I respect your service history, and have followed your blog, but perhaps your experience in the military has not been representitive of a clinician in private practice. You say “There is a problem with our health insurance and our healthcare billing, but not so much with our healthcare delivery We’re doing pretty good medicine here in America…”

While I agree that overall, there IS a big problem with the way most physicians are forced to deliver care. The problem is that the majority of MD’s in the US practice medicine very defensively, which increases costs exponentially. My wife (an internist) often describes the rationale behind her needing to order tests she knows will come back negative, but orders them none-the-less because on the slight chance there is a poor outcome, the lawyers will jump all over her.

She’s never been sued, but she’s seen her partners loose significant office time over frivolous lawsuits brought by patients families. You know, their multi-organ failure demented father whose life could have been extended by a month if not for this *error*. Sadly, a case can be made that settling the lawsuit is cheaper in the long run because of lost productivity in the office due to wasted time in court defending a meritless claim which was not dismissed pretrial.

In my opinion, tort reform is an absolute requirement for any rational health care reform effort in this country.

Are there bad doctors, sure, and do we need to protect patients? of course, but the threat of lawsuit is a significant factor in the exponential increase in health care costs.

(full disclosure, as mentioned, my wife is an internist in private practice, and I work in clinical research in the pharmaceutical industry).

We will soon have fewer doctors and nurses if this plan is put into action without some serious overhaul. Doctors and nurses want patients to get well and most refuse to shortcut care. This plan will tie our hands and result in a reduction of quality of care. Without tort reform, doctors can expect more lawsuits for not doing enough for their patients even though the feds say it’s okay.

My back surgery would not have been approved. My weight alone would have been enough for them to deny me. (Oh, go lose weight, you say? Without the surgery, exercise wasn’t an option because, well…there were times when I couldn’t even walk. So, explain to me how this would benefit me to be denied surgery and live a life in extreme pain at a relatively youngish age. Explain this to my children. Explain this to everyone else who would have to pay for me to be on welfare, food stamps, be put up in public housing. Someone always pays.) My mom’s upcoming surgery would not be approved under the new plan because she has more than two comorbidities. She’s 74, but she’s a vibrant 74. Take away her ability to walk or to get around independently and what do you have? A shell of a woman. And dare I say that your own father’s care would have been much different a few years ago if we had this new plan in place. (I know, not fair…but it is…because that’s how the plan works — everyone is equal, right?)

Regarding Dr. Chako’s statement: He’s 100% right.

Regarding Julia’s explanation of the cost of medication in the hospital: she left out the cost of us nurses knowing if the medication is the right medication for the right patient, in the right dose, given the right way at the right time, etc.

It’s so easy to complain about what’s wrong and demand something different, but it’s another thing completely to just hand over a very complex system to a bunch of people who don’t know a thing about it and hope they can fix it. For doctors and nurses, it’s an insult to the time and effort we put into education and the time and effort we put into the care we provide.

Plus, remember, chicks dig the drop-top.

But I’m happy to hear more of your strawmen…

I agree CJ! The military SUCKS! They can’t do anything right!

Yawn. Tired arguments make me sleepy.

You could have saved a ton of money had you just skipped the circumcision altogether. It’s not a “mandatory” surgical procedure. Plus, your kid would have probably been a lot happier that day! Many hospitals are no longer performing them and only about half of the boys get them now so for the next baby, you don’t have to get him the snippity-snip (I didn’t have my newborn circed fwiw)!

About the meds – I hear people, including my own family, complain about the cost of drugs in the hospital. It’s true they cost a small fortune but you’re paying for more than just the drug. You’re also paying for the pharmacist, the pharmacy tech who ordered and retrieved that med, the TON of legal paper trail the hospital has to keep to prevent drugs getting stolen or traded, the lock-boxes and alarms the hospital pharmacy has to keep for the drugs, the lawyers who review the pharmacy paperwork, the insurance the hospital has to carry in case the pharmacist actually gives you the wrong med or dose, etc., etc. etc.
So…if you keep all that in mind, a $7 aspirin makes sense. $166 for a tube of ointment still seems pretty high. Maybe your kiddo convinced them to overcharge as a payback for his procedure??? Not sure but congratulations on the new baby!

Still think Congress’s plan will be better?

I’d suggest not drinking before hand. Then, again the prices might actually seem sane to after a handle of SoCo.

While a $166 tube of neosporin may seem like a neccessity (sp?) in an accounting sense to defer some costs of hospital general operations, perhaps there needs to be an overhaul to bring those cost in line with any other place of business. Its akin to paying $9 for a pack of smokes in say an airport, but the gas station three blocks away has them for $3.

The only problem is, you’re not paying a premium on the place of business or having the freedom of walking a few more blocks to save a couple of bucks, its more like “here’s your choice, pay the $166 or enjoy some flesh-eating bacteria around those nether-parts”.

We’re all about choices in this country, lets hope the choice between paying for overpriced ointment and a shriveled dick or amputation never has to be considered and the fine doctors/nurses in this country get their dues for their hard work to learn these skills without having to resort to loan-shark type mark up.

Somewhere there’s a happy medium, I wish I smart enough to figure it out.