Follow the Money (Guest Rant)
One of the reasons we dinosaurs have three feet in the tar pits is the increasing difficulty we're having making a living. Only in this country do we have de facto price controls on doctors' fees (ie, Medicare) and over which we have no control. What to do?
There's a growing rumbling about in the land. "Cash only", the rebels intone. One by one, a few docs here and there throw up their hands and bite the bullet (often to do quite well, but obviously with a different patient mix. Some of my personal reluctance to go that route stems from my sense of responsibility to my present patients. But I digress...as it appears we dinosaurs are prone to.)
How might this be accomplished more systematically? This, too, has been discussed in assorted circles, both public and private. My friend Dr. P says it well:
We ALL together DROP all insurances. We announce a D-day, nationwide. We dump tea in the harbor; taxation without representation, off with King George's head!It would only work as all-or-none, but I'm just on the edge of being ready to give it a shot.
We tell the patients that it's a new day. Forego one dinner and movie out and you can pay for your doctor visit. Payment due at time of service, unless there's real financial hardship. Hello? If you're too poor for that, we'll see you for nothing. Those of you with six-digit incomes can subsidize the difference.
Everyone buy a rock-bottom catastrophic policy for duh? insurance (what insurance is supposed to be: spreading risk of accident or severe illness, not everyday gas and oil). And sock some money into the now-allowed HSAs tax deferred. Keep your money instead of p---sing it away to "insurance" companies.
What a concept. Sound familiar? Sound retro? Sound like the rebirth of common sense? (Have you read Philip Howard's The Death of Common Sense?)
Forget about coding. It's useless for its original purpose: to collate real disease. It's useless because we have to code for the disease in order to test for it. We have to assign a code even when we haven't a clue what's wrong with the patient. No one's codes are believable anyway. They're all fudged and we know it. (Admitting is is a different story.) Hospitals fudge for highter reimbursement -- we sign and go along as we look the other way.
It's also useless for equalizing reimbursement bewteen primary care and procedures. The RBRVS was a valiant attempt, but all that emerged were armies of coding specialists who now earn more than the family doctors, and whom we now have to hire and pay. Forget about studying real Medicine: time to learn Business Management.
Everyone wants to know the way out -- this is it.
But it all depends on the public being led, step by step, to understand that this is best for them, not just for us. And it depends on our not being afraid to do it. Courage.