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A friend is admitted to the hospital. He was experiencing shortness of breath and chest pains extending down his arms. Obviously the signs of a heart attack or an impending one. Doctors do a complete work up on him. He's diagnosed with mitral valve stenosis and needs a valve replacement [maybe 2]. One problem is his kidneys aren't functioning properly, a possible complication of his diabetes, which is causing some concern to the doctors.

Anyways, there's a lot of discussion amongst the doctors, and it's decided his condition isn't urgent. So he's sent home to recover, under a nurse's monitoring, until his kidney function improves, and his condition can be further evaluated.

So now that I've set the stage, you can pretty much forget everything I just mentioned, because it's what comes next that is so disturbing.

Upon my friend's release, he's prescribed a number of medications, one of which is a blood thinner, Lovenox, although the name of drug is irrelevant. The problem is when his wife goes to the pharmacy to pick up the prescription, she learns their health insurance doesn't cover that drug, and it will cost $1,000.

Taken aback slightly, and not having the $1,000, she contacts the doctor to see if there is a generic version, or a substitute drug he can prescribe that is covered. But instead of getting a different prescription, the doctor simply states, "oh, he doesn't really need it anyways."

WHAT THE ..............! HE DOESN'T NEED IT! THEN WHY PRESCRIBE IT TO HIM IN THE FIRST PLACE? WERE YOU TRYING TO RIP MY FRIEND OFF, OR JUST HIS INSURANCE COMPANY? WHAT OTHER PRESCRIPTIONS DOESN'T HE NEED? AND WHAT ABOUT EVERYTHING ELSE YOU'VE SAID? HOW MUCH OF THAT CAN WE BELIEVE?

No wonder Americans pay twice as much for health care than everyone else in the world, and have worse outcomes. No good can come from prescribing unneeded medications, and ordering unnecessary tests and procedures. But that is the US health care system.

It's called fee-for-service medicine, and it is the single biggest driver of increasing health care costs, and decreasing quality of care. In the US, doctors don't get paid for doing nothing. Doctor don't get kickbacks paid for not prescribing medications. They get paid for doing just the opposite. They get paid when they prescribe medications, and for ordering and performing tests and procedures, whether they're needed or not. In the US patient care comes secondary to profits.

Contrary to what some people might have you believe, health care is not a commodity like other commodities. We only get one chance at life. You can't trade yours in for a new one, like you can a car. You can't simply return a defective/malfunctioning heart, and install a replacement, like it's a kitchen appliance. And a ruptured artery doesn't yield the same result as a busted waterline in your home.

Increased competition, and shifting more of the burden of health care onto individuals and businesses is not the answer to our problems. Until we recognize that, the quality of health care in the US will continue to degrade, and health care costs will continue to soar, until no one, that is except for the very rich and of course our elected representatives, will be able to afford health care, good or bad.

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Comment Preferences

  •  Tip Jar (120+ / 0-)

    The future is just a concept we use to avoid living today

    by MetalMD on Mon Dec 10, 2012 at 05:39:04 AM PST

    •  "Free" in this case means healthcare... (16+ / 0-)

      providers are free to prescribe whatever they want, whenever and however they want -- even if the drug they prescribe is nothing but a glorified placebo -- or even worse a dangerous, side-effect-causing compound -- recklessly pushed on a desperate afflicted patient for the sole purpose of generating obscene profits for big pharma, and a tidy commission for the provider.`

      The U.S. healthcare system is the biggest, most greed-driven, amoral, ongoing ripoff scam ever pulled on a country in the history of the world. It was fundamentally setup only for those that can afford it.

      In fact, if it was setup to serve the general public, insurance companies would not be part of the process, healthcare providers would be salaried, and prescription drug prices would be negotiable.

      "That men do not learn very much from the lessons of history is the most important of all the lessons of history." ~ Aldous Huxley

      by markthshark on Mon Dec 10, 2012 at 07:53:48 AM PST

      [ Parent ]

      •  prescription drug prices (7+ / 0-)

        the dirty secret is if one is willing to purchase meds from (horrors!) overseas using the (horrors!) internet, prices are much cheaper.  Big pharma hates it so one regularly sees hit pieces over the horrors of mail order pharmacies, etc. One such even showed up on this site.  Insurance doesn't pay for it, but oftentimes the price is less than the US co-pay.

        •  And it's actually illegal (1+ / 0-)
          Recommended by:
          Angie in WA State

          to order drugs from out of the country. Although that doesn't stop people from doing it. It usually doesn't get enforced, although there have been isolated crackdowns from time to time. I've done it myself in the past.

        •  The reality is that ordering drugs from (3+ / 0-)
          Recommended by:
          mconvente, Eyesbright, SilentBrook

          overseas IS fraught with danger - there is a very high chance that the product you obtain will be adulterated.

          Now, ordering from Canada (and not being a big fan of that country I'm loathe to say this) is a totally different (and safer!) beast.

          •  I got bad insulin from Canada (1+ / 0-)
            Recommended by:
            Roadbed Guy

            Or at least insulin that took three times as long to deliver as promised, was not from where they said it was, and lacked documentation of correct handling (temperature control). The pharmacy, out of Winnepeg, refused to honor their guarantee. I was out my $175.

            •  I'm not surprised, ordering drugs (0+ / 0-)

              from a place solely noteworthy as being the origin of Winnie  the Pooh seems foolish, at least in retrospect.

              But on the plus side, at least they didn't kill you - like all that tainted heparin blood thinner stuff from China (is that what is was?)  and heck, that even went through the regulatory channels!  Think what happens if that's NOT the case (or do a Google search, it's not that difficult to document that a vast amount of "overseas" drugs are complete shit).

              Nevertheless I suppose I should profoundly apologize for momentarily letting down my guard against all-things-Canadian.

          •  having done this literally dozens of times (3+ / 0-)
            Recommended by:
            Chi, Farugia, JVolvo

            I always got what I ordered and I would know it if it was not.  Adulterated meds can occur anywhere, even in the US. This is exactly the big pharma propaganda I was talking about:

            there is a very high chance that the product you obtain will be adulterated.
            Nope.
            •  Where have you ordered from? (0+ / 0-)

              Macau? Romania? China?  

              Seriously, chances are that you will NOT be receiving what you think you are getting.   These operators are sophisticated enough on occasion to fool the FDA, do you really think you can out-smart them?

              •  You have been sold myth of American (1+ / 0-)
                Recommended by:
                JVolvo

                exceptionalism, foisted by big pharma PR, Inc.  There have been plenty of such problems in the US too. 76,000 hits on the google search string "recalls site:fda.gov".  Not to mention intentional, felonious dilution of expensive cancer meds, particulate matter in injectables, and the sterile wipes that were not sterile and caused more than a few cases of septicemia, all in the US from US sources.

                I would never buy meds or even foodstuffs from China, and I wonder how much Chinese product ends up in our multivitamins.

                I would know if my meds were not working and you can believe it or not as you choose.

              •  . (1+ / 0-)
                Recommended by:
                wilderness voice

                I think anybody with the will and money can fool the FDA, hell they just hire the 'regulators' or the 'healthcare industry' staffs the FDA.

                "History records that the money changers have used every form of abuse, intrigue, deceit, and violent means possible to maintain their control over governments by controlling the money and its issuance." -James Madison

                by FreeTradeIsYourEpitaph on Tue Dec 11, 2012 at 07:02:35 AM PST

                [ Parent ]

            •  As a caveat to my other posts (1+ / 0-)
              Recommended by:
              wilderness voice

              I personally don't think it should be illegal to order drugs from "overseas" - if people wish to take a chance with their health, I have no problem with that.

              In the same vein, I chafe under current regulations that prohibit me from running a genetic testing center out of my garage.

        •  You can also (2+ / 0-)
          Recommended by:
          SilentBrook, wilderness voice

          order them without a prescription, which in the US costs you a minimum of $50 for an office visit wherein absolutely nothing is done, or hundreds of dollars for unnecessary tests to continue taking something that's done no harm for years.

    •  hiding pricing (1+ / 0-)
      Recommended by:
      wilderness voice

      behind the cloak of 'insurance' eliminates free market price discovery which our government promotes heavily even with 'obamacare'.

       I read a story in Florida back in 2004 about a manager of a trailer park in Fla that needed heart surgery and, naturally in our oh-so-free country, it would cost $125,000 which he couldn't afford.  He did some medical tourism shopping and went to India to have the same operation performed by America trained surgeons and stayed at a 5 star resort during a 5 week recovery  period (whatever 5 star is there which may be pretty nice) with 5 nurses attending to his recovery all for the princely sum of $12,500.

      There are countless stories  out there that are similar.  Here a doctor tries to tell people the truth:

      http://truecostofhealthcare.org/

      "History records that the money changers have used every form of abuse, intrigue, deceit, and violent means possible to maintain their control over governments by controlling the money and its issuance." -James Madison

      by FreeTradeIsYourEpitaph on Tue Dec 11, 2012 at 07:00:41 AM PST

      [ Parent ]

  •  US doctors aren't sympathetic at all, generally, (21+ / 0-)

    about the high cost of medicine.

    Real reform means single payer and doctors willing to accept that the new system will allow them to exploit it for less gain than the current non-system.

    •  Fortunately the Clinic I use is aware and often (33+ / 0-)

      give out samples particularly if it is very expensive or short term. I ran into a friend this week end, pretty sharp cookie and a political junkie and she told me Obamacare is going to cut services for us no more hip replacements etc. WTF???? All because of the change from fee for service. People in general just don't understand fee for service medicine is NOT better medicine, in fact you are often over treated and over medicated and over tested. I have a hip issue, heard of tennis elbow? Well, I have tennis hip, LOL. It is not something surgery will correct, doesn't mean under the current plan I can't find a surgeon who would do a hip replacement. But as I told my friend why would anyone have that surgery if they didn't need it, the recovery is miserable. But they might not be able to get it in the future .... REALLY! I explained to her the differences and used my mother's recent passing as an example. As long as she was over all healthy she got everything she needed, pace maker, eye surgery etc. As her health declined we had to weigh whatever benefits against the strain on her ability to bounce back. Eventually her health got to the point no reasonable intervention would prolong her life. At that point she had a kidney infection and had suffered a stroke as well. The decision was made to stop treatment, make her comfortable and let nature take it's course. She was 92 had lived a wonderful life and frankly had suffered enough in the past few years being ill much of the time. Could we have added a feeding tube continued antibiotics etc., sure. No doctor said we couldn't get those things but they also made it clear NONE of those things would prolong her life or bring her back to how she had been even the day before, it was time. This is the way it should be. When my grandmother passed away she was on 32 different medications many of them conflicting. She was on uppers and downers and you name it. Not only is it unlikely they prolonged her life but the last years of her life were spent largely in a medication fog. Fee for service doesn't guarantee you will get what you need or what will help you either. No one is going to argue the Mayo Clinic is a premier medical facility with slightly higher success rates than the national average. They are not fee for service which should tell us all something very important about effective healthcare.

      The work goes on, the cause endures, the hope still lives and the dreams shall never die. ~ Edward M. (Ted) Kennedy

      by cherie clark on Mon Dec 10, 2012 at 06:55:38 AM PST

      [ Parent ]

    •  So long as Big Pharma (17+ / 0-)

      controls health care delivery in this country (and they do), doctors will still get their kickbacks for prescribing expensive medications that have generic or even over the counter alternatives that work as well. For instance, aspirin instead of a thousand-dollar bottle of blood thinners.

      If we were to create a universal single-payer system that negotiates the price of medications to the level of, say, Canada, Big Pharma would not be able to reap tremendous profits off of compounds largely created and tested by public universities and their associated hospitals/clinics, financed by public money.

      Poor babies.

      •  And we should not allow ... (20+ / 0-)

        ... direct to consumer marketing of drugs.  I'd love to know how many of the television commercials we're inundated with in a 24 hour period are for one pharmaceutical or another.  The European Union does not allow this.

      •  The other part of this equation is... (6+ / 0-)

        How drugs are developed, patented and released to the market has to be improved.

        Right now, all a new drug as to do is prove that it is a unique chemical composition and it is better than a sugar pill and it can be patented and marketed to doctors at whatever price they want.  They do not have to prove that it is better than an aspirin or better than the current leading treatment.  Doctors cannot possibly be expected to keep up with the hundreds if not thousands of news drugs put on the market every year so they get trained by the very same drug companies in which drugs to use.  Additionally, most of the watchdogs in the FDA moonlight for the drug companies and you have quite a few conflicts of interest at hand.

        The fix is simple:
        1.) Allow our government to negotiate prices with pharmaceutical companies.
        2.) Make new drug patent applicants test their drugs against the current most popular treatment.
        3.) Create a government "Best Practices" board that makes recommendations and provides training for doctors on advised pharmaceuticals based strictly on performance data.
        4.) Eliminate conflicts of interest in the FDA by outlawing part time jobs with pharmaceutical companies and replacing the revenue by offering bonuses for discovering law violations.

        "Perhaps the sentiments contained in the following pages, are not YET sufficiently fashionable to procure them general favour..."

        by Buckeye Nut Schell on Mon Dec 10, 2012 at 09:14:18 AM PST

        [ Parent ]

      •  Joieau - paying physicians "kickbacks" (0+ / 0-)

        for prescribing a specific drug is a federal crime. The practice of providing incentives for physicians to prescribe specific drugs was outlawed a very long time ago.

        "let's talk about that"

        by VClib on Tue Dec 11, 2012 at 01:36:50 AM PST

        [ Parent ]

    •  I think they just don't know. (4+ / 0-)

      I don’t think they are being callous or uncaring (most of them anyway); I think a more likely explanation is they just don’t know what things cost. They may know relative costs, like Drug X is cheaper than Drug Y, but putting a dollar amount to either one would be tough.

      Also, look at it this way: If you’re a doctor, you can’t really know the price of something anyway. For every different insurance company, the ultimate payer probably pays a different amount. Ergo, in practice there may be dozens of different prices for the exact same thing. Patient A pays $1000 under their policy. Patient B pays $35 under theirs. Most doctors aren’t going to wade into that unless their patients demand it.

      Outside of a dog, a book is man's best friend. Inside of a dog, it's too dark to read. - Groucho Marx

      by Joe Bob on Mon Dec 10, 2012 at 09:07:09 AM PST

      [ Parent ]

      •  Most of them are caring and honest. (2+ / 0-)
        Recommended by:
        Angie in WA State, Joe Bob

        But because they're trying to give every patient the "best" care regardless of economic factors, which are Evil, they prescribe the drug and/or treatment which they have been convinced is the best first.  And the education by which they determine that treatment is highly biased and skewed by the self-interest of every medical provider there is.  Companies that manufacture equipment sponsor studies proving that their equipment will increase early detection of cancer by 5% convince national boards that the test is therefore essential.  Pharma companies sponsor studies showing that their drug is the best under very controlled and specific conditions, then market it for every condition remotely related.  Device manufacturers sponsor studies that "prove" that their devices are good for "severe" Condition A, then market the device as absolutely essential for any degree of Condition A, even so mild that the patient is completely unaware they have a "condition".  Improvements of less than 10% over lack of treatment are considered "significant" and therefore justify price tags in the hundreds of thousands.  Every patient must be prescribed the BEST!

        Doctors are victims of the information which constitutes their training.  They are TRAINED to overprescribe, and disciplined for failure to overtest.  Even if they don't think a test is really necessary, they have to worry that their supervisor (most of them have those, these days) will second-guess them.  And they are rigorously trained to avoid pragmatic and expedient treatment in favor of extensive and expensive testing to determine every last factor . . . which, when you add up the likelihood of minor errors in a battery of a hundred tests, actually increases the probability that SOMETHING will show up that looks wrong, just by sheer random chance.

        Sorry, I've worked with the beast for twenty-five years, and I've never met a doctor who didn't prescribe unnecessary tests and futile or unnecessary treatments.

        •  while I mostly agree, consider also (0+ / 0-)

          that for 'family doctors', previously known as G.P.s (general practitioners); a considerable amount of the testing they order is to "rule out" specific conditions.

          Remember, medicine is still as much an art as it is a science, when it comes to determining the diagnosis for any given patient. The physician takes the patient's described symptoms and a physical examination, and goes from there. So, testing is as much to 'rule out' as it is to "confirm" the physician's preliminary (or working) diagnosis.

          This may be seen as "over-testing" to someone who does not know any better.


          "I like paying taxes...with them, I buy Civilization" -- me

          by Angie in WA State on Mon Dec 10, 2012 at 12:18:20 PM PST

          [ Parent ]

          •  In many cases (0+ / 0-)

            no doubt.  But as a patient, I don't think I needed 50 different things checked when I was obviously presenting with high blood pressure.  I needed medication for the high pressure.  And as a sleep tech, about 50% of our patients came in with a "rule out" order, which ended up in fully 80% of them diagnosed with sleep apnea which was so mild that it would never have caused them any harm EXCEPT that putting them on CPAP involved a second $2000 test night, equipment sales and fitting, and followup every six months for life.  Again, in people with mild to moderate "disease" that there is and was no research justifying treatment for.

            Doctors overtest, overdiagnose, and overprescribe.  No businessman is going to pass up an obvious opportunity for a sale.  And no one is so virtuous, as to lack a bias towards doing what is in his own best interest.

    •  A lot of times they don't know (5+ / 0-)

      Many times they don't know the cost of drugs they are prescribing and of course they can't be expected to know the coverage your insurance plan has: there are so many plans, each with their own rules. This is a problem: doctors are given all kinds of information, through  advertising and marketing, about the latest and greatest drugs, but they don't have information about cost, or any kind of cost/benefit ratio.

    •  my doctors have been very sympathetic (5+ / 0-)

      I have to disagree James. I've had continual treatment for cancer for more than 11 years and the 6 oncologists, 3 internists, 2 ophthalmologists, 2 ear nose throat specialists I've seen have ALL helped me figure out the cheapest treatments, when to postpone tests if there were no significant consequences and started out trying the least expensive therapies first if there was good evidence that could work as well.

  •  Yes, you hit the nail on the head (31+ / 0-)

    "fee for service" medicine (as compared to "fee for keeping somebody healthy" medicine) is the biggest boondoggle ever.

    Regardless if there's single payer or the current system.  

    But nobody wants to talk about this (aside from one seminal article in the New Yorker . . ) it would seem - too many powerful interest groups would have their toes stepped on.

    •  Then how do pay Physicians for you healthy? (0+ / 0-)

      How do you gauge if the ICU doc that just did a consult helped "keep you healthy".

      I hear the, "Let's pay Docs based upon the results of their medicine."  This is inherently unfair to the Physician.

      For example, a Physician says, "Stop eating sugar or you are going to get diabetes."  You keep on eating sugar and you get diabetes.  The Physician did his/her part but you didn't do yours.  Is it then fair the Physician isn't paid?

      Another example, a Lawyer says, "Don't rob a bank or you will go to jail."  You still rob a bank and go to jail.  The lawyer is still paid.

      These are simplistic examples but I hope that helps explain why I am against this approach until someone gives us a system that is fair to the Physicians.

      •  No, not at all if the obstensible goal (3+ / 0-)
        Recommended by:
        bleeding blue, Angie in WA State, Chi

        of a physician - to heal - is true:

        I hear the, "Let's pay Docs based upon the results of their medicine."  This is inherently unfair to the Physician.
        It's only unfair if the primary goal of a physician it to be a business person and suck down as many $$s into his or her pocket as possible.  Which is largely the case in this country.

        If you read the New Yorker article I link above, you will see how the Mayo Clinic is able to achieve superior health outcomes for their patients at 1/3rd the cost of the "business as usual" model of medicine generally practiced in  the USA.   Simply because they put the patient first, not their profits.

    •  That's why I belong to a regional co-op (4+ / 0-)

      I have for 30 years. I know a lot of people who dis co-ops but I've had nothing but good experiences over the years.

      The doctors are paid by salary, not by per-patient visit. There's no incentive for them to over-diagnose or over-treat. Neither is there the incentive to prescribe medications that aren't needed, or push brand-name drugs over generics.

       

    •  What's sad (1+ / 0-)
      Recommended by:
      FreeTradeIsYourEpitaph

      is that this is the same argument we were having in the 1970's, when they first brought out the "HMO" concept.  It was going to change everything!  It was going to make insurance about keeping people healthy rather than treating them after they became ill, with its emphasis on preventive medicine and pre-emptive diagnostics . . . yeah.  Well, you see how THAT worked out.

  •  How awful. (10+ / 0-)

    That doesn't even take into account the reaction he could have to the medication itself, or a reaction between the differing medications he was prescribed. Blood thinners can be dangerous! Typically patients need to be monitored to make sure it does not get to thin. This is fine if they NEED such intervention.

    In my view drug side effects are the dark underbelly of the modern medical system we have. Doctors do not pay enough attention to the burdens patients endure when prescribed medications that have a host of side effects (in some cases worse than the condition being treated for.)

    Truth is harmonious, lies are discordant.

    by Babsnc on Mon Dec 10, 2012 at 07:23:22 AM PST

  •  Lonenox patent voided years ago (1+ / 0-)
    Recommended by:
    VClib
  •  Lovenox is an injectable drug (5+ / 0-)

    There are oral anti-clotting drugs like aspirin that are easier for a patient to deal with.

    Bad heart valves can promote the formation of blood clots so an anti-clotting medication is often prescribed.

  •  Doctors aren't paid (10+ / 0-)

    to write prescriptions. Sorry, there are a lot of problems with the system, but writing a Rx in an ER, to be filled at an outside pharmacy, doesn't bring a doc a penny.

    Done with politics for the night? Have a nice glass of wine with Palate Press: The online wine magazine.

    by dhonig on Mon Dec 10, 2012 at 07:41:50 AM PST

    •  I'm not so sure about that (1+ / 0-)
      Recommended by:
      Eyesbright

      But regardless, he wasn't in the ER when the medication was prescribed.

      The future is just a concept we use to avoid living today

      by MetalMD on Mon Dec 10, 2012 at 07:47:38 AM PST

      [ Parent ]

      •  It doesn't matter where he was (7+ / 0-)

        doctors don't get paid for prescriptions.

        Done with politics for the night? Have a nice glass of wine with Palate Press: The online wine magazine.

        by dhonig on Mon Dec 10, 2012 at 07:53:05 AM PST

        [ Parent ]

        •  You're incorrect (9+ / 0-)

          Doctors do get kickbacks from manufacturers. At least those that have their own practices. When they're prescribed in a hospital setting if the doctor doesn't receive the kickback, the hospital will also benefit.

          The future is just a concept we use to avoid living today

          by MetalMD on Mon Dec 10, 2012 at 08:03:28 AM PST

          [ Parent ]

        •  like MMD said (5+ / 0-)

          Prescription trackers keep pharma cos informed of what doctors write how many prescriptions of their drugs.  There are then all kinds of favors bestowed on the high prescribers - paid consultantships, all expenses paid trips to medical conferences, big stock of free samples, etc. All nice and legal like.

          •  Sorry, but you are wrong on most of that (3+ / 0-)
            Recommended by:
            Angie in WA State, dhonig, VClib

            A nice big stock of free samples is great for patients, especially those that can't afford the drugs on their own.  That is what many Physicians use those samples for.

            Paid trips, etc.... that just doesn't happen.  

          •  Honoraria (1+ / 0-)
            Recommended by:
            wilderness voice

            I've attended seminars and conferences where I, a health care consumer activist, give a talk or participate in panel discussions with clinicians who receive $700-$1,000 honorarium fees.  I never get paid, but on very rare occasions, one of the clinicians will donate part of their compensation to my non-profit.

            Docs can be paid handsomely to spend a couple of hours at a local event for "public education", etc. on their area of specialty. Free gourmet dinner at a nice local hotel or restaurant to talk for 15 or 30 minutes plus a nice fee - not a bad gig for them.

            I prefer to not receive compensation as it leaves me free to speak objectively and openly about the health care topic at hand.  

            Democratic Leaders must be very clear they stand with the working class of our country. Democrats must hold the line in demanding that deficit reduction is done fairly -- not on the backs of the elderly, the sick, children and the poor.

            by Betty Pinson on Mon Dec 10, 2012 at 12:29:25 PM PST

            [ Parent ]

          •  Not any more (1+ / 0-)
            Recommended by:
            VClib

            sorry, but those days disappeared. Feds have been tightening the screws for quite a while, and big pharma has paid literally hundreds of millions of dollars in penalties for these past activities.

            Done with politics for the night? Have a nice glass of wine with Palate Press: The online wine magazine.

            by dhonig on Mon Dec 10, 2012 at 02:12:00 PM PST

            [ Parent ]

        •  Beg to differ. (0+ / 0-)

          I've been in the field for 25 years.  Doctors don't get paid a direct kickback, true.  They do however get "incentives" which can range from the stock of "free samples" handed out at the regular visit of their "rep", to credits for "prizes" like swanky vacation cruises with other doctors on the company's shortlist, to "enrollment fees" for entering patients on Stage IV (postmarketing) "clinical trials" which are little more than fronts for boosting sales.  Stage III trials are also used to create a ready pool of patients already using a drug expecting near-term approval; these patients will receive known active drug and be switched to a paying basis as soon as the drug gets FDA approval.  And believe me, docs are paid for enrolling subjects in clinical trials.

          •  True (0+ / 0-)

            Thanks for sharing that information.  It also has an impact on which clinical trials hospitals choose to participate in.  Not always the best system for consumers to get a disease cured or effectively treated.

            I doubt there are many docs who get incredibly wealthy from this stuff, but its enough incentive to sometimes make them practice medicine ineffectively.

            Democratic Leaders must be very clear they stand with the working class of our country. Democrats must hold the line in demanding that deficit reduction is done fairly -- not on the backs of the elderly, the sick, children and the poor.

            by Betty Pinson on Mon Dec 10, 2012 at 12:33:35 PM PST

            [ Parent ]

      •  You can be not so sure, but you'd still be wrong. (0+ / 0-)

        Corporations are driven by the bottom line, not by concerns for health, safety or the environment. This is why we need government regulations.

        by the dogs sockpuppet on Mon Dec 10, 2012 at 09:01:43 AM PST

        [ Parent ]

      •  See my comment (2+ / 0-)
        Recommended by:
        the dogs sockpuppet, VClib

        Dhoning is correct about this.  Docs aren't paid to write a prescription.

        •  Again, none of this matters (2+ / 0-)
          Recommended by:
          Eyesbright, SilentBrook

          Whether docs or hospitals get kickbacks for prescribing drugs is irrelevant.

          The problem here is a patient was prescribed a drug a doctor later admitted he didn't need.

          So all I want to know is why the doctor did that?

          And that was the point of the post.

          The future is just a concept we use to avoid living today

          by MetalMD on Mon Dec 10, 2012 at 10:11:30 AM PST

          [ Parent ]

          •  That actually wasn't the point of the post, and (1+ / 0-)
            Recommended by:
            dogdad

            I guarantee if you knew the backstory from the doctor's perspective, you would get a much more nuanced picture.  For all we know (and we don't), something new was discovered in the clinical picture.  

            Corporations are driven by the bottom line, not by concerns for health, safety or the environment. This is why we need government regulations.

            by the dogs sockpuppet on Mon Dec 10, 2012 at 11:29:37 AM PST

            [ Parent ]

          •  Actually it does matter (2+ / 0-)
            Recommended by:
            Angie in WA State, dhonig

            You are directly calling into question the ethics and motivation of the Physician, and all Physicians, into question.  

            You are asserting that your friend was prescribed X drug purely so the Physician can be paid an additional amount because he/she is paid by:

            1. The act of prescribing the medication
            2.  Kickbacks from the drug companies

            Both of these items are false and it does very much matter.  I'm not trying to be an asshat but these are just the facts.

            If you look at my long comment, and my recently published diary, you will see my attempt at trying to explain why/how a Physician is actually paid.

            •  And that is a separate issue (0+ / 0-)

              I am keenly aware medicine is not an exact science. That is why it is so difficult to question the judgment of doctors, or even know where their motivation lies, and whether they're looking out for the best interest of the patient or not.

              Certainly there are good doctors who will always look out for the best interest of the patient, but the problem is with a system where that loyalty can be brought into action, which is exactly what the US health care

              The future is just a concept we use to avoid living today

              by MetalMD on Mon Dec 10, 2012 at 12:17:15 PM PST

              [ Parent ]

          •  Bullshit (1+ / 0-)
            Recommended by:
            VClib

            sorry, but you don't get to accuse an entire industry of being unethical criminals, then say "it's not the point" when you get called out on it.

            Done with politics for the night? Have a nice glass of wine with Palate Press: The online wine magazine.

            by dhonig on Mon Dec 10, 2012 at 02:09:40 PM PST

            [ Parent ]

    •  Thank you! This diary is misrepresenting (4+ / 0-)
      Recommended by:
      dogdad, mconvente, FG, VClib

      the problems this patient faced.

      Corporations are driven by the bottom line, not by concerns for health, safety or the environment. This is why we need government regulations.

      by the dogs sockpuppet on Mon Dec 10, 2012 at 08:43:07 AM PST

      [ Parent ]

      •  ???? I think maybe you're missing the point (3+ / 0-)
        Recommended by:
        MKinTN, Eyesbright, SilentBrook

        This post wasn't about the patient, nor the condition he was facing. It wasn't even about the drug, which could have been any drug.

        The post was about the US health care system, and the perverse incentives built into it.

        It was about a doctor who prescribed a medication the patient didn’t need, and why he would do that.

        The future is just a concept we use to avoid living today

        by MetalMD on Mon Dec 10, 2012 at 09:11:02 AM PST

        [ Parent ]

        •  There was a failure of communication and there (1+ / 0-)
          Recommended by:
          VClib

          are problems with drug reimbursement, but there are not kickbacks to docs for prescribing certain meds.

          And that is what you allege here.

          Corporations are driven by the bottom line, not by concerns for health, safety or the environment. This is why we need government regulations.

          by the dogs sockpuppet on Mon Dec 10, 2012 at 09:12:50 AM PST

          [ Parent ]

          •  No, and as I suspected (2+ / 0-)
            Recommended by:
            Eyesbright, Chi

            You are missing the point.

            A doctor prescribed a medication the patient didn’t need.

            Why do you think he did that? Out of concern for the patient? Out of concern for the drug manufacturer? Out of concern for himself.

            I don't know this doctor, and I can't perceive to know what was on his mind, but I find it difficult to believe he was thinking about the patient when he did so.

            And there in lies the problem.

            The future is just a concept we use to avoid living today

            by MetalMD on Mon Dec 10, 2012 at 09:29:00 AM PST

            [ Parent ]

            •  No, often times there is an "ideal" medicine, (0+ / 0-)

              alternatives, and then the least interventional.  I wish there was an easy right and wrong, but there is just not.  I wish medicine was that cut and dry.  This is why communication is so important.

              Corporations are driven by the bottom line, not by concerns for health, safety or the environment. This is why we need government regulations.

              by the dogs sockpuppet on Mon Dec 10, 2012 at 11:17:10 AM PST

              [ Parent ]

            •  MMD - out of concern of being sued for malpractice (0+ / 0-)

              It's what drives much of how medicine is practiced in the US.

              "let's talk about that"

              by VClib on Tue Dec 11, 2012 at 01:48:14 AM PST

              [ Parent ]

    •  Well, yes and no... (3+ / 0-)
      Recommended by:
      SilentBrook, cynndara, Chi

      The Rx is tracked by the pharma company and the doctor is credited for writing it. The doc isn't allowed a specific payment, but doctors know full well that writing a lot of scrips for certain drugs gets them free vacations, expensive toys, and all sorts of free perks from the pahrma companies. Yeah, yeah, that's illegal. But, hey, this is America, illegal is just another word for only if you haven't paid off the right congress critter or are poor.

    •  it does, if they doctor's billing person (1+ / 0-)
      Recommended by:
      Chi

      files the proper ICD-9 and CPT codes for the time the doctor spent:

      1. in a visit with the patient, in person

      2. in a visit with the patient, or the patient's proxy or guardian, by telephone or facsimile

      3. determining which diagnosis applies

      4. determining which medication is appropriate

      5. Determining which category of visit was involved, short (5 mins); intermediate (15 mins) or complex (30 or more minutes)

      But make no mistake, doctors ARE paid for the time they spend writing prescriptions, if they submit the properly completed billing forms for the services rendered.

      Hospital billing staff would most definitely bill for this time.

      They are some of the nation's best Medical Coders, and they attend regular training to ensure they have the best and newest information on how to code the newest medical procedures properly for re-payment by insurance sources like Medicare and Medicaid and the plethora of private insurers.


      "I like paying taxes...with them, I buy Civilization" -- me

      by Angie in WA State on Mon Dec 10, 2012 at 12:27:10 PM PST

      [ Parent ]

      •  No (0+ / 0-)

        you don't get a pop from one E&M code to another for adding a prescription or for writing a more expensive prescription.

        Done with politics for the night? Have a nice glass of wine with Palate Press: The online wine magazine.

        by dhonig on Mon Dec 10, 2012 at 02:13:54 PM PST

        [ Parent ]

        •  You are wrong & right in the same sentence (1+ / 0-)
          Recommended by:
          Chi

          Because they do not get paid specifically to "write a prescription".

          That is absolutely true.

          What they get paid for, is the time spent using their knowledge base and the patient's symptoms, current medications and any testing results, and coming to a diagnosis - or in the event nothing has changed, and the patient is asking for a refill, the time spent to ensure nothing in patient chart is new or cause to not order the refill, or to inform the patient they must return for a visit (and likely some basic blood & urine testing prior to the visit) before a refill can be authorized.

          All of this time spent IS billable. This time is the basis for the why the doctor then writes an Rx or a refill for one.


          "I like paying taxes...with them, I buy Civilization" -- me

          by Angie in WA State on Mon Dec 10, 2012 at 04:28:29 PM PST

          [ Parent ]

          •  Nope (0+ / 0-)

            time is used as a summary shorthand to explain E&M coding, but when it comes to actual coding, it does not make a difference. The other time you describe goes into the formulation, but the writing of a single Rx during a visit won't make a difference. It won't raise an office visit from a level 4 to a level 4.

            Done with politics for the night? Have a nice glass of wine with Palate Press: The online wine magazine.

            by dhonig on Tue Dec 11, 2012 at 06:01:22 AM PST

            [ Parent ]

  •  No attention to prevention, just attacking symptom (5+ / 0-)

    My husband recently had an incident involving chest pain.  He's ok, and tests showed his ekg and stress test were normal.

    But nobody talked to him about how to prevent a heart attack.  Nobody asked him about his diet.  Nobody asked him about his exercise program.

    They asked if he smoked (no), drank (no), had diabetes (no), but didn't ask about the easiest behavior modifications that can prevent heart disease.  

    My husband is a junk-food junkie.  Though we eat well when we eat together, at work or left to his own choices he eats fast food and candy.  Just making small changes to his choices could make big changes in his health.

    He's very active on weekends, when we hike and ride bikes.  During the week he gets little to no exercise.  He has a gym membership he pays for each month, but rarely goes unless I remind him.  Lately I've been reminding him daily, and going with him whenever possible.  If he just stopped by each day after dropping me off at work, he'd get in a cardio workout that would improve his health dramatically.  

    But neither emergency room staff nor his primary care doc said a word about diet and exercise.  

    We do not forgive. We do not forget. The whole world is watching.

    by Tracker on Mon Dec 10, 2012 at 08:13:05 AM PST

  •  so true: health care is not a commodity (5+ / 0-)

    of course, neither is education.  Do you really want to wait 12 years (or even a year) to find out the education you received is worthless?  Bill Gates gets by selling "good enough" software whose problems can be smoothed over by cycling power.  Why the f$%^ anyone would listen to him about how to reform education is beyond me.  After all, can you reboot your education once you figured out it failed?  Do you want to?

    and their contempt for the Latin schools was applauded by Theodoric himself, who gratified their prejudices, or his own, by declaring that the child who had trembled at a rod would never dare to look upon a sword.

    by ban48 on Mon Dec 10, 2012 at 08:17:06 AM PST

  •  Well we were headed in that direction (4+ / 0-)

    with HMOs.  But then there was a major campaign against them in the form of taking away our freedoms AND HMOs began losing their original focus.  Greed crept in and focus turned from managing health as a way to reduce overall costs more toward managing access to reduce costs.  And in my experience it wasn't necessarily all greed there was an attitude that crept in that all providers were trying to rip off insurance and the members.  And when relatively good people begin to take on that view the outcome is the same as if greed was the driver.

    One of the many things we need in healthcare (and single payor is the main one) is a greater focus on quality and coordination of care.  One obstacle that is privacy laws.  But if we can figure out how to provide coordinated care while maintaining a reasonable degree of privacy (which doesn't sound so difficult) we would be better off

    "You have attributed conditions to villainy that simply result from stupidity"

    by newfie on Mon Dec 10, 2012 at 08:40:46 AM PST

  •  We don't get paid for prescribing medicine! (2+ / 0-)
    Recommended by:
    dhonig, mconvente

    To be sure, there is a problem here and a failure of communication... but we do not get paid for prescribing medicine.  

    I'm afraid your anger is misguided.  Patient should have gotten better care and Lovenox shouldn't be $1,000, but the two do not equate in this case.

    Corporations are driven by the bottom line, not by concerns for health, safety or the environment. This is why we need government regulations.

    by the dogs sockpuppet on Mon Dec 10, 2012 at 08:41:50 AM PST

    •  Yep, my wife doesn't get paid for prescriptions (2+ / 0-)
      Recommended by:
      the dogs sockpuppet, VClib

      Kind of a bummer. ;)

    •  I worked briefly for the (2+ / 0-)
      Recommended by:
      wilderness voice, Chi

      pharmaceutical companies and the doctors do get bonuses, free CEUs which are golf trips, tickets to the lastest shows and a lot of free lunches for the entire office.  Doctors and pharmaceutical companies use each other at the patient's expense.

      "During times of universal deceit, telling the truth becomes a revolution­ary act. " George Orwell

      by zaka1 on Mon Dec 10, 2012 at 12:17:24 PM PST

      [ Parent ]

      •  We are allowed no contact with pharm reps (1+ / 0-)
        Recommended by:
        zaka1

        where I work... In fact, that was the rule in all places I've ever worked.

        Corporations are driven by the bottom line, not by concerns for health, safety or the environment. This is why we need government regulations.

        by the dogs sockpuppet on Mon Dec 10, 2012 at 02:05:16 PM PST

        [ Parent ]

        •  That is a good rule to have (0+ / 0-)

          and when I returned to social work after taking a break for a while some doctors were doing that.  But, I worked the north shore in Chicago and I can tell you that there were many, many, doctors taking advantage of the perks.  One doctor's office wouldn't see reps unless you bought lunch for the office.  When I asked what was the next date open, it was in eight months.  They had lunch booked everyday for eight whole months and they told you what they wanted for lunch.  It was worse than social work so I went back to my own dying profession and continue to suffer through the corporate down sizings.  

          My neurologist gives a Christmas party for her patients every year, and this year it was being put on by three pharmaceutical companies.  I refused to go.  It wasn't always like this, but once I got sick and became disabled, I realized just how corrupt the medical system is.  I don't mean to put anyone's profession down, but the medical system needs to truly do some soul searching because too many people I know end up bankrupted and/or almost homeless if seriously ill.

          "During times of universal deceit, telling the truth becomes a revolution­ary act. " George Orwell

          by zaka1 on Mon Dec 10, 2012 at 04:07:37 PM PST

          [ Parent ]

      •  zaka - how long ago? (0+ / 0-)

        The rules on incentives for physicians continues to change. Golf trips and the latest shows aren't done any more. Free continuing education may still be available and pizza for the office, but the rules keep squeezing out the incentives.

        "let's talk about that"

        by VClib on Tue Dec 11, 2012 at 01:51:38 AM PST

        [ Parent ]

  •  Wow, that is crappy insurance. (1+ / 0-)
    Recommended by:
    wilderness voice

    After an illness this past spring I walked out of the hospital with a box of Lovenox syringes and my out-of-pocket expense was all of $35.

    This is the futility of trying to figure out the prices of medical care. One guy pays $1000, another one $35 and it’s all because of insurance and not something the doctor actually has knowledge of or control over.

    Outside of a dog, a book is man's best friend. Inside of a dog, it's too dark to read. - Groucho Marx

    by Joe Bob on Mon Dec 10, 2012 at 09:23:13 AM PST

  •  If you can't afford medications (1+ / 0-)
    Recommended by:
    cherryXXX69

    give this site a read:

    NeedyMeds

    •  The cost of the medication is irrelevant (1+ / 0-)
      Recommended by:
      Chi

      What is relevant is a doctor prescribing a medication the patient didn’t need.

      Why do you think he did that?

      The future is just a concept we use to avoid living today

      by MetalMD on Mon Dec 10, 2012 at 09:48:55 AM PST

      [ Parent ]

  •  You aren't right on some of this (0+ / 0-)

    You mentioned a couple of things that Physicians might do calling into question their ethics.  My wife is a Physician, she is working in an ICU at this very moment.  I have helped start and ran a medical practice.

    In this day of litigious patients, sometimes a Physician will prescribe something to help ensure the patient is getting the best care possible and help prevent bounceback of a patient into the hospital.

    WHAT THE ..............! HE DOESN'T NEED IT! THEN WHY PRESCRIBE IT TO HIM IN THE FIRST PLACE? WERE YOU TRYING TO RIP MY FRIEND OFF...
    There are times when a physician will prescribe a medication that could have a beneficial effect for a patient but it is not 100% certain it will help.  
    AND WHAT ABOUT EVERYTHING ELSE YOU'VE SAID?
    You are now calling the  Physician's ethics into question.  Again, the Physician has to ensure the patient gets the best possible care and may prescribe drugs, order tests, etc... to make certain they cover their bases.
    No good can come from prescribing unneeded medications, and ordering unnecessary tests and procedures
    What you might think is unneeded could, in fact, be a preventative or double check to make certain the Physician hasn't missed anything.
    It's called fee-for-service medicine, and it is the single biggest driver of increasing health care costs, and decreasing quality of care.
    Proof please.  Provide links backing up this point.
    In the US, doctors don't get paid for doing nothing. Doctor don't get kickbacks paid for not prescribing medications....

    snip

    They get paid when they prescribe medications....

    A Physician doesn't get paid for prescribing medications.  Please provide proof they do.
    and for ordering and performing tests and procedures, whether they're needed or not. In the US patient care comes secondary to profits.
    A Physician does get paid for performing tests, interpreting the test results and performing procedures.  

    You might view it as unnecessary but as I said above sometimes they order a test to ensure there isn't something they missed.

    Sure there are a few bad apples out there that abuse the system.  I think the VAST majority of them don't.  From my point of view, you are painting Physicians with a VERY broad brush.  I would suggest you do a bit more research into this and provide links to proof backing up your claims.

    •  If I drive a Hyundai (1+ / 0-)
      Recommended by:
      Chi

      chances are good that I can't AFFORD a Cadillac.  The Hyundai gets me from Point A to Point B just fine.

      The insistence of the medical profession in this country that every patient receive THE BEST is like forcing the Hyundai driver to buy a Cadillac.  We can't all afford to pay for your 100% certainty and peace of mind.  Furthermore, as was obvious in this case, doctors universally fail to COMMUNICATE which of their prescriptions and commands are fundamentally necessary, and which are CYA.  They thereby deny patients the ability to make decisions which quite frankly are THEIR OWN to make, not anyone else's.  When it comes to how much I want to risk my life vs my credit rating and mortgage payment, that should be MY decision, not yours.

      Finally, by failing to communicate and being at best obtuse and often disingenuous about their commands and the reasons therefore, doctors erode the trust of patients and families who come to them for advice and treatment.  Doctors often complain about patient "non-compliance"; it's time for them to realize that a good chunk of that comes from their own failure to cultivate trust by honesty, openness, and respect for their patients' autonomy.

  •  Lovenox was the wrong drug (1+ / 0-)
    Recommended by:
    cynndara

    for a patient with kidney disease.

    Depending on the severity of the valvular stenosis, some form of anticoagulation therapy is probably necessary to prevent clots forming around the damaged valve and breaking off to possibly cause a pulmonary embolism or stroke.

    But Lovenox requires a 4-hour follow up test after each dose to check for side effects when given to renal patients.

  •  There is a generic Lovenox available (1+ / 0-)
    Recommended by:
    the dogs sockpuppet

    There is a generic (substitutable) form of enoxaparin available - the drug is still expensive though because there are only two generics available (it was a very, very hard drug to copy).

    The doctor most decidedly was not getting any kickback in any form for prescribing this drug. It is quite conceivable to me that the doctor thought it was a reasonable drug to use, but not worth making the patient pay $1k for. There is a middle ground between "absolutely essential" and "not needed" and it seems to me this fell into that middle ground.

    •  Gimme a break! (1+ / 0-)
      Recommended by:
      zaka1

      Middle ground in medicine! No! It's either needed or it isn't needed? Cost should have no bearing!

      What about the valve replacement? Is there middle ground there as well? Or does it just depend whether the patient can afford it?

      You can chock it up to whatever you want. The US health care system is flawed, and we are all paying for it.

      The future is just a concept we use to avoid living today

      by MetalMD on Mon Dec 10, 2012 at 10:55:57 AM PST

      [ Parent ]

      •  We wish medicine was that cut and dry. (1+ / 0-)
        Recommended by:
        dogdad

        There is a reason it is referred to as "The Art of Medicine".

        Corporations are driven by the bottom line, not by concerns for health, safety or the environment. This is why we need government regulations.

        by the dogs sockpuppet on Mon Dec 10, 2012 at 11:32:13 AM PST

        [ Parent ]

        •  And doctors practice medicine (1+ / 0-)
          Recommended by:
          Chi

          You are correct, but that isn't what I'm referring to here. The problem here is, if the medication is not needed now, why was it needed earlier?

          That has nothing to do with the fact medicine is an art, and doctors practice medicine.

          The future is just a concept we use to avoid living today

          by MetalMD on Mon Dec 10, 2012 at 12:23:27 PM PST

          [ Parent ]

          •  Because more clinical information becomes (0+ / 0-)

            available, because things change, because there are relative priorities... so if the doc finds out the med is going to cost the patient that much, they may prioritize it less... because patient status changes, because a different doc comes on and has a different take on things...

            Unless you are there and part of the doc-patient relationship you just can't know.  HIPPA and all!

            Corporations are driven by the bottom line, not by concerns for health, safety or the environment. This is why we need government regulations.

            by the dogs sockpuppet on Mon Dec 10, 2012 at 12:49:25 PM PST

            [ Parent ]

            •  If that was so (1+ / 0-)
              Recommended by:
              Chi

              Then the doctor should have cancelled the medication. He didn't do that.

              It wasn't until the patient said he couldn't afford it, did the doctor change his mind. It had nothing do with with changes to the patients condition.

              The future is just a concept we use to avoid living today

              by MetalMD on Mon Dec 10, 2012 at 01:34:33 PM PST

              [ Parent ]

              •  Oh my goodness. You just can't see the other (0+ / 0-)

                side can you?  What don't you understand about a hierarchy of priorities?!

                Corporations are driven by the bottom line, not by concerns for health, safety or the environment. This is why we need government regulations.

                by the dogs sockpuppet on Mon Dec 10, 2012 at 01:59:20 PM PST

                [ Parent ]

                •  I'm glad you see only the good in people (0+ / 0-)

                  Unfortunately that isn't the real world.

                  How would you feel if every year you were asked to work for less and less money? Pretty soon you'd get just a little pissed off, maybe even do some things your conscience might tell you not to do. Especially when it is difficult, if not impossible for others to detect.

                  Well that is what doctors and health care providers are asked to do, every time the government and/or health insurance companies lower reimbursements to physicians and hospitals, trying to save money and (in the case of the health insurers) increase profits.

                  Believe what you want. The US health care system is flawed. It encourages over treating, over testing. To believe otherwise is just simply naivete.

                  The future is just a concept we use to avoid living today

                  by MetalMD on Mon Dec 10, 2012 at 02:31:36 PM PST

                  [ Parent ]

                  •  Hmmm. I get a raise almost every year and yeah (0+ / 0-)

                    I work really really hard.  And I stay true to my conscience because that's how I am and how most of my colleagues are...

                    And sometimes mistakes are made and sometimes communication sucks, but never blame malice for things that can easily be explained by stupidity.

                    We don't have a conspiracy against our patients to make more money.

                    I am not talking about the system (which is flawed).  I'm talking about physicians.

                    Corporations are driven by the bottom line, not by concerns for health, safety or the environment. This is why we need government regulations.

                    by the dogs sockpuppet on Mon Dec 10, 2012 at 06:51:23 PM PST

                    [ Parent ]

      •  Of course there's middle ground! (0+ / 0-)

        What, do you think that human bodies are identical make and model machines with interchangeable parts turned out by an assembly-line in Taiwan?  And cost may have no bearing for you, but it obviously did for your friend with the thousand-dollar prescription.  It certainly does for me.

        Every human body is different.  The interaction of millions of genetic variations with environmental factors leads to idiosyncratic reactions to every drug and treatment ever devised.  Yes, the US healthcare system is flawed, yes fee-for-service on a "free market" is a stupid way to run an essential social service with major informational disparities, but one thing you cannot fix is the fact that medicine will always involve uncertainties.  That's why it's so important for medical personnel to provide honest disclosure to patients and respect patient decisions.

  •  My mother was taking 26 pills (4+ / 0-)

    a day, as per doctor's orders. She hated taking pills, so we went to her two main doctors and asked what we could get rid of. We left with her taking 12.

    A foot doctor came to visit her, once, and we saw that he had put in charges for three separate visits.

    The corruption is endemic. It's malfeasant, if not criminally irresponsible, to cut back/delay things like Medicare while these kinds of practices go on everywhere and every day with no fix.


    The Internet is just the tail of the Corporate Media dog.

    by Jim P on Mon Dec 10, 2012 at 10:47:02 AM PST

    •  A real problem w/ Medicare/Medicaid (1+ / 0-)
      Recommended by:
      Jim P

      It plays hell with government budgets.

      Democratic Leaders must be very clear they stand with the working class of our country. Democrats must hold the line in demanding that deficit reduction is done fairly -- not on the backs of the elderly, the sick, children and the poor.

      by Betty Pinson on Mon Dec 10, 2012 at 12:37:25 PM PST

      [ Parent ]

    •  Right. (0+ / 0-)

      And every year, Congress passes the "doc fix" to prevent Medicare from systematically pressuring healthcare providers to reduce their unreasonable charges.

  •  Nice diary. (4+ / 0-)

    I recall a co-worker friend going thru a similar presentation to the ER.

    She got a couple stents, a week of rest and then back to work.

    She was written 17 different meds!

    All of them brand name.

    Many of them had been around since Moses went mountain climbing.

    I told her to fire the doctor immediately, go to the local clinic, get a real MD to look at them and re-write them to allow generics, or something she could afford so she could actually get care.

    Her "out of pocket" cost on the first batch of 'scripts would have been over $800 to fill the first time.

    Her second set of 'scripts cost her less than $70.00 out of pocket.

    I loved her question,
    "Can I really fire a doctor?"

    Enagaged activism wins elections. 100 million words on liberal/progressive websites gets beat by one new GOP voter casting their vote.

    by Nebraska68847Dem on Mon Dec 10, 2012 at 11:07:10 AM PST

  •  This is really outrageous. (0+ / 0-)

    This really makes me angry!  WTF????

    being mindful and keepin' it real

    by Raggedy Ann on Mon Dec 10, 2012 at 11:43:49 AM PST

  •  The health care system (2+ / 0-)

    in this country is insane, and the treatment of your friend is just another example of how crazy the expectations of patients are. . . expecting someone to pay a $1,000.00 for a medication and is that for only a month supply?  If someone has to take it for a year that is $12,000.00 a year for a perscription that is unnecessary.  Add five thousand dollars to that $12,000.00 and you have my yearly salary in the 1980's when we never saw a bill and we also had a better system.

    Do you hear that sucking sound. . . it is the medical health care system destroying itself and taking all the middle and lower income patients with it.  It was the same thing with the mental health field, the costs kept rising and finally insurance refused to pay for therapy visits and in the end the whole system collasped in on itself.  The same thing is happening in the medical field.

    "During times of universal deceit, telling the truth becomes a revolution­ary act. " George Orwell

    by zaka1 on Mon Dec 10, 2012 at 12:14:15 PM PST

  •  The US health care business is different (2+ / 0-)

    from all other businesses because it is a legalized extortion system.

    What is an extortion ? It is when a guy comes up to you and says : "Give my your money for the protection or you will be dead." and you don't have any other choices but to give him the money even though you know whatever the dude provides is not at all worth the money he is getting from you.

    That's what happens with the US health care system. Relative to the GDP, the US health care cost roughly doubles the cost in other developed countries while leaving many people bankrupted or dead due to lack of health care. It's a total ripoff without giving the consumers any other choices. The rest of us are being legally extorted.

    Some critical commodity cannot just be left to the free market. The free market is designed to make the most profit for the providers of the commodity, not to be fair. When the commodity is something people cannot live without (remember the Enron-staged California energy crisis during the Bush years ?) then it will be prone to abuses to improve the providers' bottom line.

  •  I was just reading today that one problem (0+ / 0-)

    with our healthcare system is that doctors do not know the price of things they prescribe.

    Infuriating and thoughtless as this doctors comment was, my bet is what he meant is that he could get away without it but it might be better if he were on it. THe doctor felt obligate to prescribe the most best drug regardless of cost most likely. The man may have been in a gray area between needing it or not...it may have been a just in case thing. Not deliberate trying to make anyone money.

    Yet horrible way to communicate.

    I live in an urban area which is mixed income. My guess is that most Doctors here would know when they were prescribing a very expensive drug. Wonder also if it was a resident without a lot of community experience who was the doctor.

    not trying to stick up for the healthcare system. Living the cosequences myself right now of yet Other ways the system is broken. I just wish doctors and other participants in the system would acknowledge that they work in a system that is broken and often hurts patients in various ways, such as this

    I am sorry about your friend, diarist. He sounds quite ill and the drs response is not reassuring even medically (opens questions). I hope he has a regular doctor that is not this person.

  •  Stories like this one tonight, and another on (1+ / 0-)
    Recommended by:
    FreeTradeIsYourEpitaph

    Michigan beating unions down, make me think again the US has no right to call itself the greatest country in the world. It is not, never has been and its swagger has brought it to this. It is a second-rate country, rapidly descending to its demise, a country where citizens, human beings, and especially children and young adults have no decent future ahead of them.  Not to mention the homeless, unemployed, poor, racial minorities. Not to mention a House of Representatives doing the people in. It is truly a disgrace.

    I do not say this lightly, nor to criticize. Rather I seek to motivate. Sometimes it  takes a dispassionate friend and ally to speak the truth.

    "...stories of past courage can define that ingredient..... But they cannot supply courage itself. For this each man must look into his own soul." JFK Profiles in Courage " Ontario

    by ontario on Mon Dec 10, 2012 at 08:29:24 PM PST

    •  . (1+ / 0-)
      Recommended by:
      ontario

      I agree with every word you wrote.  Next major stop, bond market blowout coupled with more war as a coverup just like the global war on terror which is a loser's battle.  Tail wagging the dog.

      "History records that the money changers have used every form of abuse, intrigue, deceit, and violent means possible to maintain their control over governments by controlling the money and its issuance." -James Madison

      by FreeTradeIsYourEpitaph on Tue Dec 11, 2012 at 07:23:09 AM PST

      [ Parent ]

      •  Thank you. You are one of the thoughtful people, (0+ / 0-)

        who will make a difference. I hope against hope regarding your scenarios.

        I shall be visiting for three months to see for myself, face-to-face with Americans (many conservative) how it is going. I also know many thoughtful, former Republicans, now strong Obama and Democratic supporters. Some may still be registered GOP, but they will never vote GOP again, nor their children and grandchildren.

        "...stories of past courage can define that ingredient..... But they cannot supply courage itself. For this each man must look into his own soul." JFK Profiles in Courage " Ontario

        by ontario on Tue Dec 11, 2012 at 10:08:28 AM PST

        [ Parent ]

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