Saturday, October 20, 2012


     I was watching the major debates between the 2 parties ,since this the 'season 'for it , and I was struck by the fact that quite many people are not aware of the changes that have occurred in last few years. I was talking to a family member of one of the patients , who happen to be a lawyer and a Democrat. When I told him  certain  changes in the practice of the medicine , he said , 'it is not possible , you are making it too simple .' After listening to his comments and then listening to many of my friends , I was stunned by the misunderstanding that exists. So I decided to write this blog . I am sure that lot of people will find it difficult to believe , some will feel that I am totally wrong, and some will feel that I am ignorant, rich person with ' no heart '.
    Let me start by saying that I am in practice of medicine for very long time  and I 'understand ' it very well . An average doctor has 4 years of college , 4 years of medical school and the extra years depending upon the speciality . Family practice or Internal medicine doctor will have 3 more years. If one does Cardiology or pulmonary etc then they have additional 3 or more years of training . I feel that  a ' college graduate ' should get more salary than a 'high school graduate ,' and a person with doctorate should get more that person with simple graduation, if they are in same field . And normally we do see it in life . So my feeling that sub specialist , who has extra 3 or 4 years of training than a family doctor should get more reimbursement than the family doctor and a family doctor who has 3 years of extra training than a medical graduate should get more money is natural. In last 2or 3 years ago this got changed . Now a days a doctor who has done 6 or 7 years of training after medical school , gets same money as new graduate from medical school who has no extra training. Does this sound right?So spending these extra years has no 'value ' per our government .
     Let me tell some other changes . If I had seen a patient in November of 2009, and then he did not come to see me till October of 2012, I have to charge him as 'follow up' visit, even though I will have to get detail history as to what has happened in last 2 and 1/2 tears . I have to spend much more time than usual follow up patient. I can not understand the thinking behind this 3 year rule .
   In 2012, they decided that all the doctors who treat patients with medicaid will need to be 'finger printed '. The original rule was that this must be done every year , as if the finger prints change . I did my finger printing more than 6 months ago . I am still not approved, and I have been participating in medicaid , even though the reimbursement is very low , for last at least 25 years. So till I get approved I am not getting paid for seeing patients with medicaid.This is how government run managed programs work.
.     Per new ACA (Obama care ) one should be in position to find health insurance for 8% of their income . So for a secretary making $30,0000 the premium should be $2400 per year or $200 per month . Per our experience premium to get $500 deductible policy is $300 or more . So if I have to provide health care  for my employee,I would ask these employees to go to the government pool . NOW think about it . What kind of health insurance one can get for such low premium?. It would be such that the befits would be low , so low that no one would accept it and then many of these patients will have to go to ER. There will be longer wait and more expense as the ER doctors do not know the patients.
    I was told that if one put a frog in boiling water it would jump out . But if one puts a frog in water and slowly heat it , the frog would not jump, but will get cooked . I was also told that if you want to 'enjoy ' the food in a restaurant , then you should not go in the kitchen . This applies to our taxes and government spending . If  you are approached by some one that you know ,and ask you to 'give'money as he wants to buy a new car, would you give it ? I am not talking about a loan but just giving it as a gift . The answer is  going to be no . So if you would not 'give' a gift to some one you know , why would you give the gift to some one you never met ? But this is what exactly was the "cash for clunkers "program. The government took money from the tax payers and 'gave' to people who bought new cars . If one is spending money for himself, then he is very careful , if one is spending his own money for someone else ( buying gift ),he is less careful. and when one takes money from others and spends it for still some other persons then he is not careful at all . The government spending comes under this 3 rd category.So money is wasted and the programs are not efficient.
    There are ways to stimulate economy . I was asking this to one of my patients . Now a days one can buy a condo for $50000.  which was sold 3 or 4 years ago for $200000. But the banks are not giving loans due to significant rules . So only those people who have money can buy it . But these people have no 'tax incentives ' . When one buyes a real estate, there is realtor, closing agent ,title company etc, they all will get work and benefit . If the property needs fixing, then handy man , carpet company , and many others will find jobs . So if these (rich )people who can afford to buy these condoes,  are given tax incentives  they will buy it and many more will get the jobs . This the domino effect . There is no question that the person who buyes the condo will make profit.But at the same time many are benefited .
   There are solutions to health care too . I have written some of them in my blog on Health care .

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