I really never thought about the medical errors or hospital acquired infections not being caused by physicians until you said something. See, I was mostly thinking about all the deaths that are caused by doctor’s archaic methods of writing prescriptions instead of e-scribing. But, now that you mention it, you’re probably right. Physicians hardly touch their patients or spend enough time with their patients to do too much harm.

Oh, and when I pointed out how the minimum wage has not been raised significantly in the past ten years, you replied:
“minimum wage workers don’t have employees who demand raises, ever increasing rents, IT costs, billing companies to pay, hospital previlage fees, skyrocketting liability insurance premiums, etc. So its a poor comparison.”

You are soooo right. It is an awful comparison. Poor people, who make $15,000/ year only have to worry about the cost of food and gas, where as people who make $100,000+/ year have more important things to worry about.

You sure are smart and I sure am stupid. No wonder schooling for doctors is so expensive. I know my flattery may hit too close to home for you since you said “comments made on a personal level [should be] be avoided.” But I figure you don’t mid since you made reference to my “utter and complete ignorance” just three paragraphs later.

Thanks Doctor!

Thanks.

“It is true that the AMA rated insurers on how quickly they paid and if they paid according to the agreed to schedule and Medicare was a top performer.” – I haven’t read the AMA’s survey since I don’t belong to that organisation. For more objective “ratings” of insurers I would refer the readers to Athenahealth’s website – this is open to the public and has real time data with comparison to the last year. Medicare comes nowhere close to best here.

“You didn’t answer my question about how much private insurers pay you for a certain procedure versus Medicare. You only get 50% of what you bill? That is pretty much the norm. You charge an inflated price and then Medicare and private insurers adjust for the allowable amount. Right?” – In our region, private insurers pay anywhere from -5 % to +10 % of Medicare payments. It is however critical to note that Medicare only pays 80% of “allowable” and we are required to submit additional claims either to patients or secondary carriers – this increases our cost to produce claims as well as delays payments (since Medicare almost never relays its payment information to the secondary carriers) by several weeks to months. If Medicaid is the secondary payer, we have to write it off because Medicaid never pays, so we end up with 80% of “allowable”. In contrast, most private payers pay within 14 days (compared to 30+ days with Medicare) and pay the full “alowable” amount. In this case time lost is worth more than the 5% loss in revenue, not to mention the hastle factors. Besides, each private carrier has a Rep we can contact directly in case of dispute; with Medicare, there is nobody – its probably easier to talk to God! Who decides what “inflated amount” is. I really thought you had a thinking head on your shoulders until I read this statement. Anyway, if you contract with an independent contractor for home repairs, who sets the prices? If you or the contractor does not like each other’s quote/counter-offer, each one is free to walk away from the deal. This is exactly what I was talking about when I said I may want to walk away from such a terrible deal. What’s worng with that?

“I am sure you spend a lot of time and money haggling a price” – Actually, don’t be so sure, because we don’t. Most physicians don’t have that opportunity because its always “take it or leave it” offer. Medicare and insurance just set their rates without any link to actual costs of providing care. There is no “haggling”, which is why the entire insurance/Medicare is a system of official price fixing and does not reflect true capitalism. If physicians were able to offer their services for a fair price, patients would be able to decide what a physician’s service would be worth for him/her, so that true competition would help good practioners thrive and poorly functioning ones would be eliminated from the marketplace. In the current rigged system, you get paid the same lousy amount irrespective of the qulaity of service you would provide. Its like you pay the same for either a Ford or a Cadillac – would such a thing ever occur in other businesses/industries?

“why don’t physicians charge every patient one fair price, not one inflated price that can be adjusted by some, but not for others” – This is where you show your utter and complete ignorance. We are required by law to charge everybody the same (our standard fee schedule) – this is exactly what happens. But insurers and Medicare only pay what they choose to pay (under the guise of “allowables”) whereas a self-pay patient has to pay the full amount. I sure hoped you should have known that it is illegal for us to charge less for self pay patients.

“If you give so much charity care and love it ,than why would a 10% cut hurt you so much offend your conscience so greatly?” – The reason is that when I choose to give charity care, it is of my own free will, not forced down my throat by the government or anybody else. Charity done under coersion is called slavery. I thought this was abolished a while ago.

“And I believe that the American people have gone about ten years with out a hike in minimum wage.” – You believe incorrectly, my friend. Please get your facts straight. I wonder if the blog editors would verify this for us. Besides, minimum wage workers don’t have employees who demand raises, ever increasing rents, IT costs, billing companies to pay, hospital previlage fees, skyrocketting liability insurance premiums, etc. So its a poor comparison.

Finally, please stop repeating the AMA’s words, because you won’t find any traction with physicians – most don’t belong to it and don’t consider it to represent them. FYI, hospital-acquired infections and errors have multiple causes, physicians being only a tiny component of it. Instead of making sound bites, I suggest you do some reading about these topics – I have already spent years researching and educating those concerned about such matters. And I clean my stethoscope more often than you would care to know, so let’s get back to the topic. I hope that you finally understand why I characterise your beliefs as myths and that you will soon come to realise the validity of my arguments.

If you give so much charity care and love it ,than why would a 10% cut hurt you so much offend your conscience so greatly? And I believe that the American people have gone about ten years with out a hike in minimum wage.

Its odd to see the president of the AMA on “Washington Journal” say that she has never seen physicians so galvanized by anything, as the automatic pay cuts, when 100,000 people die every year because of medical errors and hospital acquired infections. I would think that such an alarming rate of iatrogenic deaths would be of more concern. Oh, and one more question when the last time you cleaned your stethoscope?

By the way, the Senate did us a great favor by holding Medicare payments at last year’s level. This means that Medicare payments stay at 2001 level (since it has not changed since 2001). How many bonuses and salary increases have you had since 2001, I wonder. May be you should consider a pay freeze for 7 years to appropriately understand our situation…I suggest you get your facts straight before submitting your myths in writing. BTW I have never had a BMW even after 14 years in practice, if it makes you any happier…