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Lives of Doctor Wives: Resistance is futile

Wednesday, March 24, 2010

Resistance is futile

I can't take it anymore. I've tried to resist talking about this in a public forum, but I can't help it.

What does your DrH think about the new healthcare legislation? I'm really interested to hear if any of your husbands have decided to change specialties or retire all together because of it. Or if they are thrilled and planning on expanding their business? Or, is it just a matter of being annoyed with it, but it isn't going to change anything?

I find that most of the people I discuss this with are only concerned about the people receiving the care and have no concern for how this will be effecting the doctors.

I know this is a hot button topic, and I'm hoping we can play nice about this. I just want an open discussion among people whose livelihoods depend on this.




Blogger Camilla said...

My husband and I hate it. I think the legislation is unsustainable. Here's why:
-it assumes that all 38 million of the uninsured in the U.S. are actively seeking insurance. . .the numbers I've read are that number is closer to 12 million (these are the people who've had coverage dropped or denied care for preexisting conditions). The other 26 million (38-12) are already being seen for their medical conditions in clinics and E.R.'s. The care they seek is already being covered by the system. Incidentally, my husband does not see these people actually going through the hoops to qualify for Medicaid or other insurance. They will continue to go to the E.R. or Instacares. They do not make enough money to even have to pay a fine if they don't carry insurance. And what about all the illegal immigrants who seek their care in ER's? This legislation does nothing for them.
-This legislation poses a 20% cut in medicare reimbursement to doctors and hospitals in order to help pay for the ininsured. Contrary to popular belief, hospitals and doctors are not clearing heavy bonuses. And now they are supposed to be excited about all the new people who will be on the rolls? A hospital has to be making enough money to keep the lights on and the doors open. . . more patients with less money coming in--you do the math.
-This legislation forces every American to purchase something whether they want it or not. This is a dangerous precedent, even if it is in the name of the common good.
-This legislation ignores TORT reform. Ask any doctor if this is a huge oversight, and they will agree. I've read many articles recently that defensive medicine costs are going up. How can doctors and hospitals practice smart, efficient, cost-saving medicine when every decision they make has the ability to be scrutinized by a jury?
-This legislation forces companies to offer insurance to employees (minus small businesses-- read up on it). Not that I don't think that is a good idea, but as a business owner if I am forced to purchase insurance, that means I'm not hiring new workers or not giving raises.
--If a person is no longer able to be denied coverage based on pre-existing conditions, why not pay a fine till I get really sick??? Then the insurance company has to take me on and my expensive costs are passed on to others who actually carry insurance in the form of higher premiums and deductibles. As premiums and dedctibles rise, I'm sure I'll think twice about dropping insurance as long as I know I can can join back on when I get really sick.
-This bill is not actually deficit-neutral. The taxes start next year, but the benefits don't start for 4 years. This was a tricky device employed by the drafters to make the bill appear like it is saving the country money. In the long run, it won't. We all know you can't get something for nothing. . . .
-This bill doesn't do anything to fix the SGR index (reimbursement scale for physicians). This means medicare/medicaid reimburements have the capacity to drop even farther than they already will.
-This bill grows government and is an entitlement program. No, I don't think it is right for a company to drop coverage on you once you are sick or deny you coverage because you have pre-existing conditions-- but those things could have been legislated without all this other crap.
-Whenever you tell people they are entitled to something, it paralyzes them to want to earn it for themselves. In the name of charity, you are actually doing more harm than good in the long run.

March 24, 2010 at 11:36 PM  
Blogger SDW said...

We do not agree with the bill.
I heard this and think it sums things up pretty nicely:

1. You cannot bring about prosperity by discouraging thrift.
2. You cannot strengthen the weak by weakening the strong
3. You cannot help the poor man by destroying the rich.
4. You cannot further the brotherhood of man by inciting class hatred.
5. You cannot build character and courage by taking away man's initiative and independence.
6. You cannot help small men by tearing down big men.
7. You cannot lift the wage earner by pulling down the wage payer.
8. You cannot keep out of trouble by spending more than your income.
9. You cannot establish security on borrowed money.
10 You cannot help men permanently by doing for them what they will not do for themselves.

William J. H. Boetcker

March 25, 2010 at 12:00 AM  
Blogger Laura said...

Thank you ladies! You said that much more eloquently than I could have.

March 25, 2010 at 8:40 AM  
Blogger Carol said...

I am not for this bill either, which is kind of strange considering I was born and raised in Canada. :) While living there, the system was wonderful - how could it not be, I was young and healthy - and when I moved to the US after I married my resident husband, it was really hard to adjust to thinking about health care in terms of whether or not I could afford it. But the more I've learned about what doctors have to deal with, the more I see the down side of this kind of health care in terms of how it treats the providers of our health care. I don't know all the facts, all I know is that I will hate to see my husband, who works so hard and hardly complains, finally make it through all these years of training, of putting others before himself, while holding onto the belief that it will all be worth it in the end, only to find out that it wasn't.

March 25, 2010 at 9:24 AM  
Blogger EthidiumBromide said...

My husband -- and 16 of his 18 fellow residents in his program -- all support the bill. While they acknowledge that there are many faults with it, they all agree it is a step in the right direction, and in the richest country in the world, they believe we should be able to guarantee a minimum level of medical care for people (basic, primary care, not the ER care they can already receive).

March 25, 2010 at 9:52 AM  
Blogger Heather said...

Well said EthidiumBromide. My med student husband and I both support the legislation too. Like you said, it's not perfect, but a step in the right direction.

March 25, 2010 at 10:03 AM  
Blogger Aly said...

I have also tried to avoid talking about this because people just feel SO strongly and get all riled up so easily :) but I WILL say that you are absolutely right in that I have heard nothing on all of the news shows, commentary, etc about how this will impact the men & women who actually provide the healthcare! It's unreal. I honestly believe that this is because unless you are a physician, or living with one, or know one well, you just have NO idea what they go through to enter this profession. It's been discussed time and time again, but the average person has no concept of how much time and work it really takes to get them through this process, how much debt is incurred throughout medical school, how long it takes them to get to a point where they're making "doctor money" (and hi, when they're at the point, ever stop to wonder what malpractice insurance runs these days??)...people have no clue - they truly think that doctors just get insanely wealthy doing this job. They have no idea that we are short on doctors as it is, and they are overworked to say the least. To me, THAT is the most frustrating part about this whole thing.

March 25, 2010 at 10:05 AM  
Blogger Hi, I'm Ginny said...

While I know I am not the most educated person on this topic because I have not read they bill nor do ANY of us know EXACTLY what is coming from this bill, I'm worried about what this is going to do the quality of care we currently receive.

My husband, a 4th year medical student, has spent a lot of time in the E.R. this past year. One thing he always brings up when talking about the uninsured is he would like to take a poll to see what the uninsured are actually spending money on. He sees them come in with iPhones, iPods, etc. Frankly, health insurance is not top of priority to some of these people, just like Camilla said her husband doesn't see a lot of these uninsured making an effort to take care of what is currently offered.

Yes, something needs to be done. TORT reform is a MUST! I grew up around medicine. My father is a physician and my mother was a practicing physical therapist for ten years. Diminished reimbursements to physicians from this bill and INCREASED MALPRACTICE PREMIUMS are going to kill OB/GYNS and surgeons. We need good OB/GYNS, but if they can't afford to stay in practice because of malpractice premiums due to lawsuits who is going to deliver our babies?

My husband will make on average $10.80 per hour while working his 80 hour work week during his five years of residency. We will have $200,000 worth of loans to pay back from medical school. After residency, he will have to build a practice AND pay back loans. It will be years before we see any financial reward from his service. I think many physicians, especially primary care, will leave their own practices and consolidate into larger practices. They will be forced to see a higher number of patients (less time with doctor=less attention to individual patient) because there won't be as many physicians. Smart college graduates will choose other career areas other than medicine. The return on their investment (M.D. or D.O. degree) will not be worth it. They can make more, have more time at home with family and have less debt going into something other than medicine. It is a shame. We already have a physician shortage in Oklahoma...glad we are trying to fix that problem.

I want to help people. I feel horrible for people that have horror stories about being sick and not being able to afford care. I think what is happening now though completely neglects to take into account what these changes will do to the brilliant men and women that provide all of us quality care. It neglects to make sure the QUALITY of our care will remain supreme. I want to be able to call my doctor and get in the next day if I have a problem. I don't want to wait months for testing.

I'm a big believer in if you work hard you get rewarded. I do not believe in handouts. I believe in helping people who want to help themselves. I do not want to be required to pay (with taxes) for others who do not help themselves. It may sound harsh, but I work hard to provide for MY family. To make sure MY children will be taken care of. I am livid that my tax dollars may help fund abortions. A woman has right to choose, but I should have a right to choose if I help PAY for that choice.

Here are a link that breakdowns some stuff in "lay" terms that no one is talking about. Some has changed, I know, but take a look anyway:



I guess the best we can do is try to educate ourselves. I'm sure there are good things that will come of this. Hopefully we will all be pleasantly surprised. I think it is a shame though when the majority of the country is against something that Congress went against our wishes. For the people, right?

March 25, 2010 at 12:00 PM  
Blogger melissa said...

thanks so much for bringing this up. also, thanks to everyone for keeping it polite. this is such a polarizing subject. I too am against obamacare, and so is my dr. h. he probably isn't quite so passionately against it as I am though :) it's a very scary thing to me, but I need to say that for those who are for it, I do feel a little comfort in knowing others appreciate it. I hope that makes sense. I also want to stick in my two cents... for those who agree with it because it is a step in the right direction, please just remember that one step forward doesn't make up for the five steps backward. healthcare absolutely needs reform, I think we all agree on that. my biggest concern is that it doesn't at all involve the voice of the american people. there are so many special interest groups in washington whose voices seem to be a much bigger priority than our own. I can't offer bribes or perks to our government officials, I just wish that my voice could be heard, there were days where our representatives actaully represented us, and I truly believe that if this were the case now, we'd see a bill that makes sense and benefits all. not just some.

March 26, 2010 at 10:35 PM  
Blogger MW said...

DH goes back and forth on this topic, as do I.

I'm not particularly concerned about doctor salaries as they are such a minuscule portion of hospital operating budgets. Also, if push comes to shove, this current bill doesn't prohibit doctors from working for cash.

Tort reform is sticky. Every doctor thinks it's necessary, but most doctors don't really know that much about the law. Speaking with lawyers (not the ones who have anything to lose with tort reform), I'm not sure that's as necessary as some would have us belief.

What really bothers me about this bill is that it requires citizens to purchase a product. That is dangerous territory and unconstitutional. I realize that's the only way to assure that people will simply not pay while healthy and then sign up when sick, but I think that just means we need to be searching for new solutions altogether.

Anyway, I'm really concerned about small businesses as well. Sure there's an exemption if your payroll costs are under something like $400k/year, but when you look at industries like manufacturing, there are a lot of small businesses that are over that cap. I have a friend in Ohio whose dad is barely breaking even as now, mostly staying in business so that his employees can keep their jobs. They will have to go out of business with this bill.

As with most legislation, the intentions are good. I don't want my fellow citizens going bankrupt because of medical bills! I wish there was an affordable option for my brother who works an $8/hr temp job with no benefits. But people need to look at the unintended consequences this bill could have:
*companies going out of business, and thus increased unemployment
*shortage of primary care doctors
*decreased innovation
*decreased quality of care
*bloated federal government

This is not about scare tactics or over-reacting. It's about prudence. Careful consideration. Both sides have been fighting against each other instead of working with each other and what we got was crap with a side of crap.

Reform is necessary, but I think this bill is a bad one. I agree with SDW's post.

March 27, 2010 at 9:34 AM  
Blogger Kathi the wingspouse said...

My husband advises hospitals and physician groups on how to maintain quality, stay competitive, pay out what is fair, and get reasonably reimbursed. He has beensifting through all of the "summaries" of the new legislation to process what he needs to address. What he found was that none of the summaries were comprehensive enough. He is now reading the actual bill, page by page and learning just how much it will affect medical care providers. Tell your MDH's to stay on top of things and don't do business as usual.

On a more personal note, all of my sons iare considering becoming physicians. My youngest who is 13 has watched the news every day and is now quite outspoken about how the bill is forcing him to reconsider his career choice. He's afraid he won't be able to afford the loans if his pay isn't adequate. How sad. My middle son doesn't want to know anything about politics, so he isn't affected. My oldest is graduating this year and has changed directions from becoming a plastic surgeon to becoming a physician assistant - something the gov't will likely be using a lot of in place of MDs.

Did I mention this month we decided to begin building our Costa Rica home since CR offers free health care even to expats? Medical tourism is likely to become a popular thing, if any of you want to be our neighbors (wink).

March 27, 2010 at 8:55 PM  
Blogger Kathi the wingspouse said...

Article worth the read. Has an interesting perspective on physician compensation and isn't a rant.
Unintended Consequences http://zikkir.com/health/85539

March 29, 2010 at 12:04 PM  
Anonymous Anonymous said...

It's such a complicated issue. My DrH is so-so about it. He's been trying so hard to follow it even with the long hours he works. He mentioned that he does not think that the reimbursement cuts are going to fly with physicians, because they already receive such a tiny percentage of what they charge to medicare.

I'm skeptical/positive towards the legislation. Although a lot of it seems unsustainable, so does our current health care system. I'm glad someone is at least trying to do something. At this point I'm crossing my fingers it will be better than nothing.

March 29, 2010 at 2:17 PM  
Blogger TheFamousStacie said...

A step in the right direction...?

Once I remember a friend and I talking out on the school yard.

We turned to walk together toward where our mothers would be picking us up.

In her haste she took a big step in the direction of her mother's car.

She didn't look down to see that she was stepping into a deep hole that had been left uncovered.

Right in front of me I saw her leg snap in half.

My point being: a step in the right direction doesn't do much good if you step in a hole and break your leg.

March 29, 2010 at 5:27 PM  
Blogger Camilla said...

TORT reform is important becuase of defensive medicine costs that are increasing every year. Once you've been in a lawsuit-the hassles, the costs of defending yourself (even if it is frivilous) you will make medical decisions with the thought of how your decisions will be percieved by a judge.

A gallup study of physicians concluded that they estimate 26% of healthcare costs are driven by defensive medicine. 73% of physicians surveyed said they had practiced some form of defensive meicine in the last 12 months. Here's the link: http://www.jacksonhealthcare.com/online-media-room/press-releases/gallup-defensive-medicine-release.aspx

March 29, 2010 at 10:53 PM  
Blogger Beba said...

Keeping fingers crossed and hoping it will be better than nothing???!!!

The $200,000 ++ investment in a career as a physician deserves more consideration that keeping ones fingers crossed and the apathy that goes along with it.

It is not always better to do "something" just to do it, or to get a spot in the history books. You would be hard pressed to find a medical professional who doesn't think the healthcare system needs reform, but agrees with the current legislation. The young medical students who support this bill may not yet fully understand the implications of this type of legislation on a practice.

April 8, 2010 at 2:21 PM  
Blogger Liz said...

My uncle, who is an ER physician, recommended last week that my husband, who is almost PGY2, go back to school - PA school (physician assistant) - because of the health care bill.

In reality, though, it is so complex. It is hard to predict the actual changes it will have. A lot of the effects of the bill will not be seen for years and years. I liked Camilla's points though. It is too bad that so many people will potentially suffer when the insurance and drug companies will continue business as usual.

April 9, 2010 at 1:37 AM  

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