The Right Man for Healing and a Rare Find

Hippocrates of the Hippocratic Oath

I was not sure my ENT specialist was a good fit for me even though I read the glowing praises framed on his office walls, praises coming from his patients, colleagues, and other doctors. The young man seemed to know what he was doing but his bedside manner was brief and rather cold.

I attributed his demeanor to his introverted personality, his professionalism, and to his respect for his patients’ time. Very punctual, he very seldom made anybody wait to see him, he was always on time.

One day I realized that he was much more caring on the inside than he let people see. A young woman with her mom and a three-year old in tow had an appointment to see the doctor. The receptionist, Lupe, asked her if she was prepared to pay for that day’s visit. The young woman had a grief-stricken look on her face and wondered how much the visit was going to be. The receptionist told her that she did not know because each patient was different, depending on the problem. The prospective patient replied in a sad and disappointed voice that she will reschedule until such a time that she would have enough cash on hand to pay for the visit.

Lupe kindly explained that her insurance, Obamacare, had a huge deductible, and unless she met this deductible for the year, it will not pay the doctor anything. She offered to ask the physician, left the young woman waiting, and returned to tell her that the good doctor will see her anyway.

I decided then that this man was the right person to see in an ENT medical emergency or a problem requiring a caring specialist. His humanity, in addition to his medical professionalism, punctuality, and his education in the U.S., made him, in my opinion, an exceptional doctor, a rare find.

At the other end of the spectrum was the endocrinologist’s office in Fairfax who told me, they are no longer taking any new Medicare patients, just the already established ones who were in transition to Medicare. The receptionist’s explanation was that Medicare does not allow their patients to be seen every three to six months as needed.

I was told previously by a doctor friend that Medicare made low and very slow reimbursements to physicians because of Obamacare; therefore I did not believe the office’s explanation. Personally, I would not want to be seen by a doctor who put her profit motive above the care for a patient, any patient.

But I pressed on. What if I paid in cash, could I then see the doctor? The answer was again no because, she said, they had a contract with Medicare and thus could not accept cash payment.

Having read the pertinent section of the law, I knew this was part of the Affordable Care Act as well, the euphemistically named piece of legislation Obama’s administration and Nancy Pelosi’s Congress forced down middle class America in the middle of the night, “pass the bill to find out what’s in it.”

We did find out all right, and we did not like the price we had to pay for it in order that the Democrat Party could unilaterally force an entire nation, one fifth of the economy, to become a socialized medicine nightmare for decades to come.

More insultingly, members of Congress have their own subsidized and separate health care insurance and can see whatever doctors they wish to see.

It used to be the case in America once when patients could pay cash for doctors’ visits and the fees were affordable. But that gradually changed thanks to modifications in health insurance, new cafeteria health insurance plans, in-network and out-of-network type of employer insurance, and health savings accounts that disappeared at the end of the year if unused.

If you lost your job or quit, the insurance terminated, and you were at the mercy of Cobra insurance for a while, at confiscatory monthly premiums, but nothing as expensive as Obamacare premiums today that can easily exceed a family’s mortgage and car payments combined.

Lack of insurance portability across state lines had always been a problem for Americans seeking affordable insurance. Aggressive law suits against doctors and medical malpractice awards by the courts, forced doctors to drastically buy more and more expensive malpractice insurance, making care more expensive for the average patient who did have insurance. The infamous $50 aspirin in a hospital setting was legendary.

As a student without insurance in the early 1980s, I paid $10 cash per visit to my children’s pediatrician. Once we could afford and bought insurance, each visit was $85. The pediatrician made a comfortable living, had a thriving practice, but he was certainly not a millionaire.

If you ask most doctors today what they spend a good portion of resources and time, it is not patient face to face care time but electronic documentation, record keeping, and staff to handle insurance justifications and payments – bureaucracy.

Primary medical care, day-to-day healthcare, is now provided by a general practitioner, a family physician, a gerontology, pediatric, or family nurse practitioner, a physician assistant, a registered nurse, and even a pharmacist who coordinate and triage specialist care that a patient may need.

Secondary and tertiary care is harder to find as physicians are cutting their losses and focusing on accepting private insurance rather than Medicare and Medicaid.

We are headed to a single payer socialized medical insurance which will limit doctor visits and access to procedures based on rationed care. The entity that will hold the key to your ability to pay for and receive medical care when you need it will be the federal government, the same bloated, out of control entity that spent your Social Security lock-box savings and has doubled the national debt in eight years of the Obama’s administration.

How Obamacare is Destroying our Health Care

Romanian hospital 2014
Photo courtesy: Digi24 on line

Virginia is one of the few states in the nation who has taken the bold step to automatically enroll all Virginians covered by the traditional Medicare/Medicaid plan into a Humana managed health care plan. By managing elderly care (read rationing), money will be saved by denying needed medical tests, surgery, care, and physical therapy to elderly Americans who have paid into Medicare/Medicaid for decades.  How else will millions of illegal aliens recently granted amnesty by executive action receive free ObamaCare?

There is an option to opt out of the Humana managed care in Virginia and return to the traditional Medicare/Medicaid plans but few patients understand the language in the letter or are able to read it for themselves. This is one of the veiled moves to strip Medicare of $719 billion dollars in order to help fund and support the (Un) Affordable Care Act.

If you like your rationing of care, you can keep your rationing of care. If you like the loss of your well-trained physician, you can keep your third world doctor who is yet to be licensed in this country.

If you enrolled in a plan that fit your budget and your medical needs last year, the Centers for Medicare and Medicaid Services (CMS) has proposed the rule to strip that option from your list of choices, they are going to enroll you this year by December 25 into a cheaper plan of their choice. Too bad you forgot to choose a plan annually. They will select what is best for you, without knowing your medical history, your financial situation, your current treatment under a specialist, and maybe take away access to your favorite doctor who did not play by the new government rules.

When the open enrollment ends, the government would have effectively stuck you with a plan you did not want. Rep. Mark Meadows from North Carolina wrote, “I sent a letter to CMS demanding they immediately strip this provision from the pending rule and abandon any future attempts to single-handedly choose Americans’ healthcare plans.” I am sure the bureaucrats will listen, just like they listened when a majority of Americans asked them to defund ObamaCare. http://www.washingtontimes.com/news/2014/dec/19/rep-mark-meadows-obamacares-christmas-surprise/

Because there is a “war on doctors,” as Dick Morris so aptly described it, we will eventually have a sort of CastroCare in this country that Americans are not prepared to deal with but will be forced to accept it.

The double reimbursement for procedures that doctors in a hospital setting receive when compared to doctors in private practice, will eventually regulate doctors into a 8-4 hospital employment which I witnessed recently when my mother was in a hospital for 8 days and I never saw the doctor visit her once, she was treated by a nurse practitioner the entire time. There was not much hands-on care, just robotic, computer-driven medical care delivered by inadequately trained people. They were more concerned about her falling out of bed and a lawsuit from a potential fall than anything else. She was discharged without a proper diagnosis.

The forced electronic medical records-keeping will make it more difficult and expensive for private practice physicians who would be forced to spend a large part of their day on record-keeping and data entry instead of treating the patient.

In addition to reducing doctors’ income, physicians retiring early because they do not want to practice government-regulated medicine, Congress won’t expand residency programs to train more doctors.

Residency programs are funded by Medicaid/Medicare which gives higher reimbursement rates to teaching hospitals. Since the government refuses to pay for more residency programs, Americans should prepare themselves for substandard care delivered by nurse practitioners, nurses’ aides, and ER treatment replacing high quality medical care.

Hospitals are busy buying up private practices of retiring doctors in order to “capture their patients.” Most physicians are busy forming Accountable Care Organizations (ACOs) which combine multiple care providers under a hospital umbrella which has better access to capital.

This will lead to a doctor passing the care of his/her patients after the end of the shift to someone less qualified whom the patient has never met.

I recall the EU-modeled socialized medical care in 2012 Romania where I saw no doctor or RN anywhere in the large hospital in which my uncle was a patient. His wife delivered all his care, meds, diabetic shots, bandage changes, bed linens, bathing, towels, food, and trash removal. She was the de facto medical person caring for her own husband who would otherwise die of medical neglect in one of the largest hospitals in the capital. Incidentally, the courtyard was littered with stray dogs and we had to pay 5 euros to the gate guard to gain access into the hospital with five dingy floors and no operational elevator.

Online magazine Digi24 reported on December 17, 2014 that patients’ rights are often trampled on by medical personnel who refuse medical services unless the patients offer them personal benefits in the form of bribes. The accompanying photograph published by Digi24 is visual confirmation of the unsanitary conditions in some socialized medicine hospitals. http://www.digi24.ro/Stiri/Digi24/Actualitate/Sanatate/Ministerul+Sanatatii+intreaba+pacientii+Cat+de+multumiti+sunteti

According to Zoel M. Zinberg, associate clinical professor of surgery at Mount Sinai Hospital in New York City, “The new breed of physician-employees will split their allegiances between their employers and their patients.” The employer’s goals of making money and saving a buck every which way and the patient’s welfare will not coincide, and the physician will seldom be allowed to use his best judgment in treating a patient. He continued, “Salaried employees and independent professionals behave differently.” http://www.city-journal.org/2014/eon1218jz.html#.VJO-l_vj7J4.facebook

Dr. Zinberg cited a recent study in Health Affairs which found that …”practices owned by hospitals had 50 percent more preventable admissions than practices owned by physicians.” He concluded that “The days of the family physician who made house calls are long gone. The doctors who would squeeze you in for a visit on short notice and take your calls after regular business hours are disappearing.” http://content.healthaffairs.org/content/33/9/1680

The less discussed issue of economic side effects of the Affordable Care Act should not be overlooked. Casey Mulligan, professor of Economics at the University of Chicago, in his speech
delivered to Hillsdale College on October 24, 2014, explained the three taxes in ACA, two taxes on full-employment and one on income. All three combined have a net effect on employment (3 percent less) and on Gross Domestic Product (2 percent less).  He concluded, “If you like your weak economy, you can keep your weak economy.”