  Get
it?

                                         Steve Harris, M.D.

From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: sci.med,sci.med.cardiology,alt.activism,talk.politics.medicine
Subject: Re: Backlash against HMOs: a declaration of war (was Doctor-bashing)
Date: 10 Apr 1999 17:37:11 GMT

In <7enh0u$6iq$1@nina.pagesz.net> henryj@nina.pagesz.net (George
Conklin) writes:

>    And who set up Blue Cross and Blue Shield?  It was the
>hospitals and the doctors themselves. So you can't have it
>both ways, CG.
>
>    And why did insurance get set up?  Because the AMA
>got laws passed OUTLAWING anything but fee-for-service.
>Before the laws the AMA got changed, a fraternal
>organization could and did hire a doctor to look after the
>needs of all the members...prepaid medicine.  The AMA got
>that kind of thing banned totally, and we are still paying
>the price.
>
>   Your comment revals a profund ignorance of history.  I am
>sorry so many people trash history to support ideology.


   Well, George, I'm sure this is illegal in Canada, also, where the
AMA has little influence.  Why don't we just assume it's the
fulminations of liberals trying to take care of everying who wants to
do it themselve?  It would explain the data from many counties ever so
much more neatly.  And wouldn't require the AMA to have more power than
either major political party, one of whom much surely recognize that
this kind of thing is not in the best interests of its members.  Most
of whom aren't doctors.

   And don't give me any crap about AMA lobbying, either.  AMA lobby
money is such a tiny fraction compared to big business lobby money,
that if the AMA ever took a position which big business understood
would raise health care costs, it would be swamped in a minute.  Heck,
the AMA has been held off all these years by the NRA, which isn't even
a business, and doesn't have a tenth the lobby money any decent-sided
car manufacturer has-- that's how potent the AMA is as a lobby.
Bascially, they're nowhere.

   Medicine is a trillion dollar industry in the US, but doctors get
only something like 15% of that, and when it comes to lobbying, getting
doctors to vote together is like herding cats.  Less than half belong
to the AMA in first place.  And they have increasing lost control of
spending of that 85% as they become employees themselves.  The main
lobbying in healthcare is done by the folks who get the other 85%--
HMOs, hospitals, pharm companies, medical device sellers, insurance
companies, laywers, other health care workers, and generally people who
push paper.  As I've said several times now (I ought to make it a tag
line)-- look at the large buildings in the middle of your nearest big
city?  Who are they owned by?   Doctors?  Not on your life.  The people
they ARE owned by have the lobby power, and make the rules.

   You may not even know the connections.  I have a friend who does
medicare audits and medicare coding advising for both doctors and the
feds-- anybody who'll pay, which is a lot of people.  She works for
Price-Waterhouse-Cooper: the guys you think of only on Academy Awards
night.  But they have thousands of people doing this, and they bill for
my friend's services at over $300 an hour.  They work her 50 hours a
week and pay her $75,000 a year.  You figure it out.  And take another
hard look at those buildings.

                                         Steve Harris, M.D.

From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: sci.med,sci.med.cardiology,alt.activism,talk.politics.medicine
Subject: Re: Backlash against HMOs: a declaration of war (was Doctor-bashing)
Date: 10 Apr 1999 17:40:06 GMT

In <7engsm$3ub$3@fir.prod.itd.earthlink.net> kurtullman@sprintmail.com
(Kurt Ullman) writes:

>
>        Saw two very interesting charts in a Health Affairs article a couple
>years ago. One showed the falling line of out of pocket expenses, the
>other showed the rising line of % of GDP that went to health care. It was
>striking how they went in opposite directions over the same time
>frame......


   Particularly since they are completely unrelated.  Not.  We have
come a long way toward healthcare communism, and the cure being
proposed is complete healthcare communism.  Seems that nobody learns
anything from history.

From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: sci.med,sci.med.cardiology,alt.activism,talk.politics.medicine
Subject: Re: Backlash against HMOs: a declaration of war (was Doctor-bashing)
Date: 10 Apr 1999 17:50:20 GMT

In <7enic9$7s8$1@nina.pagesz.net> henryj@nina.pagesz.net (George
Conklin) writes:

>   So are you going to charge your patients less if they
>have to pay out-of-pocket?

    Only if the law allows me to.  Cash for service places (most of
them InstaCares) are a booming industry, BTW.  Lower charges are one of
the reasons.


>  You are not?  Didn't think so.


    You thought wrong.  Do a medline search on copayments and their
effect on health care costs.


>   Of course, all the industrialized democracies spend on
>the average half of what we do on medical care, they don't
>have out-of-pocket expense.  Of course, we cannot look at
>their success because they are 'different' and thus we can
>only look at what allows MDs to keep raising their fees at
>twice the rate of inflation, something even the HMO has not
>been able to stop.

    We are different. In American we have a very annoying habit of
questioning authority (which sometimes is good and sometimes bad, but
there we are). In other countries when the doctor says something, the
patient goes home shaking his head, and accepts it.  You don't get the
5 person evaluation for autism we heard about, for instance, because
that kind of care doesn't exist on demand.

  The hilarious thing about your ranting is that the sort of thing you
describe with GPs and limited access to specialists is just what you
get with socialized medicine in most industrialized countries.  I'm
terribly sorry you've missed out on the experience.

From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: sci.med
Subject: Re: Medical crisis -- the real one.
Date: 13 Apr 1999 03:53:14 GMT

In <3713fbfe.349894767@news.erols.com> vl-hb001@erols.com (Terri)
writes:

>>    But I've got better evidence.  I've never downsized a patient, and
>>thereby removed his salary so that he wonders who's going to pay the
>>mortgage.
>
>Maybe not, although I *have* see doctors downsize their office staff
>to lower overhead,


In which case they are acting as managers.




>  but your bills may well have "removed his salary"
>and made him wonder "who's going to pay the mortgage."  or the bills
>for the drugs you prescribe may have done it. Downsizing isn't the
>only way to separate someone from his/her salary.
>
>Terri


    I bill mostly medicare.  I help my patients find the cheapest drug
which works.  I fill out multitudinous forms for drug company indigent
patient programs, which provide free drugs (nobody pays me to fill out
such forms-- certainly not medicare).  I listen to the B.S. of drug
reps in order to have office samples, which I can then give to patients
who cannot otherwise afford them.

    It's a real shame you don't know what my days are really like.  Or
those of the average doc.

                                         Steve Harris, M.D.

From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: sci.med,sci.med.cardiology,alt.activism,talk.politics.medicine
Subject: Re: The Patients' Bill of Rights (was Backlash against HMOs: a
Date: 13 Apr 1999 04:04:35 GMT

In <37122BA1.47F2C54@emory.edu> Andrew Chung <achung@emory.edu> writes:

>My worst nightmare would be that I would become critically injured
>somewhere too far from a tertiary trauma center.  Better to be alive
>and surrounded by medical students and residents than end up in the
>morgue of a community hospital.


   Better for be surrounded by medical students and residents even at a
community hospital (which do have them, in some cases).  You get
watched much more closely.

From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: sci.med,sci.med.cardiology,alt.activism,talk.politics.medicine
Subject: Re: Backlash against HMOs: a declaration of war (was Doctor-bashing)
Date: 13 Apr 1999 04:17:16 GMT

In <7eton4$3lg$1@nina.pagesz.net> henryj@nina.pagesz.net (George
Conklin) writes:

>   But here is the problem.  Libertarians continually state
>that the uninsured poor get 'enough' medical care.  If this
>be true, then the middle class gets 'too much' medical care.

     That doesn't follow.  They may get more convenient medical care.
It's possible to get enough food for a nutritious diet.  Does that mean
those who spend more get "too much" food?  No, some of them are rich
and thin, too.

>Taken one step further, people would demand too much until
>they were injured.

    Which some people indeed do.  It's hard to accept the idea that
here is no fix for some things.  If your back hurts terribly, it's very
tempting to have a surgery, if somebody promises it will help.  It's
very hard to grit it out on the basis of statistics which suggest that
(except in rare cases), you'd get better just as fast with excercises
and hot water.


                                      Steve Harris, M.D.

From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: sci.med,sci.med.cardiology,alt.activism,talk.politics.medicine
Subject: Re: Backlash against HMOs: a declaration of war (was Doctor-bashing)
Date: 14 Apr 1999 07:12:41 GMT

In <7evblb$vp6$1@nina.pagesz.net> henryj@nina.pagesz.net (George
Conklin) writes:

>   You are just publishing any old fact you have in your
>head.

   I published the latest figure I found on medline.  You're welcome to
post a later reference for your figure.  If you think the fact that
William Jefferson Clinton said it, makes it the Truth, why then I think
you win the wet cigar award for gullibility.


> That may be the way you practice medicine, but it is
>not economics.  And when Clinton wanted to cut that way, way
>back, guess who screamed the loudest:  the medical
>establishement.


    I happen to think $200,000 a year is way too much to pay a guy who
spends his time in the oval office being serviced by student interns.
How about $30,000?  Probably the shift manager can get the same kind of
thing from the underlings late at night at McDonald's, so why should
Clinton make more?   This is a guy, remember, whose bright idea it is
to blow up kids in foreign countries using million dollar disposable
robot jets originally designed to carry nuclear warheads, and now being
used to deliver little love taps of TNT, just about big enough to kill
civilians, but not much else.  This is a guy who should be cleaning out
the shake machine each night and mopping floors, not making important
decisions which cost the taxpayer more in two weeks than your entire
beloved Office of Alternative Medicine gets in a year.  On the other
hand, I really don't think I'd trust Clinton to clean out the shake
machine. I'm thinking: food poisoning.  The idea that he was going to
"fix" the health care system is what ought to make your skin crawl.
He's a real fixer, that guy.  His elevator doesn't go all the way to
the top, though, George.  He's several fries short of a Happy Meal.
You understand?   I'd rather he didn't mess with my profession.

                                       Steve

From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: sci.med,alt.activism,talk.politics.medicine
Subject: Re: Backlash against HMOs: a declaration of war (was Doctor-bashing)
Date: 16 Apr 1999 16:07:46 GMT

In <3715EF16.592E4F2E@cs.uoregon.edu> Bret Wood
<bretwood@cs.uoregon.edu> writes:

>is ludicrous because it is already essentially mandatory.
>And it appears that you agree with me.  There is no effective
>way for a consumer to apply feedback to the insurance industry.


    In this case the consumer may be a business, and you can bet that
inefficient insurance companies still disappear, since businesses do
indeed have choices.  And the individual still does business with
insurance companies in person in any ways.  Self employed, part time
employed, and people employed in many firms simultaneously (me, for
example) do this.  Blue Cross Regency Plan, remember?  Tell me where
you live, and that you can't get it.

    Yes, the government is slowly killing consumer choice.  The result
is rising prices.  It hasn't gone all the way yet.  But it's headed
there.

From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: sci.med,alt.activism,talk.politics.medicine
Subject: Re: Backlash against HMOs: a declaration of war (was Doctor-bashing)
Date: 17 Apr 1999 19:08:18 GMT

In <37186E2F.D0D6E680@cs.uoregon.edu> Bret Wood
<bretwood@cs.uoregon.edu> writes:

>"Steven B. Harris" wrote:
>>
>> In <3715EF16.592E4F2E@cs.uoregon.edu> Bret Wood
>> <bretwood@cs.uoregon.edu> writes:
>>
>> >is ludicrous because it is already essentially mandatory.
>> >And it appears that you agree with me.  There is no effective
>> >way for a consumer to apply feedback to the insurance industry.
>>
>>     In this case the consumer may be a business, and you can bet that
>> inefficient insurance companies still disappear, since businesses do
>> indeed have choices.
>
>Yep.  And the business I used to work for had the philosophy of
>"the cheapest plan which won't get us in legal trouble."  If the
>people who receive the health care don't have any effective feedback
>into the insurance plans, then the only pressure (from the stockholders
>AND the customers) is to cut every possible service.


   But there are no businesses in which each employee has less
"effective" feedback than you do, as a single citizen, to our federal
government.  No matter how big the business is, it's smaller than the
Feds.   No matter how low you are on foodchain, when you quit, your
employer is more inconvenienced, and takes more notice of the fact and
your reason, than does congress when you vote, write a letter, or make
a campaign contribution.   People who complain about "effective
feedback" in the workplace should never propose that the solution is to
have big government cure the problem.  That's just plain ludicrous.

   But there are voting coalitions and blocks and pressure groups, you
say?  Yes, and there are also employee unions.  Same argument applies.
You may be a nothing to your employer (worst case), but even so, no
matter how little you mean, you mean less to your congressperson.

From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: sci.med,alt.activism,talk.politics.medicine
Subject: Re: Backlash against HMOs: a declaration of war (was Doctor-bashing)
Date: 17 Apr 1999 20:01:54 GMT

In <7fa0tt$otl$2@fir.prod.itd.earthlink.net> kurtullman@sprintmail.com
(Kurt Ullman) writes:

>>The State of Oregon has created a small-business insurance pool system,
>>because it was too expensive for small businesses to provide insurance
>>to their employees. My wife ran a small business with 3 employees for
>>several years. She tried to provide insurance for them, but couldn't
>>afford it. We went without insurance for a while because of it. There
>>are a large number of uninsured people in the US. Do you suppose that it
>>MIGHT be because insurance is too expensive for them?
>
>        Of course. You do know that most studies show that for every added
>mandated coverage, the number of uninsured people go up.


     Yep.  The system has a way of biting back.  Unions which employers
MUST deal with by law, and minimum wage laws, make salaries go up for
those who are employed, but they also increase the number of
unemployed, since nobody wants to hire somebody they can't fire easily,
or hire for low wage on a trial basis.  In the end, the total amount of
money employees get (their TOTAL pie slice) is not changed by
government backed unions or miniumum wage laws-- it's just distibuted
differently.  Fraction of increase in productivity which goes to
workers has stayed amazingly stable thoughout this century.  The only
thing that has happened is that the gap between weathy and poor workers
has widened, mainly due to distortions induced by government.

   In the insurance industry, it's no different.  You can't make a
blanket larger by cutting some off one end and sewing it on the other.
We have high expense guys telling us about how they forced themselves
into the insurance pool, and complaining that insurance is now way too
expensive for them to buy, otherwise.  That there might be connection
between these observations completely misses them.

From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: sci.med,sci.med.cardiology,alt.activism,talk.politics.medicine
Subject: Re: Backlash against HMOs: a declaration of war (was Doctor-bashing)
Date: 23 Apr 1999 13:55:08 GMT

In <371f33bf.6056189@news-server> LTorreyXX@maine.rr.com (Larry Torrey)
writes:
>
>On Wed, 21 Apr 1999 08:56:16 -0400, rponiarski@earthlink.net (Richard
>M. Poniarski, MD) wrote:
>
>>In article <371eae55.52222619@news-server>, LTorreyXX@maine.rr.com
>>says...
>>>
>>> Well again, not exactly. Your post appears to assume that the HMO in
>>> question is both a for-profit business and publicly traded. There are
>>> many that are neither. While they too have pressures, they're not
>>> usually as starkly profit-oriented as you describe.
>>>
>>> What is your view of physician owned and operated managed care
>>> organizations?
>>>
>>> Larry
>>>
>>> * to reply via email, remove the XX from my address *
>>>
>>	I don't have to like them either, though they *appear* to be
>>somewhat better than a for-profit insurer owned company. They are less
>>likely, in my experience limited though it is, to reject claims
>>outright. They may argue a bit, as all of them do, and want more
>>information than I think they should be entitled to, but usually if it
>>is medically necessary they end up paying.
>
>Interestingly, this is the origin of a number of HMOs such as Harvard,
>Tufts, and Puget.
>
>>	All that begs the point. Physicians should not be in the business
>>just to make a profit.
>
>But regrettably, some are.  It's the same in virtually any type of
>business endeavor.



    With the difference being that where physicians are concerned, this
business of some physcians being the employers of others, hiring and
firing at whim and turn of the market, has done a lot to wreck what
once was a fair amount of fraternity in one of the last of the great
fraternal organizations.  Once upon a time within the memory of living
man, it was common for physicans to treat other physicians for free, as
professional courtesy.  Now, you start to feel lucky if as a physician
you call another physician about a patient, and they come out of the
exam room for the call.  Doctors used to treat each other with the
utmost respect and professional courtesy, since they were each
independent contractors, and depended on each other's good will and
good opinions for referals.  Now, that's hard to do when you each know
you've been hired by some human resources person not long out of
college who in turn works for an HMO, in turn run by who knows who.
Maybe some other doctors somewhere-- former radiologists or
anaesthesiologists who now have MBAs.

   Expect more from your fellow Mason.   And all you have to do for
that is learn the secret signs and wear the funny clothes for a few
hours.

                                       Steve Harris, M.D.

From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: misc.consumers,misc.consumers.frugal-living,talk.politics.medicine,
	sci.med,misc.legal
Subject: Re: Disappointed and confused--don't know what to do
Date: 24 Apr 1999 07:05:17 GMT

In <3724b7ed.18705771@news.glou1.nj.home.com> pat@meadows.pair.com (Pat
Meadows) writes:

>  Tough.  My heart bleeds for you. Try going without ANY medical care,
>as so many of our citizens are forced to do under our present system.

   Only if they want to keep significant assets.


>>As long as the HMOs are in competition with others, they still will
>>provide pretty good care.
>
>  Competition?  Horsefeathers.  Most people have no choice of HMO,
>they go with the one chosen by their employer.  Competition is
>supposed to mean that the consumer has a choice of suppliers.  This
>situation doesn't exist with regard to health insurance in the USA
>today.


    You have your choice of employers.  Far more than you have your
choice of countries if you don't like the one and only goverment
system.  You want to take a system in which people have more power to
change their HMO, and replace it with one in which they have less.
Sorry, but since the majority of people have bought insurance, they'd
be fools to do so.  For they'd spend even more money to have even less
choice in what care they get.


>   I am not eligible for either a VA or military hospital.  VA and
>military hospitals, nevertheless, are operating under our present
>money-rules-all system, and probably severely handicapped in their
>efforts to compete for employees with money-making enterprises.
>
>Pat Meadows


    ROFL!  And your proposed giant goverment-covers-all medical system
would not be?   All it would do is exploit (for a while) a few older
doctors who had invested a great deal in their profession, and were now
trapped by rules changing in mid or end game (now, that's a fair idea).
Younger people are not stupid, however, and the bite back would be
fewer doctors, and worse quality ones.  In the Soviet Union doctors
made little more than janitors and the quality showed.   If that's what
you want in this country, wouldn't it be faster and easier to move to
Sweden or New Zealand instead?  What, they won't take you?   But let me
guess, you've for open borders, too.

From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: misc.consumers,misc.consumers.frugal-living,talk.politics.medicine,
	sci.med
Subject: Re: Medical insurance Re: Disappointed and confused--don't know what 
	to do
Date: 24 Apr 1999 08:13:38 GMT

In <7fr17h$l9a$1@nntp.Stanford.EDU> dhinds@zen.stanford.edu (David
Hinds) writes:
>
>Miguel Cruz (usenet@admin.u.nu) wrote:
>>
>> You're missing Tim's point. If insurance companies are required to take
>> every death's door subscriber at the same rate as their young healthy
>> subscribers, they'd have to raise prices to keep solvent. This would
>> eventually result in no young subscribers signing up. So they'd only
>> have people in 24-hour ICU care, and in order to balance their books
>> they'd have to charge them a rate approaching the direct cost of
>> 24-hour ICU care. At which point there is no point in their existing;
>> why not just have the hospital bill you directly?
>
>I don't think this slippery-slope scenario could happen: I don't think
>there are enough of these very-sick, very-expensive patients to start
>the slide in the first place.
>
>We actually have a somewhat similar experiment already in place.
>Insurance companies currently offer insurance directly to individuals
>who qualify (giving the insurer the right to refuse known risks), and
>they also offer group plans to employers, where they must charge
>everyone the same premium.  If your suggestion were correct, then
>employer-sponsored plans should be significantly more expensive per
>person for young, healthy people than the more selective individual
>plans.  But this is not actually true.  I can get a small discount by
>enrolling directly in Kaiser in my area (since I'm a young, healthy,
>nonsmoker), versus paying for the identical plan through my employer.
>But the difference is not large: when I checked, it was on the order
>of $10 per month.
>
>-- Dave Hinds



    Remember, when you're looking a group of people with full time
jobs, you're looking at a group of fairly healthy people.  And there is
also something rather odd about the health-risks of people applying for
insurance as unemployed or self-employed individuals, even if they are
young non-smokers.  You're seeing two quite powerful group selection
effects, acting in opposite directions, offset finally by some of the
power of group-bargaining (volume discount).

From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: misc.consumers,talk.politics.medicine,sci.med,misc.legal
Subject: Re: Disappointed and confused--don't know what to do
Date: 27 Apr 1999 04:31:34 GMT

In <7g2drb$t9b@troy.la.platinum.com> bgold@platinum.com (Barry Gold)
writes:

[a nice capsule history of the way we got to this creaky mucky medical
system]

>Within a couple of years it because obvious that poor people could no
>longer afford to see the doctor.  So we got Medicaid to help the poor.
>Each of these plans had its own rules and regulations about what they
>would cover, how much they'd pay -- and what forms the doctor had to
>submit to get paid.  Of course, it was to their advantage to make
>things complicated.  If the doctor makes a mistake and the insurance
>company or Medicare sends the form back for corrections, they get to
>hold onto the money a little longer.
>
>Meanwhile, people got tired of complicated fee-for-service plans that
>required filling out a form every time you went to the doctor.  And
>even with the coverage, co-insurance and deductibles could make it
>expensive if you're old or have several children, either of which
>usually leads to a lot of visits.
>
>Enter HMOs.  (There was one HMO already around, founded by Kaiser
>Steel as a benefit for its employees.  Now other companies started
>copying the idea.)  For a fixed fee -- usually paid by your employer
>-- you get all your doctor's visits free or for a nominal fee.  All
>your drugs free.  What a great idea!  Lots of people signed up.  And
>most of the ones I talked to back then were happy.  They saved a lot
>of money.


    The other reason for those HMOs is that the paperwork necessary to
satisfy the insurance companies and Medicare noted a couple of
paragraphs before, had gone up exponentially.  Physicians offices had
to start hiring coders, accountants, compliance people for JCHAO.
Eventually regulations got so bad that private offices started
realizing they couldn't complete with larger organizations which got
better regulatory economies of scale.  HMOs were also able to swing
better prices for drugs and hospitalization, and offered some of that
as kickback on rates.  Pretty soon, small group practices found
themselves in roughly the same situation as your local pharmacy, trying
to compete with the generic chains that do it by mail. Pretty soon, new
docs found themselves working for HMOs instead of themselves.  Wups.

   So here we are.  It happened to the farmers and we didn't speak up
cause we weren't farmers, etc.  It happened to pharmacists and we
didn't speak up cause we weren't pharmacists.  The horrid thing about
medicine, though, is that it was avoidable.  Unlike pharmacy, you can't
do it by mail.  Unlike the case with automobile manufacture, the
Mexicans or the Japanese can't take your job.  There's nothing
inherently *that* cost-saving about a large group of doctors vs. a
small one, in the absense of regulation, and the absense of very
complicated insurance plans.  All of this fiasco is due to failure to
recognize that there's no free lunch, as you say, and there's blame to
go around on every side for that.  All that paperwork results from
everybody putting their money into a pot, and then everybody trying
with paperwork to recover more in services than than he put in, in
money.  Just like April 15th.   Same thing, same reason.  Like a
casino, if everyone didn't think they were special and could win at the
game, maybe we wouldn't waste the time playing it.  As it is, the house
take is killing me.

From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: sci.med
Subject: Re: Hemochromatosis NOT a zebra!   was:  Elevated Alk Phos
Date: 11 May 1999 14:30:34 GMT

In <3737C18F.553BA8AB@pacbell.net> Don Royal <droyaldc@pacbell.net>
writes:
> My
>solution?  Save your insurance money.  Pay your doc cold hard cash. If you
>don't get better care than the HMO and or ERISA guys it's time to change
>docs cuz you got a dumb one!
>
>DCR
>
><Large snippets>



  Amen.  I make some money now seeing people for cash as a supplement
to the lousy care they get from their HMOs.  That practice is growing,
and I enjoy those patients more than any.  I figure when the time comes
I can't make a living doing that, it'll be time for me to hang up the
shingle.