Wednesday, March 31, 2010


It is difficult. I have often wondered what preachers do. Wondering aside, I know physicians are often intellectually dishonest. How so? To talk with us you would think we are the poorest, most maligned people on the planet. Health care reform is going to kill us.

Yes, medicine as we know it today will probably go away. I have to tell you that I don't believe that to be all bad. This is opinion you understand but the facts get distorted usually by the person reporting them.

Here is a fact I was confronted with yesterday. "Well, one of the reasons health care costs so much is we are practicing 'defensive medicine.'" Honestly, I am not. I try to see the patients, go through my list of differential diagnoses, order the appropriate tests to rule out all but one, and come up with a cause for and a solution to the problem. Often, I encounter other problems which have to be dealt with along the way but I don't believe I am doing tests defensively. My liability insurance, though expensive (remember I deliver babies and have 20 years of liability for each one), is half of what it was when I entered private practice 25 years ago thanks to tort reform.

When I entered private practice twenty five years ago, 9 months of obstetrical care, the delivery and six weeks of post partum care cost $850. Today, in the same zip code, most major carriers will pay over $2000, some go as high as $3000 (and if you don't have insurance you are paying over $3000 which is another reason physicians don't want everyone to have insurance). And physicians I know well are gaming the system by doing sonograms at almost every visit, charging $300 each. One of the reasons I left private practice had to do with our sonography practice and what I believe was unethical behavior. Again, this is my opinion, so don't get me sued for slander.

So why does health care cost so much today? Well, first off, there are all those uninsured people out there but that doesn't affect your visit to your local obstetrician. No, the local OB's office is filled with people to monitor your insurance, make sure you are covered, what level you are covered, and how much you will have to pay for that sonogram. All that along with someone to make sure the sonogram is coded properly so the insurance company will pay for it.

If you feel like your doctor is managing a business rather than your health - you are correct.

Now, I am going to ask a question. Of those 16 million Americans who are at the lower income levels and now required to purchase insurance, how many of them are going to go out and buy a policy or take the chance that they can use that money on a 52 inch flat screen TV and not get caught?
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