What a mess for the ones that really need a doctor! This bill is going to haunt this country for many years to come!!

a field losing out to the better pay, better hours and higher profile of many other specialties.

Hmmmmmm... didn't it used to be that most people became physicians / nurses because they had an innate sense of wanting to actually DO SOMETHING for people. You know... like being a missionary. Doing something to really HELP/BENEFIT others. Now being a doctor is all about MONEY MONEY MONEY and screw the patients.

See, that's the one thing I admire about the healthcare workers in Europe and other countries who have Universal Healthcare. They do it out of a commitment to help others. NOT to have 3 houses, a Mercedes, a BMW and a HUMMER, Wednesdays off for golf and twice yearly trips to the Caribbean.

Maybe if the US made Medical School more affordable, ( those so-called "socialist" countries educate most of their doctors FREE which is why they're not money grubbing like ours ) doctors would go back to actually caring about their PATIENTS and not their WALLETS. Also most doctors in Universal Healthcare systems are paid bonuses on their PERFORMANCE and are far from being "poor". This is an incentive for them to provide good quality care. There IS no incentive for doctors in this country except for the one to get rich.

Good Doctors will still be along!!! It will be the crooks that we will be getting rid of... Now when someone becomes a Doctor are Nurse will ones that wants to be in Medicine for curing the People not just the money!!!

My doctor is around 60 years old and limits his number of patients because he doesn’t want to kill himself anymore. There are many benefits to doing this such as at your appointment time you go right in as opposed to the doctors that overbook and you arrive at the appointed time only to sit in the waiting room for over an hour.

Accordingly, my doctor said he will not be accepting new patients and if ever forced to do so by the government, he will retire. I wonder how many other doctors share that sentiment?

Lmk02. Pretty good fantasy. You'll live a happy life as long as reality doesn't set in.

Good point SMC, there is a really high direct cost and even higher opportunity cost to going to medical school. Them loans ain't cheap. But, I don't see how paying primary care physicians more money decreases health care costs. I think making specialization a little less lucrative while providing primary care physicians with a smaller bump in pay might be the better mix.

LMK, what forces do you see at work that are going to rid the profession of the "crooks?" It is making up pretend circumstances like this that prevented this legislation from being legislation that is good for the country.

Smc, doctors in Europe don't think about cars,houses, or vacations.... Sure they don't because the system doesn't permit them. Kind of like me wishing I was in Bill Gates's shoes. Not going to happen so I don't think about it.

Whatever happened to the American dream.... the harder you work, the more talent you have, you get paid the value the market will bare.

zoroaster, So you are for the government dictating what someone should make. If so, who's next? Plumbers? Electricians? Carpenters? If we dictate what they can make then new houses would be cheaper.

I'm sorry Paul, where did I say I wanted the government dictating what someone should make? However, since you asked, did I see you out there demonstrating for the government to allow your electricity provider to jack up the costs in your neighborhood? Hmmm, I guess the government telling someone how much they can make isn't that bad.

Paul71:

We are already being told what we can make; if not by pay czars deciding how much we can receive as bonuses, then thru a "progressive" tax structure. Docs in Europe and Canada routinely receive payment in excess of the mandated limits. The usual vehicle is a fee to move a patient up on a scheduleing list. And the health system in Canada is no great shakes. Their citizens come down here for treatment.

This whole nut role is to provide benefits to under motivated slugs that did not bother to get an education or those who did not bother to enter this country legally. The net effect is that everyone, inclusive, will have the same opportunity for misery and a lesser life style. It is called redistrubition of wealth, a socialist dogma.

“It’s gonna be like Christmas, you know your first Christmas when you want that Barbie doll, so it’s gonna be just like Christmas. I mean it’s gonna be great, you know worries, you know the bills, we can go ahead and pay our co-pay and be all right.”

Get in line its "Christmas" and everyone wants their "presents".

zoroaster, " I think making specialization a little less lucrative" How do you do that if you don't dictate.

Also zoroaster, can't make out what your point is on the electric comment.

Really Paul? The electric comment is that the government limits how much money a utility can charge you for your services. I'm assuming you aren't for that and would like the electric companies to charge you as much as they seem fit. Making something less lucrative does not mean telling them how much they can make. They can provide incentives for primary care education that makes the risk greater for specializing equalling out the expected return they can get over a primary care provider. They could also put more tringent limits on referrals from one doctor to a specialist. Otherwise, then we just have people in a position of power taking advantage of people who are at a disadvantage. I don't know if that referral to a specialist is really necessary when my doctor refers me. When you go to a mechanic and he charges you for putting in a new timing belt when the one you had could last another 3 years, do you think that is great and pull out the check book? Free markets don't mean totally free to take advantage of people. Otherwise, Business Schools should all be showcasing their Bernie Madoff case studies on how to maximize your income.

zoroaster, OK, your talking about Public Utilities Commissions. The reason that utility companies have to get the Ok from the PUC is the lack of competition or choice people have with many of their utilities. Where I live there is one power company. Its them or no electric. In that case I don't have a problem, if there was competition then I would have a problem with it.

Do I understand you to say that they should make it harder for your family doctor to refer you to a specialist? You question when your primary doctor refers you if it was necessary. That is called defensive medicine. Thats why we need tort reform.

jasfox- Your comment is out of line! You are making an assumption about the people that don't have health insurance without thinking beyond your prejudice. I would be that there's a good amount of college students without adequate coverage as they're not able to stay on their parents plan (if their parents HAVE a plan).

For those of you that think that the 32,000,000 uninsured or under-insured aren't already part of the medical system, you're deluding yourself. These are the patients that are going broke trying to pay for health care and they are everywhere. They may be disabled, have lost their job, have a pre-existing condition. I speak for these people and myself every time I split a pill to get an "extra dose", or delay a dental visit for cleaning because I can't afford it.

The model that's mentioned in this article is excellent in that there would be an electronic "checking system" put into place that can compare tests to see if anything is changing. PA's and NP's are an integral part of our health system, I'm so glad that was pointed out.

Live long and prosper!

People actually believe there will be good Drs. available with Obama care? No way in hell, we will have poorly trained people claiming to be Drs. as our source for medical care. The quality Doctors will not be able to stay in practice. the type of medical care provider we will have will be like all the socialist countries have. however, our socialist leader will have to pass a "new law" so you the harmed patient can not sue the "doctor" he (Obama) has created. Socialism/communism or Obama's favorite Nazism has NEVER created a quality medical population. Do you see a lot of English,Russian, Chinese or any other Socialist/communist getting license to practice in the United States - YET? No and the reason is they are not qualified to give quality care. Hope all you socialist supporters of the Obamacare enjoy your death by Obamacare. I feel the saddest for my grandchildren because they will have to live with the actions and antiamerican activities of the worst example of American Presidents. Obama - the first to destroy a great nation and take it so communism/socialism. I weep for America, doomed by Obama ideas. We not have the MINORITY rule, just like every dictatorship in the world. Revolution is coming, and the antiamericans will be put to pasture, where they belong - in the manure pile.

So Paul, you understand that utilities have monopolies and therefore, the government tells them how much they can charge; and you are alright with that. How many hospitals are in your area? 10, 15? Each offering you better service for more money or less service for less money right?

And you have complete control over whether you go to a specialist correct? I ask this, because, if a doctor tells you he can't prescribe medication until he's gotten a second prescription for medicine, you can decide that the specialist isn't needed and just live with the pain, at least for a while right? If you live in a large city, you might have two hospital Systems and maybe 5-10 specialists in any one specialty within reasonable distance from your home. As this article highlights, there isn't a lot of supply there, yet, there is a great deal of demand. Additonally, given the choice to see a specialist verses deciding it costs too much and living with a disabling illness is hardly a choice. Although this is not a pure monopoly, there are monoplistic qualities and, therefore, is a candidate for government restrictions.

And no, seeing a specialist is not called preventative medicine. Seeing your doctor for regular check ups to catch potential problems before they are problems, eating healthy, and exercising are preventative medicine. I've never gotten a physical from an Eye & Ear specialist. I've never had a to go to a heart specialist for diet planning or a workout plan. They have dietitions and personal trainers for that.

Free Markets are the best system out there. However, a pure Free Market, like Socialism, only works great in theory. You and I consider each other free, yet, you can't go up and beat a man and take his money because you are in a position of advantage. Does this mean you aren't free? And what about gouging laws? You are against that?

Uh, yeah. That was supposed to be a doctor not giving a prescription until he's gotten a second opinion from a specialist.

Quite the dilemma huh Ray? Becoming a doctor isn't like bcoming a marketer is it? So you end up with a professin with a steep entry cost and high standards for practicing. I have to agree that there either aren't going to be enough doctors, or more likely, they will lower standards to allow more in. A recent article highlighted the fact that more people where going to school for family practice than specialization since the talk of health care started heating up. Unfortunately, that doesn't mean they will all complete the rigorous process. This health bill may give quite a few people the "warm fuzzy" feeling that things are somehow rectified. However, the reality is that things are most likely more screwed up than they were before. Too many factors go into high health care costs for one silver bullet through the chest of a blood sucking insurance agent to address.

Paul, just caught your comment on tort reform. Yes, indeed.

I think people are missing the point as to why med students choose to pursue a specialty. Although money is a significant plus to help pay off enormous student loans, the primary reason students pursue a specialty is to have a life. Specialists, for the most part, are not "on call". They have a life outside of the care facility. Primary care physicians make rounds at hospitals and see patients in their offices. Yes, OB/GYN docs are on call, but most specialists are not.

Having served in the military, I have seen medical treatment provided by some adequately trained soldiers. I firmly agree that the use of PAs and NPs can assume many of the routine responsibilities of primary care physicians. It is the fastest way to prevent a shortage of healthcare providers that will be brought on by the new law and should reduce costs. Although this is not mandated by the law, I believe this is the trend of medicine regardless.

The real problem with this law is the financial burden placed on the states.

Another reason for large companies to outsource as much of the work to smaller firms who employ less than 50 people.

I like to think that I care for my fellow man. But, having a full understanding of corporate America, it is all about sustaining the corporation and its profits. Everything else is negotiable. So, the backlash from this law will be some unintended consequences that will result in some unpopular outcomes.

Once again, I'm amused at the general level of understanding how physicians get educated and "allocated" - as if this is something new,

Medical schools admit students - to some degree they get in based on what their eventual choice of practice area will be (a great sob story about being just like Albert Schweitzer doing primary care was always helpful).

But where the REAL determinant is where you want to do a residency (where you REALLY learn medicine).

The allocation of residencies is a HUGE medico-political issue. Remember, most residencies slots are determined by a complex mix of federal money to support research programs which have training slots as a byproduct (same with Fellowships that follow Residencies), self-funding by hospitals that need a cheap source of labor for hospital rounds and "on-call" (often 2nd and 3rd rank programs, and Residents and Fellows *are* cheap labor), politicking within Specialty Medical Societies wanting to limit or expand competition and the AMA, etc.

These issues have been going on for at least 30 years and last raised their ugly head when the advent of "managed care" and forcing primary-care givers to be "gate-keepers" restricting access to specialists; they are just now more apparent as we "unload" from ER's into primary-care.

I want a doctor, not a f88king nurse.

I can prescribe aspirin and chicken soup myself.

This health care bill just screwed all Americans into settling for PAs and FPNs.

An FPN almost killed my mother three months ago.

Corsair, what happened to your mom?

those so-called "socialist" countries educate most of their doctors FREE which is why they're not money grubbing like ours"

and how many universities in these "so called socialitst countries" are ranked as top ranked universites in the world? i'll give you a hint, the usa has more top ranked world univerisites then any other country in the world. so are you suggesting we lower our standards to match these "so called socialitst countries"?

I know you are wishing him well but consider if he can see twice the number of patients and still provide care in the manner in which you have become accustomed to. That, too, is a place where mid-level providers can help.

There are a lot of Doctors like that out there!!! Now many more will come into practice instead of just for the money...

All of you are living in the same fantasy land Obama is. This will create a nightmare shortfall for America.

What??? LMK, please don't bring crack to the classroom unless you are going to share. What are these mythical forces that are going to have every good samaritan in the world signing up to be doctors?

No, let's not bring crack anywhere--I get to see plenty of it when my neighbors have to call the plumber... *lol!*

As for physicians, I think there are legitimate concerns about their ability to provide the very best care that they can, without compromising on patient quality. And it's been that way now for years... *sigh!*

"Massachusetts offers a snapshot of how giving more people insurance naturally drives demand. The Massachusetts Medical Society last fall reported just over half of internists and 40 percent of family and general practitioners weren't accepting new patients, an increase in recent years as the state implemented nearly universal coverage."

Why do you think they were against implementing it on a national level?

getit, You sound like the south afraid to give up slavery because it wasn't what they were accustomed to. You will get use to it.

pjam09, Not accepting new patients is a good thing. We don't want over worked doctors. What we need is patients triaged to see the right person to care for their problem along with adding more medical professionals into the field. Basic care can be performed by a nurse practioner. Your basic medical needs can be treated at your local pharmacy or prompt care. Not everyone seeing the doctor actually needs to be there. We need to educate the public and make these other options available and affordable to them.

crittenden - yes, you nailed it but made it sound way too simple. How do you suggest 'educating the public' when most folks do NOT have the insight to understand why their appointment is for 1pm and its 2:30 when they're called back! They don't realize that the doctor was scheduled to see 15 patients between 8:30 and 12pm and another 15 from 1pm tp 5pm. However, the first patient of the day announced that 'I think I'm going to kill myself" thereby extending the doctor's first visit which was listed for 'medication review' (normally 15 minute appointment) to a major triage to psychiatric emergency intervention. Doc's day already off to a bad start and 30 minutes behind. There was a walk in put in for a no show (your doc is always double booked due to NO SHOWS who take up visits and never cancel). Then doc's 9:30pm slot which was a hypertension review reveals the patient who is an elderly 89 YO brought in by is daughter who tells your doctor that her elderly dad has not been taking medication and seems disoriented. A cursory review reveals the pt. is febrile and has bilateral rales with dry mucous membranes and hasn't been able to void. The doc now needs to get this pt. started on IV fluids and arrange for hospital admission for likely community acquired pneumonia. More time spent arranging the transfer and explaining to the daughter why this is NOT open for discussion and a matter of urgency. The rest of the morning is full of hectic catch up, charting and phone calls and of course there is NO LUNCH, there NEVER IS! And you are still in the waiting room wondering WHY you've been watiting so long. While your doctor's schedule tumbles into the afternoon I would ask you to kindly realize that he's working his butt off as he does each day and NOT playing gin rummy. While you get angry in the office, he is focused on his patient. Your turn will come, too - and then he'll give YOU HIS FULL attention. His practice is owned not by him but by a large health concern who says how many patients he'll have to see each day to remain profitable, and how much hospital work he'll need to undertake on top of medical conferences and administrative work. THIS is primary care on any average day. WHO WOULDN'T prefer the relatively calm routine of specialty care by comparison. As to seeing specialists, please know that those in HMO's cannot see a specialist without 'permission' in the form of a referral while those who pay more for a PPO can see whoever they want, for a higher premium. THAT is how the system works. You pay less for having to get 'permission' to the specialists office and you will likely have to WAIT for that appointment. Your HMO doc, called the PCP, is like a parent who works under a DISINCENTIVE to refer you to specialist care EVEN WHEN YOU NEED IT. I think it would behoove everyone to learn how their own policies actually work before they start screaming about how evil and mercenary doctor's are. As medicine becomes less profitable and more demanding on a young doctor's life - he/she will become vasting disenchanted at primary care and no one could blame him/her. I truly welcome retirement. Medicine has changed very much in the last 30 years - these changes have not been beneficial to patient OR doctor..

e's not working his butt off

buche; Thank you for saying the many things doctors and their families feel. It is exactly as you describe. Some of the posters have no idea what really goes on in the day to day office. Ms Crittendon must have an address in Nirvana. She says "let's not overwork physicians" then in another post, "patients have to be the first in doctor's lives" Which is it? buche-thank you for your comments. I am with you. People don't realize that thousands and thousands of doctors will retire with this new health plan

buche de noel, Clearly you are speaking from experience, and I understand your frustration. We need to get doctor's out of the postion that they are forced to take on 15 patients a day. Two patients should not be scheduled for the same slot. Three no shows and you are out. Obviously there are going to be emergancy situations, but not everyday all day long. It is the large health concern who says how many patients he'll have to see each day to remain profitable, and how much hospital work he'll need to undertake on top of medical conferences and administrative work, that we need to address. This is no good for our doctors. We need to bring down the costs of doing business. I am not suggesting doctor's are playing gin rummy. I know they are running around like chickens with their heads cut off.

I understand how HMO's and PPO's work. I have dealt with them both. If you chose an HMO you won't have a deductible, but need the doctor's okay to see a specialist. The primary care doctor get's no reward for sending you to a specialist, but if you need to see a specialist, they will send you. PPO's make you pay a deductible, but you can see any doctor you want whenever you want. I personally think an HMO is the best way to go. People with PPO's who see specialists without a referal should wait in line behind those who have one and doctor's should get incentives for sending people who truely need to see a specialist and nothing for sending people who don't. They should also get incentives for quality of care and not for the number of patients they are treating.

allison, I am saying both. We don't want our doctors over worked, and patients should be more important than becoming filthy rich. Wealthy, well sure, they desire to be paid well for their work. It is the insurnace companies, drug companies, the cost of education, and the large health concerns that need adjusting. Thousands and thousands of doctors right now can't afford to retire. We need to make things easier on doctors to keep them in the field and inspired to help patients.

Crittenden - I'm afraid you still don't really comprehend reality in world of a family practice physician in today's world.. I wish the docs in primary care today we could wear hidden cameras and post the day online (any day will do, they're not all that different). As for your statement about 'emergencies happening rarely" please know that only any given day at least three admissions, are the norm in a typical, 8 provider FP office is expected and is TYPICAL. This includes the rig that brought the patient in extremis TO the OFFICE because THE PATIENT didn't want to go the the ER!!!!!!

Note to EMS - look at your ekg strip!!!! PLEASE!!! DO NOT EVER bring your patient to the PCP office no matter WHAT they say. I have seen this happen more than a few times and each time it results in a decreased chance of survival for that patient. They lose PRECIOUS TIME!!!! Thank you.

Furthermore - the doctor sees fifteen patients in the morning and another fiftreen in the afternoon for a total of 30 patients. THIS is expected and the doctors are actually given "encounter expectations" meaning that YOUR doctor is told by his bosses that if he/she FAILS to meet those encounter numbers they will be sanctioned and bonuses will be with held. Amazed? Don't be. This is medicine today.

More to the point, there are always walk ins sitting in the waiting room just hoping for an open slot! The office temp might just 'squeeze them in' because YOUR doctor sees EVERYBODY turning NO ONE AWAY.

Regardless of their ability to pay, insured, no insurance, sliding scale, medicare, medicaid, and self pay. Your doctor's practice turns away NO-ONE! Look! Here is a known, noncompliant, non-english speaking diabetic who just moved here a 'ran out of meds'. He picks tomatoes for 25 cents a bushel and the nurse informs you that his random fs glucose is 450. Well, he needs immediate insulin and hydration and subsequently, a full Diabetic workup which is exhaustive and takes 90 minutes on a good day, but now? forget it. He'll get immediate care but he'll sit in the waiting room until six o'clock unless one or your doctor's colleagues can help you -but their all in the weeds too.

The waiting room now exudes pent-up fury and patients start challenging each other. "when was YOUR appointment?" They demand to know of each other. Not a very healthy place and blood pressures are increasing everywhere. Some who have been waiting over an hour get up and leave in frustration. Yet, your doc will never know it because he's up to his a-- in alligators.

After the day ends in the office your doc goes to the hospital and rounds on his inpatients. They're a sick bunch, I assure you. One may die of liver failure- a 55 year old female, chronic ETOH abuser for over a decade, has hepatic enzymes are over 2,000 and she's not breathing well. Her abdomen is HUGE with ascitic fluid and she has a large family along with a living well. She begins to bleed from esophageal varicies which, if you've never seen it happen, seems as though you are suddenly filling a swimming pool with blood. So now, it's urgently off to the ICU with bleeding everywhere, and once in the 'unit', the price per day of care goes from hundreds to thousands. Her family wants EVERYTHING DONE to save her and her living will also delineates that she will only be a no code if all possibliities of recovery have been exhausted and she's in a persistent vegetative state. But of course, this lady is only 54 and there is a chance if she stops bleeding out and LIVES, recovers and stop drinking that she'll have a decent quality of life and we're going to see that she gets that chance.

Down goes the Ewald tube to press those bleeding veins flat and hopefully stops the bleeding. Your doctor rounds on the other few patiients who are thankfully stable. He takes a quick shower in the dr. lounge where he dumps his bloody scrubs and five hours after your doctor got to the hospital, he finally drives home and puts the key in his door at 9:45 pm. His children are asleep. Maybe he'll get to see them in the morning? His little girl age 4 left him a sweet little card the sight of which brings water to his eyes. His wife, used to this by now puts a sandwich and some soup on the table for him and he inhales it gratefully while casting an apologetic glance her way. This is not an unusal day, crittendon!

When a young doctor lives this life he/she says "I'm going to look into dermatology,or opthamology or orthopedics' because THEN my personal life WILL RETURN, my INCOME might easily DOUBLE and my pager will still alert but only on certain nights and then ONLY for patient needs my specialty expertise. I'm familiar with this scenario because I lived it many years ago. It's part of MY PAST but still part of many a PCP's daily experience.

Now - for a last assessment of HMO/PPO . HMO is a very good choice for a person who is 1) young, 2) essentially healthy and free of any chronic dz. Vis a Vis referrals there is NO JUSTIFICATION for your putting the PPO patient behind the HMO patient in a 'specialists office". For example - say I am anesthesiologist with special expertise in pain management and epidurals, specifically. There are two patients who have called me needing appointments. One (Pt A) has an HMO and has three blown discs in her neck, she needs a referral for the epidural and so must now see her PCP, be evaluated, and hopefully get her referral in a timely manner, and then call my office for epidural treatment. The second patient (Pt B) is a member of a PPO and needs no referral she has the same injury as the first patient and is in similary agony. What do you think I (or more specifically, my well trained office staff will do)? HINT (both need MRI's FIRST before I could treat either one of them!)

Answer, I have already treated Pt. A before Pt. B ever even got to my schedule. Reason? Pt A, needed no referral, so she called her family doctor, explained her pain and he in turn who ordered a stat mri with instructions to hand carry the films to my office. Family doc called ME to inform me of the patient's injury, provisional diagnoses (HNP of C4,5,6 on left) which was confirmed on the MRI which was done already and brought to me by the patient. Since my office now had all the necessary info, Patient A was placed on the schedule and came into the center during the next 48 hours and was seen emergently. I administered a left cervical epidural (THE ONLY real treatment for a herniated disc with other discs bulging hearby). The patient will have two more injections over the next three months and will do well. Early intervention does make a difference. Sadly, patient B (the HMO patient) took a very long time getting in to see me. Her doctor had no urgent appointments but agreed to see her in 24 hours anyway. Since she required an MRI before she could be seen in MY OFFICE (her insurance rules, not mine), she struggled through agonizing days before the MRI authorization could be written. Then more waiting getting INTO the imagine center added more waiting time. Pt B was suicidal with pain. Finally her PCP had to read the MRI (something I would do anyway). Her PCP was not skilled at MRI interpretation and they had to wait for the hospital radiologist to render his impression. FINALLY she was put on my schedule for an cervical epidural and was treated almost a full FOUR WEEKS after patient A.

Crittendon - you need to fully appreciate how things work in medicine today and realize that 'it's not right' means NOTHING at the end of the day. HMOs SUCK for patients who want and need quick, effective treatment for their health. They pay MORE in order to get MORE service and in a more timely manner. IF you select an HMO BE FOREWARNED and BE PREPARED TO WAIT for care, and you might not GET the Doctor you select if that specialist does NOT PARTICIPATE in the HMO. As a rule please know that the more expert the specialist and the more well known he/she is in the field (usually surgeons in various fields) the less likely they will even take your HMO because it pays, at the most, ten cents on the dollar for a procedure that is no only RISKY, but required them to spend likely twelve additional years after med school to perfect. Right or wrong folks, you get what you pay for. As a young doc I learned that I couldn't sacrifice my entire life to primary care with all its demands and none of the rewards I knew then and now that I deserved. Society values certain skills in this life. That is because 1) not everyone has these skills and in order to achieve them one must work hard for many years, and incur vast costs during that time. While I and many others donate our time each year to those in desperate need who'd NEVER be able to pay our fees otherwise, we don't apologist for earning a good living nor should any of you begrudge us that. IF you are angry about this - I suggest you take the complaint to the real enemy....YOUR INSURANCE CARRIER. I know - a huge rant. But with a few minutes off between duties tonight - thought I'd weight in on the juggernaut. Still, looking very forward to retirement and emeritus status. It's time for ME to REST!

buche de noel, I am not at all angry. I do have health problems, and it has taken me more time to get treatment because I need to see my PCP first and normally wait three business days for my referal, but I prefer this over paying the deductible I use to pay for a PPO. All that I can afford to pay for medical care is already being taken out of my check and my wallet in the form of co-pays. It is interesting to know that the best doctor's don't take HMO's, I wasn't aware of that. What I personally have encountered whether I had a PPO or an HMO is not the wait time for the referal, but the wait time for an opening at a specialists office which is about three months even though I am not a new patient and it has not been over a year since my last visit. I have encountered this problem with a wide variety of specialists, but not all. Urologists and Rheumotogists seem to take the longest to get in. One reason may be that there are very few , two or three at the very most, of these type of specialists anywhere remotely close to our area (within an hours drive).

When the patient calls the office it is very important to have someone there who will get as much information about the reason for their visit as possible. If there is any reason to believe this person may be at risk of an emergancy they need to be directed to the ER right then and there. No need to make them an appointment at all. You can't be expected to take on all the world's problems. That is why we need to triage medical care to a variety of medical professionals in a variety of different settings, so you can concentrate on the type of patients who really need your help.

I agree the EMS should not be dropping patients off at the doctor's office. These people should be going straight to the hospital. Walk ins should be advised to go to the nearest prompt care or pharmacy. Many pharmacies now have staff on hand who can treat most common illnesses, injuries, vaccinations, and provide blood testing. I have been told many times that my doctor had no openings for 5 days and if I needed to be seen sooner to go to the nearst prompt care, which I did. We need to prevent these doctor's bosses from pushing them into taking on way too much. It is really awful and I can see why you want to retire and are so stressed out.

I am not sure if these specialists are triaging me when I call for an appointment, but what they are telling me is they are fully booked for three months. I think once you have a referal to see a specialist they should take you first come first served. The issue I have with people who have no referal getting in to see specialists ahead of people who have a referal is you can't know ahead of time if this person without a referal has a more severe case than the person a doctor has already confirmed as needing to be seen. What is to say some of these people don't have an anxiety disorder or are self diagnosis themselves? Seeing a primary care doctor can explain to a lot of these people they are worried over nothing. That their mole is not cancer, that sort of thing. When you are dealing with something as serious as ruptured disks, I agree with the way you are dealing with it, both the person with the HMO and the PPO need treatment ASAP, but it is my understanding in an emergancy situation like that, people with an HMO do not need a referal prior to treatment. Those people should be admitted into the hospital until their surgery is completed. What I have learned from you though, is that because I now have an HMO, I might not get the best doctor. That is a very important piece of information and I appericiate you taking the time to explain it.

I just think HMO's should get more respect for helping doctor's triage patients. In the long run you would think specialists would make more money filling their schedules with patients that actually need procedures, testing, and treatment, even if PPO's pay more off the top. Would you get paid more to see 10 PPO patients with nothing wrong with them, or 10 HMO patients who are seriously ill? If the answer is you would get more for the 10 PPO patients, something needs to be done to change that.

rocKSINYOURHEAD,

Awfully presumptuous of you to assume that there are 32 million "Freeloaders" as you inaccurately describe them. The MAJORITY of that 32 million are hard-working Americans that have been denied healthcare for OTHER than purely monetary reasons....either pre-existing conditions, losing healthcare along w/their jobs or because of changing jobs, employers decreasing benefits, or insurance companies rescinding policies as soon as or shortly after someone is diagnosed w/a catastrophic or chronic illness. I'll bet most of THOSE people make more money than YOU do. Where the HELL do you get off putting any of them down ?

I think the gov't should EXCLUDE people like you and your ilk from any kind of social service benefits.... healthcare, education, police/fire service etc. Afterall.. I don't like MY hard earned tax money supporting greedy fascists who don't want to pay their fair share to uphold the community and help others in need.

Count me a one of the presumptuous ones.

SMC, I really think you are just as guilty as Roc in your fantasy about who that supposed 31 million migh be. Yes, there are a lot of free loaders who will benefit. There are many hard working families and people with prior conditions that don't have insurance, but, I'm quite sure they don't make up the majority as you pretend. In reality, they are college students and you single people who may work hard, or not. I would point out that, since many of the "welfare" cases already get government assistance, I doubt a large percentage are looking for handouts - they just choose to spend their money elsewhere. Like on cars, televisions, and a few probably invest their cash also.

Rocks:

Do you really have to debase the discussion to calling others names? Why not try keeping the thread to the issues, not personal attacks.

According to the info from the gov't 15 million of ther 31 million will go on medicaid. It seems that there are people who would qualify for it however for whatever reason they have not gone through the process of applying for it.

The only way everyone will be covered by health care is to automatically enter them into the system. Some people don't care about their health until they loose it. You can't expect the alcoholic, the narcotic addict, the mentally ill, so forth to be able to go through the process of applying for Medicaid. Others maybe ashamed to ask for welfare but thanks to government reeducation that is changing in America.

Pumba - "Others maybe ashamed to ask for welfare but thanks to government reeducation that is changing in America."

Believe it or not you should be ashamed to live off of others who already have their own dependents to support, removing the shame of being a freeloader would be about as beneficial to America as pretending obesity is a disease has been.

I really love my "Cadillac" plan now.

It'll be like having a "Fastpass" at Disneyland.

BOO HOO... let them retire. Obviously they are more concerned about their wallets than their patients and providing reasonable, affordable, quality healthcare to those who really need it. Let them retire and rot in hell.

PS... "Socialized Medicine" as you inaptly and incorrectly refer to the new Health Care reform is not run by PRIVATE COMPANIES. The SAME EXACT private companies running it BEFORE Health Care Reform. You don't have a damned CLUE what you're talking about. Typical uninformed, propaganda spewing right wing response.

So your nephew, niece and your "young student" are in medicine strictly for the money and as long as they were on the gravy train all was well. It doesn't matter that hard working americans are dying because they couldn't get or lost insurance or a family is losing everything they worked for because a loved one got sick.

We KNOW that this scenario is being played out thousands of times accoss the country.

Smc and Want Truth,

Why do you go to work? I know, you love your job. If you win the lottery today, will you go to work tomorrow? If you say yes, you are both liars. Did you read the article? It said 80% of students go into specialty fields rather than general practice. Why? MONEY!!!

Want Truth,

One other thing. You made the comment that the student was choosing engineering over medicine just to make more money. You obviously have no idea what engineers make. I am an engineer and I can tell you I don't make anywhere near what doctors make. The student wanted to leave medicine because she did not want to spend her entire life answering to the government on every patient and every diagnosis. Most doctors are fairly independent people. Same with my relatives. They are not considering retiring because they will make less money, but the pain-in-the-ass government.

Jobseeker... the difference is... People's LIVES are dependent on those in the medical profession. No one is going to DIE because they can't afford to hire an interior decorator.

They voted for him so they are part of the problem as far as I am concerned. They drank the Kool Aid.

Smc,

The fact remains, people are human and they work to make money. If you pay less, you will get less talent. It is that way in all professions. But as I said, money is a secondary factor in doctors choosing to retire or the best and brightest going into other fields. Is the government going to take over the engineering industry next? After all, LIVES are dependent on the engineer's calculations. One mistake can mean a plant blowing up and thousands of lives in jeopardy. It's whole different ball game when the government tells you what procedures are allowed and which ones will be reimbursed. Oh wait, the govenment does that already with Medicare. With ObamaCare, it will just get worse. Now can you see the frustration of doctors? How much can they take before they say I can't take it anymore?

It's not money that will cause doctors to leave the profession. It's government intervention and regualtion. Soon we will have medical quality similiar to that of public schools, post office, etc..

Smc and Want Truth, Carl Marx would be very proud of you.

Jobseeker: pay no attention to your responding posters. You are correct about overworked physicians. They will leave. Money doesn't matter when you have been fatigued for 15 years. This can't possibly work if there are not enough doctors.

smc and want truth,

Reading this forum disgusts at times me due to comments like yours. My husband and I are both physicians (he is military). He is Internal Medicine but I'm in training to become one of the "greedy specialists". Why am I doing this? Well I can tell you point blank it has nothing to do with money. It has to do with the fact that I found a field that is intellectually stimulating, challenging, and personally rewarding. I think I can speak for many specialists (especially ones in training) when I say that the idea of general practice is just not appealing to me. I would be bored to death if that was my career. My husband, on the other hand, loves general practice and has no plans to specialize. I'll make more money than him, but I'll also be paying a heck of a lot more for malpractice insurance. Yes, physicians make more money than most people, but you know what? I've been working my butt of since I was 17 years old. I would never advocate getting something for nothing, but I would ask you to think a little before you post such rude and untrue comments about us being "greedy".

Reesa - As a doc from a long line of military surgeons turned civilian (until recently I still drilled with my reserve unit and met MY husband (marine aviator type) when he flew in VN and DstSheild) let me say thanks to your husband for his current service and to you for supporting him during your own stressful fellowship. Pay little heed to the laypeople here who think that we're all sending millions to the Caymans. I always answer that by saying if I'd wanted a fortune and 9-5 workdays with golf Wednesdays there were easier ways than becoming surgeons!

Anyway - unless your inside, laypeople have NO CLUE what our lives entail. They are simply and entirely uninformed having been lead to believe that Television Doctors like House and Marcus Welby are real. Have YOU considered military medicine in your speciality? Not having divulged where you're headed, I only ask you to consider the possibilities. You husband, as a primary care man faces a lifetime of things he already knows will get worse. While I always applaud those guys/gals who take on that challenge, especially in underserved populations it's going to be a touch nut to crack (not professionally - but personally, even in IM/peds or FP. MANY of my colleagues took advantage of Uncle Sam's full range of specialist opportunities and there might be one for you AND your guy.

Just a thought. I was proud to serve and take my commision back in the day and after I 'got out' I drilled with my unit and additionally did a lot of pro bono for those who'd NEVER be able to afford my services. (Like you - I'd rather NOT divulge here on NV -too public) However, do you spend much time on Sermo? Interesting perspectives but I hear that Sermo's been hacked.

Good luck to both of you - tell hubby to keep his head down. Navy medicine was my home for a long time. I consider it some of the BEST experience I've had during my long career which will soon become long awaited RETIREMENT. NEVER feel you need to make an excuse for your economic rewards. If everyone could do what you, your husband and I do, then it would not have the value which society places on it. Then, anyone could do a heart transplant, right?

thanks buche and reesa,

doctors are just another casualty of this administration’s demonizing hard working americans. If you make over 250k a year then you are evil greedy monsters

You're dreaming if you think all of this is going to go away in November. Like the man said, get your doctor now.

They already do and did before he became president. Did you complain to George about this?

drbob, That sounded like my doctor talking. Its going to get ugly.

You have lived through the worst of it, and you will live to see us take back control from these insurance giants once and for all.

Anthony - are you a fan of Charlton Heston and Edward G. Robinson, Too? I though we were a dying breed?/!!!!

May I suggest that you pinch yourself, sir? And awaken from your scifi channel nap?

anthony you can join me in the sewers for rat burgers...lol

Get over yourself. All that ranting and raving and not saying anything. Thirty million people now looking for doctors. If you haven't notice, people are out of work. With one stroke of a pen, we'll have more high paying jobs than we have people to fill them. All those medical students who might find work now. All those college graduates, thinking about going into medicine have a great future a head of them. All of the nurses, techs and other health care professionals and medicdal supply companies that will be needed. High paying jobs. High eduction jobs. That's taking America back. Jeez, keep talking partisan junk. Crawl back under your rock.

jim - you are correct in the assertion that health care is a field which never lacks for workers. While there have been cycles in certain ancillary fields (nursing, radiology, respiratory, OT, PT, ST, etc.,) these fields cannot be outsourced nor can they be eliminated by a computer program. (YET). While telemedicine is already in use - it's a far cry from what a real doctor at the patient's side can do (especially in a code). I am sad to see what I think will be a further 'dumbing down' of American medicine which has always been the best on earth.

Jeannie: So much of what you say is correct. Your responders who say "now all those doctors will come", "now all those nurses will come". Really? It takes 10 years to be a doctor! 5 or 6 years years to become a highly specialized nurse. Who are these people they refer to? An NP or a PA can do a lot of things, but if you need a heart bypass, you need a highly specialized doctor. Jim: "With the stroke of a pen all those medical students will find jobs" Really? Those students already have practices lined up the absolute second they take their boards. In the US, NO physician is job hunting unless he has a checkered history. My husband has been an ER doctor for years and years. He gets letters almost every day asking him to join a group. There are not enough doctors already.

Allison - Your points are well-taken. I think we would rather be in a position of needing doctors, rather than having a too many. I addition to the doctors, there will be a need for more people to support the medical infrastructure.

Just one other point. So is it your position that our society benefits by having uninsured people in our mix? That having more insured people will be a burden? We pay for the uninsured already. In addition, the uninsured are getting (partially) treated already. Ever go into a large urban emergency room? We (those with insurance) pay for flu and cold treatments at Emergency Room prices by higher prices to cover these costs. The argument that we should not insure the uninsured because we don't have doctors to support them doesn't hold water with me.

I don't see anything wrong with a doctor wanting to make money, as long it was kept second to wanting to care for their patients. And as long as they did not take risks with their patients health to make that money. Like taking on more patients than they can handle to keep the money rolling in. A doctor should make enough to live comfortably, the question is how comfortably do they need to live exactly?

Doctors ( my husband) go to school 10 years and live on $3.00 an hour for years as a resident/intern while other professions are starting families and buying homes and cars. Their education can easily be $250,000 in student loans. Yes, they are highly paid. But they are overworked. I have seen my husband be at the hospital for 24 hours straight plenty of times! You don't bill for all that time. And Ms. Crittendon- no one would be a doctor under their grueling schedule if the didn't "want to care for patients" as you say. You have to love medicine or you will never make it. People always make it about money. My husband has seen plenty of people for free. Some have paid him with chickens, pecans, vegetables, whatever they could. There just aren't enough doctors for all the patients. Time will prove that unfortunately. I hope everyone finds a doctor.

Allison, That is why we need to bring down the cost of student loans and cut costs of doing business so they are not forced to be over worked. This would inspire more good doctors into the field. I know there are a lot of doctors out there that want to help people. Clearly your husband is one of those people. You must be very proud. He sounds like the kind of doctor I would want to see.

Oh.......I forgot......If I have offended nurses or a physician's assistants - GOOD!!!! You are NOT doctors!!!! Not even remotely close!!!!

And you're an idiot of the lowest calss, UnBeliiever. Sheesh. Just when I think I've seen the most idiotic thing I could ever see, someone comes alone like you and I know that there are depth of stupidity yet to be explored. LOL Of course, you don't know how stupid you are, do you?

Thanks!!! By the way....what is "calss".....I am Unbeliever not "Unbeliiever" and I don't really give a s..t what you think. But thanks for thinking it.......perhaps you should change your orbit, Sputnik, and fly deeper into space.

See, you're so stupid that you can't recognize a typo from stupidity. LOL Of course you don't give a @!$%# what I think. Idiots rarely do. You are truly an idiot.

Sputnik, UN - please. This is disgraceful. I understand where UN comes from. As a physician I was faced with a difficult situation when I sent a family member to a specialist who I personally know. When she went to her appointment, she was initially seen by the NP. I found this entirely unacceptable and called the surgeon (a friend, who apologised immediately for the 'oversight', stating that he ALWAYS sees all new patient's personally. I was none too sanguine with this answer. While the NP was personable and knowledgeable and educated at the masters level, had prescriptive authority and was doubtless a competent provider - SHE IS NOT THE SURGEON who I wanted my sister to see. The change was made, my colleague the surgeon DID see my sister and that was that. However, there MAY certainly be cases where the NP could make all the difference in a practice - just not on the FIRST visit. Analagously, we don't need to call the plumber to remove a hair in the sink. NPs and PAs are NOT doctors and Un is right.

Sputnik while you disagree - if you are representing the midlevel's position please be professional. You have not done anything to advance the cause of PA/NP care with your response to UN.

The physician alone is poised and trained to manage the care of the patient. When the management plan has been established, however, there is NOTHING wrong with having the midlevel assist as a provider. The exception is in far flung rural or inner city locations where you will not find a physician (other than a national health service scholar payback type) to build a practice in those area. It simply will not happen. I will wait with great interest to see how it all plays out - and I truly hope that name calling between levels of 'professions' does NOT become the norm. THAT will bode most poorly for the public's health in every venue and realm of practice. For now - Walmart is growing their 'minute clinics' in leaps and bounds

buche: I agree with you. My husband-Internal Medicine and ER-is worried that many will not see the specialist they think they will get under this health bill. Like yourself, years of training enables doctors to evaluate a person just by listening, talking and LOOKING AT the patient. They have that ability. I am not sure midlevels have that to the degree a physician does. Most of time it can be fine, but WalMart will eventually mess up big time. And secondly, there simply are not enough physicians or physicians in the training programs at this time to accommodate this health bill demand,

Very good points. It does cost money for doctor's to stay in business. Obama's healthcare plan is to stop insurance and drug companies from over charging. Doctor's and hosptial's will get a larger cut, and patients will pay less for services.

You might feel better to know last year med students are qualified in most cases if something goes wrong. Far more so than the EMT that picks you up and keeps you alive for 45 minutes on the way in. You can trust all of these people including the EMT, know what they are doing by the time they see you, and the boss is always available if it turns out they are needed.

Randy: I have a neuro surgeon friend in Austin,Texas who pays $1,000,000 (that's one million, yes) in malpractice insurance before he even opens the doors on January 1st. He has NEVER been sued for malpractice and that's his rate.

Sorry Ms. Crittendon-this bill may ATTEMPT to lower malpractice fees, but malpractice carriers will fight it

I am afraid there is a lot of fantasy in the new bill. Well see

You're a stupid @!$%#, beyonddisgust. Act like you have some sense.

beyonddisgust -

Get with the program. Except for a few comments like yours, this is one of the first threads I've read in a long time where people are actually keeping on the topic and not throwing out partisan junk.

It's time to take the debate and conversation back from the likes of beyonddisgust and talk about the issues.

The Issue is that there may not be enough Primary Care Physicians to cover the United States! This is not partisian anymore, it passed A$$es! This is FACT! WHo is going to be our doctors?? Great you pay for insurance, but have nobody to care for you!
This is about our Health Care!

Like you Stupnik?? Your a jerk and non-contributor! I bet your IQ is about the size as the letter words your constantly calling other people, while not offering anything!

Im sorry Jim, but a nonpartisian news article is pointing this out! (And really this is A Progressive Leaning Media Source!).

The Bill passed, now lets both hope there is no truth to this Dogma!

LOL@ beyonddisgust. I can't believe I'm actually responding to your inane post. Most of the time, I don't acknowledge irrelevent idiots like you, however, your intellegence level is a tad bit above the average conservative (which isn't actually saying a lot), so I will respond. I'll keep it simple so a simpleton like you can understand. YOU ARE AN IDIOT. Got that, Goober? An idiot. LOL @ conservative stupidity.

I have actually got a BA from The University of La Verne in Political Science. I really don't care what you think! Your writing says enough about yourself! You have offered nothing in any of your posts; which only tells everybody that you have no thoughts of your own to offer!

So why don't you do everybody who might agree with you a favor and zip it!

So MS I would like your input on the cuts on home health care in this bill?

Jake, Home healthcare is a very important issue and the best place to be if at all possible during an illness. Not only is it most often the prefered choice, it is the most cost effective choice for patients. The problem is that equipment and drug companies, along with the home healthcare companies that send assistants are charging far more than they should be. The plan is to force these companies to charge the right price instead of draining this money unfairly from medicare and medicaid, or even directly from their patient's pockets in many cases. Many of these caregivers take it upon themselves to visit their patients off the clock, bring groceries, and all sorts of things out of the kindness of their hearts. At the same time there are also caregivers abusing the system, charging far money then their job requires just to sit with a patient, cook for them, and help them up and down the stairs. Is a job like that really worth 15 dollars an hour? Perhaps it is, but the average mentally disabled caregiver only receives 8 dollars an hour and has basically the same amount of education. Cost does not always mean quality, and of course that is what we are looking for when it comes to our loved ones no matter what their condition. When a nurse is coming in, of course they deserve even more pay, but how much are these companies charging medicaid and medicare for equipment, drugs, and how much exactly are the home healthcare companies getting for sending out these assistants? If the nurse or therapist is getting 20 dollars an hour, what is the company who sent them getting just for sending them? That is the issue we are trying to address.

As long as we make sure the equipment and drugs are sold for the right cost and medicaid and medicare are charged correctly, and the nurse or assistant is paid only and all of what they are due, and the company who is running the assistance and home healthcare program is only being paid what they deserve, there should be room to make these cuts while providing the same care. I don't think anyone would suggest we cut the quality of care to these patients. These patients deserve the highest quality of care, but at the same time we need to cut off the fraud against our medicare and medicaid system that is needed to care for these people properly. We need to cut out the waste of tax payers dollars. It is similar to when the White House wrote off a toilet seat for something like 10,000. Once everyone is charging the right amount, we will have a much more stable system in place and offer better services making sure that the money is going where we really want it to go, directly into the hands of the caregiver who is caring properly for our family member.

You may say, well how are we going to get these people to change their prices? The choice is theirs. They bring down their costs to do business, or we will find another company who will. We are still willing to pay reasonable prices, and they aren't about to give up their companies. They know there is still a profit to be made. They'd be hard pressed to find anything better than our new offer unless they want to go into some other field. That option doesn't look too promising in this market. Who else is going to buy their extra equipment, drugs, and hire their assistants if medicare and medicaid won't? We can always import cheaper stuff and our nurses could start working independantly, but certainly we would hope the companies we are already doing business with will come to their senses before we have to resort to that. I am confident they will find a toilet seat in our price range.

They bring down their costs to do business, or we will find another company who will.

You say: "Is a job like that really worth 15 dollars an hour?" is fighting words to any union. You propose to pay $600/wk to sit with a patient, cook for them, and help them up and down the stairs. Those jobs must have certified people - trained and responsible for care to helpless patients at home. Get it?

You propose paying $16,000 a year ($8/hr) as fair for the job. Perhaps you should start by offering teachers the job at that pay. They get to supervise kids all day. Play games, read stories, show them counting. Much easier than caring and feeding old stinky invalids. Start there!

Your threat, "find another company who will" is hollow and government will be less effective than insurance companies at lowering or even keeping the same cost levels.

6 very large home health companys are already positioning themselves to dissolve. It really is sad as there will be alot of hospice,small children, etc who will be the ones to suffer, not the goverment.

Grinspoon97, I think you misunderstood. I don't think 8 dollars an hour is fair pay in today's market. I believe 15 dollars an hour for a homecare assistants to sit with a patient, cook for them, and help them up and down the stairs is probably reasonable, hut they could also make a little more effort, perhaps clean up the house while they are there. I also believe that mental healthcare assistants should receive that amount of pay. They both receive the same amount of training. I think minimum wage needs to be raised to 10 dollars an hour across the board. I am not suggesting we lower these workers pay to bring down the cost of of doing business. I am saying that we need to bring down the costs of management, supplies, drugs, training, etc. to the actual cost of services charged to medicare and medicaid. And we also need to get more good people working as home healthcare aids and mental healthcare assistants. The only way we can do that is to offer them decent wages by giving them the right cut and firing those workers who don't work up to expectations. Right now in the mental healthcare field you can't get good workers into these positions because they are being paid beans for the job and doing twice the work. 8 dollars an hour isn't going to convince too many people to wipe someone's butt for a living. You would be suprised how many of these people are hired without any type of training or background check.

Jake, That also means alot of people out of work. Why would they do that? Someone will be willing to take their place.

As far as tort reform and malpractice goes, just because the physician did nothing wrong does not mean they "win". Many malpractice cases, in which the physician was not negligent or responsible for the bad outcome, are settled by the hospital and insurance company out of court. This is the cheaper option than fighting it, which is an incredibly long, drawn-out, painful, and expensive process. Even though the physician was not at fault, he or she still has to report any malpractice settlements when applying for and renewing a medical license. In certain instances, I feel that lawsuits against physicians are entirely appropriate and justified; however, these represent the minority of cases. I think that there should be a significant monetary penalty imposed upon lawyers and plaintiffs who enter into frivolous cases. This would cut down on expenses and malpractice insurance, as well as continue to support parties who bring on appropriate lawsuits. In an ideal world, only those with justifiable claims will sue, and they will be adequately and appropriately compensated.

Like this will ever happen...

Reesa, Medical malpractice insurance companies are not going out of business. They are making plenty enough to afford to charge doctors and hospitals less for their services.

Most plantiffs work with small town lawyers who charge no fee unless they win. If the case is not solid and they lose, it is their lawyer who pays for putting the case together. Surely they aren't in business to lose money. It shouldn't cost medical malpractice insurance companies any more to put together the case than it costs these small town lawyers to do it, and they too are still in business.

If the defense is confident, they should have no reason to settle out of court.

Ms. Crittenden,

You wrote: The plan is to force these companies to charge the right price instead of draining this money unfairly from medicare and medicaid

Right price according to whom? If you are running a similar company and are offering your company to lower prices to what you believe is fair - then your good intentions have weight. In our system, such competition lowers price. The way to FORCE the "right prices" is to just compete them out of business. Good for you. Only government has the power to force higher prices with laws and subsidies.

What is the name of your Company which charges the "right price"? Might as well get a plug and some free advertising here.

Ms. Crittenden,

As someone who works in the medical field, I respectfully disagree. It is often NOT the physicians choice whether or not to settle. Even if the defense was not at fault, it is still cheaper than a court battle in many cases. Besides, juries are not made up of physicians. You can get all the expert testimony in the world to support you, DNA evidence, whatever, and there's a chance you'll still lose. Insurance companies know this. Physicians and hospital know this. American people, for the most part, seem to be unable to accept that bad outcomes do happen and no one did anything wrong. Our society always has to say "it's not fair" and has to find someone to blame. Bad things happen to good people.

Ok, I'm done ranting. I hope everyone has a lovely day.

I also respectfully disagree. How many medical malpractice lawsuits use DNA evidence as a defense? Usually the case has already been completely put together by the plantiffs lawyer before the lawsuit is issued through medical records, witness testimony, and review by other medical professionals. By that point it is really just a matter of the defense copying records. From there the defense has to decide if they have a good argument, or if the hosptial or doctor really did screw up above and beyond what was expected of them. The court room itself costs nothing to them. It is the cost the defense's lawyers are charging for their services that is too high. I also think we need to give juries more credit, we have our justice system set up this way for a reason. If it cannot be proven beyond any shadow of a doubt that the hospital or doctor made a mistake that any other professional in their field would be expected not to make, than the case is closed. The Plantiffs lawyer loses all the money they invested, yet the defense still takes way more money in the form of insurance from hospital's and doctor's than the case actually cost by far. If they settle out of court, it's because they don't have a good case. And if they win, the still are taking way more from hospital's and doctor's in the form of insurance than it actually cost to prove their case. Consider the cost of their insurance, and then consider the actual cost of putting together one of these cases. On average it should cost the plantiffs lawyer about 20,000-40,000 dollars to put together a solid case . By the time the defense receives it most of the work is already done. It should not cost them more to put their case together. It costs nothing to sopena, or call on witnesses. How much money are they taking from hosptials and doctors per year? And we know there are not as many lawsuits per year as there are hosptials and doctors. I believe there is room to bring down the price of their insurance while providing doctors and hospitals the same protection. These lawyers who work for insurance companies are bloated with over compensation. It is also important to remember the reason we have courts which is to make sure that people arebeing treated properly according to our laws. It helps us to weed out corruption, and prevents corruption from occuring in the first place.

While diet and exercise are certainly important and valid in health maintenance, many illnesses do not have their roots in these two arenas. What about pediatric cancers, or degenerative neurological disease? What of multiple congenital anomalies and/or major disfiguring hemangiomas of the neonatal era. Type 1 DM in a four year old who runs around and plays normally as any 4 year old does cannot be blamed on diet and exercise! Certain illnesses are incompatible with life such as the grave epidermolysis bullosa and NO link exists to diet and/or exercise. These major illnesses need expert, specialized medical treatment and are mostly illnesses of children. Who will care for them? Ask yourselves these questions and realize that you CANNOT see this crisis in black and white. The questions are too complex. That is why it's so hard to try reaching a consensus. This and the fact that knee jerk reactions are unhelpful in the extreme.

I am concerned about losing my freedom to live life as I see fit and enjoy. I really have that covered, it's more about what my kids and theirs will be able to do. You duck my concern and deflect to another. Again here is my concern.

Say Don's cholesterol test, scheduled after his yearly checkup, came back borderline high. That new lab result will show up, with discussion of diet, exercise and medication options to lower it in light of his other risk factors. He might try some on his own, or call up the doctor — who also gets an electronic copy — for a more in-depth discussion.

I think YOUR concers is as follows:

These major illnesses need expert, specialized medical treatment and are mostly illnesses of children. Who will care for them?

Them? Would they be amoung the great majority who had Health Care under the private system? Guess they would have been treated then. OR are we talking about some who had no health care and would rot on the side of the road where cruel Americans complained about having to step over them?

I personally think the system could have been extended to those without a government grab - which makes us wait years while these helpless children suffer waiting for 2018 and beyond for the plan to take effect.

If the goal was to cover more, then both D & R could have agreed to immediately require: No pre-existing conditions denial. No lifetime limits. And the rest which just set the rules for offering health insurance. The companies would just set new rates for the insured pool - done!

I don't see the CRISIS if it is victory to wait several years - apparently letting children die horribly - for the plan to take effect. Most of it could have been had bi-partisan, the rest could be argued to the next election. This makes the URGENCY a lie to the sheeple.

The children with these very serious conditions are first in line, and will be getting help right away. There will be no more waiting for them. Adults with life threatening pre-existing condtions are next in line. From there medical health insurance coverage for children until they are 26 will go into effect. They are moving into this plan in steps, starting right away with very ill children that were mentioned.

Under what provision will your claim of help right away to currently uninsured children be met?

The children with these very serious conditions are first in line, and will be getting help right away.

Reading from synopses of the bill and when it takes effect:

"For people who have the greatest need, a number of things will start quickly and make a difference," said DeAnn Friedholm of Consumers Union. For others, 2014 may seem like a long way away. "Some people may be frustrated that it's going to be several years, but that is the reality of what it takes to make these significant changes," she added.

Q: I want health insurance, but I can't afford it. What do I do?

A: Depending on your income, you might be eligible for Medicaid, the state-federal program for the poor and disabled, which would be expanded sharply beginning in 2014. Low-income adults, including those without children, would be eligible, as long as their incomes didn't exceed 133 percent of the federal poverty level, or $14,404 for individuals and $29,326 for a family of four, according to current poverty guidelines.

MS they forgot to include children in this bill.

No, no, children with life threatening pre-existing health conditons are first in line and will be getting help right away. All the other things mentioned, will come into play later.

"pre-existing health conditons are first in line and will be getting help right away."

You might be right. Just asking for the part of the bill or a news report which says that about pre-existing conditions are immediately covered - for children or anybody.

Thanks, Got a link?

Grinspoon - Printed words being somewhat inadequate, I come to the conclusion that your comment regarding fear of retribution for 'not taking a test' is a specious one. Were you here before me - I would have known instantly what your intent was. Nonetheless, if you perceive my response as deflection - then you miss the point. I suspect your 'concern' is not likely to ever become reality because you and I both know that NO ONE GIVES A RATS A-- about your OR ME, for that matter that they'd ever insinuate themselves into our lab values in the way you suggest. Be sane, man. There's NO WAY and NO MOTIVATION for such intervention. But if, as you suggest, none of these health concerns affect you, then why contemplate recriminations of ANY sort. Face it Grin, no one really cares about you, personally, in a real sense and you are not that important. Not by a long shot. I responded as I did becuase lay people seem to think that if only 'diet and exercise' were embraced by all, the gates of heaven would blow wide open and we'd all be miraculously free of any and all maladies. THAT was my intent, not to DEFLECT your duplicitous future view. Your family, of course, who love you and to whom you are son, father, brother or grandfather certainly want you around, hale and hearty. That is their personal interest and need for you in their lives. To make a mockery of this discussion is what you are doing and perhaps, you have succeeded. As a provider of health care services for my entire career I have met patients like you before. You purport to have an interest in whatever topic may be at hand, but in fact you are simply and entirely disingenuous. You are full of displaced hubris with a POV than fails to advance the argument in any way.

Since you care nothing for your own health yet lay claim to wanting only the best for those children and grandchildren you love, then why not lose the ersatz interest, get on board and actually DO something about the current scenario. Or not.

There's NO WAY and NO MOTIVATION for such intervention.

Use the motorcycle helmut law as a model: Helmuts are required because some get hurt and the costs are put on society. It is no leap to consider social healthcare a matter of public determination.

• Mandatory testing in the name of preventative medicine
• Mandatory treatments based on test results
• If compliance with treatment not demonstrated, penalties and fines applied.

If requiring a citizen to buy health insurance is NOT unconstitutional, then neither is this outcome. It can all be done in the name of public good.

When my brother has the RIGHT to be my keeper - he will. Just a matter of time. I hope the constitutional challenges are successful and this encroachment on individual rights is stopped.

I don't know how the healthcare initiative will play out. But I do know that there are a lot of countries you didn't mention (Sweden, Germany, Great Britain come to mind) that have universal healthcare and are not failing. In fact, I hadn't noticed that China's economy is weak, either.

Heh...

So "charity" is for the people who are "too poor, too ignorant or too lazy to afford healthcare," is it? You realize that many people struggling under the current healthcare system are working taxpayers, just like you and me?

Someone is showing their ignorance here, and it isn't the large group of poor, dumb slackers you claim is benefiting from health reform.

"I hadn't noticed that China's economy is weak, either."

if you will take a educated look at chinas economy you will find that it started to grow when they began embracing capitalism