The Diane Rehm Show

Your guests fail to mention one of the largest causes of increased volume of services: The ease of upcoding a visit or claiming it was more complex than it was, combined with the overpayment for procedures which may be unnecessary or detrimental. As primary care and visit payments go down, most peoply supplement their income by working for administrators who insist on overdocumentation to fool billing auditors into thinking a simple visit is complex. Those of us who lived on complex primary care, doing what is necessary for complex patients to be as well managed as possible in this system, faced constant threats of cuts and no raise for a decade, while others did whatever they needed to instead of the exgtra work of doing good primary care. What would you do if it litterally took an act of Congress to not get a cut every year, while the system punishes you for doing what is best for your patients? Eventually I closed my practice. Yes doctors will still take Medicare in the cities where they can make up for it by overbilling and overproviding.

Bridget Reidy MD

I'm against the cuts. I'm for universal health care (the "right to life"). Get rid of the health insurance companies, take the profit out of health care. To pay doctors for "results" has dangers -- like with the educaton system. Doctors could choose patients where the results will come more easily while the patients with confusing, more difficult symptoms will by 'shunned' by doctors.

two comments: the first addresses the medical contribution to the deficit problem. were we to place healthcare providers on salary instead of fee for service, much of this particular difficulty facing us now could be averted.

this second comment addresses the larger deficit issue. ilt's astonishing that increasing taxes is not on the table. if you go to wikipedia and look up US income tax, you'll find just below the middle of the article a table that shows the rates of taxes for the highest and lowest tax brackets since the income tax was instated in 1913. that table shows that, whenever the country was saddled with great debt - or with a debt-inducing activity such as war (and we're in TWO as we speak) - the tax rate on the upper 10% of income bracket has been as much as 92%, and that was in 1952!

with all the justifiable anger at all these obscenely wealthy financiers and oil magnates and so on getting away with virtually NO contribution to our national coffers, you would think a push for such a high tax on the excessively wealthy would be quite welcome by the voting populace.

but of course, this assumes our votes are more valued than the campaign contributions, and employment guarantees after our leaders leave office. what was i thinking? except that this tax plan has worked so very well in the past to lift our country out of debt.

Funny how social security and medicare seem to be lumped together all the time when they are two entirely different types of programs. Medicare is always in deficit while social security is sound and has accumulated a very large surplus (maybe 2.5 trillion in securities). Social security is a true government program that does not rely on the private sector to function while medicare is wholly dependent on the largess of the medical delivery system. Two points:

1. when will we finally come to terms with the fact that a for-profit system is going to function strictly for maximum profit and will always be gamed to increase costs (profit and salaries).

2. Back off of social security and stop lumping it in with the completely dysfunctional medical profit industry. Social security is sound and has plenty of funds but conservatives want to kill it by using the debt argument. In reality, they want to default on valid securities held in my name because of reckless management of government particularly by republican. talk about a transfer of wealth!

degrene, i agree, and i'm a healthcare provider.

in my profession, we are now being encouraged by our professional organization (which interestingly holds the purse strings for our malpractice insurance) to refuse to take "high risk" cases. and in my profession, our cases are almost by definition "high risk."

had we even leaned in the general direction of discussing these issues in this way when i was in my grad school ethics class, we'd have been kicked out of the program.

let's face it, we're confronting the consequences of the "greed is good" zeitgeist of Reagan's 80s. making decisions solely on the bottom line will get you nowhere else, on the bottom. it's created scum of us all.

My 91 years old grandfather lives in Delray Beach, Florida is in very good shape, still drives. Last fall he was having some digestive and stomach problems. He goes to his regular Dr. for this appointment he determines that my 91 year old grandfather must do a colonoscopy AND endoscopy which you have to have anesthetic for. At 91 years old anesthesia can be very dangerous. Of course they find nothing. My mom’s friend who is a nurse asks if the doctor did a H. pylori bacteria test which is a basic test that any good Dr. would run on someone who is of that age and is having a digestive problem because it’s very common. When my grandfather asks his Dr. about it he says “oh I guess we could test for that”. He then has my grandfather make another appointment to come back so he can read him his results, it was positive. He prescribes antibiotics which will clear this problem that’s now been going on for 3 months. He schedules him for another endoscopy to make sure there is no damage from this common bacteria because it could possibly cause ulcers. Well they didn’t find any ulcers from the first one so there shouldn’t be any now. My mom convinced him that he did not need to go back for the 2nd endoscopy. He hasn’t had a problem since. My mom is thinking there is going to be no medicare left for her. We explained that he does not need to make appointments to have his results given to him, our doctors call us on the phone or send them in the mail and send prescriptions to the pharmacy instead of us making appointments to spend a co-pay. It is absolutely ridiculous how some Drs seem to take advantage of the medicare system and of their patients.

You obviously are not in the medical field nor a business owner. You have no idea of the expenses or stress or the life that physicians give up for their patients. Why is it that people are so stuck on the fact that doctors get paid for what they do. How would you feel if you didn't get paid at your job. I have been in this field for over 25 years and have my own business and I can tell you 95 percent of docs are hard working people who care for their patients. They put up with constant regulations, stress from frivolous law suits and people like you who expect them to work for free. You also have obviously never lived in a foreign country where you either can't get the services needed or you have to wait for months for care. Well I lost a good friend because of socialized medicine. What the public does not understand is that insurance contracts are based on Medicare so if this cut of 21 perct goes thru their whole income is cut by this much .. How about we cut your paycheck by that much...wouldn't like it would you.

First of all I doubt your grandfather had anesthesia...they give twilight to pts who have endoscopies,which is very safe.
Second endoscopies save hundreds of thousands of lives every year..thank God nothing was found.
Third imagine all of the patients your doctor has, the how many times they call wanting him to call in and give free advice, prescriptions, referrals, etc. Etc. Etc. Then when they come in and want to take up his time with questions but, don't want to pay their copayment because he/she had positive results..thank God...but they take 30min of his time and the insurance company pays him $10.00.
Fourth If he had not done the test and your grandfather had cancer you would have called him incompetent at best and sued him at worst.
Shame on you for not feeling your doctor should be paid for his services he has a family to feed too.

You still don't know what your talking about..I'm not a physician and wouldn't want their job. Doctors took an oath to do no harm....not work for free.
And there is not one single person in the USA who cannot get care. Thebproblem is they don't want to go to free clinics because of the fact that they have to wait so long to be seen, may not be able to get the services they think they need, can't get an appointment for months....hum sounds like socialized medicine....be careful what you wish for you might get it.

I happen to be a woman who left her home state with 2little children when her husband lost his job. We drove to Texas in a rusted out pea green impala with no job ..no money..didn't take one dime in hand outs..never expected a thing for free....worked hard and long , taught myself my field and now own my own business employing 15 people. I didn't have insurance when we were working our way up, but paid our bills,saved our money. I have noooo sympathy for people who always have their hand out. I can bet they have cell phones, 50 inch Tv's, nice dresses.etc. Take from those who work hard and give to the useless..... That's precisely why small businesses are struggling and the unemployment rate is rising...don't blame the doctors.

The Bush tax cuts added Trillions to the deficit. Why not get rid of them now and then rescind the Soc. Sec. cap so everyone pays the same, 71/2% of their income. If there had been no cap would S.S. be in trouble now? It's nice to freeze the little guy's income while the rich and the filthy rich whistle nervously as they hide and play golf.

First, Medicare is a program for Senior Citizens- most of whom PAID into the system while they were working and almost EVERY Senior in the United States is on Medicare. Medicaid is a public health insurance system predominantly for low-income children and the disabled - paid for by ALL tax payers and is NOT a handout. I don't know about you, but I like the idea of children and disabled Americans getting proper health care. If you didn't use the public healthcare system when you should have that is your fault. The thought that you allowed your children to go uninsured because of your pride is sad.

Lastly, I agree that the cost of medicine is too high. I have plenty of family and friends that are doctors. They do have families to take care of too- but all the docs I know serve predominantly low to moderate income and Seniors. They also work for or run organizations that recieve pubic tax incentives - like non profit status...and they care deeply about the community. I think it is a sad state of affairs that docs are turning Medicare patients away.

Part of the discussion addressed costs of health care in America re currently 17% of GDP and expected to keep rising. Amazingly, and in typical American naivete and simple mindedness , not one of of participants, be they panel members or the host or people who called in, thought of or wondered about how it works in other countries ( Canada, U.K.,Germany, France, Norway, Sweden, Japan, Taiwan, Switzerland, etc ) where costs are typically 5 to 7 % of GDP with better outcomes and they cover everyone ? Refer ' Frontline...getting sick in america ' , and T.R. Reads book ' The Healing of america '. One big reason : insurance companies operate as non-profits.

It was disappointing to not hear one word of the massive amount of fraud in the Medicare system. The government estimates that fraud accounts for nearly 60 billion dollars a year in waste, but does nothing to control it. Also, Bill Clinton had a surplus due to less spending by Congress. George Bush just let the Congress spend whatever they wanted and endorsed that drug plan. It's time for serious cutbacks across the board in every government agency and programs.

Who is John Galt?