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Licensed To Serve

Quite a few people are talking about the Florida urologist who has decided to encourage his Obama-voting patients to seek their health care elsewhere. A person's take on the story seems to depend on their position on ObamaCare -- those who back it are outrageously outraged, while those who oppose it feel a sense of smug validation. (I'm firmly in the latter camp.)

But it also reminded me of a situation that arose in Georgia almost 25 years ago, when a small group of doctors in a certain specialty decided to prescribe their own form of "justice" against someone who they felt had done them great harm. It seems that in Brunswick, a certain attorney had earned a reputation as an exceptionally potent litigator in the field of medical malpractice, and whose very name made even the best of doctors' blood pressure skyrocket. They'd even swap horror stories amongst themselves about this attorney's practices.

Well, this attorney in question found herself pregnant. But when she sought out an obstetrician, not a one in town would take her on as a patient. Not one of them could see her strictly as a patient; they all saw a future legal antagonist who would be trying to bankrupt them.

And they extended that informal blackballing to include all lawyers, lawyers' spouses, and employees of law firms. Not one doctor in town believed that they could treat them in good conscience, that they could set aside their own personal fears and concerns to give their undivided attention to their patients' well-being.

I can't seem to find any stories on how the situation resolved itself, but the principle demonstrated here is immutable: doctors are not slaves. They are not public servants. They can -- and will -- stand up for themselves and their colleagues' best interests when pushed too far.

The study that shows many doctors will retire or quit when and if ObamaCare comes into full practice has been questioned, but it seems pretty clear that a large portion of the plan's provisions are based on some hefty assumptions. One of them is that doctors, in order to continue practicing, will accept significant government controls and oversight on their decisions and actions and recommendations -- largely from a financial standpoint.

Back in 1986, that assumption came to a brutal collision with reality, when the lawyers in a Georgia city got themselves kicked in the crotch by their cash cow. Now, in Florida, a doctor who specializes in those kinds of injuries is saying he'd rather not help the people who are trying to shove him into the milking machine.

This is not an aberration. This is an omen.

There will be many, many more Dr. Cassells if ObamaCare comes to pass.

I close with a philosophical question: of what use is a "free" good or service that you can't access?


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Comments (54)

"I close with a philosophic... (Below threshold)
Pete:

"I close with a philosophical question: of what use is a "free" good or service that you can't access?"

Excellent line. I am going to be using this over and over again.

Jay Tea: "doctors are no... (Below threshold)
Justrand:

Jay Tea: "doctors are not slaves. They are not public servants"

YET!

But that is the clear path Obama and his verminous Leftist ilk want us on.

In fact they want EVERY skill, EVERY profession, EVERY resource harnessed for the "good of the citizens!"

Forward Comrades...it's almost 1917!!

How many doctors will choos... (Below threshold)
TexBob:

How many doctors will choose to retire or simply give up practicing because of Obamacare?

Thousand will. This is just the tip of the iceberg.

Soon, visiting a doctor will be like calling HP's tech support line. Either way you end up talking to someone from India who cannot speak English.

What a buffoon this guy is.... (Below threshold)
Bruce Henry:

What a buffoon this guy is.

It's like being a restaurant owner and posting a sign: "If you voted for the recent Smoking Ban Referendum, take your business elsewhere."

Only a fool would try to turn away a third to a half of his clentele.

I hope his campaign succeeds and he does lose that many patients. What an idiot.

The point is lost on Bruce ... (Below threshold)
iwogisdead:

The point is lost on Bruce Henry.

Again.

There you go trying to put ... (Below threshold)
BluesHarper:

There you go trying to put logic to liberal thinking.

Oops, that's an oxymoron.

What percentage of doctors ... (Below threshold)
Les Nessman:

What percentage of doctors are against Obamakare?

I was hoping to see more protest from docs and med associations throughout this whole fiasco. I think maybe they were reluctant to protest because they (like everyone) didn't know exactly what all was in this sneaky, secretive, hastily-constructed, partisan-crafted, 2000-page monstrosity.

However, if anyone couldn't guess that this was going to be a socialist fubar, then shame on them.

Bruce Henry "knows" that lo... (Below threshold)
klrtz1:

Bruce Henry "knows" that loyal union members like him will go straight to the front of the line when they need medical attention. So he doesn't care if anyone else has to wait even longer to see a urologist if this one sees 50% fewer patients.

I really hate that the taxes I pay go to bastards like Bruce Henry.

Tis still a free country. A... (Below threshold)
Ron:

Tis still a free country. Are we ready to sue that freedom and vote with our feet? How about our pockett books?
I wonder if anyone really gets that we are all tied in and are being dragged somewhere we won't like?????

Who is really pulling this cart?

The AMA, which has lost mem... (Below threshold)
epador:

The AMA, which has lost membership over the years for a number of reasons including its political stances, represents less than a quarter of all physicians. It is still staunchly pro-Obamacare (though its also for fixing the big drop in Medicare reimbursements that started this month).

I'd guess from my knowledge of most local physicians, that a majority oppose the current health care reform plan. I'd bet that a majority of them feel trapped out of economic necessity to keep practicing despite the steady rise of onerous regulations and obstacles to practice sensible medical care.

If anyone here decided to similarly limit their patient population based on their voting habits, then about 80% of the city-based population would have only 20% of the physician population to see, and about 70% of the rural population would have 80% of the physician population to choose from, if they could get to their offices.

There must be a message there somewhere.

As an aside, the mid-level providers (NP's) are divided - I see a lot of Obamaphile NP's and few Obamaphile PA's. Note most of the NP's are female and PA's male. Hmmm....

As to why they aren't prote... (Below threshold)
epador:

As to why they aren't protesting - it takes pretty much universal physician disgust with a problem before they'll group together. Its like herding cats trying to organize physicians, even on a little hospital staff.

I was in Michigan in the 80's when the malpractice threat exponentially metastasized to every corner of medicine. 10,000 docs marched on Lansing - it was like a giant Tea Party - and the Governor and legislature promised reform. We're still waiting.

There haven't been any more 10,000 strong marches. I think there's too many tax and education loans to pay off in the State's physician's financial portfolio to justify further futile efforts.

This is the hard reality th... (Below threshold)
GarandFan:

This is the hard reality that "ObamaCare" will run up against. If you offer only so much for a service, the one providing the service has the final say in the arrangement.

Those embarking on their 'free' Medicare may find it hard to find a doctor who will take them. Medicare has a higher rate of refusal then do health insurance companies when it comes to requests for specialized services. And the government drags it's feet when it comes time to pay the bills.

It's gotten to the point that many businesses now REFUSE to do business with government (state or federal). Who wants to provide a service only to be told 'we'll pay what we think it's worth, and we'll pay you when we feel like it'.

"I think there's too many t... (Below threshold)
Les Nessman:

"I think there's too many tax and education loans to pay off in the State's physician's financial portfolio to justify further futile efforts."

This is a big reason why we ended up with Obamakare.
I appreciate those in the medical arts, like ep, who spoke out all along. But too many docs were silent on this. They could have done more. (So could we all, but the docs could have had a big voice in this.)

Exactly; doctors are not sl... (Below threshold)

Exactly; doctors are not slaves. But Obama wants them to be. It is really funny how the first black president ever is the president that is trying to usher in a new form of slavery. I guess that is what happens when skin color is the most important reason for voting someone into office, you do not look at who the person is.

How ignorant can you get? I... (Below threshold)
June Manley-Davis:

How ignorant can you get? Instead of trying to do something positive for all the Americans concerned, a small group of Terrorist who call themselves AMERICANS, are whining and running around acting like a little child on sugar and kool aide. What do you think the foreign folks are thinking when they see this division in our country. Hypocrites! That must be what they are saying. We are hypocrites! United we Stand Divided we fall...well some are just ready for us to fail and fall...you know you are ugly and you are wrong...Health care reform is good and it is a plan that will bring about a positive change for Americans. We really should show how much we can work together to make America Great, instead of making it look like a place that never works together to make a plan work...Racist bigots and hypocrites... is how foreigners must see us. No wonder they don't take Americans serious. Shame on those doctors for not continuing service to ALL people, no matter how they voted...You should be ashamed of yourselves.

In the one party totalitari... (Below threshold)
davidt:

In the one party totalitarian state the Democrat party is striving for everyone will be a slave to the party leaders.

Bruce Henry is a fool, plai... (Below threshold)
Killerwhale52:

Bruce Henry is a fool, plain and simple. Why on earth would a Doctor act against the best interests of his family and practice? If You are asking Doctors to commit economic suicide, then, yes, go somewheres else. What is going to happen is that much smaller, cash only practices will be the way a lot of Doctors go. Some of the Doctors I know personally are in the process of closing their practices. Medicare and Medicaid aren't worth dealing with. Cash is going to be King, and if You can't afford it, well, Thank Obama. The brutal fact is that Obama can't force these Doctors to keep working. Personally, if I was a Doctor, I would close my large practice, and find a small rural town looking for a Family Doctor that would honor a cash only business. You can work for less money if your costs are much lower. Think of it as going semi-Galt, if you will.

Just thought of something, ... (Below threshold)
Rodney:

Just thought of something, if everyone's student loan comes from the government then you have taken the kings coin and if they say you will work for this much, guess you have to. Nice way to take over the medical profession.

What do you thi... (Below threshold)
What do you think the foreign folks are thinking when they see this division in our country.
"Well, it's still better in America than it is in this cesspool."

What do I win?

This guy is the canary in t... (Below threshold)
Pretzel Logic:

This guy is the canary in the coal mine. We need to repeal this garbage bill asap.

I close with a phi... (Below threshold)
progressoverpeace:
I close with a philosophical question: of what use is a "free" good or service that you can't access?

The same as a Constitution meant to limit the federal government being totally ignored in the lunatic left's quest for a national government that has total power over all. The facade is kept for show and propaganda, which is all the left really cares about.

"What do you think the fore... (Below threshold)
GarandFan:

"What do you think the foreign folks are thinking when they see this division in our country."

Don't recall seeing any of posts from you on this topic between 2000-2008 June. Is something "different" now?

Maybe Dr. Cassell is overwo... (Below threshold)
glenn:

Maybe Dr. Cassell is overworked and doesn't need the money. I retired from full time work nine years ago (different discipline entirely) because I had enough money and because so many people regarded me as a fixture or a resource to be exploited while they went to the golf course. Served my interests very well and gave a couple of the youngsters in my company an opportunity to grow up a little. Pay a lot less in taxes as well with not much change in lifestyle. See before I "had to" work 60-70 hours a week. Didn't have time to spend all that lovely money.

Lets see what a small doc's... (Below threshold)
epador:

Lets see what a small doc's solo practice costs to run:

You have a receptionist, a medical aide, a nurse and a biller (someone has to keep track of the cash and credit card payments). If you are smart they are all part time employees because you keep the office open only about 30 hours a week to give you time for nursing home, home, hospital and emergency room visits. Maybe the biller is an independent contractor. So being the cheapskate you are you have no employee benefits to fund. (It helps if your office staff are all married to folks who have family employee benefits at their job) You are still paying out salary/SStaxes/Workman's Comp/unemployment, etc. of about 6,000 a month.

You have to pay rent/utilities. Even in a small 1200 Sq Ft office you are paying about $2000 a month (that's if your front door is in a back alley with minimal parking - think double that in your typical medical office complex). If you want to own your facility, you are going to pay about $120 per square foot to license, build and outfit your office.

You have to buy disposable medical supplies including lab/xray/drugs. Depending upon what you do in your office, that could be $600-$12,000 a month.

You fork over 1-10k a month for malpractice insurance.

Then you have to pay licensing fees to your State and pay your DEA fees, maintain currency with CME education and resources for looking up medical information (this used to be books but now is on-line medical information) which will average about $200-400 a month.

So for a rock-bottom cash only solo practice you have expenses of over $10k a month. Without benefits. If you want to include health care, life and long term insurance, dental benefits, retirement benefits, then you need to tack on about 4-5 grand a month. If your office is open 120 hours a month, that's over $80/hr expenses before you see any profit - or $135/hr with benefits for you only. If you want to make 160k a year with 6 weeks vacation/sick time (far below many physician salaries) you are going to need to gross over $200-250 an hour. [If you are a Board Certified non-surgical non-specialist practitioner, today you're silly to expect to make less than $180k a year, but expect that to change real soon]

There are many folks who might be able to afford AND be willing to pay a $25-35 fee for a quick visit to the primary care doc. 10-15 minutes tops. But to see an overweight diabetic with high cholesterol, low thyroid and high blood pressure, depressed because their spouse is threatening to leave them partly due to their erectile dysfunction, and they are still smoking a pack of cigarettes a day, you are going to need about 20 minutes just to get started, and see them every month or two until they straighten out (if ever). And they are NOT going to want to fork over $80 bucks of their beer, Cheetos and cigarette money to hear you say they've got to stop that nonsense.

So the folks that open the Cash Only clinics and Boutique Practices end up "Cherry Picking" the easy and profitable patients and leaving the chronic disease and difficult patients to the folks still willing to take Medicare, Medicaid and whatever is left after Obamacare excoriates the insurance industry.

Most of these providers will be employees of hospital/health conglomerate corporations, or smaller Federally supplemented clinics that pay out a lower salary and meager benefits. They'll be earning about $55 an hour (current locum tenems rate for outpatient primary care WITHOUT benefits).

You won't have any luck collecting cash for your ER, Hospital, Nursing home patient visits, so stop right there on doing those any more. The home visits force you to charge about $300 a visit to make them profitable, so unless you are in a big city or a retirement community for the rich and famous, count them out too. (There are a few corporations that run home care doc visit programs and charge more than this, but they pay the docs less than $120k a year).

Oh well, a rambling post on medical economics, but you get the picture. I shoulda been a plumber.

June Hyphenated Liberal sai... (Below threshold)
TexBob:

June Hyphenated Liberal said. How ignorant can you get? Instead of trying to do something positive for all the Americans concerned, a small group of Terrorist who call themselves AMERICANS, are whining and running around acting like a little child on sugar and kool aide.

I agree 100%. Obama and his marxist minions should not act this way. It's time for libtards to grow up, but there are no adults in the White House.

BTW, do you have hyphenated children too?

Here you go, Jay:<... (Below threshold)
jim2:
June Manley-Davis wrote:</p... (Below threshold)
iwogisdead:

June Manley-Davis wrote:

kool aide

which would be an assistant who smokes menthol cigarettes. I just don't see how this relates to the discussion.

"..if everyone's student lo... (Below threshold)
Les Nessman:

"..if everyone's student loan comes from the government then you have taken the kings coin and if they say you will work for this much, guess you have to."

yep.

Sounds like the Pay Czar is going to be awfully busy.
A lot of people had no problem with the gov't regulating people who worked for companies that got 'bailouts', so I guess they won't have any problem with the gov't telling them what they can earn. I hope they're happy with the gov't getting so involved with their lives.

Worth remembering that when... (Below threshold)
glenn:

Worth remembering that when the Belgian Govt nationalized health care in the 50's they gave the recalcitrant Drs the choice of signing up or being drafted into the Belgian Army and sent to fight the Mau-Mau in Congo.

Um.... thanks, jim2, but th... (Below threshold)

Um.... thanks, jim2, but that's the same link I used in my posting. What I didn't find was a followup story on how things played out after the article.

Might have to do some Googling on that later...

J.

Well that would explain Bar... (Below threshold)
GarandFan:

Well that would explain Barry's desire for a "National Service Corps".

Although I think it will be a hard sell when you tell the folks the ONLY ONES being drafted are trained medical people.

First... Hey little "Miss H... (Below threshold)
Marc:

First... Hey little "Miss Hyphenated," screw you and your ability at pulling out your race card.

Nitwit.

But hey you got company in being a nitwit.

Alan Grayson is as bad if not far worse.

REP. ALAN GRAYSON (D), FLORIDA: "He's a very confused individual, that much is obvious. But what he's doing clearly is a violation of the ethics rules that you cited earlier, the Hippocratic Oath, the rules of the AMA and it's at the expense of his patients in care."

"What he is doing is no different from saying I will not treat a black person, I will not treat a Catholic."


Hey grayson FOAD!

June Manley-DavisHealth ... (Below threshold)
Carol:

June Manley-DavisHealth care reform is good and it is a plan that will bring about a positive change for Americans. We really should show how much we can work together to make America Great, instead of making it look like a place that never works together to make a plan work...
No, actually the health care reform as Obama and the Dems have orchestrated it is not good. And I say that Obama, the Dems and yes, even you, should really work together with Republicans to make America Great, instead of making it look like a place that never works together to make sure a plan is a good one.

The hyphen wrote:<blo... (Below threshold)
iwogisdead:

The hyphen wrote:

What do you think the foreign folks are thinking when they see this division in our country...well some are just ready for us to fail and fall...you know you are ugly and you are wrong...Health care reform is good and it is a plan that will bring about a positive change for Americans.

I can't speak for all "foreign folks," but Danny Williams is pretty damned happy with pre-Obama American healthcare.

http://www.nationalpost.com/news/story.html?id=2510700

Thanks to the narrow thinking of folks like The Hyphen, however, those days may be gone.

Well, to get back on topic,... (Below threshold)
epador:

Well, to get back on topic, while I don't see a lot more doctors being overtly political. I see a lot more who are near the last years of their practice limiting their risk and stress in any number of ways. That will affect patients access, or their expenses, but I doubt many will realize how or why the changes occur.

I've seen local docs cut back on their patient populations by switching to boutique medicine, effectively denying access to those unwilling or unable to pay $500 a year. Most of the patients they lost were Medicare patients on limited incomes. Most of these patients were only able to get into clinics and be seen by mid-level practitioners, and not another internal medicine MD, despite their complex conditions.

Other have sold their practice to a hospital, and take a salary. The smart ones got a decent agreement, but those that didn't find themselves having to work harder than they used to to make less than they were before without any control over their style or quality of practice. Non-compete clauses force them to stay on or sell their homes and move to escape this form of slavery.

The younger ones still having a decade or more of practice to go are struggling, advertising more, trying to market and adjust to local demands while positioning their patient mix to take the most profitable and avoid the costly patients. They are not treating new Medicare and have few if any Medicaid patients. "Pro-Bono" or discount for cash only treatment does not happen.

This leaves patients with Medicare, Medicaid and no insurance limited choices for providers of Primary Care.

Specialists in this rural and geographically remote area choose not to take Medicaid and most limit the number of Medicare patient's they'll see. Patients with these forms of insurance have to travel 50 or more miles to see a neurologist, for example. The population is small enough that it would be hard to support a second neurologist. Thus this specialist is effectively shutting out any competition that would serve the entire population while cherry-picking the good paying patients. As reimbursement for Medicare drops, this scenario will play itself out over and over.

Obamacare will not likely help this situation, from what I've seen. Sure, some folks that don't have insurance will get some, but not all. You will see more and more with Yugo medical insurance instead of Cadillac, and fewer providers willing to participate.

So instead of seeing "If you voted for Obama, seek care elsewhere" signs, folks will be seeing "money talks, your insurance sucks" signs.

For all the lefty morons: ... (Below threshold)
jim m:

For all the lefty morons: The current US Healthcare system is the envy of the rest of the world. People come to the US from all over the world to get treated. They do not go to the UK. They do not go to Canada. They come here. People from Canada come here because they cannot get the same quality of treatment. We send doctors around the world to do charity medical work. No one ends doctors to the US to do charity. It isn't needed.

So when some idiot says that this is going to be a good change I have to wonder how? We already have the highest quality of health care. The only explanation is that they desire some social justice/redistributionist BS.

This has never been about better healthcare. This has always been about control. Control healthcare and control the masses. So they slipped in education financing. Control education and control the masses.

The good that the left sees is that they will be able to use their control over who gets educated and who gets healthcare to silence opposition. They have found that they cannot shout us down. They are turning to other methods. It won't be long before you see that federal money goes to hospitals in areas where people vote the right way. Student loans will go to people who want to go to the right school with the right victim studies major.

When June above says that good changes are being made, this is what she envisions. A society with uniform thinking and no dissent against the all powerful leftist government.

I'm bemused, but not much m... (Below threshold)
James H:

I'm bemused, but not much more. As long as he's not asking patients if they voted for Obama just before administering life-saving care (and withholding if they did vote Obama), what he does with his practice is his business.

I am a urologist that has q... (Below threshold)
Imhotep:

I am a urologist that has quit my practice (large group of 23 urologists in the nation's 5th largest city) in 2 weeks I will no longer see patients. I did not get paid for 9 of the 12 months last year due to expenses being greater than revenue. I will be moving to a smaller community and make more money, have more free time and hopefully complete my career there.

I am 40 years old and have been a board certified urologist since 1999; re certified last year.

Obamacare is going to be a disaster for this country. This will hasten the emergence of a "two tiered" system; just like the UK.

So Imhoptep, RU going solo,... (Below threshold)
epador:

So Imhoptep, RU going solo, as a hospital employee or joining a smaller group?

The professional studies ha... (Below threshold)
Jim Addison:

The professional studies have shown anywhere from 35-45% of doctors will either retire immediately or earlier than they had planned due to Obamacare, if implemented. But that's not the real problem.

The income and independence of a successful medical practice is one strong incentive for smart people to enter the profession, enduring 8 years of tough schooling, taking on huge debt and astronomical insurance costs before they ever bank a dime. Obamacare will necessarily restrict physician income, and economic law is clear on what happens then: we get fewer doctors, and even fewer of the best qualified students will chose medicine.

From there, consider medical equipment companies. The new taxes will force one medical device company to lay off a third of their workforce. There will be fewer new life-saving devices discovered and brought to market.

Obamacare guarantees one thing: more people will die needlessly as a direct result of it.

My bad, Jay. I missed the ... (Below threshold)
jim2:

My bad, Jay. I missed the link as I read to the article end and decided to go looking w/o back-checking to see if you had given a link. I'm also curious, and wondered at the time what the effect would be. I'll look some more, and will be checking in here to see if anyone else posts about it.

Well, both the docs still s... (Below threshold)
jim2:

Well, both the docs still seem to be there in the same practice.

"Obamacare guarantees on... (Below threshold)
JLawson:

"Obamacare guarantees one thing: more people will die needlessly as a direct result of it."

And it's hard to imagine that they really haven't recognized just what the unintended consequences and costs are of their programs. The best managed (for certain qualities of 'best') was Cash 4 Clunkers, and it only cost about 4x the actual rebate for every car bought.

I'm not sure any of you her... (Below threshold)
olsoljer:

I'm not sure any of you here realize the extent of the chaos this "healthcare bill" will cause. (it has already started)
The professional medical practicioners: Doctors, Nurses, Physicians Assistants, Nurse Practicioners are already in critical shortage. The demand for these healthcare professionals is increasing, and we already see the beginning of the exodus from the field of medicine.
It takes 8 - 10+ years to become a MD at a huge financial cost. Less individuals are entering the medical field. There is going to be one hell of a gap in available physicians in just a couple of more years if this health care bill continues.
Individual practicioners and various types of healthcare facilities are refusing to accept medicare patients because of the loss of revenue and the payments "capped" by the FEDERAL GOVERNMENT. Do you think for one minute the FEDERAL GOVERNMENT will not "cap" payments to these same entities under a government run insurance plan?
In the same bill, the FEDERAL GOVERNMENT will be the benevolent bestower of student loans. Sure, we will lend you the money to become a doctor RN, PA, NP, just sign this additional box on the contract that you will treat patients under our government run programs at whatever we decide to pay, or you don't get the loan.
Paid for your own education did you? Hmmm...but you did take the Hppocratic Oath and we deem that is a contractual obligation, so either you see any/all patients at our pre-determined prices or:

All your student loans become due and payable IMMEDIATELY
You will be heavily fined for each patient of ours you refuse to see
You will lose your license
You will be guily of a FEDERAL CRIME and incarcerated subject to all the provisions listed above.

And what is to stop the FEDERAL GOVERNMENT from doing the same with any other profession? Medical research, technology, drug manufacturing. Teaching, or any specialization that requires a certification or license?

Do you think people are already not dying because of the implications of government intervention AND the escalating refusal of individual/facility to see Medicare patients?

I may not be the brightest bulb on the tree, or be as eloquent a writer as many of you here are, but I do know enough not to step in front of a bus.




Hey Hyphen Lady: Why do yo... (Below threshold)
DocinPA:

Hey Hyphen Lady: Why do you advocate slavery? For when you say health care is a "right", you are saying that my labor is somebody elses "right". The other name for that is "slavery". The other point that necessarily flows from this is that in order to pay for this crap, somebody elses property (in the form of taxes) is somebody elses "right" to have (steal). You're pathetic, lady. You obviously don't have a clue about what motivated the formation of our Republic and what our Founding Fathers (a bunch of white guys, dontcha know) risked their lives, their fortunes and their sacred honor for.

So the folks that ope... (Below threshold)
John S:

So the folks that open the Cash Only clinics and Boutique Practices end up "Cherry Picking" the easy and profitable patients...

That's the whole point. Usually these cash-only providers charge their clients a monthly retainer that is about 1/10 that of a normal family insurance plan for routine preventative care. Any service beyond that is extra cash upfront.

Smokers, Obama voters, McDonald's eating fat pigs, will and should get true Obamacare. Imagine a VA hospital combined with Hell.

John, that approach may wor... (Below threshold)
epador:

John, that approach may work in the big city, but in the small town, its cash only urgent care-type clinics that open weekdays, maybe Saturdays, and charge $100 up front for whatever they do (using limited CLIA lab and an old Xray machine, perhaps). One fellow tried that locally here, but as soon as he started billing rather than collecting up front he went out of business.

The local hospital had clinic's that encouraged sending patients to the ER (to boost ER income which is bigger than clinic income) and so patients with urgent but not life-threatening problems were looking for an option other than the ER. He competed successfully for a while, but after they caught on and made a few adjustments in their clinic policy, his numbers dropped. He tried expanding to billing patients and didn't do a good job watching the financials, finally went under.

People will pay at the time of service, but if they don't they often pay the doctor LAST if at all.

I have shared in the past h... (Below threshold)
WildWillie:

I have shared in the past how I work in the healthcare field, particularly hospitals. I currently work in a physicians owned hospitals. I have had many conversations with doctors in the Doctor's Lounge about this legislation. Almost to a person they will fight this bill. They will refuse medicare patients because the strings already attached to these patients requires two FTE's to manage. Now some doctor's will continue to see these patients, but can you imagine the wait? You lefties really have no idea what you are doing. You are going for a "kumbaya" moment when medicine is a business. Plain and simple. No person will operate a busines without a profit and with someone outside the business telling them what business dicisions they must make. It is ludicrous. ww

Epador,I am "techn... (Below threshold)
Imhotep:

Epador,

I am "technically" joing a smaller group: there are 23 in my current practice, but we don't cover each other's call, there is no revenue sharing and frankly my "division" of the current group has been crushed financially to the point of bankruptcy. So, I will be the 7th man in the new group I am joining; my "on call" schedule is going to be 1:7, instead of 1:3. Also, there is NO "level 1" trauma call in the new group, but the group I am leaving only works at Level 1 Trauma Centers.

I also have a skill set (robotic surgery) that the new group needs. We are saturated with robotic surgeons in my current geographic area.

Most importantly, E, the people I am joining are all good "people"; that is not the case in my current geographic location. It is very ugly where I am and the economic disaster has made what is normally a difficult decision a very easy one for me to make.

Happy Easter and God Bless

Imhotep,Staying in P... (Below threshold)
SCSIwuzzy:

Imhotep,
Staying in Philly?

Good luck, but no matter ho... (Below threshold)
epador:

Good luck, but no matter how "GOOD" the people are have someone legal and business minded read the contracts three times before you sign, and don't be afraid to haggle. I've regretted it when I didn't and never when I did.

Never been to Philly. Sorr... (Below threshold)
Imhotep:

Never been to Philly. Sorry SCSIwuzzy.
E, I've had the contracts read multiple ways by the people I trust (and some that I don't trust). I've learned a few things over the last 18 years since graduating from medical school....most importantly is what my definition of "good people" has become. There is no measuring stick of this characteristic.

Dear Bruce Henry - as has e... (Below threshold)

Dear Bruce Henry - as has every entrepreneur I have ever known, I have always gotten 80% of my income from 20% of my customers.

Secret of success in business is often as simple as getting rid of that 80%.

Doctor Cassell's principled stand will likely get rid of the thirty percent of his customers who comprise about 95% of those able to rationalize and justify having others pay their bills by way of their employing the DC fascists to confiscate and squander the lives' energies of America's most innovative, creative, productive and industrious. Of the creators and owners, that is, of America's wealth.

A Good Step in the Right direction!

Way to go, Doctor Cassell!

Ah, this is the sort of new... (Below threshold)

Ah, this is the sort of news that makes me proud to be human.

Even so, I'm bracing myself for the outcome of the tale. It rather reminds me of the photog who refused to shoot a homosexual wedding and was sued, then compelled by the courts to provide the service.

I expect as more of us stand our ground, more of us will be put into the grinder. After all, we've got to silence agitators, for the common good.




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