You simply were not practicing in the 80's or 90's. In 1987 I had a couple come into my office with the grateful wife clutching a purse like it was her life savings. It was her first post op visit, s/p Chole, (Open, no lap chole yet). I assisted, fee is 25% of the surgeons. Medicare paid 70% of the allowed charges, but as I wasn't yet accepting Medicare they were on the hook for the whole fee. If I reduced the fee I feared an audit by Medicare that would reveal I didn't really charge what I said I did. So I sat in my office and watched as this elderly couple counted out nearly $800.00 in 10's and 20's which were clearly close to their lifes savings. (Having been to their home for house calls I know they didn't "live fancy"). It staggers the imagination to consider what this scene looked like at the surgeons, although he did take Medicare assignment. Of course I signed up to be a 'Participating physician' the very next year. Similar events preceded my entry into managed care. My current attitude which is a near embrace of managed care has evolved as I stood side by side with my patients trying to figure out how I could find insurance that I could afford for my own family. Anyone who is not concerned about the plight of patients who are trying to pay the enormous cost of health insurance should probably not be practicing medicine.
Paul I hope you understand that I hate the insurance and pharmaceutical companies. But we need them. And so we are stuck with them. People CANNOT risk going uninsured, (although more than 50 million do). In my area there are enough Doctors and patients that a competing idea could be tried out. (First was Kaiser). Some patients are forced to chose between no insurance and the cheapest alternative. That has been HMO coverage. When people got HMO coverage and it was adequate, there friends and neighbors began to question why they should put up with the high prices they were paying for coverage that didn't seem much different. So the patients switched to HMO's. They switched in droves. The doctors who were brave and drew a line in the sand,... were forced to retire. The rest of us accepted HMO patients so we could survive. You will do the same thing when the HMO penetrates your market. Doctors who have come to understand how the HMO system works have made very comfortable livings. It is certainly a system that needs to be overhauled, but it is the system we currently have.
