Gyroscopic Investing

I've worked with hundreds of physicians and surgeons in a previous life in medical device sales and consulting.  I would say the vast majority of them would put the burden of our government (medicare/medicaid) and trial lawyers right up there with insurance carriers as the biggest problem with medicine.

When you combine

Megacorps (insurance and most hospital groups) + government bureaucrats + trial lawyers + people who are quick to blame doctors when there is the slightest error or problem....

You have the makings of a system that virtually no one is happy with, but often times for different reasons.

clacy wrote: I've worked with hundreds of physicians and surgeons in a previous life in medical device sales and consulting.  I would say the vast majority of them would put the burden of our government (medicare/medicaid) and trail lawyers right up there with insurance carriers as the biggest problem with medicine.

When you combine

Megacorps (insurance and most hospital groups) + government bureaucrats + trail lawyers + people who are quick to blame doctors when there is the slightest error or problem....

You have the makings of a system that virtually no one is happy with, but often times for different reasons.

I have known many physicians who joined the Air Force simply to minimize the extraneous problems you mention even though it costs them in salary. 

OK, read the article.  It's a rather limited viewpoint that boils down to "please be my psychologist as well as doctor".  Some doctors can do that, others can't and that's just life.  Similarly, hospitals are not spas and never will be.  They're for treating people too sick to stay home, not the "worried well."

The badness that can result from doctors having to rush through appointments is a valid point.  When you spend more time with patients you pick up simple things you might have missed in a flying 30 second interview.  Like just yesterday...encountered a patient who was crushing extended-release pills, and then complaining that they made him sleepy.  Problem solved quite easily and for essentially zero cost (switched to cheaper non-timed-release version).

That particular problem is caused by the current care system rewarding procedures while devaluing office visits - a problem that long predates the Obama era.  The increased paperwork burden and pressure to bring in more and yet more $$ exacerbates it further but isn't the primary cause.

It would help if people didn't equate surgery with medical care.  Whenever you see medical shows on TV it's always the operating room that's featured, even when the subject in question is an infectious disease where the OR has no place in care.  I thought it was funny, but it most certainly contributes to the devaluation of medical (non-surgical) care.

Could this be a good sign for the cost of healthcare?

Every day low prices?

http://www.marketwatch.com/story/wal-ma ... =afterbell

And I guess the question I should ask is who do you think would be more likely to actually deliver on the promise of affordable care - Walmart or the USG?

But I'm guessing the USG will find a way to shut this down if it goes too far?

That is awesome...I can see people getting high deductible plans and then paying cash for the occasional office visit.  Totally sensible!

They have managed to avoid some of the traditional expenses like getting preauthorizations for tests and answering patient calls after hours.  Still, if they had to go the EHR/PQRI/CMS billing route since they do take traditional Medicare, that still has to be a pretty slim profit margin.  It sounds like they figure they'll make money not from the clinic, but from the fact that people have to walk through their store to get there, and probably will get medications from the pharmacy.  Incidentally, they use NPs not MDs.  I have zero problem with NPs for primary care.  There's nothing that goes on in a PMD's office that a good NP can't handle.

The USG might not shut this down but the AMA is trying to (not them specifically but all the store-associated clinics).  They're arguing conflict of interest since they will sell patients any drugs prescribed through their pharmacy.

Just one more reason why I refuse to join the AMA :-)

clacy wrote: I've worked with hundreds of physicians and surgeons in a previous life in medical device sales and consulting.  I would say the vast majority of them would put the burden of our government (medicare/medicaid) and trial lawyers right up there with insurance carriers as the biggest problem with medicine.

When you combine

Megacorps (insurance and most hospital groups) + government bureaucrats + trial lawyers + people who are quick to blame doctors when there is the slightest error or problem....

You have the makings of a system that virtually no one is happy with, but often times for different reasons.

Oh the irony of this thread and the Ebola thread comments in juxtaposition. 

... Mountaineer