Beleagred Health Care Providers

I went to my physical therapist yesterday for knee treatment and we talked about the fact that Blue Cross is cutting their reimbursement to the point that the cost of providing care will not even be covered. All I could do was lament with him and listen. One insurer even told him (the owner of the business) to just "make the sessions shorter and don't give as much care." As if that is how it works..."You get little just do a little".

Clearly the insurance intermediaries, who never actually see a patient or deliver any care, haven't got a clue how this whole health thing works. They are happy with mediocre doctors that cut time and care. Those doctors (and physical therapists) run mills, but the insurance companies are happy with them. Quality and quantity of time are not rewarded, and in fact are punished in the health care environment we have.

He asked me if Primary care had any problems like that. I felt like screaming "Aren't you reading my blog?". Or more to the point...why doesn't the entire population know that access to a primary care physician will become as rare as swimming with dolphins. It will depend upon how much money you have to buy concierge/retainer medicine. Where you live will play a role. If your community has a large multispecialty clinic like Kaiser or Sutter Palo Alto Medical Group, you may have access.

Doctors in training are flooding away from general Internal Medicine, Pediatrics and Family Medicine in droves. Only 2% of medical students plan to go into primary care. It used to be over 50%. A recent Jim Lerher report discussed the reasons. We've been talking, talking, talking about it for years but things have only gotten worse, not better.

The whole premise of health care reform ensures that everyone has access to good quality care. Every nation that provides good, quality access has a strong primary care base that is the foundation. Primary care is valued by the government, the payers, the population and even by the physicians.

We have it all backward. It is time to revamp the system from the bottom up. Frankly I don't care if we get one more multimillion dollar robot to assist in a rare surgical procedure or one more new " next generation" imaging scanner until we can rationalize how we pay for care.

We have not yet begun the hard work to bring costs under control because there are too many pigs at the trough. One of my favorite teachers (you know who you are, Ed) said "you can't clear the swamp until you get the pigs out of the way".

We have a lot of pigs to move aside so more people can get to the water.


Doc kk said…
Right on! It can't be said enough and this post nails it. Thanks.
bfouskas said…
Great blog! I found this one a couple weeks ago, and when I read yours I instantly thought of this.

It speaks on how Tom Daschle, the new Secretary of Health and Human Services wants to increase Medicare payments to primary care physicians and emphasize more preventive care.
Kellie said…
This must be Antham BC. Another thing that makes me angry with them after just raising rates across the board. They force you to pay more $$ to give less care coverage. Health Ins. operates the opposite of what it was originally supposed to be used for. Love your greedy pig description, you point the whole thing out exactly how it is and what has been happening.
Dear Dr. Toni Brayer. it is great post, but i want to ask you : what do you mean "It is time to revamp the system from the bottom up." how do you plan to do that?
Republican party over the past year essentially only had one mission - derail any proposals from the Obama administration and with the loss of the senate seat held by the late Ted Kennedy has now given the Republicans the ability to filibuster any significant healthcare legislation.
i think that by now American Dream is dead as the Democrats have essentially no chance in passing any sort of healthcare reform package.

also, i read in some place that the health insurance coverage is considered luxury now by many people and Americans seems willingly accepted that fact, so now many wiill live without it.
The faces in your photo look familiar. Are they in Congress?
This comment has been removed by a blog administrator.
Anonymous said…
The answer is thus: Don't penalize a person for trying to make a living. If you have the brain power to be an MD, you should be paid for that talent. You should not be penalized or made to appear as "greedy" if you expect to be paid a good salary.
This whole idea of "spreading the wealth around" stinks. It is a self-improvement killer.
If a person wants to be a GP, let him make some money at it.

Anonymous said…
Steve, I think it is the health ins. companies are the greedy ones. Doctors don't charge you for not coming in Ins. charge everyone at the beginning of the year just because they can and want big bonus for their CEO's.
prashant said…
you point the whole thing out exactly how it is and what has been happening.

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bjmdjd said…
Dr. Brayer: I am posting this on MY blog! I've said the same thing again and again but you say it well and the folks can't hear it too often! Thanks.
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