The Great Physician’s Revolt (the one the liberals said would never happen)

The solution is to become Medicare independent and unburdened by insurance companies. Cash only practices are quickly becoming the norm.

Welcome to the beginning of the two tier system I was warning the crazy fucking liberals about.

From the WSJ:


April 28, 2014 7:34 PM

A Doctor’s Declaration of Independence

It’s time to defy health-care mandates issued by bureaucrats not in the healing profession.

In my 23 years as a practicing physician, I’ve learned that the only thing that matters is the doctor-patient relationship. How we interact and treat our patients is the practice of medicine. I acknowledge that there is a problem with the rising cost of health care, but there is also a problem when the individual physician in the trenches does not have a voice in the debate and is being told what to do and how to do it.

As a group, the nearly 880,000 licensed physicians in the U.S. are, for the most part, well-intentioned. We strive to do our best even while we sometimes contend with unrealistic expectations. The demands are great, and many of our families pay a huge price for our not being around. We do the things we do because it is right and our patients expect us to.

So when do we say damn the mandates and requirements from bureaucrats who are not in the healing profession? When do we stand up and say we are not going to take it any more?

The Centers for Medicare and Medicaid Services dictates that we must use an electronic health record (EHR) or be penalized with lower reimbursements in the future. There are “meaningful use” criteria whereby the Centers for Medicare and Medicaid Services tells us as physicians what we need to include in the electronic health record or we will not be subsidized the cost of converting to the electronic system and we will be penalized by lower reimbursements. Across the country, doctors waste precious time filling in unnecessary electronic-record fields just to satisfy a regulatory measure. I personally spend two hours a day dictating and documenting electronic health records just so I can be paid and not face a government audit. Is that the best use of time for a highly trained surgical specialist?

This is not a unique complaint. A study commissioned by the American Medical Association last year and conducted by the RAND Corp. found that “Poor EHR usability, time-consuming data entry, interference with face-to-face patient care, inefficient and less fulfilling work content, inability to exchange health information between EHR products, and degradation of clinical documentation were prominent sources of professional dissatisfaction.”

In addition to the burden of mandated electronic-record entry, doctors also face board recertification in the various medical specialties that has become time-consuming, expensive, imposing and a convenient method for our specialty societies and boards to make money.

Meanwhile, our Medicare and Medicaid reimbursements have significantly declined, let alone kept up with inflation. In orthopedic surgery, for example, Medicare reimbursement for a total knee replacement decreased by about 68% between 1992 and 2010, based on the value of 1992 dollars. How can this be? Don’t doctors have control over what they charge for their services? For the most part, no. Our medical documentation is pored over and insurers and government then determine the appropriate level of reimbursement.

I don’t know about other physicians but I am tired—tired of the mandates, tired of outside interference, tired of anything that unnecessarily interferes with the way I practice medicine. No other profession would put up with this kind of scrutiny and coercion from outside forces. The legal profession would not. The labor unions would not. We as physicians continue to plod along and take care of our patients while those on the outside continue to intrude and interfere with the practice of medicine.

We could change the paradigm. We could as a group elect not to take any insurance, not to accept Medicare—many doctors are already taking these steps—and not to roll over time and time again. We have let nearly everyone trespass on the practice of medicine. Are we better for it? Has it improved quality? Do we have more of a voice at the table or less? Are we as physicians happier or more disgruntled then two years ago? Five years ago? Ten years ago?

At 58, I’ll likely be retired in 10 years along with most physicians of my generation. Once we’re gone, who will speak up for our profession and the individual physician in the trenches? The politicians? Our medical societies? Our hospital administrators? I think not. Now is the time for physicians to say enough is enough.

Dr. Craviotto is an orthopedic surgeon in Santa Barbara, Calif., and a fellow of the American Academy of Orthopedic Surgeons.


16 thoughts on “The Great Physician’s Revolt (the one the liberals said would never happen)

  1. The funny thing here is that this is the answer. Doctors go to private, cash-only systems.

    Then, start a new insurance industry. Just figure a way to organize it so that it does not fall into the current system. Make it available to those who wish to buy real insurance (as in, it only covers emergencies and catastrophic care events). Congress cannot regulate this new system until it writes new laws. That will take time. So the moment Congress starts to even mention doing so, this new industry starts preparing another new structure that will be outside Congressional control. Then, if Congress passes a law aimed at the new industry, the industry dissolves into the new structure and the customer never notices. Just keep doing this to stay ahead of legislation.

    Now, for those who do not think this is legal or could even be done, let me ask you something: how do you think the automobile industry stays ahead of all these crazy CAFE regulations? They just ‘create’ a new class of car. That is how the SUV replaced the station wagon, and then the cross-over replaced the SUV. Industry has been doing this for a long time. The only reason they do not do it in health insurance is because of the cronyism involved.

    Do not be deceived: the drug/health-care industry and ‘government industrial system’ are linked to and working with each other. If you do not believe me, start this new health insurance system I just described and watch how fast both of them — the govt. and existing system — come after you 🙂

          • I am confused Kells, I thought you were asking if CareCredit is a physicians insurance. I must be missing something here.

          • Kells,

            Not necessarily. You could construct a company that could back its own bonds. Or you could do something similar to the Christian co-ops, where the entire group helps to cover each other by paying into a centrally managed fund and using that fund for actually need as opposed to want.

            The point is this: Get out of the box! Stop looking to do it the way the system says you have to do it and find new ways to achieve the same goal that are still inside the law. That is how we break their power over us. Given these modern times, we can mutate faster than they can write laws. We just have to stop being stuck in the box (and lazy).

    • Joe,

      The only problem. The IRS Gestapo makes you list your qualifying plan to show compliance with the ACA. I don’t think cash will work.

      So now you are forced to have an approved company/government plan or purchase insurance on the exchange or pay an annual penalty that is being raised every year. For a while the penalty will be less than the cost of a plan however, the trolls in DC will just change the law with another 1000 pages of regulation to really stick it to you if it becomes an issue.

      They will have no problem making cash worthless in a government controlled system for anything other than very routine office visits and medical procedures.

      The only way out now is a total repeal of the ACA which is no longer an obtainable goal outside another Patrick Henry moment.

      Now bend over and let them implant that RFID where the sun don’t shine and be happy you had the opportunity to live in the freest country on Earth for a while.

      • Chhelo,

        No, this is not a problem. I propose we just ignore the law. Now, this does not mean I am saying we should think we can escape it. That is not what we are commanded to do. I am saying we start going about setting up a way to take responsibility for ourselves and our families within the law, but ignore the ACA. If this means they fine us or jail us, then so be it. But that will only go so far until even they realize they are destroying the very engine that drives the system they seek to control.

        But, if they don’t, then the righteous need to be prepared to go to jail for, in a society where doing the right thing is against the law and the law protects and advances the wicked, the only place for a righteous man is in jail. And if we do not have the courage to accept such a fate and put feet to our words… Well, then we don’t really mean what we say at all, we’re just complaining with hypocritical tongues.

        • ‘But, if they don’t, then the righteous need to be prepared to go to jail”

          If they do that Joe, then nobody will be around to treat their syphilis. It’s the only affliction in a prostitute (which they are) that would account for their obvious brain damage … something you might want to point out them because prostitutes frequently contract it, and after all, you are only trying to help them out. 🙂

      • “The only problem. The IRS Gestapo makes you list your qualifying plan to show compliance with the ACA. I don’t think cash will work.”

        Concierge healthcare models, despite your insurance choices, are here to stay. They are likely to see marked growth as well. So, the Free Shit Army can flash their pretty Affraudable Healthcare cards all they want, but if the physician does not participate, get ready to pay cash for the competent physician of your own choosing.

        “If you like your doctor, you can keep your doctor” — for a cash price, of course.

  2. I have a simple solution, but likely unworkable because there are too many soft-brained physicians to get this to work….as of yet….

    If all physicians in the country united and refused to treat ANY politician, their staff members, and their family members until obamacare was completely repealed IN TOTO, and an amendment passed to require all laws passed by congress to be fully imposed on all members of congress and the president exactly as they would be imposed on all US citizens. This would prevent Congress from doing the end runs around obamacare they have given themselves (by including payment of the exhorbitant premiums as a government benefit at taxpayer expense) and get rid of the socialist trojan horse that evil bastard Obama and his slimy acolytes have imposed on the entire country.

    But knowing how many of my physician colleagues are political leftwing idiots, such a move is not CURRENTLY likely to succeed. Once the full enslavement of physicians that obamacare will enact comes into play, then maybe the leftist doctors will finally pull their heads out of their fourth point of contact…..

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