From: sbharris@ix.netcom.com (Steven B. Harris )
Subject: Re: Help Save a Man's Life
Date: 09 Oct 1995
Newsgroups: ab.politics,talk.euthanasia,soc.culture.canada,can.legal,
	can.med.misc,ont.general,sci.med,can.infohighway,can.general,
	talk.religion.misc,alt.actvism,soc.culture.quebec,soc.culture.usa,
	soc.rights.human,alt.support.mult-sclerosis,alt.journalism,bc.politics

In <459d46$3rj@head.globalcom.net> bjwilson@globalcom.net (B.J. Wilson)
writes:

>You may also post from the bible about money being the root of all
>evil. This is why I do not agree to euthenasia, some poor slob may be
>bumped off because of insurance or to save a few bucks.


  As opposed, of course, to vegetative folks being kept alive and in
discomfort indefinately, because the money to do it was available.
During my training I saw very elderly people so demented they couldn't
talk, let alone have any idea of where there were, or what was
happening to them, carried from their nursing homes, yelling, down to
dialysis 3 times a week, where people stuck big needles in them.
Medicare paid for it-- a very sucessful program (3 billion a year now
for 50,000 people).  What can I say?  They couldn't say "stop," and
nobody else could either.  No doubt it's happening all across the
country as we speak.  Why not?  Dialysing for dollars.


                                       Steve Harris, M.D.

From: sbharris@ix.netcom.com(Steven B. Harris)
Subject: Re: Dr. Livingston, I presume....
Date: Sat, 27 Sep 1997
Newsgroups: alt.support.menopause

In <342C6003.B162CCC6@erols.com> kakkrikor@erols.com writes:

>Joan Livingston wrote:
>>
>> On Fri, 26 Sep 1997 kakkrikor@erols.com wrote:
>> > I don't care who pays for them. I don't have "free" tests paid for
>> > by the government or anyone else, unless I see a good reason for
>> > them, and then God only knows they aren't free. I'd love to see the
>> > Medical Savings Accounts notion set up where you pay for your medical
>> > care out
>>
>> Terri,
>>
>> The US Goverment already as set up a Medical Savings Account pilot
>> program to encourage the use of high deductible insurance plans. The
>> patient will now be more actively involved in asking whether a test or
>> procdure is really "worth" it, plus having a financial incentive to
>> "stay well."
>
>Steve, do you approve of these types of accounts? Or do you see mommy
>socialism creeping into them too? Don't you think, as a good libertarian
>and all, that making people responsible for their own health care costs,
>is a good idea? How many people would spend the money on "preventative"
>testing do you think? The current accounts where people put money aside
>to pay their deductibles don't work because the money goes to the IRS if
>you don't use it. Doctors love this system because Americans, tax-haters
>that they are, would rather give their money to a doctor than the IRS
>even though they get nothing out of it either way. Hell, they'll even pay
>a bank $100.00 in interest to save at most $30.00 in taxes and think
>they're getting a good deal. But if _they_ get the money if they don't
>give it to doctors I wonder if they'll be so eager to have mammograms and
>dexxa scans. Be an interesting situation to watch.
>
>Terri



   Such accounts were first proposed by Libertarians (as were school
vouchers),and I think they are a superb idea.  In general, I support
any system which returns decision-making to the people who stand most
to gain or lose.  It's only natural that this will result in the best
decisions.  That's HOW a market economy works, don't you know-- and why
it works so well.  In a market economy (unlike a centrally controlled
economy) supply and demand decisions are distributed among millions of
brains, all working on the same hard economic problem, like millions of
parallel computers.  The free market price of a good or service is just
a piece of information which allows all those computers to work on the
same problem together.  Any system which acts to distort true costs by
making prices artificial just mucks things up, and in the end causes
pain and suffering, ala the USSR or Romania.

    Of course, some people cannot afford true costs in medicine, and
require charity to stay alive.  A society may decide to provide this.
Other people could pay full costs if they were wise about savings or
planning for the future, but they aren't.  Rather than let them suffer
or die, a society may decide to provide these people with charity also.
I have nothing against some of this in principle (though I wouldn't
provide such care on a silver platter with the same convenience that
better planners and self-deniers and savers get), but I do think that
such charity should be clearly labeled.  Otherwise, again lack of
information about good and bad choices, and the rewards for making good
and bad choices, distorts the system.  Medical savings accounts go a
long way toward solving both problems.  They aren't perfect
economically, but then no system which rewards incompetent decision
making ever will be.  And all humane and decent systems do some of
that-- no getting away from it.

    I saw a woman in the office the other day who uses Medicaid to pay
her Medicare premiums.  She didn't come in last month because she was
vacationing in Hawaii.  She had shoulder pain from moving furniture
into her new home.  I live in an apartment because after years of
research jobs, I cannot afford a house yet.  It's been a hell of a long
time since I was in Hawaii.  But you should see my income tax this
year.  Such encounters tend to concentrate a doctor's mind on economics
in a rather direct way.

                                             Steve Harris, M.D.

From: sbharris@ix.netcom.com(Steven B. Harris)
Subject: Re: Deja News - Author Profile on sbharris@ix.netcom.com(Steven B.
Date: Sat, 27 Sep 1997
Newsgroups: alt.support.menopause

In <Pine.SUN.3.96.970926182207.601C-100000@coyote.rain.org> Joan
Livingston <joanliv@rain.org> writes:

>Ah, Steve, there you go again, not reading my posts thoroughly. I said
>who said it first - inconsistencies are the hobgoblins of little minds.
>But maybe you missed that.


  I didn't miss it.  Nobody said it first, because it's an incorrect
version of a quote from R.W. Emerson.  Which means perhaps that you
said it first.

>Funny though how the good old capitalistic supply and demand ends up
>paying them so well. Oh well, I guess there is always medical school and
>finding a way to suck off the federal Medicare trough if I wanted to find
>something more intellectually challenging.


    If you can find a way to make any money honestly from Medicare on
outpatient geriatrics, you'd be a genius.  And do let me know, please.
I'd have sunk long ago if I wasn't being subsidized by a hospital which
is essentially diverting inpatient reimbursement funds to try to learn
how to run a full geriatrics HMO program (which means I get paid partly
for teaching an HMO-- something that can't last forever).

                                       Steve Harris, M.D.

From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: sci.med,sci.med.laboratory
Subject: Re: CBC Questions
Date: 2 Apr 1998 01:56:23 GMT

In <6fuoqi$gu4@news.cybernews.net> jrfox@no.spam.fastlane.net.no.spam
writes:

>As a matter of fact, this is exactly what is happening in the United
>States in attempts to control Medicare costs, as laboratory expenses are a
>great proportion of them.  Panels are now discouraged, and medical
>justification of each element of a battery of tests is now to be
>documented each time one is ordered.
>
>--
>Jonathan R. Fox, M.D.



   The idea that this controls costs, of course, being completely
moronic.  An SMAC-20 panel, being automated, costs less than 2 or 3
tests ordered separately.  And since you generally want more than 2 or
3 tests in your patient complaining of general fatigue, tired,
weakness, weight loss, etc, etc, you're going to end up costing the
system far more.  Same goes for the Chem-7, which simply orders all the
electrolytes which a doctor is going to be interested in, in a
dehydrated patient.  Duh.  So we can order 6 tests separately for twice
as much money?  How clever.  Now add in the doctor's time to "justify"
all this to medicare.  That's time spent away from the patient, who
already complains that he doesn't have enough face-to-face time with
the doc.  Well, gee, how come?  His doc is in the back room documenting
things for the nice government.

   If you asked the average person whether or not they'd rather spend
more time with the doctor, or have the doctor instead spend the time
satisfying the mania for statistics which torments the bureaucrats in
Washington, what do you suppose the average voter would say?  But none
of this, of course, was ever put to a vote.

                                           Steve Harris, M.D.

From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: sci.med,sci.med.laboratory
Subject: Re: CBC Questions
Date: 2 Apr 1998 21:12:47 GMT

In <3524a279.5466575@news.couriernet.infi.net>
<kiminy@couriernet.infi.net> (Pete.) writes:

   >>What about the doctors who order the same tests, regardless
of the patients symptoms? I have seen several ER doctors order a
chem 20, CBC, PT/PTT, UA (with C&S) on one patient with an FUO,
then again on another patient with vague abdominal pain, and then
again on a patient with chest pain. It wastes my time, because as
I piddle around with the FUO and abdominal testing, the doctors
calls me, demanding results on the chest pain who now has an
abnormal ECG. It aggravates the doctor, because I'm not priori-
tizing my testing according to his needs. The ER doctors I now
work with order things like a chem 7, CK and troponin for chest
pain, a CBC for fractures, liver profile and coag for a palpable
liver, etc. This make a whole lot more sense to me, and allows me
to get everyone's tests back out as efficiently as possible. And
note that I'm *not even* taking into account the work load from
the floors. It just makes good sense to order what you need
based on what you see, rather than rattling off a series of tests
without a second thought.<<

   But now let me tell you the other part of the story.  I'm a
geriatrician, and I see patients in their 80's with very vague
and nonspecific symptoms, because they don't get clear markers
for what's wrong with them when they are ill.  Rather they get
weak and dizzy.  Or they get what we know as the "dwindles."
They quit eating.  They fall down more.  They become delirious.
Their temperature goes up half a degree from its normal 98.1 to
98.6, which means they now have a life threatening infection.
When they have MI's they don't get chest pain.  When they have
bowel infarctions or perforated ulcers they get nauseated, but
have more or less normal abdominal exams.  When they have
appendicitis they don't have right lower quadrant pain.  When
they get pneumonia, they sometimes don't cough (and guess what--
they have rales in one base ALL the time, so that doesn't help).
Urinary tract infections don't cause dysuria.  Their fevers are
unimpressive, and when identified are things you would ignore in
a 6 year old without a second thought.

   All of these things cause me real problems in trying to figure
out what is wrong.  They mean I rely on lab tests more and more,
and my indications are things which make medicare reviewers laugh
and think I'm a lousy doctor.  Well, I'm not.  Rather, I'm trying
to work in a system with rules written for 25 year olds who show
up in the ER with very specific problems, or 45 year olds with
hypertension and nothing else wrong.  And those rules don't
*work* in geriatrics.  For more, I can only refer you to a
geriatrics textbook, and say: read.

   Now, in the bad old days, I had ER docs who understood that
the elderly person who isn't feeling well, needs the battery of
lab tests.  And they did the X-ray and diff on the guy with pulse
ox of 90 but no fever or cough.  They did the lactate on the lady
with nausea but a soft belly.  They did the CBC on the folks they
didn't do rectal exams/guaiacs on, and I got the diagnosis that
way.  They did ECGs without chest pain complaints.  They caught
the hyperparathyroidism in the people who'd gone wacko, and the
CBC diff and the SMAC-20 caught the sepsis in the people with
temps of 99 F and no obvious source (guess what--gallbladder).
They did UAs on every ill elderly woman, which is a cardinal rule
in geriatrics, dysuria or not.

   Now, what do they do with elderly who present with little or
no fever, but some nonspecific (but clearly constitutional)
complaint?  Very little.  They send them home with one or two
tests that they can justify (they hope).  Or none, which is what
you'd do with a 10 year old with the same problems, who probably
doesn't want to go to school.  I get a call 24 hours later that
the person is comatose from something that was eminently fixable
24 hours earlier, and now is going to require hospitalization and
a HUGE bill.  Welcome to Federal healthcare planning.  It wasn't
planned by geriatricians.  Even medicare reimbursement MUST have
been planned by internists or maybe even anesthesiologists and
pediatricians.  I have no other explanation for the stupidity I
see in these programs.

                              Steve Harris, M.D.

From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: sci.med.cardiology,alt.health.policy.drug-approval,alt.activism,
	talk.politics.medicine,sci.med
Subject: Re: Doctor-bashing
Date: 12 Mar 1999 10:19:31 GMT

In <36E8A815.DD163143@emory.edu> Andrew Chung <achung@emory.edu>
writes:

>For all you know, Dr. Harris may have been a resident physician at a
>hospital with very few Medicare patients and so it is entirely possible he
>got very little Medicare DGME.


   During residency and fellowship I served in an LA county hospital
(Harbor General), a private hospital (St. Mary's, Long Beach), two V.A.
(Veteran's Administration)  hospitals (Wadsworth and Sepulveda), and an
academic institution (UCLA Medical Center).  Who knows?  Not only is
the mix different for each, but it changes from year to year.  Nobody
worried about billing in VA's when I saw them from the inside as
medical student, resident, fellow, and even attending (which last was
in 1990).  However, right now the medical coders tell me that VA
hospitals are doing a big push to make sure their docs capture medicare
billing (!), which they used to basically ignore.  So that's one part
of the government paying another.  And the mountain of paperwork
generated to make sure this happens would reach to the moon and still
have a fair diameter.  The time and effort comes out of patient care.
And the amount of that to go around at VAs was never in great supply to
begin with, if you'll forgive me for saying so.

From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: sci.med.cardiology,alt.health.policy.drug-approval,alt.activism,
	talk.politics.medicine,sci.med
Subject: Re: Doctor-bashing
Date: 14 Mar 1999 10:51:38 GMT

In <7cdgah$k1p$1@remarQ.com> "fiona" <fiona@amdyne.net> writes:

>Steven B. Harris wrote in message <7capnj$9ru@sjx-ixn8.ix.netcom.com>...
>
>> And the mountain of paperwork
>>generated to make sure this happens would reach to the moon and still
>>have a fair diameter.
>
>If I am not mistaken, the Department of Veteran's Affairs Hospitals are
>leading edge when it comes to creating a paperless system. Please shift
>paradigms and think electronic - all Y2K compliant of course. fiona



   "Paperwork" need not literally involve paper, Fiona.  One way or the
other, data entry and retrieval of a kind which is not directly
necessary for the health of the patient, simply comes out of time which
would otherwise be used for doing things that are.  If you've ever kept
a careful diary, you will have found that it is quite possible to have
done more, and thought more, in a day, than you have time to describe
even if you had another day just to do it.  Well, that's what nedicare
now wants from doctors-- diaries.  Properly coded and formatted, of
course.

   If you will tell me what YOU do for a living, I will be happy to
generate the appropriate analogy for what would be expected in YOUR
job, if the government required YOU to opperate the same way.  Then
perhaps you'd understand the frustration out there among physicians.

From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: sci.med.cardiology,alt.health.policy.drug-approval,alt.activism,
	talk.politics.medicine,sci.med
Subject: Re: Doctor-bashing
Date: 14 Mar 1999 16:50:32 GMT

In <7cgip3$q3o$1@remarQ.com> "fiona" <fiona@amdyne.net> writes:

>>   If you will tell me what YOU do for a living, I will be happy to
>>generate the appropriate analogy for what would be expected in YOUR
>>job, if the government required YOU to opperate the same way.  Then
>>perhaps you'd understand the frustration out there among physicians.
>
>It's already been done thank you ;-) We just finished route inspections
>where I was required to record my actions minute by minute throughout the
>day and actually count every piece of mail which I handled and show what
>I did with it. This inspection covers a one week period. For me, it is
>five days of hell. I am a mail carrier by profession and choose, as a
>general rule, not to have such "data entry" in my life. In the short run
>it does nothing to help my putting correct mail into the boxes of 450
>families, but in the long run it will, hopefully, lead to equitable
>balancing of work loads and, possibly, expedite the delivery of mail by
>allowing management to see where inefficiencies exist. I well understand
>your frustration with the system. It isn't only the Government that
>requires these details, the insurance industry and fear of liability add
>this burden as well. I chose not to accept the burden and stress of all
>that when I chose not to go to medical school. I am too much of an
>idealist to have been happy with it. Go ahead and vent, though, it's good
>for your heart to get all that out. fiona


   Actually, you didn't choose not to accept this when you chose not to
go to medical school, because it probably didn't exist then.  My major
problem is that they've changed the rules in the last 20 years since I
committed to medicine.  The job I trained for is not the job the
government is twisting it into.  And my investment in it is (if you'll
forgive me for reminding you) a hell of a lot larger than yours.  So
yes, I've got a right to vent.  If it had taken you an extra decade of
school, fifty grand of loans (that's counting interest) and so on to
become a mail handler, and then they decided they wanted time-motion
audits on you once a week, and then more frequently, quietly twising
the knobs, you'd have a beef.  Now wouldn't you?

From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: sci.med
Subject: Re: Medical crisis -- the real one.
Date: 13 Apr 1999 11:57:01 GMT

In <37171158.420912170@news.erols.com> vl-hb001@erols.com (Terri)
writes:

>Since you're on record as objecting to medicare (governemnt
>interference in health care), I find this response a little
>contradictory.

   I object to taxes for roads, and yet I drive on them.  If I didn't,
I'd have to pay twice-- once for the roads and once for my helicopter.
There are some things about the world I can't change.  Libertarians use
public facilities.  If burglar stole your color TV and left you a $100
bill, I doubt you'd burn it on principle.  Rather, you'd spend it.  But
doing so doesn't condone the act, or indicate your agreement with the
goodness of the enforced "trade" (aka, theft).  All it does is minimize
your damages.  Get it?


> But I wasn't speaking of you personally. I was speaking
>of the medical profession and health care in general. I know people
>who have lost everything in order to pay medical bills.


    I know people who have lost everything in earthquakes and floods,
farm disasters from failure to rain, and every type of accident and Act
of God.  That's life.  It's not an argument for robbing me until we're
even.  There is, for one thing, the parable of the grasshopper and the
ant, and what they did all Summer.  You may speak of mercy vs justice,
and I'm all for a certain minimal amount of mercy.  The problem is that
too much mercy brings injustice and even greater suffering.  We've long
exceeded that point, and probably did during the 60's.

  Did you know that Americans presently have a savings rate less than
zero--- that means on average we spend MORE than we earn?   That wasn't
true in the past.  Now, why would we do that now?  Why aren't we saving
against future disasters?  Answer: we no longer feel we need to.  Our
more prosperous neighbors (whoever they might be) are doing that for
us.  Should we have a disaster, we just vote ourselves relief from our
neighbor's savings accounts (those who have them, perhaps by dint of
hard work).  It's so much more convenient that maintaining our own,
don't you know.


> Unfortunately
>with HMO's and PPO's the only person who is charged the full price for
>a procedure is the one who can least afford it - the one without
>insurance.

    Yep.  But people do many things rather than buy medical insurance.
I once had to do a malarial smear on a febrile person on medicaid in
the ICU because she'd been on a recent trip to see relatives in
Tanzania.  I've had others with nice tans they got in Hawaii.  Nearly
everyone scares up the $500 a year it takes to smoke.  Somehow.  We're
not a country in which people are thin from starvation (not adults, at
least).  Rather, we're a country in which medicare pays for glucometers
because they are overweight and diabetic.  Re-adjustment of priorities
is in order.


> I'm always stunned at the difference in rates paid to
>participating doctors/institutions in an insurance plan, and the
>amount of the original bill. Factors of 2 or even 3 seem to be quite
>common.  You probably do jump through hoops to make your care
>affordable to your patients, and I'm sure they're grateful for it.


   Somestimes they are.  Others know about samples doctors have and
figure it's their due.  And I'm never sure I'm doing the right thing
there, anway, since somebody pays for those samples (namely- those
people with insurance plans that cover prescriptions).  But I'm not
responsible for the system.  If the samples are available, however, I'm
going to make use of them, since that's my job as advocate for the
people who come to see me.  It's just like the roads.  I'm not King of
the World.  It was pretty much the same place when I got born here.
Except for a gradual decay in self-reliance, which I've seen even in my
lifetime.

                                      Steve Harris, M.D.

From: Neal Lippman <nl@alum.mit.edu>
Newsgroups: sci.med,sci.med.cardiology,alt.activism,talk.politics.medicine
Subject: Re: Resident Training Costs and Subsidies (was: The Patients' Bill of
Date: Sat, 24 Apr 1999 04:22:10 GMT

Launching into the fray.

I can understand that most people find it hard to be sympathetic when
doctors talk about financial hardship when doctors have, for many years,
made a very good living, and most doctors continue to do so. Certainly,
most (but not all) doctors are paid reasonably well for what they do.

There are some other aspects to this discussion that I would like to
point out. Please bear with me. Not all of this will be coherent; I'm
going to throw out some thoughts.

1. Medical school is very expensive. More so than other comparable
professional fields, such as law, business, etc, although perhaps not
more so than veterinary school. On the other hand, the financial rewards
for veterinarians can be better than for many fields of people medicine
(some limited data below). Most medical school grads today come out quite
heavily in debt.

2. Because of the length of medical training and the time spent at
relatively low incomes (35K is perhaps not bad as a resident, although I
doubt too many people in other fields would work 60-80 hours / week at
that salary level), coupled with the high debt level, most physicians
find that their ability to save for the future (houses, kids&college,
retirement) to be dependent on a high level of earning once training is
completed, to counteract the loss of many years of earnings that their
peers in college have already had. By way of illustration: I began my
first non-residency job at the age of 30 (or maybe 31, I forget). This
followed 4 years of college, 4 years of medical school, three years of
residence, 3 years of fellowship.  [You may think the years don't add up,
but I was in college when I was 16.]  I did earn a salary during the
training years (not as much as my friends fresh out of law school did in
NYC, I made 27K my first year of fellowship while they were 3rd - 4th
year law associates at 70-100K; but I digress). Still, in NYC, 27K
doesn't go all that far, so I had little in savings after rent, food,
loan payments, and incidents.  Fortunately (<G>) my work schedule didn't
leave a lot of time for discretionary spending. Anyway, at the age of 31
I had my first job with a pension plan and began saving for a house,
college for my son (then my only child). In contrast, my friends who
entered the work force at the age of 22 had already been saving, and
compounding interest for 9 years already. I needed to make more to save
more to play catch up.

3. If the above doesn't seem convincing, I reference you to an analysis
in the NEJM I think now about 2 years ago. Written by economists, five
professions (MBA, law degree, MD, DVM, DDS/DDM) were contrasted from an
economic / return on investment point of view, taking into consideration
number of years of training, cost of training, reimbursement after
training and during training, etc. Guess which field was at the bottom of
the totem pole from an economic point of view?

4. In our society, we consider health care of be of paramount importance,
we have tolerated a massive shifting of health care dollars away from the
health care providers and into the pockets of insurance company
executives (one guy who sold an HMO he had founded to a bigger insurance
company got 980 million (yes MILLION) bux for the sale, plus a corporate
provided jet, plus a pilot paid for for life....). We have withstood
cutbacks on nursing and support services and personnel in hospitals to
dangerous levels. We have tolerated cutbacks in payments to physicians
leading to increasing physician dissatisfaction and sometimes outright
hostility, depression, and dispair. What in the world is wrong with us?
If healthcare is such a right, why aren't we willing to ensure that the
best and those with the greatest ability become our doctors and nurses by
ensuring job satisfaction, financial rewards, whatever it takes?

5. I for one would like to feel that the doctor taking care of me to be
the best around, and not someone who couldn't get into law school, or
business school, etc.  When you are in the ER at 5 AM and need emergency
surgery, stop and think about how much that surgeon is worth to you. I
can recall the very complicated delivery of my son like it was yesterday.
The doctor who got him (and my wife) through that ordeal was worth every
and any penny she charged.

6. Doctors provide a lot of free service, when you really look at it.
Forget the charity work and indigent patient care. How about all those
phone calls to your doctor, the ones where you get free advice and
treatment? A few nights ago, a patient had me paged at 9PM because she
"had a few questions that couldn't wait until her visit with me the
following week." OK, fine. None of the questions were emergent, or
urgent, or pressing. She admitted that. She just didn't have anything
else to do that night, so I spent 45 minutes on the phone with her that
night, all for no reimbursement (actually, it cost me money because now
she can cancel her appointment).  Why did I do it? Because I like to
think that I am the kind of doctor who will spend the time for his
patients, and hopefully I am at least the majority of the time. I have
had sick relatives and called the doctor, and always appreciated the time
the spent, even at odd hours, talking to me, and I hope that I can give
that back to my patients. But keep in mind, folks, had she called her
lawyer, the clock would have been ticking and the billing goes on.

7. We are already seeing a change in the way that doctors view their
patients and their practice, and what they are willing to do, based on
the declining financial value of our services. Example: right now, it is
unclear whether patients with an acute MI should recieve acute
angioplasty or thrombolytic therapy. At my hospital, it has been common
for acute angioplasty to be done, but now many doctors are looking at the
reduction in payment for angioplasty and thinking "why should I get out
of bed at 3AM to do this procedure when the ER doc can just give the tPA
and I don't get paid enough to cover the cost of coming in?" I am glad to
say this hasn't made it out of the coffee room and into practice yet, but
if you squeeze people enough, behavoirs will change.

8. I already spend more of my time on paperwork than on patient contact
when I am in the office. The Medicare coding guidelines are so complex
that they are virtually impossible for the practicing physician to
reliably code. Add the criminal penalties, fines, and presumption of
guilt that presently exists into the mix, and it is small wonder that
most doctors are afraid and therefore deliberately under code to avoid
getting "caught." Ludicrously, it is more financially rewarding for me to
take a complete review of systems with my history, most of which has
nothing to do with my very focussed subspecialty of cardiac arrhythmias,
than to spend the same time discussing the arrhythmia and the patients
symptoms. What a dumb state of affairs.

9. Sure, teachers are underpaid. So are nurses. I find it incredible how
little we value the people shaping the minds of our children, and
performing the minute-to-minute care of our sick relatives and friends.

10. Lastly, I am no longer ashamed to make the money that I do for the
work that I do.  I studied hard, I have a lot of years of schooling (even
if it doesn't show in this diatribe), I work extremely hard, and under a
great deal pressure compared to most occupations (I am glad not to be an
air traffic controller, though!). I earn my salary, and then some, for
the work I do, and I am no more ashamed of it than the corporate CEOs I
read about every day taking home 100 million or more in a year in which
they cut 15000 jobs from their company. Interestingly, I have noticed a
change in recent years in the way doctors talk about their own incomes.
In the past, no one mentioned it, or if someone admitted to making a lot
of money in medicine, they always acted a little ashamed, as though it
was somehow wrong to make money from helping people. Well, folks, the two
aren't mutually exclusive. The important thing is making sure that the
financial reward does not become more important than helping people; when
it does, it's time to get out of medicine. I'm still here because I still
get that warm fuzzy feeling when I help someone, and because I still
think I can be the kind of doctor for my patients that I want to be, at
least most of the time. That doesn't mean that I don't expect to and
deserve to be paid for my time, expertise, and skill, any more than you
expect the guy painting your house to do it for free.

Hey, thanks for letting me rant. If you read this far, my appologies for
chewing your ears (well, techically eyes) off.

Neal

George Conklin wrote:

> In article <371D8A89.B1842FD@wireco.com>,
> Daniel Carmody  <carmodydw@juno.com> wrote:
>
> >I'm in medical school now. I expect to owe >100K when I graduate. After
> >graduation I expect to work as a resident for about 35K for around 50 -
> >80 hours per week(depends on program, specialty, etc) while beginning
> >to pay back the 100K in loans.
>
>    And that pay for the resident will be about the maximum a
> school teacher in NC will ever make, even 30 years into a
> career.  Stop the whine.  You will have all kinds of time to
> pay back your loan, which will about one-year's pay at a HMO
> for a family doctor, or six month's pay for a specialist.
> Get a life.  We does this nation select whiners for med
> students?

From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: sci.med,sci.med.cardiology,alt.activism,talk.politics.medicine
Subject: Re: Resident Training Costs and Subsidies (was: The Patients' Bill of
Date: 24 Apr 1999 10:02:10 GMT

In <372146B2.BCEEFA3F@alum.mit.edu> Neal Lippman <nl@alum.mit.edu>
writes:

   [A lot of stuff I want to just sign my name to, except that I
trained in Long Beach and LA and didn't have to suffer NYC on a salary
not much different (17.5 K in 1983, going to 20 the next year).  Had a
little appt not far from the beach in Long Beach.  Not the world's
prettiest beach, but still a real beach.  Take that <g>]

>8. I already spend more of my time on paperwork than on patient
contact when I am in the office. The Medicare coding guidelines are so
complex that they are virtually impossible for the practicing physician
to reliably code. Add the criminal penalties, fines, and presumption of
guilt that presently exists into the mix, and it is small wonder that
most doctors are afraid and therefore deliberately under code to avoid
getting "caught." Ludicrously, it is more financially rewarding for me
to take a complete review of systems with my history, most of which has
nothing to do with my very focussed subspecialty of cardiac
arrhythmias, than to spend the same time discussing the arrhythmia and
the patients symptoms. What a dumb state of affairs.<

    Yep.  I'm in geriatrics-- imagine. Henry/George, our local full
professor sociologist at Your Old Politically Correct U, is going to
shortly demonstrate how you can work 35 hour weeks and make $170,000
net on medicare office visits.  And go to jail, too, of course.  But he
doesn't say that.  Gerontolists in the real world survive by skimming
off something else.  Nursing homes, academic salaries, private grants--
something.  If you spend 45 mintues talking to your phone patients on
call, nobody's going to reward you for it.  "That's fine" you say.  But
what they don't tell you as a little kid is that the price of doing a
mitzvah is that you'll actually be punished for it.  Wait and see. I've
been there. I hope you're very philosophical.

   Yes, it's crazy. I can help a bit: if you spend a lot of time
talking to your patients about their problem, note that code upgrade
for spending more than 50% of your face-to-face time teaching (which no
doubt you often do, and would do more).  That'll get you out of some of
the ROS crap and back to practicing your specialty, sort of, by the
back door.  God damn medicare for doing this.

  Take a coding class.  It's horrid, but no more so than being a
leftist sociologist.  Thank Clthulu there aren't any in my family-- I'd
have to skip reunions.



>9. Sure, teachers are underpaid. So are nurses. I find it incredible how
>little we value the people shaping the minds of our children, and
>performing the minute-to-minute care of our sick relatives and friends.
>
>10. Lastly, I am no longer ashamed to make the money that I do for the
>work that I do. I studied hard, I have a lot of years of schooling (even
>if it doesn't show in this diatribe), I work extremely hard, and under a
>great deal pressure compared to most occupations (I am glad not to be an
>air traffic controller, though!). I earn my salary, and then some, for
>the work I do, and I am no more ashamed of it than the corporate CEOs I
>read about every day taking home 100 million or more in a year in which
>they cut 15000 jobs from their company. Interestingly, I have noticed a
>change in recent years in the way doctors talk about their own incomes.
>In the past, no one mentioned it, or if someone admitted to making a lot
>of money in medicine, they always acted a little ashamed, as though it
>was somehow wrong to make money from helping people. Well, folks, the two
>aren't mutually exclusive. The important thing is making sure that the
>financial reward does not become more important than helping people; when
>it does, it's time to get out of medicine. I'm still here because I still
>get that warm fuzzy feeling when I help someone, and because I still
>think I can be the kind of doctor for my patients that I want to be, at
>least most of the time. That doesn't mean that I don't expect to and
>deserve to be paid for my time, expertise, and skill, any more than you
>expect the guy painting your house to do it for free.
>
>Hey, thanks for letting me rant. If you read this far, my appologies for
>chewing your ears (well, techically eyes) off.
>
>Neal


    Just sign me, too, like I said.  Thanks, Neal.

From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: sci.med,sci.med.cardiology,alt.activism,talk.politics.medicine
Subject: Re: Resident Training Costs and Subsidies (was: The Patients' Bill of
Date: 25 Apr 1999 08:59:13 GMT

In <37228BB3.CECE5280@alum.mit.edu> Neal Lippman <nl@alum.mit.edu>
writes:

>Thanks for the support. I am already hep to the discussion upcoding
>thing, and now I routinely include in my dicatations the amount of time
>spent discussing issues / treatment / test results, etc with the patient
>during each and every office visit. I upcode when appropriate, but again
>this requires face to face time. For instance, if I am seeing patient in
>the hospital and I spend 30 minutes dicussing a procedure with him, and
>then at the end he says "say, could you call my wife and repeat that for
>her", if I call from the room and make the patient listen to the call, I
>can bill for that time under Medicare guidelines, but if I call from the
>office or the nurses station I can't. What's the deal with that?


    Just Medicare use of your patients to police you, that's all.  With
the exception of certain family conferences lasting more than half an
hour, Medicare make you charge by face-to-face time so that there is
nothing chargable you do for a patient in the way of teaching, that the
patient isn't present for.  Which means that when the patient gets the
bill (already paid by the government) he knows that if he's charged for
a service he didn't observe, that there's a good chance he can call the
Medicare fraud line and get the reward for turning you in.  Same with
test bills.  I suppose you do know that Medicare fundamentally is
stuctured that way quite deliberately?

    You should see me smile when I hear somebody say we need socialized
medicine, because HMO and managed care turns doctor and patient into
"adversaries."

From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: misc.consumers,misc.consumers.frugal-living,talk.politics.medicine,
	sci.med
Subject: Re: Disappointed and confused--don't know what to do
Date: 25 Apr 1999 09:08:22 GMT

In <3722A083.CC3BE4BF@emory.edu> Andrew Chung <achung@emory.edu>
writes:

>Your doctors are anti-HMO and I suspect they've also had their fill of
>government bureaucracy else they would be working in the VA system.

   In which case they're going to be quite disappointed. now that VA
docs are starting to have to do Medicare CPT coding.  How they scream.
I can almost hear them from here.

   Andrew, don't you get it?  The VA IS socialized medicine.  That's
what it would ALL be like if we had a single payor system in the US.
The fact that the VA is now making the VA docs capture Medicare dollars
by doing Medicare paperwork is completely expected.  By everybody but
them.  And you.  Not by those of us who understand the nature of
government, however.  Beware.

From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: misc.consumers,misc.consumers.frugal-living,talk.politics.medicine,
	sci.med,misc.legal
Subject: Re: Disappointed and confused--don't know what to do
Date: 26 Apr 1999 00:29:58 GMT

In <37284383.9867506@news.hiwaay.net> Ken H.  writes:

>On 25 Apr 1999 08:10:40 GMT, sbharris@ix.netcom.com(Steven B. Harris)
>wrote:
>......
>>   That's my claim.  There are also free clinics.  For certain chronic
>>disabilities you are also eligable for medicare, no matter your age.
>>.....
>
>Medicare?  Thought that program was restricted to those 65 and older?
>Sure you don't mean Medicaid?
>
>Ken H.


  No, I mean medicare, since about 1974.  You might not think of that
30 year old paraplegic guy in the wheelchair as being on medicare, but
he may well be.

From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: misc.consumers,misc.consumers.frugal-living,talk.politics.medicine,
	sci.med
Subject: Re: Disappointed and confused--don't know what to do
Date: 26 Apr 1999 08:04:35 GMT

In <3723EA11.6A344386@emory.edu> Andrew Chung <achung@emory.edu>
writes:

>"Steven B. Harris" wrote:
>
>> In <372205FD.8E902ACC@emory.edu> Andrew Chung <achung@emory.edu>
>> writes:
>>
>> >I already charge as much (or as little) as I want and always will charge as
>> >much (or as little) as I want single-payer or not.
>>
>>    I take it you don't take medicare?
>
>no, I don't.
>
>--
>Andrew Chung
>http://userwww.service.emory.edu/~achung



   Hmmmm. Steve Harris, M.D. here considers a bold move:  First
geriatrician in America who does not take medicare.....

From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: misc.consumers,misc.consumers.frugal-living,talk.politics.medicine,
	sci.med
Subject: Re: Disappointed and confused--don't know what to do
Date: 26 Apr 1999 08:22:44 GMT

In <3723ECD5.33DE736D@cs.uoregon.edu> Bret Wood
<bretwood@cs.uoregon.edu> writes:

>I have had email correspondence with several people who supported
>my interpretation of the situation.  One of those people has
>apparently gone so far as to complain to Steve's ISP for his
>refusal to trim newsgroups from his off-topic posts when he was
>asked.  (BTW, I _did_ trim sci.med.cardiology from all of my posts
>for a week or so.  I assumed that everyone else in the thread did
>too.  Apparently Steve was extremely rude to the person who asked
>HIM to trim the group from this meandering insurance thread.)


    The actual story:  I got email from someone asking me to trim this
stuff out of sci.med.cardiology, and including a message in which I was
complaining about medicare coding.  I wrote back to say that what:
cardiologists don't have to do medicare coding?  This was considered a
rude response. In retribution for my not agreeing to do everything he
asked me to do, immediately, yessir, this person's blood pressure rose
so high that they sent a complaint to my carrier that I was posting
"illegally" in sci.med.cardiology.  I assume that my carrier is still
laughing.

From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: sci.med,sci.med.cardiology,alt.activism,talk.politics.medicine
Subject: Re: Resident Training Costs and Subsidies (was: The Patients' Bill of 
	Rights (was Backlash against HMOs: a declaration of war)
Date: 29 Apr 1999 13:30:08 GMT

In <7g9br0$a19$1@nina.pagesz.net> henryj@nina.pagesz.net (George
Conklin) writes:

>   So the answer is obvious: to justify sky-high salaries
>the public has to pay, make the training more nasty and
>infinitely more painful.  Then the public can be told it has
>to pay more and more and more forever.


   Still waiting to see your Medicare Calculation, George.  You were
going to use CPT codes to show us how doctors can bill medicare at
$150--200 per hour of time, and not go to jail.  Right?

From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: sci.med,sci.med.cardiology,alt.activism,talk.politics.medicine
Subject: Re: Resident Training Costs and Subsidies (was: The Patients' Bill of 
	Rights (was Backlash against HMOs: a declaration of war)
Date: 3 May 1999 03:03:03 GMT

In <7gijmd$c3i$2@bgtnsc02.worldnet.att.net> "John Garzillo"
<mjdgdc@worldnet.att.net> writes:

>That is true, they do not administrate the Medicare system, they just set
>the rules and put the money in the checking account. Local private
>carriers write the checks and administer the plan (usually a Blues
>company). But a "national healthcare program" could be the same design
>(federal funded, locally run), so a national system could quite easily be
>"just like everyone having Medicare". Which brings us back to the
>original question: Is Medicare so bad? I can speak as a provider in the
>system, but not as a member. Any Medicare insureds out there? Please
>comment on how you feel Medicare has served your healthcare needs
>(bearing in mind that universal coverage would probably include drug
>coverage). I'd like to hear comments from our Medicare-covered members in
>this group.
>
>Jon Garzillo DC


   The problem with Medicare is that you don't see what it really
costs.  Administrative costs of the program are hidden in other
government overhead.  The benefits of it are completely tax free, and
paid for by tax free money, something that can't be said for large
fraction of the private system (yes, insurance companies do pay taxes
at the comporate level, and so do many hospitals and hospital chains.)
Medicare does not pay its way, and many systems would cut it or cut it
way down for purely business reasons, but are forbidden to by law (true
especially for hospitals and health plans).  So medicare rides on the
rest like USPS packages ride on the distribution system created by the
artificial monopoly of first class mail, funded by a hidden tax which
is an unfunded mandate.  Like so many things.  It would hardly work if
applied universally; we'd go broke (one way or another) trying to
finance it.  Either that, or we'd have to buy all of our docs PCs and
cut some of the paperwork, as Canada has.   Hmmmmm.

   The horrible thing is that when the baby boomers begin to hit 65 in
about 2010, things are going to go to pieces anyway in Medicare.
People over 65 take up 3 times the medical resources, and they're going
to go from 12% of America to 24%. That trend will drive per capita
medical care costs in the US up by a third, perhaps as much as 50%, all
by itself.

From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: talk.politics.medicine,sci.med
Subject: Re: Medicare and Bret's Reality (was: Disappointed and confused--don't
Date: 9 Jun 1999 04:45:32 GMT

In <375DD905.238C303B@lucent.com> Martin Braff <braff@lucent.com>
writes:

>Very little of this applys to the doctor filling out a medicare claim
>form. He has to put down the CPT code for the procedure he is billing (he
>should know what he did and be able to look up the code) and the
>patient's diagnostic code. Anyone with a college degree should be able to
>handle it.
>
>Marty Braff


    Sure, if they have all the time in the world.  If you do an H&P on
somebody for Medicare you don't "look up" a code.  You go through a
rather large matrix that looks at number of problems addressed, whether
new or old, whether the same or worse, how much depth of history you
went into for each, whether or not you put in the relevent parts of the
ROS, the family history, the medication history, whether or not you
looked at enough systems in the PE to qualify for this or that category
(was it 8?  Was it 9?  Are we still using 1997 rules, or did they
finally change?), what diagnostic tests you did and whether you did the
interpretation yourself, whether the risk in diagnostics or
therapeutics is low, medium or high, how much time it took you, whether
or not you spent more than half your time answering patient questions,
yada, yada--- and then you get to look across categories and make your
boldest pick on the highest number, bill it, and hope you don't go to
jail if the auditors don't agree.  A computer can help here but (alas)
sometimes different programs give different answers, and you can bet
your bippy that Medicare doesn't make an official one, because if they
did they'd have to stand by it.  So yes, it's a lot like the IRS.

   But wait-- we're not through yet.  Are you a teacher?  Did your
resident do some of this?  Were you there the whole time?  You don't
need to be, because you're probably back giving a lecture to the other
resident, or pulling something off medline.  Okay, were you there for
the significant parts of the history and physical, and if so, what were
they?  Will the feds agree?  And if you weren't there, did you repeat
those parts?  Do you say so?  Is saying you did, good enough, or do you
need a summary of your own?  How complex a summary?  Last, and just for
grins, if you have a paperless office system, how do you sign the
thing?  They have to have some way to put you in jail for stuff you say
you did, and they can't if they don't have your signature.  So now you
have to have a form saying that when you say or type your name, you've
given formal permission for it to be considered a signature.  But don't
forget to sign THAT form....

   Are we having fun, yet?  Anyone with a college education can do it,
to be sure (though not everybody gets the same answers, strangely).
But that's not the real question.  The real question is: is that what
you went to college (or medical school) FOR?

    My answer, increasingly, is "no."  I did not go to medical school
so that for every person with a medical problem I diagnose or treat, I
could fill out a thing like a 1040 form for the Feds, in order to
convince them to send me a refund.  I'd have become an accountant if I
liked that (there's no accounting for taste, they say-- but they're
wrong).  My role in life is not to playing a neverending
ethico-philosophical game with the government about how much of my
thinking I have to put down in electrons to convince somebody or other
that I actually did it, just on my word, so that they then can take a
certain amount of money they took by force from person A, and send it
to me, person B.  A set of rules which changes every few years, though
the medical problems and patients I see may well not.  That's asinine.

   And just as soon as enough physicians come to the same conclusion,
(which is happenening quite rapidly) you can kiss the Medicare program
as you know it, goodbye.  No other country on this Earth puts up with
that much paperwork per patient, and this one won't for long, either.
As it is, we're only doing it out of force of habit and charity.
Greed, you can be sure, does not enter in, since it's a lot cheaper in
time and money to see NO medicare patients at all.  Ever.  Period.  No
exceptions.  As soon as it becomes clear that our charity is being
taken advantage of by people who really are not trying to fix things,
but really don't give a flying f&&^%$, then that's the end of it.

   And please don't say I didn't warn you.

From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: talk.politics.medicine,sci.med
Subject: Re: Medicare and Bret's Reality (was: Disappointed and confused--don't
Date: 9 Jun 1999 04:52:17 GMT

>The medicare billing form is pretty simple. You put down the CPT code for
>the procedure, and a code for the diagnosis. So what was your complex
>billing question?
>
>Marty Braff


   My complex billing question is: how many non-procedural things have
you actually billed Medicare for?  If you pull out 10 sets of cararacts
a day, or peer up 10 colons a day, you don't really have a problem.  If
today you see 10 little old ladies who are weak and dizzy, you do.

From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: talk.politics.medicine,sci.med
Subject: Re: Medicare and Bret's Reality (was: Disappointed and confused--don't
Date: 9 Jun 1999 05:01:52 GMT

In <375DD4B5.55425113@lucent.com> Martin Braff <braff@lucent.com>
writes:

>  You could take the course, or you could hire a billing company that
>would answer your questions.


   Yep.  Price Waterhouse Cooper only charges $310 an hour for that
Medicare coding consultant.  Not that you're guarantteed by anyone, and
certainly not Price Waterhouse Cooper, that the answers you get will be
correct.  It might be nice if the government sent out a person for
this, even for the same money, if the accuracy guarantee held.  But the
government isn't THAT stupid.  If the IRS doesn't do it, you can bet
Medicare doesn't either.  So yes, the billing company will answer your
questions.  That and a quarter will buy you coffee at Denny's.

>There is no one forcing you to participate in
>medicare. You could just change to pediatrics.

   Internal medicine, more likely.  Yep, that's true.  And it's
happening.  It will take several more laws to keep it from happening to
a larger degree.  Which, of course, they will try to pass.  And
eventually, it will all come down to the doctors union vs. the
government, just like in France.  The only question is: how long. But
it will happen.  Along the way, the older patient may experience some
inconvenience.  Bill and Hillary apologize.  And thank you for flying
United.

From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: talk.politics.medicine,sci.med
Subject: Re: Medicare and Bret's Reality (was: Disappointed and confused--don't
Date: 9 Jun 1999 17:07:19 GMT

In <375E68BE.F11EE34A@iname.com> Ted Rosenberg <tedrosenberg@iname.com>
writes:

>As for the crap about how hard medicare billing is, it is PURE crap.
>Except for doctors who specialize in exotic problems, or large diverse
>clinics and hospitals, there are very few codes that any single source
>is likely to use regularly.  SURE, there is the ONE oddball which
>causes some head scratching, but its RARE.


   I see.  That's why Medicare coding instructors bill $300 an hour--
because it's so easy.  And institutions and their doctors like to give
money away.  They have too much of it already, and burning it in the
fireplace was tedious.

    Tell us now how much you've billed Medicare and in what capacity?
We're very curious as to how you know so much about it.  I, myself, am
a geriatrician.  You?

From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: talk.politics.medicine,sci.med
Subject: Re: Medicare and Bret's Reality (was: Disappointed and confused--don't
Date: 10 Jun 1999 07:47:09 GMT

In <375F4205.88610357@iname.com> Ted Rosenberg <tedrosenberg@iname.com>
writes:

>>         This is about the place I start laughing uncontrollably every time
>> someone says that Single Payer will cut the administration and overheads
>> costs....
>
>Just shows that you don't have the SLIGHTEST understanding of the
>situation.  It WILL cut administrative costs -  There may be OTHER
>problems with the idea, but THAT isn'nt one.


   It all depends on what you define as an administrative cost, and
whether or not you want to cut them all.  Some administrative costs are
good, and some are bad.  Administration is another name for information
processing.  It's how you find out if what you are doing is good or bad
for your legal risk, whether it is efficient or inefficient for your
business, or if it's causing so much anger among your employees and
customers that it negates all the money you spend on advertising or PR
or labor relations or whatever.  Administration costs are money you
spend to analyze markets, and advertise so people know to come to you
when they need your service.

    Now, if your administrators are tormented by a mania for collecting
statistics which they never look at, and use only as excuses for
paperwork which is used to deter people from doing things your
administrators don't want them to do for expense reasons, by making it
difficult and frustrating for them-- why then such administration may
not be Good.  Particularly if the expensive things done now save having
to do REALLY expensive things later.  Adminstrators, strangely enough,
sometimes do not understand the business perfectly.  Sometimes (here's
a horrible secret) administration has no earthly idea whether or not
the customer is being served and the business is doing it efficiently.
Cutting such stupid administration is a fine idea.  And whenever you
have an artificial monopoly and no market forces operating to keep it
lean and trim (as in the VAH, government, military, etc) there's
usually a boatload of stupid administration.  And it always costs.  And
not just in salaries of stupid adminstrators.  The money you pay them
is the least of the damage.

    In the private sector, it's a mixed bag.  McDonald's wastes a lot
of money competing with Burger King.  Wouldn't it be better just to
combine them, and give the franchises some new name?  I mean, look at
adminisration costs in merchandising.  Suppose we just pass a law that
says Wal-Mart and K-Mart and Target are all now going to be one big
chain, and we're going to save one hell of a lot of money on
duplication of management.  Won't that be great?  Stockholders get new
certificates for WalKTarmart, and they're happy.  Eventually, perhaps
you could even have the government run it, and gradually absorb a bunch
of other megastores, too.  Think of the economies of scale!  No
advertising!  Medicare and US military levels of efficiency on
inventory control.  Pretty soon, savings on all that stuff will drive
prices so low we'll all be rich, just from being able to buy milk at 50
cents a gallon at the same time you pick up your pharmacy prescription
and the latest trashy paperback novel for a couple of bucks.  Right.
Let's get to it.  And next, we ought to really combine all those
airlines.  I can't think of a single reason it shouldn't work.  Mr.
Rosenberg, how about you?   If medical insurance isn't like Burger King
or Walmart or flying on Delta, what makes it different?  Burger King
can food poison you and send you flying to the restroom, and Delta can
certainly make you into hamburger.  Why do we trust their functions to
the private sector?

From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: talk.politics.medicine,sci.med
Subject: Re: Medicare and Bret's Reality (was: Disappointed and confused--don't
Date: 10 Jun 1999 07:52:31 GMT

In <375F4998.271DA648@iname.com> Ted Rosenberg <tedrosenberg@iname.com>
writes:

>I am an economist and a consultant in financial systems.
>
>I have ocassionaly consulted on medicare and medicaid billing - and I
>didn't get ANYWHERE near three hundred dollars an hour.  I don't have
>the slightest idea what the totals were, but there were thirty two
>seperate sub-providor numbers, one for each clinic.
>
>I also have a friend who will be HAPPY to straighten out all of your
>billing problems, she spends most of her time as a billing consultant,
>and has NEVER gotten $300/hour The CODES are not the problem. Its the
>doctor who hires an 18 year old fireman to set up his computer system, or
>the doctor who, to "save money" won't spend an extra $500 to upgrade a
>system, leaving an unnecessary receivables balance of a half million
>hanging out. OR.....


    I'm sure there are many ways to screw up office computer systems.
However, if your friend says that CPT Medicare coding is not a major
problem for geriatricians and internists and family practitioners,
independent of any computer system they use, she's not worth ten cents
an hour.