Leslie,
Forgive my ignorance, but why can't you say "no" as individuals? We opted out of Medicare, and it was a great decision. When we get those computer generated letters from insurances telling us a patient is non-compliant with medications and asking for a two page response, we just ignore them. In fact, we ignore probably 75% of unsolicited forms, pre-authorizations, and insurance requests for medication changes. The insurance a patient has is not really our concern. If he or she wants to discuss a medication change because it would be cheaper, they make an appointment, and we discuss the pros and cons of that change (not all statins are created equal, and I chose the one I did for a reason.)
I am frankly puzzled and intensely frustrated by the discussions I see of all the time spent by my colleagues here on tasks that are not directly to the practice of medicine. I simply fail to see the imperative in spending my time in the foolish projects of others, just like I ignore the surveys from drug companies that will pay me $5 to fill out a 4 page form. I keep getting the impression that most of the world is talking a different language when it comes to medicine. I say "I practice internal medicine", and you say "I practice Internal Medicine", but what you mean by that and what I mean by that are may be as dissimilar as being a reactor tech on a submarine and being an aircraft mechanic; maybe more so. There is the distinct aura of indentured servitude in your posts. Is this true? Were you sold to an HMO by your residency program when you were not looking? I, at least, can and do just say no when it is not in the best interest of me or my patient. Why doesn't everyone else?
