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Is there a "Medical Mafia"?
Personally I feel that the responsibility of finding a "good" doctor that you are comfortable with and trust is ultimately the patient's responsibility. Like anything else in the free market, you need to shop around and ask questions. The problem is that doing so is cost-prohibitive, and some folks are forced to play the hand they are dealt.

Also, what's with doctors giving referrals? Are they best buddies? Does one get kickbacks from the other?

I agree that prices for services need to be published. Why is it that the doctor's office can't tell you how much something costs, and all they care about is scanning your insurance card? Why is it that I have to wait until after my insurance company processes a claim for me to find out what the doctor is billing and what my costs will be? And why is it that insurance rejects a large portion of the doctor's bill as "overcharge?" Is it that the doctor padded the amount? What's the real price? Presumably what insurance allows is the real price, but then why do they charge different (higher) rates to uninsured people?

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Archangel, that is simply not my experience. It may be so in your town, but certainly not in the bulk of the US and not over here at all.

Yes, collegiality is very important in our field (in what field isn't it?) but there is a medical board in every state, and sooner or later bad doctors are carpeted by it. I have seen it myself several times both during my time in the US and here.

Considering how Americans are willing to sue at the drop of a hat (and is one thing that pushes medical costs through the roof, BTW, due to the massive malpractice insurances medical professionals in the US must carry), I doubt that dangerous doctors can stay in practice for very long unless there is an "old boy's network" in the justice system that helps them out. My experience is that for the most part, the bad ones don't manage to stay on for long.

Laser eye surgery is licensed differently the US than over here - you don't have to be a board certified ophthalmic surgeon to perform it in the US and that will lead to all sorts of abuses. Personally, I wouldn't have it done anyway, since there is a growing body of evidence of negative side effects as one ages, but that is another debate for another time. I assume no one ever filed an official complaint with the state licensing board against said eye-cutter?
(06-23-2013, 08:15 AM)DocWils Wrote: If the US adopted the Swiss system, for instance, there would be little opposition, as the insurance companies would not lose their patents.
Switzerland Has Its Own Kind of Obamacare — and Loves It

The country requires everyone to purchase private health insurance, a system that seems to work efficiently while keeping costs under control.

Read more: http://nation.time.com/2012/08/16/health...z2X4xrwYpZ


I am not sure what your question about referrals is all about - much of the US practices the gatekeeper concept - your GP screens you before sending you to a specialist so that the specialists aren't overburdened with cases that really have no call seeing them. HMOs in the US practice closed shops, meaning that the referrals are to other doctors in that HMO scheme, although there are insurance companies that practice open referral policies, meaning the gp can refer to any specialist who will take the patient. I am unaware of kickbacks - I have never been asked for any and have never paid any. Sometimes specialists and gps know each other socially, but the bulk are either in the same insurance plan and are therefore on a list of permitted doctors or are, like here, often practising in the same neighbourhood or are known to the referring gp. I tend to send people to specialists that I know to have a good reputation, and avoid sending them to ones I either don't know or have heard that they don't know their fibula from their ileotrochanter. And trust me, word DOES get around.

Publishing service charges is a nice idea, but then the doctors have to do flat rate charges, and most insurance schemes in the US (and here)don't like that idea, nor do most doctors. A law passed last year here putting hospital surgeries under flat rate charges has shown to be financially disastrous for many hospitals - although it keeps insurance costs down a bit, there is always unexpected costs, and the hospital has to eat them, which means the Kantons (states) have to cover the costs for the overages, and that means the tax payers are covering it.

The tax-point system we employ here is pretty strait forward and simplifies the billing system a bit. But even then it doesn't always work so well, as you run into situations all the time that fall between one tax-point and another, and that means you either over or undercharge for a procedure, even if it is only a few franks. A good example would be the basic exam time: the first five minutes is a flat rate of 60 franks (set by the government, not us or the insurance companies, btw), and then there are two additional five minute flat rate tax points, after which you charge by the minute. All fine and dandy when your patient takes 17 minutes to treat. But if they take 7 minutes? Or 12 minutes? Do you charge only the first tax point for the first case or two tax points? In the second case do you do three tax-points or two? Are you under charging or overcharging? While it may seem simple to you, I assure you it is not - and we are a bit hamstrung by "official" guidelines in that respect, too. Now, we have time and again suggested to the health minister to change it so that we can charge either by the minute after the first 5 minutes or by the 5 minute period, but there are civil servants advising him that that would be a bad thing and would lead to abuse of the system, although I suspect there are more abusing the system the current way than we know of. I am the generous type and tend to round down if they are only a minute or two over. My secretary is not happy with me for that.

Unlike pharmacies, most doctors don't have card on the wall explaining the charges for a bandage or whatever. It is counter productive and most times would be rendered useless by the problem at hand. And how would we explain the nuisance tax-point (yes, we have that too, thank the gods!)? we all have our fair share of nuisance cases and time wasters and but-inners here, mostly because we DON'T have the gatekeeper concept here, nor HMOs (the Swiss people overwhelmingly rejected a proposed government mandated HMO scheme here last year in one of our quarterly plebiscites (we vote on just about everything at least four times a year at all levels of government - Switzerland is one of the few true democracies on the planet (and no, the US isn't one - it is a Republic) and so we get to busy body into everything all the time here))). I do think there should be in the US a basic flat rate for the first 5 minutes, just like here, and yes, you could publish that, but a list of fees for disimpacting a bowel or whatever? Really? No, I don't see that as workable. We do too many different things to patients to make that a viable idea. For big things, I do give cost estimates to patients, to give them an idea of what they might be getting into, or more often to discourage them from getting into it if at all possible (you would be surprised how many come it wanting an MRI for pretty much nothing worth putting under the Torus, until I make it clear that they will have to lay out 900 franks for it, and even then if they are well insured, they'll do it anyway). But for, say, cancer patients, there is no way I can give an estimate, since there are far too many factors involved to work out ahead of time what it will cost them for anything during their treatment arc. Medicine is a very flexible thing, and no two patients are alike in their needs or costs. Flat rates would be possibly ruinous for many practices.
A government that forces each and every citizen to purchase a product (health care insurance) is bordering on criminal, IMHO. I should have freedom to choose, or not to choose to be insured. And this requirement is not the same as the requirement to purchase auto insurance - that requirement is there to protect other people from the damage an auto driver can potentially cause. People can opt-out of purchasing auto insurance by using other means of transportation. People can't opt of out "being alive", which starting in the U.S. soon, will be taxed under the new health care system.

Never thought I'd see the day that this nation taxed me simply for being alive.

I'm libertarian and Constitutionalist in my beliefs - I currently can't afford health insurance, and I will not be forced at gunpoint to purchase it. Neither will I pay a "penalty tax" for my refusal to purchase insurance. They will have to put me in prison first or forcibly take my property under the color of "law" to pay for it. Either way, I don't give in to criminals - whether they be street thugs or government paper-pushers.

Off-topic a bit, I realize. Just my opinions - feel free to go back on topic, please. But I do believe that any "Medical Mafia" will only be expanded with socialized health care - more paper-pushers ain't gonna help the system at all.

Yeah, I like to tilting at windmills from time to time. Not much I can do about all this mess, but I do get to complain about it here at least.

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Actually, what is being referred to here as the Medical Mafia would be killed under socialised healthcare, but I take your point - the biggest reason for socialised medicine is LESS paper pushing, not more - I waste more time filling out insurance forms for thirty or so different insurance companies, and that drives my costs up and takes away time I could give to patients - if I had to deal with only a single insurer, I could cut that time by 70%, and so could all other doctors and hospitals here, saving immense amounts of money and time, all which ultimately would make medicine cheaper and improve healthcare here. But it WOULD put a lot of paper pushers out of work.
(06-23-2013, 06:35 PM)DocWils Wrote: - the biggest reason for socialised medicine is LESS paper pushing, not more - I waste more time filling out insurance forms for thirty or so different insurance companies, and that drives my costs up and takes away time I could give to patients - if I had to deal with only a single insurer, I could cut that time by 70%, and so could all other doctors and hospitals here, saving immense amounts of money and time, all which ultimately would make medicine cheaper and improve healthcare here. But it WOULD put a lot of paper pushers out of work.

Putting the government in charge always decreases paperwork. There's nothing government hates more than bloated burocracies. Yessiree...the government would get this whole mess streamlined and simplified (or "simplificated" for all the G.W. fans).
@DocWils - Please don't take offense to the analogy I am about to give as I hold doctors in high regard, but it's the best way I can get my point across at the moment. When we here in the US are looking for a contractor to do some work, be it a plumber, electrician, or whatever, we ask for work estimates. It's understood that an estimate is just that, and actual costs will vary depending on circumstances. Why can't medicine work this way?

I'm not asking for flat rates per se (your point is well taken), but going back to my original question: why don't they tell you what something might cost? Interesting that you mentioned MRIs because I myself had to see a neurologist once. Getting an MRI was discussed as an option, but when I asked how much it would cost I was not given an answer. I was told "it depends" and the doctor said he really couldn't tell. Why should I have to jump through obstacles and navigate through hospital bureaucracy to find an answer... at least an estimate or a "ball-park" amount? How is one to know what his out-of-pocket costs will be, even with insurance?

I once had an X-Ray of my shin because I had developed shin splints. They billed over $800 to the insurance company for the x-ray. Of course they did not discuss that with me first (to be fair, at the time I didn't care because my employer was providing excellent insurance) but really? $800 to take a picture? I understand the equipment is expensive but surely it doesn't take $800 a pop to amortize its cost over its service life. I don't think the technician makes several hundred dollars an hour. Maybe a hospital fee for usage of the room? I was only in there for a few minutes. You see the charges are both hidden from us, and exorbitant. It just appears as a line item after insurance has processed the claim and SURPRISE... you now owe 20% of $800 on top of your premiums.

I'm sorry I wasn't clear about my referrals question; I wasn't meaning referrals as required by HMO plans. I have a PPO which gives me the flexibility to see whoever I want (assuming they accept me as a patient) without a GP referral. I have had instances where doctors try to push me into seeing someone that they know or recommend (coincidentally within the same practice or hospital system). They will often times try to schedule a visit on my behalf. Case in point: my sleep study. The referring doctor didn't say "Hey, paptillian, I want you to get a sleep study and see me again." What she did was order a sleep study from the hospital where she works with a doctor that she chose. Granted, it worked out, but it's the principal of it. I probably could have declined if I wanted to, but the point is I wasn't asked. They try to keep the money in their own little circle.

I'll add that socialized healthcare doesn't always get patients priority or quality treatment. I have relatives overseas in Greece that have to pay the doctor under the table to be seen. They call it giving "fakelakia" or "envelopes." The envelope contains bribe money to get you service today vs. 2 months from now (or possibly never). People have died due to doctor apathy and older people are often neglected and left for dead. You won't read about it on Wikipedia most likely, but I know it's true from first-hand experience and accounts of others. You can even search "fakelakia" on Google. Corruption is extremely pervasive everywhere in that society but especially in hospitals. If the system worked, then maybe that wouldn't be the case. Anyway, we're headed in that direction.
In the US a lot of Dr's hire intern technicians that get paid close to nothing. This further increases the profit line.

"With ordinary talent and extraordinary perseverance, all things are attainable." - Thomas Foxwell Buxton


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I think Paptillian summarized well. It is all about corruption and not so much the issue of medical care being based in capitalist or socialist foundations.

Whatever system is used it MUST be transparent and subject to oversight.
There must also a structure in place to make bad things happen to those who would defraud or practice shoddy techniques. (malpractice)

But then...I am waxing idealism again.

Right now the best policy is to be wary and watch your six.

Sad but true...

"With ordinary talent and extraordinary perseverance, all things are attainable." - Thomas Foxwell Buxton


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