With reference to President Obama's possible overuse: All presidents and other US government oficials-the VP, the leaders of both houses-nobody wants to see all the successors in line die or be immobilized in case they need to to replace the President should he expire in office. Much ado is made (PR for our benefit) about how healthy presidents are with their annual 'inspections' of practically every organ in his body.

Dr. Harris, I could not agree with you more. Those to whom you refer are a phenominally huge sector of the people who contribute to '...excessive tx and or dx testing,. They are in the same line with the prescription drug addicts who read books to determine symptoms that are somewhat nebulous, but will get them visits to one doctor or another who will unknowingly feed the addiction. I volunteer and see more than a few people like these-It is a shame.

The Health Care Reform impetus is not about the people above, who are likely very well insured, or able to pay outright for these tests on their own. Their only contribution is the hitherto unexplained 'overuse' which is being used to bludgeon the HCR bills to a gory death.

An aside: If insurance companies continue to throw people out because of pre-existing conditions or choose to not renew a sick person's policy, what they will be left with is this very large group of patients who demand the expensive services or will pay anything for what they want. That would make the continued exclusion of medically needy families the objects of discimination.

It would be a crime to allow 'true statistics' to be used to give the lie to an honorable legislative effort. These people who will be the benefactors of said legislation are families and couples who have been priced out of the market in the 90's and into this decade. Ironically, they are the most in need of service simply because of the trends in modern medicine.

I, for one, appreciate you speaking on the issue. Thank you very much.

Dave, is a fear of being sued also a factor in the number of tests that are run? That's always been my theory as to why so many tests are performed.

Tell this article to breast cancer survivors. If it weren't for early detection from this "evil defensive medicine practice," many women likely wouldn't be survivors. Unless you have a different and cheaper way for early detection, don't complain defensive medicine practices.

Both Greg and the doc have points, but I have to go more with the doc on this one. Yes breast cancer screanings should be heeded has well has self checks for lumps. However people who "have" health insurance often times demand every test imgainable and every treatment imaginable becuse it's free to them. It means people like me who don't have health insurance have to pick up the extra tab, and it also means that when I have to seek treatment for something I have to wait for some hypercondrict getting is 5th cancer screaning this month. It adds to the helath care, I wish that helath insurance would only cover the major stuff and that a lot more would come out of patience pocket. It would lower cost and stop this BS.

I think about this a lot. There are such huge contrasts within my own family. Some, that have reliable health care, go to the doctor for EVERYTHING. Like it's some value they are going to lose if they don't get sick and go. Seriously, I can count the times on one hand we have taken our kids to the Dr over the past 20 years. Some of my extended family members take their kids what seems like every other week.

I had a very old friend (80+) tell me once. If they look for it, they'll find it. Speaking of why he didn't go to Doctors.

looks like the health tax bill will pass.. insurance is already paving the ground for conditioning the sheep to get less for what they MUST pay for..

1. Lawyers sue right and left, with the hope and expectation of having an untrained jury decide that their client suffered because a doctor did not order a test. Happens all the time. This is the defensive medicine which probably accounts for 25% of the health care dollar, in addition to the 2% of the dollar in legal expenses and "malpractice" awards.
2. That virtual colonoscopy Obama had? That is the most modern procedure to screen for colon cance and polyps. But: The program of which Obama is the CEO, Medicare, has stated that it will not pay for this procedure. It is not approved. This is health care rationing that Obama and Congress now already do. If Obama had Medicare, or nationalized health care, he would not be able to get this procedure...nowhere. If you are covered now by Medicare, you cannot go to a doctor or facility (radiology) and even pay for it out of pocket.
Since Obama is part of some government insurance, did he pay for the colonoscopy out of pocket? His alternative would have been to have the tube stuck up his you know what, as everyone else covered by his plan has to do.

Dave, I agree with you and I'm not a doctor. A good friend of mine is one of those "worried well" people. Frankly, she's a hypochondriac. She requests (demands) that her doctors order one test after another, even though she has never indicated she has experienced symptoms that would raise suspicion. Instead, she bases her requests on health issues her siblings have had or are currently experiencing.

I do believe, however, that many physicians do practice "defensive medicine" because there are folks out there just waiting to sue over a missed or misdiagnosis. The insurance industry, which used to say no to many of these more expensive exams, now go along because they fear being named in litigation. However, I've noticed that the insurance I have through my employer now charges a co-pay for exams such as endoscopies and colonoscopies.

Nobody thinks this might be a "cost-cutting benefit" of Obamacare?

Guess who gets to decide whether you have five cancer screenings in one month, under Obamacare. NOT YOU! EVEN IF YOU PAY OUT OF POCKET!

The GOVERMENT decides what's best for you!

They'll let you know what tests you want depending on your sex, age, income, and overall worthiness.

Having just undergone a series of tests, I can say my doctor ordered them to rule out any other possible health concerns. Now the tests have concluded it was exactly what I thought it was to begin with. I didn't want these tests, he did. While I have insurance, there is a deductible to be met, and then I'm responsible for a percentage of these costs. It is anything but free! As a single parent struggling to make ends meet, this will hurt financially. What aggravates me is that the hospitals will accept a greatly reduced payment from the insurance companies, calling it usual and customary. Yet, If I didn't have insurance, those same discounts would not be given.

The Colonel-964761

Obama's exam included prostate cancer screening and a virtual colonoscopy.

A colonoscopy was definitely needed to determine how far Obama had his head stuck up his a$$.

And to determine if Reid's and Pelosi's noses were still lodged up in there.

Didn't take long for this to be turned into an Obama bashing forum, but coming from "The Colonel" should it be a surprise? The "Colonel" hahaha.

That aside, this clearly shows one of the many causes of our current out-of-control health care system. There are many hands in the disfunction of the sytem from the patient to the provider to the insurers and regulators. While reform as currently proposed is not acceptable to many, me included, I don't know how anyone can feel that the current system isn't seriously flawed.

As firmly as I am against Obamacare -

This phenomenon is one of the reasons health care costs are so high, and that is especially true for seniors. One good thing that could come out this whole wasted year, even if the stupid bill passes, is an understanding among people that the quanitity of health care they demand DIRECTLY impacts the costs for everyone.

Anecdotally, do you know that Medicare pays for routine tests like CBCs once a month - whether they're NEEDED or not? So what do some doctors do? Order monthly CBCs. Why? To demonstrate the need, because if there is no need, they loose the funds. I'm researching this more, after my father mentioned it to me - he recently became eligible for Medicare.

People go to the doctor too damn much, period. They demand a pill for everything, a procedure for everything - and there is an enormous amount of defensive medicine. I've been saying this for 13 years, since I was pregnant with my first child - which was really my first encounter with the medical establishment of any duration. They wanted to test me for every thing they could possibly think of, and I refused because I had NO symptoms. Every time I refused a test, I had to sign away my right to sue them.

If people are going for tests they don't need, their insurance pays - and raises rates. It's really simple. We have to stop consuming health care like we consume latte.

This all about preparing us for what is to come. A lot less availability or access to quality care. There are, in fact, too many tests and procedures done, primarily because doctors and hospitals WILL BE SUED if they don't do them and something turns out unfortunate.. Democrats in bed with the Trial Lawyers..

Buckle your seat belts America.. you're about to be screwed from both ends.

Tort Reform would reduce over testing. Is it the fact that so many of our representatives are lawyers or funded by them that this reform is not addressed?

Absolutely needajob. Why would anyone with questionable scruples to begin with want to bite the hands that feed them?

I have seen the repeated use of the phrase "demanded testing." Where do you folks live??? We can't "demand" anything around here, unless it is to refuse a test or treatment. Whether we have insurance or not. Additionally, most of the testing in the article is routine testing. There are times when testing is not routine and are quite necessary, expensive, yet necessary.

Lets see here, I am almost 35 now....

I remember less then 10 years ago, that Drs were screaming about early detection and saving lives. There was a direct correlation between surviving cancer and finding it before it is too late.

Fast forward a few years.. Drs are now saying that you do NOT have to have regular screenings. Colon, prostate, and breast screenings are not needed as much.

I call 100 percent BS on articles like this. I pay for insurance.. I will use it for screening. I am not going to go overboard and get 3 screenings a year, but I see nothing wrong with once a year. I will tell my wife to keep getting her yearly pap screenings and mamograms.

I am not going to say for fact that all of this is a precurser to limmited health care due to money problems, but I wouldnt be suprised if it was a foundation for why NOT to do the screenings.

another way lawyers have ruined the world. doctors do too much testing to cover their arse, and it doesn't hurt that they can bill more to the insurance co. had this happen to me recently, in the end it was nothing, but not until after some expensive and painful testing by a doctor I now refer to as dr mengele.

...and I would venture a strong reason why a lot of this is done is CYA in case of law suits... So why isn't tort reform part of the current bill? No reasonable answer from Obama or Congressional Democrats pushing the spending spree...

It is because of that fine upstanding young man- JOHN EDWARDS (lying sack of crap) that there are so many cesarean sections, he sued over cerebral palsy, so now doctors are afraid to let nature take it's course, afraid to be sued. Thanks John, you POS.

Not only many of the preventive medicals procedures and tests can be called into question, many medical treatments that are very common also have dubious benefits. Heart bypasses and stents for example have been shown in medical research not to extend life significantly, while at the same time they are very expensive and have severe negative side effects. People who recieve these extreme surgical procedures to treat heart disease often help the circulatiory problem in the short term, but seriously degrade the quality of life of the patient in the long term because strokes and TIAs degrade mental function in the long term. I have also heard that for people with certain alergies to the materials used in stents, stents can cause inflammation and make the patient's circulatory problems worse. If the treatments are as bad as the disease, it is really hard to justify the risks of the tests that are used to justify the treatments. I think that we should focus far more on improving comfort and quality of life for patients. Perhaps instead of doing as many heartbypasses and other surgeries for heart disease, we should treat the pain of these diseases with medications instead of surgical procedures. Then we could free up resources that up to now have be unavailable for "elective" hip replacement surguries that can improve the quality of a patient's life significantly. Until we can overcome the problems of senile dementia and Alzheimers we should quit trying to extend life indefinitely and focus on improving mobility and mental fuction in order to improve the quality of life.

So why isn't tort reform part of the current bill? No reasonable answer from Obama or Congressional Democrats

One of the MAJOR problems I have with the proposed bill as I understand it.

No tort reform + no addressing ILLEGAL IMMIGRANTS' abuse of the system = no support for anything close to the current bogus health care "reform" proposal from me!!

Like prescribing antibiotics for a viral infection?

So, is it faith and works, just works, or just faith? A federal law should decide once and for all time.

And, you don't need a middle man to pray to God. You can pray anytime, any place.

This may sound callous, but highway engineers routinely use a lives saved/cost analysis in designing or repairing highways, and they actually have a cost figure for each estimated life saved that limits how much they should spend on improvements. Theoretically, they could prevent perhaps a majority of traffic deaths by spending a lot more money - but then they would have fewer roads to handle the traffic - It's a "Value to society" approach to cost analysis.

We could probably do something similar in the medical profession - They do it in socialized medicine countries - that's why many people don't qualify for expensive treatments in Europe.

Some people would call them "Death Panels", and from a certain perspective, they are correct, but how much sense would it make to give a new heart, or liver, to a 95 year old invalid or an alcoholic?

OK, HERE'S THE REAL POOP ON ALL THIS.

Is it doctors practicing defensive medicine?

Yes.

Or are patients so accustomed to a culture of medical technology that they insist on extensive tests and treatments?

Yes.

Doctors also often order tests or procedures to protect themselves against lawsuits — so-called defensive medicine — and also because the fee-for-service system compensates them for it, said Dr. Gilbert Welch, a Dartmouth University internist and health outcomes researcher.

The only way a doctor gets compensated for testing is IF he owns the testing facility. This is frowned upon in the medical community as a conflict of interest. Does it occur? Yes. Not all doctors are totally Hypocratical.

Traig has had many costly high-tech tests, including an MRI and several heart-imaging tests, for symptoms that turned out to be nothing. She thinks doctors were right to order those tests, but that counseling could have prevented her from "wasting resources" and getting tests it turned out she didn't need.

BULLS**T!!!!

Ms Traig can espouse all the virtues she wants AFTER she had her MRI and heart tests (probably a stress test, MUGA, angiogram, heart cath or all the above) and found everything to be OK!

Now, if she didn't have some or all those tests and she had a medical event that those tests could have prevented or cured she'd be calling 1-800 LAW-YERS faster than you can say SUE 'EM!!!!!

It never ceases to amaze me how anyone can denounce a test that may diagnose a disease and as soon as the results are negative they start screaming it wasn't necessary. Tell that to the 38 year old woman with no family history of breast cancer that feels a small lump in her breast that she doesn't need a mammogram or ultrasound or biopsy or probably all the above to rule out cancer. Sure, it's probably a cyst, but you tell her to go to sleep each night NOT knowing if it is a cyst or cancer.

Everything in life is easier after the fact.

First of all let me say thank you to all the doctors, you literally save lives each and every day. Coming to the over testing part, though some patients pressure the doctor for extra screening because they are paranoid, it also comes down to the doctors who can't take a few more minutes in their schedule to sit down and talk to the patient.

Everything stems down to the lack of time on the Physician and the lack of trust in the doctor from the patient. It takes my PCP 40 mins (from the time of the appointment) to see me, who spends around 5 - 10 mins to diagnose me. Most of the time I tell her the symptoms and she screens and agrees with me and prescribes medicine. Sometimes I feel like I should be able to call her and tell her the symptoms so she can fax the prescription to the pharmacy saving both of us time.

Some doctors are condescending on their patients, which at times might seem judgemental to the point where I don't think I want to trust the doctor. Long gone are the days where doctors engage with the patients, they seem to be in a hurry to see the next patient. At times I feel like this has become more of a business, if you keep the patient sick there is always flow of income.

I still believe in medicine and the importance of doctors but I haven't found one doctor in the last 3 years I trust. I don't think most doctors are out there to treat patients the "BEST", they are out there to "TREAT THEM". If it takes me over 2 weeks to get an appointment to see a doctor my symptoms might have worsened or gotten better and the doctor no longer has a clear understanding of what my symptoms were when they first occured, this leads to speculative treatment as opposed to required treatment. No wonder america is becoming sick one day at a time because PCP is becoming a rarity becaues there isn't much money there. I laugh because majority of the people don't even make half of what a PCP makes. The oath should be rephrased to fit the times, its no longer a service they do to communities, they do it because they get paid.

"Defensive medicine
Doctors also often order tests or procedures to protect themselves against lawsuits — so-called defensive medicine — and also because the fee-for-service system compensates them for it, said Dr. Gilbert Welch, a Dartmouth University internist and health outcomes researcher."

Someone pointed out that many years ago, the ratio of attorneys to doctors was 1:1. Now, I am told, the ratio is 4:1, with the largest growth in plaintiff attorneys who will readily sue any doctor for a missed diagnosis or even a good-faith misinterpretation of symptoms.

Not all doctors are geniuses like Dr. Gregory House on TV. Most are very well-educated, trained and conscientious in the performance of their duties. Lawsuits, however, are abundant, whether deserved or not, and now cause annual malpractice premiums for many specialists of $100,000 a year.....or more !

Attorneys now actively SEEK VICTIMS because everyone they can convince to become "a victim" is a potential GOLD MINE..........because of contingent fees. Thus we have an explosion of TV advertising by plaintiff attorneys. Thus, doctors order more tests, to cover their butts for 20/20 hindsight, and they charge a lot more than they used to charge because of their increased operating costs.

This my friends, is one significant reason why medical costs are escalating so rapidly. Whether anyone wants to admit it or not, TORT REFORM IS NEEDED to reduce costs.

Lawyers advertise encouraging people to contact them to bring legal action against anyone they can to hit a big payday. If providers don't run tests and their patient develops an unforeseen condition the gates are open for legal action. Do they go after the doctor or the government?

Connie,

Its really quite simple, your doctor ordered those tests to rule out all possibilities, no matter how unlikely. It is called CYA (cover your a**). If he/she did not order those tests and something ended up being wrong, the doc could have been sued by you. Sorry, but your doctor cares more about his career and being able to provide for his family then your deductible payments.

USARouge,

Your exactly right about compensation. In the hospital setting, the doctor does not get paid for ordering tests. This would be a kickback and we all know kickbacks are illegal.

It really does come down to unrealistic patient expectations as others have said. They think some miracle pill will cure 30 years of smoking/drinking/obesity. Patients want the doctor to see them at any time but also want the doctor to spend at least 30 minutes with them. Sorry but you can't have it both ways. They want to be able to sue the doctor over any bad outcome/missed diagnosis but yet they complain when they have to undergo excessive testing. Once again, can't have it both ways, doctors aren't miracle workers they are human beings.

Stand up, speak out Didn't take long for this to be turned into an Obama bashing forum,

You didn't like that? I was surprised nobody beat me to it.

It's great if you want to bash on the President Colonel but it fails to recognize the fact that inept and corrupt politicians of both parties have contributed to the current broken health care system. I oppose the current proposals aimed at health care "reform" because they fail to address the problems,not because I oppose real reform.

Fred G. from N.C. but it fails to recognize the fact that inept and corrupt politicians of both parties have contributed to the current broken health care system.

Trust me. I don't think that fact is lost on ANYBODY here.

I'm not sure what kinds of tests people are talking about, but it probably runs the gamut. I can tell you this: The scenario where a seemingly healthy patient comes into a doctor's office complaining of one thing or another, the doc doesn't order a test, then a condition develops is very hard to prove up in court. If you look at actual cases, most of the the big jury awards come from screwing up a surgery or other procedure. The "doc missed the diagnosis" attack is a tough hill to climb and tends to occur most often in an ER, not a primary's office. Don't get me wrong, it happens, but not that often.

All I know is if this bill isn't something Congress or their families are going to use, then there is something wrong with it.

I'm on board with those that say doctors are covering their backsides with tests.

This all has to do with Malpractice Insurance. Either Doctors cover their arse or get sued. And yes, again the Insurance Corporations are involved up the arse in the Medical Profession. And guess who has more Lawyers (individuals nope, Insurance Corporations yes). So as long as the conflict of interest (profits as a Business, including Non Profits to pay payroll, leases, etc.) Insurance Corporations are involved with the Medical Profession you will have Medical Professionals that realize that they are in a non profitable career, meaning less Doctors; Doctors will only do Medical Procedures/Treatments that are approved by the Insurance Corporations or the Insurance Corporations will jack up their Malpractice Insurance, meaning dead patients and hippocrites as Doctors (cannot fulfill the Hippocratic Oath or if they do, then they go bankrupt or have their Malpractice Insurance revoked by the Insurance Corporations (cannot practice)).

And as previously posted with the proposed Bill being about Insurance Corporations NOT the Medical Profession (Health Care) as payback for Campaign Contributions from:

***************************************************
THE PRESIDENT'S PROPOSAL February 22, 2010

Page 10. Like the drug industry, the health insurance industry stands to gain as more Americans get coverage.

Page 10. The medical device industry also stands to gain from expanding health insurance coverage.

Page 9. Both policies will result in new revenue for the pharmaceutical industry.

President Obama on Face the Nation, September 20, 2009:

Obama: No, the difference is that they're making huge profits on it, Bob. I mean, let's take the Medicare HMO programs that are being run by insurance companies. It's estimated by everybody that they're overcharging by about 14 percent. This amounts to about $177 billion over 10 years. About $17 billion a year, $18 billion a year. That's just going to pad their profits, hasn't been shown to make Medicare recipients any healthier. And in fact because those huge subsidies are going to insurance companies, Medicare recipients are not getting a good deal. Now if we are enforcing what should be the rules around Medicare and making sure the people are getting a bang for the buck, it's not going to be possible for insurance companies to simply pass on those costs to Medicare recipients because ultimately it's Uncle Sam that's paying for those services anyway.

(do you know who "Uncle Sam" is, that's right all US Taxpayers).

AGAIN THE REAL HEALTH CARE REFORM is to get the Insurance Corporations out of the Medical Profession. With the known Result:

Decreases cost 80% (last part of video, 1:40) by Doctor David Ores, New York.1:45

http://www.cbsnews.com/video/watch/?id=5247963n&tag=contentMain;contentBody

If you think this is not payback for Campaign Contributions (reason for Manditory more suckers for Insurance Corporations or go to jail):

House speaker will keep money from 'villains'

http://www.msnbc.msn.com/id/32237227/ns/politics-cq_politics

And:

The Price Tag Of Politics

http://www.cbsnews.com/video/watch/?id=6228712n&tag=related;photovideo

Sorry, Politicians' Dance Cards Are Full

http://www.cbsnews.com/stories/2010/02/21/ftn/main6228685.shtml?tag=cbsnewsTwoColUpperPromoArea

Not even considered is what Congress gets for $42 per month: Unlimited irregardless of cost per Medical Treatment at USN Bethesda (Senator Kennedy) or USA Walter Reed (VP Cheney). These treatments are not even available to US Military Veterans. Special Facilities (whole hospital wing) for US Congress, VP and President.

*******************************************************

arizonafirst

Correction: Read the play. What Shakespeare said was if you want tyranny, the first thing you do is kill all the lawyers. It was intended as a compliment to the profession. Again, you have to actually read the play to know this.

The Colonel-964761
You didn't like that? I was surprised nobody beat me to it.

No, it's just that it's of no value in regards to this forum.

The "Colonel" haha

Bobby Skuller,

You hit on a lot of problems but look at it from the docs perspective for a second. You have to wait 40 minutes for a 5-10 minute appointment. However, imagine if your PCP stayed with each patient for 30 minutes instead of 10 minutes. How long would you have to wait then? Definitely more then 40 minutes. It would also take you much longer then 2 weeks to get into the office because the patient turnover would be much lower.

Obviously many people make less then 1/2 of what the PCP makes. PCP are reimbursed by the number of patients they see, not the time spent with them. Lets do a little math and stick with the example above where your PCP spends 30 minutes with you instead of 10. Further lets say your PCP works 11 hours a day, 5 days a week, for a total of 55 hours, about the average.

With an average of a 10 minute visit, your PCP sees 330 patients a week versus an average of 110 patients a week. If your PCP starts to see 110 patients a week, their revenues will be 1/3 of what they will get seeing 330 patients a week. Average PCP income (different from revenue) is around $150,000 (a little fun fact, nurse anesthetist's average income is around $146,000 with much less training, schooling etc). Lets say revenues of around $250,000 minus around $100,000 for overhead equals income of $150,000 for seeing 330 patients a week for the entire year.

Now lets look at what happens when your PCP sees 110 patients a week (30 minutes per patient). Revenues will be 1/3 of what they used to be which equals $83,333 and overhead will still be $100,000. This is a loss of $17,000. Your PCP's income will be negative $17,000. Sorry but this won't pay back the student loans or the mortage etc. now will it? Your PCP would have to work 165 hours a week to keep their income at $150,000. Either way, your PCP needs an above average income to be able to pay off $150,000 + in student debt.

I hope you now see why your allotted so little time with your PCP. It really comes down to the way PCPs are reimbursed. If they were instead reimbursed not by how many patients they see but some combination of number of patients they see and time spent with them, there would be less of a problem.

Lastly (sorry for such a long post and math), you make a good point about the condescending tone many doctors have. I really think this comes from a number of places. 1- Many doctors see every patient as a potential lawsuit and in many cases rightfully so. 2- The overall brutal nature of the training. Myself and most of my classmates came into school excited and couldn't wait to start saving lives. We were hit with a dose of reality very quickly and all of us have lost that attitude for a multitude of reasons (I still like medicine and what I am doing but I am not looking fowrad to residency). Anways, one thing is clear, doctors don't trust their patients for good reason and patients don't trust their doctors for good reason. Obviously this has to change.

BusinesstoMed

You're way understating revenues. But your point is still correct. Compensation should be based on outcomes, not volume.

Either way your income will equal your revenues minus your expenses. If a PCP's income is, on average, $150,000, then their revenues must be $150,000 greater then their expenses. In other words, if I way underestimated their revenues then I also way underestimated their expenses. Is this correct? Definitely a good possiblitly I am completely missing something here (long week).

To those of you who are questioning why tort reform is not part of the bill, I say yeah, right.

Laws are written by lawyers to benefit lawyers. And tort reform does not benefit lawyers.

Doctors perform unnecessary tests because when a money hungry patient sues the lawyers will ask why was this test not performed?

While many patients also demand routine tests, they're often bolstered by advertisements, medical information online — and by doctors, too, Welch said.

Marketing is a major problem with drug and insurance companies trying to sell thier products....? Send insurance companies packing and down the road...

BusinesstoMed

A PCP's income depends largely on two things. First, geography. Second, whether or not he/she owns a share of a practice. Setting aside the first point, if a practice is owned, the income number goes way up. I do not weep for doctors, even PCPs, in terms of their income. $150k of student debt is nothing. I know social workers that have that much after 4 years of undergrad and 2 years of grad school. I'm not saying that was a wise decision on their part, merely that you can bear the burden of $150k in student loans on a helluva lot less than $150k a year. I know lawyers making $50-60k with a similar debt burden. Again, not easy, but doable.

Bottom line, PCPs could spend more time with patients. But then they'd have to put in upwards of 80 hours a week like those lawyers I mentioned. I don't know a PCP in private practice that works more than 60. (On-call doesn't count unless you actually get called in. I'm talking about the average of actual hours worked.)

I'll take my chances when my doctor sends me for a test.

Last spring I passed out a couple of times. My doctor sent me to a neurologist who changed my migraine medicine. A few months later, I felt a small lump on the back of my head. Over the next couple of months, it got bigger. I finally went back to the doctor when it started pressing on the back of my ear. The tumor has to be removed shortly.

I was walking every day to lose weight. One day my leg started to hurt really bad. It didn't go away even after a few weeks. Finally I went to my doctor. She said she thought I had torn my cartilage but would need an MRI to verify it. The MRI found 3 tumors in my knee that are literally pushing my knee cap off. They come out in a couple of weeks.

These tumors are all benign but still dangerous. They can squish blood vessels, nerves, etc. I will take whatever test my doctor recommends and be glad for it.

I am sure in many cases it does, Doc. But I went into a new doctor when we moved here. I told him I had sinus surgery a few years back, and I had a sinus infection. I had my charts sent to him too. The DR told me that he didn't want to do a xray because if he sent me to a specialist they would need a scan. So, I agreed to the scan, knowing that all I needed was something for a sinus infection and maybe I could get that, boy was I in pain. He also told me I needed blood pressure meds, mine was 145/90. He gave me a scrip for that too. When I went back in to get my results, they can't tell you over the phone you have to do a $75.00 visit... he told me the test showed nothing. And that I needed to have an xray now??? I told him I would think about it. He then check my blood pressure and it was till a bit high so he scheduled ANOTHER appointment. 3 weeks later I go back in he checks it and says it looks good. I fill it three times and on the third time the druggest tells me I need to call my DR, it was only a 3 month prescription. I call his office and he wants me to come in again, turns out he wants me to come in every three months, he will not fill out a years worth. My medical plan does mail order for a year, and I can not afford to visit a DR every three months. Did I mention I triped over drug reps in his office every time I went t here?

Then hubby gets sick, he calls in to find a dr. and gives them his concerns, rapid heartbeat, sweating, cool skin, numbness age 59. He called several offices that could not get him in for a couple months , so he goes to urgent care. Urgent care runs his tests and then tells him to do a follow up with a DR for the results. So, now we have urgent cares bill, and then a DR bill. The DR tells him he isn't sure, and wants more tests, so he goes in for more test more money, and back again to get results. Now we have 4 dr appointments if you count urgent care before they tell him they THINK he has COPD. Here are your meds and a inhaler the inhaler is 180.00 per month. He goes back one more time for a follow up and begs for cheaper meds as my insurance will not cover the 180.00 meds. So, we are paying about 300.00 per month for insuarnce that has a deducatable of 1200.00 and a total out of pocket of 11000.00 per year to get a run around many times back to a DR office when a phone call would work? Some are good, I have found only bad now for a long time. I always ask what I can do instead of what pill can I take. They still give you pills.

hello, timely and regular check-ups are needed in people's life's at certain times..with all this media placing medical care on the back burner is a ploy.. the plan is a ploy, to pass health care reform and Not give much Care..while charging Everyone the Extreme Revenue to keep the Fat Cats, Fat....where is the Love and Sincerity anymore..why do they Act like they Care, when other motives are apparent..Thrive, yeah right !!!..........

I admit that I have had some pain, some sick feeling, and went to the doctor only to be told the obvious. Once my doctor ordered and MRI and I asked him if it was a fishing expedition, and he said yes, so I declined to take it. Still, I suppose if you want to be paranoid, there's always the 'what if'?

Levi777... suddenly, it's Looks as though we're all being herded into becoming mortals with your thinking..Am I Right ??..

They don't have the votes yet. Please take an hour today and call all the Blue Dogs--especially those who won by narrow margins--and put the pressure on to stop this legislation. There are enough of us here that we might just make a difference. Please call. Your life may depend on it and that of someone you love.

What baloney, you doctors only care about making money. The more you make the more you want. I'm sure you will order as many tests as possible to make sure you get a good paycheck. Patients be damned, golf trips and holidays are what's really at the top of your lists.

I hope you are not MY FriendAndNeighbor!

Vaccine does not give you life long or 100% immunity. you were "pretty stupid"(using your own words) to consent to this test, i am sure they didn't tie you down and do this. they explained why they were doing this and then got your permission and then did the procedure

they come close to tying you down- they harass you until you consent because they are scared to death of getting sued. even if you ask to sign something to absolve them of responsibility, in my experience, they keep harassing you (while you are already sick) until you consent

and, for kids, they knock them out with phenobarbital for unnecessary tests- basically get them drunk to the point of passing out & also hallucinating (even at super great hospitals). that i have a problem with.

If you had symptoms of meningitis, you are fortunate that they decided to do the tap (even if negative). The vaccine may have been ineffective, been fraudulent (as 44% of the imported drugs, published article),or may have worn off. Even more probable, and which you need to know, is that there are several types of meningitis which are not covered by the vaccine, which is for the most dangerous kind.

A patient alsways has the right to decline the test and /or treatment.

It's OK to say no.

You have to accept the consequences if it was the wrong choice, but you do have the choice.

Serious,

Parents have been charged with crimes for refusing cancer treatments for their children. Children belong to the State, not to parents. That is the decision of the courts. A lot of lip service is given to "informed consent", but doctors do everything they can to bypass informed consent so they can get paid for tests and procedures.

Phusi

I NEVER SAID VACCINES GUARANTEE LIFELONG IMMUNITY. And my dad had to consent, not me, so shut the @!$%# up. I didn't protest, although looking back, I don't think it was needed.

The ruling elite are not to be subject to any form of rationing.

hear hear!

To bad you failed the poke in the eye test. Medicare is a government run health plan, do you use it now or plan you use it, when you are 65. If you do then you are brain dead to write something like this and have failed the poke in the eye test

Phusi, medicare is a great example of why most people are scared to death of this proposal. First, it is in serious debt, probably to the state that it can not recover once all the baby boomers are enrolled. Secondly, talk about rationing. Seniors are constantly searching for doctors and hospitals that will accept new medicare patients. It sort of like having a family PCP. In the old days, before PCP, a doctor would actually listen to the patient, do a few tests after a physical exam mostly done in the doctors office. He gets paid now based on a head count, regardless of your health. I probably see my PCP twice a year for a total of about 14 minutes. Now that my friend, is rationing. My doctor doesn't know me or anything about my conditions other then what is in his files. If he can't pull it up on the computer, then he's flying blind. I certainly don't blame him, he needs to have about 20,000 patients in order to break even with all the costs of running a practice, we're lucky he's still in business. The last two times I didn't even see him, but instead saw a PA. It lead to a heart attack within six days of the last visit.

My father suffers through Medicare mess all the time.. I know what I'm talking about.

and if Medicare was ditched he wouldn't have any healthcare coverage at all. Medicare should be imporoved.

Kibby--If Medicare was ditched, his private insurance would pay if he is like my parents. They paid for their own insurance and continue to do so but Medicare intervenes and messes everything up. We don't need it.

Or he could have paid for it directly. I believe we should all get rid of all but catestrophic insurance coverage and no cadillac plans. Then we will be more cautious about running to the Dr. for every little thing and will pay for it outof our pocket if we do. That will cut the cost of medical care by leaps and bounds.

Pay as you go. No one pays for my car or my house. I don't need or want the government paying for my insurance. I'll gladly take that responsibility. Why won't the rest of you lazy suckers???

wouldn't it be nice if extra tests could be offered but you could decline them?

Would it be better to have the carpal tunnel surgery and then discover the real culprit was a nerve compression in the neck? Probably not.

Yes and people think we have no rationing in our so called system....we already do and it is called...how much does it cost

Yes I think it would have been actually, the hand surgeon said it was classic carpel tunnel. I always thought it made sense to start from the most simple explanation and then work your way up. I could have had further testing/ surgery had this not solved the all the problems.

minnps:I did have that carpal tunnel test because my arm was hurting badly.from that test I did find out it wasn't carpal tunnel,it was in fact my spine.I went to a Dr at the Baptist hos in Boston,had a cervical fusion done,and I'm fine now.There are women in their 30`s with breast cancer,if they were denied mammograms because their to young, they would die.No one is Immune from disease because of age,especially the major killers such as cancer and heart problems.My friend works in a cancer clinic out of Portsmouth hos in NH.They treat patients in there 30`s fighting cancer,both breast and colon, both,men and women.We have come so far in treating the major killers.When do you draw the line on how to save money by cutting tests, virses how to save lives.Obama`s health care plan will cause more deaths in this country.How will any of you take it when you yourselves or your mother,dad husband,wife, son,or daughter is denied a test to save money because of their age

You have the right to refuse any treatment, You also have the right to informed consent... to know exactly why some test is being done. And if you dont like the answer you can get a second opinion.

you need to control the infection before you can be operated upon and 99.5 % don't even need surgery they get better with antibiotics. but if you are advocating surgery on day one they is a good chance you would have been dead or worse by now.

If they caused it, they should pay for it...why should insurance pay for it?

Phusi-

I agree. If people think they know what is the best treatment for them because they got their schooling from WEB MD, we wouldn't need doctors that go to school for 10+ years. As the saying goes, "better safe than sorry". Or how about, "I'll take the doctor's word for it".

A good doctor discusses all the treatment options and then ASKS the patient how they would like to proceed.

Your health is YOUR responsibility - not anyone else's, not even the doctor's.

Tort reform is the true answer.

You are both right-kudos-

{but like the ability to get all the testing they want because they are not of the: unwashed--thank you Nibor}see below-

What this AP reporter doesn't get is reduced medical care and testing is only for the unwashed. The ruling elite are not to be subject to any form of rationing.

they will always be able to give enough money to an attorney to start something, and by the time it peters out into nothing, there are a lot of medical reputations ruined.

Also-when the 'worried well' come knocking to doctors like Dr Harris above, in his shoes, I might want to do the testing-at least to the point I was satisfied there really isn't anything to worry about.

I have the terrible feeling this will never really come down to an intelligent approach in Washington. They and their policies have us on a one way run to a caste system in this country: the unwashed-they are already well represented in the streets.

I lost a child at birth because of the negligence of the doctor and the hospital. My daughter was born 95% brain dead because the doctors were reluctant to do a cesearean section. (Would not be surprised if the insurance companies have a quota for each doctor / month) It has been eleven years and I have done my best to make those concerned accountable for what happened. On one hand it is the legal system which drives the insurance premiums of doctors to protect themselves against unnecessary litigation. But on the other it is the same legal system which shields these doctors from their mistakes. I am clearly frustrated with how this system works. But thanks to my lawyers that they are not giving up and now will I until I die.

Yesvee50, no amount of money can replace the child that you lost and I can only feebly attempt to empathize with your situation because I have never had to experience it myself. As I recall the emphasize around that time was to reduce the number of c-sections that were being performed and perhaps that was a factor in your situation. I think that the physicians are getting stuck in the middle of a tug-of-war between insurance companies, patient expectations for perfection, and the legal system. I was a nurse and got out of the field because I did not want my family to suffer for an incident that might occur in my job. When I got a message from administration saying to be sure to chart carefully because a patient/patient's family look like "suers", then it's time to do something else for a living. My son is considering a career as a Surgeon and frankly, I am very nervous that he is choosing that route. In years past when a parent heard their child say they want to be a doctor it usually is followed by cheers and applause but now, I'm afraid for what the stress in his life will do to him and his future family.

Yesvee50 - Sure sue sue sue. Unfortunately people die. Even babies. My wife had toximia and I almost lost my 1st. In the pre-mature pediatric ward several babies died. The Doctors there were incredible. Yours were probably too, but you sound like you just like pointing your finger at someone to blame. Unfortunately its a fact of life. If there was no signs of threat there was no reason for a C-section. I feel your pain, but these things do happen. Why is there always someone to blame? I think your tooting your own horn blaming it on the insurance companies and just looking for revenge on anyone with deep pockets!

Yesvee50, I also lost a child, stillborn after being about 10 days past due. Frank discussions with the doctor allowed me and my wife to accept it......without ever truly understanding the cause. One day, she was kicking my wife inside her tummy, the next day, when my wife was in apparent labor.....I saw the bad news on the ultrasound with my own eyes, our child's heart was no longer beating !

We could have sued, claimed malpractice by the doctor and probably would have been offered a big settlement. But in our judgment, the doctor did nothing wrong. Sometimes, I still wonder about the real cause....................but with 3 teenagers today, it is pretty much a faded bad memory.

My point is this, just like the book says......sometimes, bad things happen to good people. That being said, it's not always someone's FAULT.

Unfortunately, in our sue-happy society today, it IS always someone's fault.

Bear Truth--the idea the Dr's will give the wealthy the care they can afford is not true. Even with Medicare when my husband had back surgery, they disallowed more than half of the very fair and even low billing of our Dr.

We felt upset that a fine neurosurgeon was actually going to loose money (obvious with malpractice insurance, his office staff even when he was at the hospital and payment for hospital privileges)by saving my husbands life so we offered to pay the rest of the bill ourselves. He informed us that it would be illegal for us to give and for him to receive. The G'vment wouldn't like anyone to be better able to get care than someone who has boozed away their lives and deserve no care at all. They want us all to be vanilla. There is no motivation in Socialism/communism. With no advantage to working hard, who will?

I Agree.

Healthcare is a big business making profit out of sick people. The cost of healthcare and medical equipment is way too much.

just-passin-through

I couldn't have said it better myself.

You doctor, should learn that what you consider the stupidest thing is not necessarily so. The reason they do that alot of times is because they are afraid of you and of the cost and the lack of trust is a huge part of the problem. I don't trust any doctor because I don't think they really are concerned about us...if they did, they would know how much things cost and their patients would believe what they say

I would like to respectfully disagree with your remark, Jim373311

Unless primary care docs start getting paid to spend time with their patients then you have no right to complain when you get 5 minutes with your doctor and that's all. You made this system what it is. You must now change it if you don't like it.

The era of specialization in medicine precipitated many of the dilemmas we see today. Graduates specialize because of the money and because it allows them to avoid dealing with the parts of medical practice they dislike.

Specialists among you claim so much of the insurance pie there isn't enough to pay a family practitioner what he[she] should earn. This trend also precludes potential savings in cost by eliminating the possibility of offering the Family practitioner the opportunity to know his patient better, thus being able to treat, not just UPS the patient on to a specialty practice. The patient is not the archiect of the present medical structure in this country.

This answer is a misconception.....it shows our biggest problem because if you had to pay, you would ask better questions and you wouldn't have everyone running to the doctor cause they have a blister on their toe.

I can remember in the eighties having to pay forty dollars for a pediatric office visit. I did not take my kids unless I was sure that it was something that could not be treated by me. Nowadays I think people feel they are bleeding money to the insurance companies and they take their children for everything because, they paid it so they might as well use it.

A weird example of anonhymousone's statement occurred when dental patients in my son's managed care group came in (20 somethings) and wanted all their teeth to have crowns. Now that is a very unhealthy idea since once a tooth is ground down and crowned the time that tooth lasts on average is severely compromised. The reason they wanted the procedure--it was covered by their program.

Fools! This is just what will be happening under Obamacare--folks getting a lot of things just because their plan will cover it instead of because of need.

Thats the way it was! One visit one bill no matter what was done.

Today, the primary care facility bills, radiaology bills, blood testing facility bills, etc etc etc. Each department is a profit center and functions accordingly. This allows the HMO to pro-rate each bill and you get stuck with the balance.

I think you are right!

"Negotiated Rates" are also very suspicious along with "Network Discounts"

Why does a hospital bill BlueCross $40,000 but write off $30,000 and accept $10,000? But if you have Humana the write off is $28,000 and they get $12,000. If you have no insurance you get billed the entire $40,000.

What is the real cost of the service?

Guess what...the insurance carriers base their rates on the amount billed. Do the hospitals get to write off the difference as a business loss? What is the purpose of this 75% discrepency?

How about using the medicare fee schedule or a version of it? Standardize the rates per procedure. Enough of this smoke and mirrors games the providers and the carriers play.

Health care is already rationed to only those who have insurance and those who fall down in the street and are too indigent to pay. Medicaid and Medicare, shall we say, are very very conservative in exactly how much care they will partially pay for.

Check above, the fist post from Dr. Harris-he has it his sights.

Rationed care and death panels, welcome to obama care!

shamwow-camera-guy
Don't forget the death panels.

Your attempt at sarcasm sucks.

The only sucking sound your hearing is the dems going down the drain in November.

Tookie12345 - finally, a comment I can agree with. People posting here today are such a bunch of ignorant a holes!

You make so much sense-they want the viewers to see these ads because then the viewers will tell the Dr. they want this medicine. So then the Doctor will go back to his drug cabinet and get a bunch of samples. I have never heard that anyone but the drug company benefits from this practice. Scary, wot??

And don't forget tests are needed for those drugs!!!!

The mass marketing of the latest, most expensive medications from the pharmacetical industry is an extremely troubling problem. Many of these newer products are often no more effective than cheaper existing alternatives and does nothing more than pad their bottom line.

Their shameless promotion for profit fuels our countries obsessiveness about beauty, youth and health, and helps drive much of the unnecessary health care costs that are bankrupting our system. With the recent Supreme Court decision, these and other corporations will have an even greater ability to influence this process.

And for every person who has had a condition discovered and treated, there are many (including a close friend) who suffered and often died from a "routine" test or procedure.

Its about time to stop blaming Obama and pelosi, for problems that started long before they came on the scene, the problems with health care is the result of greedy Physicians, and isurance companys and rich greedy corporate Americans who saw a flawed system and took full advantage of it. So harve, where have you been the past sixty plus years or so!

Exactly fxrp or my Canadian friend who since last September is still waiting to get word when she will be scheduled for cataract surgery? Cataract surgery and she is still waiting? How is that better or even acceptable? Six months have gone by! LOL and they don't have the illegals problem we are stuck with here in the US.

My mom just waited about that long here in the US? What is new...rationing is here, will continue to be here and even with insurance will get longer....you just haven't tested your insurance recently....then, think if you lose your job: who will ration care then? You will

So true sncknbrg.

AMEN!

sncknbrg you are right. Keep sending the message. Vote them out!

That's a big IF....have you costed out an MRI recently? I just had a blood screen done on my daughter....the cost was $1600....and that was just for an annual physical...

Health care is not something you are owed and I don't feel that other's should have to pay your way plus all of the over head in this reform bill. Not only do we get to pay for you, we also get screwed by the goverment by them control what options we have. Don't you find it strange that none of the politians will have to take part in this plan? And what do you have to do? Nothing! Just set back and let the socialist goverment take care of you. And they will do that until your not needed any more.

OK, when you are out on the streets who is going to take care of you?

Well put.

And may I add something, please? I've noticed an increase across the board of advertising for pharmaceuticals, and a friend who is a family physician said that alone causes patients to ask for particular drugs--whether they are appropriate or not.

My point is, all these tests, all this advertising for drugs, has turned this country into a bunch of hypochondriacs at worst--and at best, a nation of the self-absorbed.

Having said all that, my mother was diagnosed with cancer last year and underwent chemo and radiation. She noticed a change in her body and went and got it checked out. She is ever-concerned about herself, but it probably saved her life. Meanwhile, she's 73, has had two invasive surgeries with respect to this cancer, and her chemo/radiation was horrifying. I'm not sure what the answer is...maybe somewhere between all or nothing is something.

Well put, M Winners, as is your post, PW-667632. My mother had a similar situation. When she was offered the 2nd round of radiation and chemo,

she said to the Dr, "Tell me where this cancer had 'returned to', please."

the Dr. said "It is metastatic disease from your colon cancer and the attending surgery."

she said, "I will choose to not endure either of those treatments again and ruin the months I have. There are things I want to do with my family and I would appreciate good pain control when that time comes."

I think it has to be within the patient to decide in an appropriate manner when enough is enough with treatment.

I can't imagine how it can be done, given 'free speech' but there has to be a stop to the media's approach to presenting the idea that there is a quick & simple cure for everything.

I believe that if I was offered yet one more painful procedure or treatment that would impair my quality of life that I would do as Mom did and opt out -even if there was a 50% success rate.

I am 66 now. I am quite well, and I am also afraid to die-for the end of all-but I am prepared to do it when necessary because of Mom's example-we had seen the suffering for her the first time around, so we never discouraged her in her decision.

I have asked my children to accept that decision when that time comes-or if they cannot, don't cry and carry on in front of me as if they even think I am meant to live forever.

That may be the key: family members present their emotions to the person who is ill-when that person already has too much to deal with. We have to teach differently-The notion of medicine as heroic might need to be readjusted.

You are both thinkers-thank you.