I know that this is one of my longest to date, but please try and deal with it and see it through...
Chicken and the egg here folks, chicken and the egg. Which came first, all of us punting to find a way to make a real doctor's income in some crazy inside out, and upside down market? Or perhaps the CARTEL's who control our access to our own end retail consumer of your services, who have been able to artificially stagnate and reduce your fees for twenty years now, so now all of you are punting???
Come on now, put on your thinking caps, return to real analytical critical thinking skills, and see where this all came from. I say that if we had a solid and steady ecomony where folks were able to afford the things in life that they needed and that the real regulations that were needed were inflicted upon super larger, multi-national corporates with almost a totally free market for micro and small business our economy would flurish like it hasn't in almost half a century. Funny how all the talking heads have suddenly rushed to small business to buy a few votes, but all the deregulation, tax breaks, a one sided legsilation is always written to the advantage of those super large ones. "They need to make enough money to afford to buy my cars."
We have allowed these mega no national pride or responsiblity bastards to rape your nation and our people to the bone, drive down wages while still charging us prices for goods and services as though the products were still produced on shore with union labor. Who do such policies serve? The majority of Americans? Certainly not. The top 1 or 2 percent, definitely. Are the insurance carriers any different? Or Big Pharma, GE, Welch-Allyn, and many others? Why is it OK, just accepted business as usual that these folks should be the ones to profit from all our hard earned healthcare dollars, but not the practioners of the actual plying of the art and trade of medicine folks like yourself.
Without you the whole damn thing comes to a grinding hault. No Rx for a scan, no MRI's test to make money on to pay for their extremely profitable machines. No Rx for drug therapy, no drugs sold for their extremely profitable drugs. You guys are at the heart of it all, the center of this universe and yet you can't walk away being properly compensated for a good days work that gets a good days pay.
Ya see I haven't mentioned this lately, I would love to see basicly affordable primary care, not to be covered by this crazy system because people need to apperciate what they pay for and what they get, and while they basically get it all for free they seem to apperciate in not. But to have real good old fashioned covered out the butt Major Medical so nobody goes poor from really bad illnesses.
But I see so many supposedly poor people who they and their kids are on S-CHIPS health insurance plans that pay crap, who still have $50-$75 a month cable TV subscriptions, cell phones, $20-$40 a week smoking habits, probably the same for some of them for beer and booze too. But god forbid they have to $75 to visit their PCP for a sick visit. Sorry I'm not buying it.
I know I was a working class kid from the Bronx. Do you want to know just how many patients we have here on some form of gov't support insurance and they are small business owners and contractors almost certainly scamming away? How many of them are driving nicer cars, their homes are in better states of repair and they can afford to eat out more than we can??? But we're supposed to take their cheap@$$ insurance that frequently doesn't even pay Medicare rates? I need to post some pictures of our house, my roof, our collapsing fence, and my 188K mile rust bucket Jeep. We're a F'ing doctor's family and we live in the house that is in just about the worst state of disrepair in the entire community!!!
Now I totally agree that people should not give up their nest eggs just to pay a doctors bill, but how did we get here and should those of us who had nothing to do with what happened 20-30 years ago "back in the day" have to suffer all these repeated rules, regulations and insults while having nothing but stress and worry to show for it??? I think not! We need to level the paying field between doctors and insurance gov't or private, grant us an free and clear anti-trust waiver for the purpose of having national strikes and organizing.
All of these issues, what kind of reporting do you need to have, how much and what kind of work, and under what terms and conditions, how much work for how much pay, these are all really "Labor Managment" issues that should be hammered out across a collective bargining table. I know, I'm a founding member of an IATSE local, Local 481, New England Studio Mechanics. I was one of a number of folks who were in on the writing, and wrangling back and forth creating a constitution, and creating and electing our first board. I've been to the Goerge Meanie center in Maryland for organizing training.
As long as they have us all divided up because only our side is artificially and wrongfully constrained by anti-trust laws because we are supposedly all private contractors, (we're not they control our access and fees to our customers of end retail services) we can never have a positive effect on any and all of the issues that affect us and our patients. And yes we too are consumers of healthcare, and every month that I have to cut an obscene sized check to cover my family of four to the same SOB's that treat my wife like dirty and pay her CCHIT it makes my blood boil.
I say we need one insurance pool that by law must be put in an "Al Gore Lock-Box" (the same should be set to Medicare and Social Security that both have big, nothing but funny money IOU's in the boxes right now) to be conservatively managed, for modest and safe rates of return. Think about it, I know I pay almost $11K to cover my family and four and even on a year that one of us has a small issue or an interesting scan we are probably not using more than $3-$5K worth of services. Without the SOB's in the middle stealing the best for themselves, if just left there for the next twenty years and invested wisely there should be plenty to care for Paul and Nancy when we grow old and grey. Espeically if we actully half bargined all the other rich greedy players in the this system of a change and had then finally have to work of reasonable margins that still far exceed our own. It is time to stop taking meat off our our bones, and start to really trim the fat everywhere else first, not a dollar more from us, espeicially in Primary Care, until everyone else has been hit for as much and as long as we have.
One collective national insurance pool, combined with collective bargining for the providers with a real right to strike is the real answer to all of this. What kind of work we do, under what conditions, how much for how much compensation, who do you report to, what are the measures of your work, out put quantity and quality, these are all labor managment issues to be hammered out in collective bargining. Nurses and tech's certainly have it for the same industry for very similar measures and issues, so why not you? And you really can still work for many employers at the same time like you do right now for all the Cartels. We do it in both my indurstry as stagehands as well as many construction workers just to name the two most know industries where this happens. I used to work at two or three places all in the same day or two. Didn't stop me from being declared labor and not a private contractor and having the rights of association and collective action and bargining, and it shouldn't for you. They are dictating so many of the terms and conditions of you work that they basically have made you employees. Heck they even claim to have a vested and financial interest in the end output and quality of your work, this is a really big one for determining if a trademen is an employee or a private contractor. They even control which customers you can or can not work with, your call schedule is demanded to be 24/7, they tell you when to work! Give me a break.
Hey perhaps I have this all wrong, pehaps I should work with all of you to hasten the implimentation of P4P, because once it is in full gear, there will be no denying the docs are employees instead of private contractors and we can finally get down to striking, picketing, hard across the table negotiating, force them to finally "Bargin in Good Faith" which they certainly have never done in all of modern insurances' history, via the NLRB and the laws that govern such, and finally we can start to fix things for us and our patients... OK I'm with ya now, P4P it is.
I'll only accept P4P under a collective bargining style terms and conditions properly negotiated via such. This would at least allow you folks to ability to have real science and real math, access to all the data, their's too, to hammer out what is measured and why. Real quality or is it just bean counting? Or is it bean counting maskerading as quality which I'm sure most of it would turn out to be. Under such conditions they would probably abandon half of it. Funny how when employers have to pay themselves for quality programs how many of them suddenly get very adverse to the idea..... Don't you think that is funny, I sure do. Just like worker safety programs. Bitch about the cost of compensation coverage and your ratings, but when suggested they actually take proactive actions to reduce injuries and therefore save money and human carnage suddenly they get cold feet.
I'll be with you on your half if and when you're willing to be in on this on my half. Only if bargined in good faith, openly in a fair collective fashion, with the real threat and right (no Taylor laws) to strike. Only the right to withhold services and to put the hurt on the other side, has ever brought really tough issues into allignment and forced both sides back to the table to settle things in a positive fashion for both sides... Now who's with me on this kind of P4P???
So in short, collective bargining first, then nationalized healthcare and P4P only afterwards. This levels the playing field and gives you guys like kind leverage to negotiate back in the open, on a fair and level playing field, using your unique skill set, knowlegdge and training as the bargin chip it should be seen as all along.
"Solidarity forever, solidarity forever, solidarity forever, our union keeps us strong!" Are ya with my???
Good Night and Good Luck,
Paul
