Well researched and well written. But I think everything you’re aiming for can be summed up in one phrase: separate medicine and state, for the same reasons we separate church and state. Free minds and free markets would put physicians and patients back in charge, in a relationship that benefits both. Government’s only role should be to prosecute fraud and violence.
Your readers need to understand that the quality of healthcare and positive health outcomes will continue to deteriorate with the path medicine is on in the 21st century in the USA. The fundamental issue is that corporate interests in all segments of the medical system have the goal of return on invested capital which is priority number one. The White House is painfully aware of this because on their website they have a chart comparing cost of healthcare and longevity with other nations around the world and the US has a system twice as expensive and longevity is minimal in comparison to many other countries. The impediments to fixing the healthcare system are many.
First, the chemical industry drives the agricultural and food industry and the beneficiary is the healthcare system which is given the task of treating the victims exposed to chemical exposure driving cancer rates and much more. Second, the medical curriculum is managed to drive drug treatment as the focus and is expensive and limited in student enrollment. In addition education on how good nutrition plays a central role in maintaining good health is lacking. In turn, medical corporations are importing personnel from other countries that are creating communication barriers and under skilled healthcare workers. Detrimental to the quality of healthcare. I have personal experienced this in the last several years when hospitalized.
The task RFK Jr. has is formidable and the NIH mindset that has been shaped by those who are suppose to be regulated, but have created a system of regulatory capture. It is painfully apparent in the continued push to inject with experimental RNA injections that have not been proven to be safe and effective.
On a personal note I have twin grandson who are in the medical profession and are working for corporations. It is apparent they are maximizing the work loads of their medical professionals to
maximize the bottom line which in turn raises the risk of medical errors that harm. Death by Medicine is for real and needs to be addressed rather than left in the closet. The fact the eliminating C-Diff that kills over 30,000 patients annually is not addressed and the focus is on injecting our children with MMR where the risk of dying is negligible speaks volumes of where the medical priorities are and why.
Finally, the ultimate gate keepers are the Congressional leadership in DC, which is around 600 politicians that are supposed to be representing the interests of their constituents, but in turn are serving as facilitators for the corporations that actually shape the medical system we have today.
Senator Ron Paul was a outlier, as well as a few of our current Congressman, but most remain silent so they are not targeted for elimination from DC by the corporations. I became aware of this in 2011, when I went to DC to ask why they are not addressing the autism crisis. Answer: Our hands are tied. Transalation, I will be targeted for elimination from DC if I spoke out on this issue.
For those interested in more of my views on healthcare, go to my website. seveninnocents . com
100% agreement!!! I've been dreaming of poisonous spiders often lately. This web of corporate entities surrounding the medical profession would seemingly be related to my nightmares.
I would highly recommend anyone checking into or needing a hospital for any number of days - have a healthcare advocate by your side as often as possible. And make sure they sign any required paperwork to be able to speak as your advocate. If no family member or close relative or friend, I understand there are outside people who can and will do that job on your behalf.
I have no advocates and avoid hospitals as I would a plague. My experience as my Mother's advocate is burned into my brain. Once a hospital or nursing home has a patient in their custody and control even the most credible advocate is generally ignored. Its a climb up the mountain pushing a major boulder affair. Be prepared or recognize the inevitable consequences!
My oldest daughter has been a speech therapist for 30 years. She works with children, many of whom are autistic. Most of which the parents report the child was fine until the vax. One day normal then the next day not. This is not coincidence.
Our group is committed to independence. Never will I be told by a practice owner how to treat my patients, which vaccines to promote.
Independent family practice is rapidly going extinct. Our overhead is up over 30% in the last decade while reimbursement rose less than 10%.
We did Medicare and Medicaid for years at cost or at a loss. We had to limit how many of these patients to accept to survive.
We did colonoscopies for less than half the reimbursement given to hospitals for the same service. We could not afford to continue this important service so now some patients decline to have it done.
Hospital owned practices are given “facility fees” that nearly double what we are given for the exact same service.
Electronic medical records is a nightmare of expensive poorly functioning complexity that gives insurers opportunity to require endless documentation of meetings their care requirements. We hire extra staff for this with no reimbursement to cover the cost.
To survive we went to concierge. I had to say goodbye to a large panel of patients who can not afford the annual fee. But it was this or close the doors because we will not be owned.
I believe the escalating cost of care will soon be used as justification for a government takeover. It will not surprise me if concierge is legislated away. They clearly want control.
I'm very appreciative of any and all doctors who are responding here. I know you all are out there, struggling along with the rest of us.
I'm very frustrated with the whole Medicare dictate. It's all pretend, smoke and mirrors, in collusion with the Big Pencil Pushing Lobby Fomenting Fortune Hunting Insurance Corporations.
As I said, as I walked out the door of my GP for the last time, "I applaud what you are doing, I wish I could continue on here, but Medicare is mandating my payment and I can't afford the double costs". Oh, how I wish it were not so!
I would take a Concierge setup along with Major Medical each and every day otherwise. I will do my best to explain my vision of what you are trying to achieve to any and all younger generations.
Great article, but I don't think that more "help" from the government agencies will actually turn thing around. HSA accounts can help. But I tried to get an SBI loan at one time, and it was weeks of paperwork, and no results. Everything the government touches get more and more complicated, with pitiful results.
Government is the exact opposite of the word Help. We are on our own. I also try to avoid the 'medical system' as much as I can. It gets harder with each passing year even as I try to come up with answers.
I have recently ordered, and received today, two Grounding Mats. I try to ground on my walks, but never sure of the ground being safe. And I have been reading that grounding all night is preferred. We will see. Each day, each experiment - win or lose. I hope more wins for sure!!!
Little Birdie is on the right tree limb. I am 78 in a couple of days. I have never been more healthy. That's not to say as I age (more) I won't need to have help/doctor. I don't have one. I would love to have a doctor to help me make decisions, but alas....perhaps in the next life.
I'm with you also, LouMcKenzie. Best strategy is to take good care of yourself, and not depend on doctors and all their prescription drugs. Most of my peers, (I'm 75 years old) are always talking about their doctor visits, how their doctors change every few months, all their tests and procedures, and long waiting times, etc. It is such a turn-off to me. I don't say anything, but I wonder why so many people participate, and don't question anything??
For anyone interested, I have had some very positive results using a somewhat new technology (music sound vibrations that heal) and instrument called the WavWatchII. I intuitively bought the first one that came out due to a friend's opinion of it. The WavWatchII is the 2nd generation of this amazing invention. It came out while covid was going on and I guess FDA was asleep or preoccupied at the time. Its quite amazing how it addresses the early symptoms of diseases that are dominant during this time. Its incredible for detoxing/cleansing heavy metals, and other environmental issues that create dis-ease.
Good job that you are trying whatever you can to avoid getting sucked into the "system", Little Birdie. I also am doing the same thing; eating carefully, getting more exercise, getting good sleep, etc.
agreed. There is nothing the government will do to help, other than remove regulations, get out of the way, and let people spend their money how, when, and where they want to. We can only hope that medicare and medicaid bankrupt the USA quickly so they can be scuttle, allowing patient and doctor focused practice to begin again.
This is a hot topic for me now because i am in the fat middle of it. I had hip replacement surgery last week. I could write a 2000 word treatise on the hospital experience. At least 75% of the staff spoke broken English. This is because the seasoned nurses and aides left during covid.
But I am doing okay. I've discovered a lot about the new medical system. It's been a learning curve for sure given all the conversations I've had with physicians, PTs, nurses and other medical staff in the past 2 months. On Wednesday when my PT came we got into the weeds in regards to the corporations taking over health care and what it is doing to the ones in the trenches doing the real work, hampered by new protocols.
Our long time GP is a DO. I guess some time ago his practice was bought out by a corp. I think he would quit if he could. Hubs and I went recently for our 'annual wellness Medicare check up'. He told us about his sister who is a doc and quit her corp owned practice. She bought a farm and cleaned up the barn and opened a free range practice for the locals. He said this happening more now and it's called concierge medical.
When my PT left on Friday - I sat and wrote lyrics, then made the comp, then the video and wrote the substack - all based on a story he told me.
Not only do foreign physicians come here with less debt due to heavily subsidized education but also heavily indoctrinated in socialism which is why I am bemused by Texas having having 6 that were born, bred, raised and trained in India on the state medical board...the same board that I believe censured Dr. Bowden.
My husband and I have always had some type of insurance with a large cost sharing or deductible,. Since we work in the physician billing industry we have learned to navigate through the system as cash pay to reduce our costs. Annual labs billed to insurance all seem to apply to deductible so we would end up paying $500.00 to $700.00 for labs each year. Instead we take the paper order to the lab and say we are cash pay. The full labs costs us $50.00. We do not send this to our insurance or the lab gets fined, we walk away saving $450.00 to $650.00 dollars. EACH! We do the same thing with x-rays. A client ordered a 6 view x-ray of my shoulder two years ago. I went to the imaging place, said I was cash pay and they charged me $25.00 for this x-ray. Insurance allows $300.00 for this, so I saved $275.00. We have never met any deductible or cost share in 20 years by navigating the system this way. Even though we are now on Medicare with a supplement, we continue doing this to keep our costs down. We still have 4 primary care practices in 3 states that are independent and are running their businesses like professionals. When we see that things are not running properly we work with physicians to help them be more efficient. When they make more, we make more.
Oh how I miss the independent Physician. Especially during "Covid". I had antibodies and my doc (who I worked with at an NYU primary care practice) still insisted that I get the jab. Talk about not thinking for himself! I eventually got fired from NYU for not taking it. I filed for unemployment and was rejected because (and I quote) "I was fired due to misconduct". Unreal...
I didn't get the covid shots, and had the Delta strain of covid in August 2021. My doctor told me to be sure to come get the covid shots as soon as I recovered from Delta. I asked him why I would do that when I would have my own immunity, and he told me that the shots would give me much better protection than would my own immunity. Couldn't believe my ears when he said that. Based on what? Something the government told him, I guess. My confidence in our medical system is almost zero, except for trauma injuries and repairs!
Reading the part about regulations pushing routine lab testing out of independent doctors’ offices made me think about something else.
Could the same thing happen to entire medical technologies?
For the past several months, I’ve been looking into Delbeta, an old Polish injectable multibacterial preparation. It came out of a different way of thinking about immunity — not just targeting one pathogen, but trying to strengthen the host’s broader defenses. I’m finding similar approaches in other parts of Europe.
The more documents I find, the less this looks like a story about one forgotten product. What interests me now is why the products disappeared along with the manufacturers, the know-how, the clinical experience, and eventually the ability to make them at all.
Your example with office labs gets right to the point. A rule can make sense on its own, but the combined cost of complying with enough rules can eventually make something disappear from practice.
Maybe that happened on a much larger scale with entire classes of medical technology.
Independent medicine may need more than independent doctors. It may also need independent medical technologies.
And maybe the oldest “biological shield” was never just the drug. It was the host.
Could be wrong but think Ted Kennedy was behind that law that effected lab tests by docs. Also wiped out sideline business of folks who prepped bacterial culture plates for hospitals at much lower cost than commercial sources. And you can believe no degree of altruism was involved in his doing so.
Why was it possible to have good health care in Europe, Especially in Germany (where even spas were being paid by the insurance) until Europe became EU? Then all of a sudden it went down hill in a hurry. Group practices, no more house calls, cost going up, people having to drive hours to get the right care. At the time the doctor was just the doctor. No nurses, no aids, no paperwork. The only independent group practice hereabouts is more than one and half hours driving away, no weekend service, 1500 $ before you I even get a foot inside... that is not what we want either is it?
Robert, Well done. There are nuances here, especially regarding data, that are important and that are underrepresented in this analysis. Such nuances become far less nuanced, far more expensive, and far more dangerous in the burgeoning generative AI/ambient listening world. This is worth a chapter in itself.
The role of pre-authorization is broadly misunderstood...it should be a good thing for all, but is always painted as a noxious burden. You should see some of the malpractice I have seen and you would appreciate it more -- it just needs to be done differently. That is largely data driven as well.
And one of the key points you mention, the difference in pricing between hospital outpatient and real outpatient is perhaps the single biggest drag on the overall health budget -- I could give you numbers that would boggle your mind. This is nothing but a money grab for the large provider organizations which are largely responsible for not only the diminution of good medical practice but for the entire cost crisis in health care.
We should spend half a day going through some of this stuff -- it would make your analyses even better. R
I entirely agree Dr. Malone and would desire your vision come to pass. I just don't share your faith in our big corporate captured big government to do something antithetical to their greed unless left with no choice. I frankly am not sure what "no choice" would look like although I suspect this way it comes. In the meantime individuals have to take responsibility for understanding their own medical needs, having a primary is critical in this regard and Concierge can be very helpful if it is an option for you. AI also has lots of potential to be helpful. But, in the end one should not let the Government or Corporates stand in the way of being healthy and unfortunately too many do today particularly if they are on the Medicare train.
This was an excellent statement. The comments were all worth reading and I believe represent the opinions of professionals in the field of healthcare as well as mere patients. I have been the beneficiary of the US healthcare system when exceptional docs took the time to repeat tests and biopsies because the results could not be fit into categories: I needed personalized medicine when what I had was medicare and fortunately received it.
When I worked, I worked for a strategic planning firm, and many of the problems he lays out were those we forsaw almost 40 years ago as possible threats to a planned system. It is not too late to begin eliminating those threats. It will just take time.
Thank for this, I am with you entirely. I have a lot to say about this, anecdotally, but no time now. I may come back to add it later, but for now thank you.
I have so many reactions to this thought provoking article. I've been retired for 8 years after a long career in health care. I've been an army medic, a hospital nurse, worked in the managed care insurance world (the dark side!), a physicians organization (created in response to the managed care craze during the Bill/Hillary years)and then as an executive of a hospital owned clinic network. Most of my career was focused on quality and operations.
Here's what I have observed:
1. Over the years we built our network by building clinics, recruiting physicians (many from our FP residency) and sometimes buying practices. Often, the physicians we hired were seeking a better lifestyle, less stress from having to hire, fire, manage contracting, billing, marketing, property management, etc. The practices we acquired thought they knew what they were getting into, but the reality was always a shock--their employees had to join the union (higher wages and impossible to fire), work according to their license (often they staff performed tasks they were not credentialed for), manage their office spaces and practices to comply with accreditation standards (which were sometimes incredibly stupid), give up their autoclave (couldn't meet the quality standards), implement the EMR, comply with reporting requirements (which drove compensation), have their practices flooded with medicaid patients, see their manager attend hours of meetings rather that support the practice, and on and on it went. So it was a shock to them. My administrators would ask, "When are the clinics going to make money?" And I'd say, as soon as we don't have to take medicaid patients, don't have to pay union wages and deal with chronic absenteeism--which the union protects, & don't have to have the expense of accreditation (in other words, act more like a private practice). Not a popular answer.
2. Private practice had its down side, too. Our organization was probably like nerve gas to these practices, but they were cleaner and safer in the end (and more expensive). Private practice was after a profit, too ("eat what you kill" is what they called it.), and they benefited from having in house (physician owned) labs-which included additional reimbursement and incentivized unnecessary testing. It incentivized building physician owned surgery centers & imaging services. That could be good, bad or just redundant.
3. After 5 years in managed care, I came to see that as a sink hole for money and resources. We dutifully built our medical management department, full of nurse case managers, referral specialists, and utilization review staff. For every nurse we employed, there was one less at the bedside. Ugh. And I'm not sure we had any impact on quality or utilization.
4. In the clinics, we built elaborate measurement systems to provide feedback, support the physician compensation system, promote quality and meet insurance requirements. We tracked the usual stuff, A1c's, messaging turn-around times, patient satisfaction, it was endless. In the end, it encouraged a lot of gaming (send your out of control diabetic to a specialist, close your messages at the end of the day to beat the 24 hour turn around goal, and re-open it the next day). It was shocking, but to me it meant that the physicians (and staff) did not trust the measurements or the people doing them.
5. Many, many physicians wanted autonomy, and by that they meant "I want to do things my own way." But it's hard to support 5-6 individual practices/processes and still have efficiency, consistency and quality. We had one practice that simply would not standardize their order sets. The staff never knew exactly what they should be doing and when. A vital order was omitted and a grave medical error occurred. This is where the checklist manifesto would have helped.
I loved the work that I did and the people that I worked with, but sometimes I wonder, did it do any good?
Both Big Pharma and Big Medicine have been US Government corporacracies for decades. Their interest is for-profit facilitated by frequent treatment; ergo, the sicker we are, the more profitable.
However, I'd be happy just to have naturopathic services reimbursed by my insurance and by Medicaid/Medicare. But it'll never happen because the former will recommend Mediterranean and Lyon Diets, and NO sugar/HFCS consumption that will both cure morbid people of their highly-profitable pathologies.
Well researched and well written. But I think everything you’re aiming for can be summed up in one phrase: separate medicine and state, for the same reasons we separate church and state. Free minds and free markets would put physicians and patients back in charge, in a relationship that benefits both. Government’s only role should be to prosecute fraud and violence.
Your readers need to understand that the quality of healthcare and positive health outcomes will continue to deteriorate with the path medicine is on in the 21st century in the USA. The fundamental issue is that corporate interests in all segments of the medical system have the goal of return on invested capital which is priority number one. The White House is painfully aware of this because on their website they have a chart comparing cost of healthcare and longevity with other nations around the world and the US has a system twice as expensive and longevity is minimal in comparison to many other countries. The impediments to fixing the healthcare system are many.
First, the chemical industry drives the agricultural and food industry and the beneficiary is the healthcare system which is given the task of treating the victims exposed to chemical exposure driving cancer rates and much more. Second, the medical curriculum is managed to drive drug treatment as the focus and is expensive and limited in student enrollment. In addition education on how good nutrition plays a central role in maintaining good health is lacking. In turn, medical corporations are importing personnel from other countries that are creating communication barriers and under skilled healthcare workers. Detrimental to the quality of healthcare. I have personal experienced this in the last several years when hospitalized.
The task RFK Jr. has is formidable and the NIH mindset that has been shaped by those who are suppose to be regulated, but have created a system of regulatory capture. It is painfully apparent in the continued push to inject with experimental RNA injections that have not been proven to be safe and effective.
On a personal note I have twin grandson who are in the medical profession and are working for corporations. It is apparent they are maximizing the work loads of their medical professionals to
maximize the bottom line which in turn raises the risk of medical errors that harm. Death by Medicine is for real and needs to be addressed rather than left in the closet. The fact the eliminating C-Diff that kills over 30,000 patients annually is not addressed and the focus is on injecting our children with MMR where the risk of dying is negligible speaks volumes of where the medical priorities are and why.
Finally, the ultimate gate keepers are the Congressional leadership in DC, which is around 600 politicians that are supposed to be representing the interests of their constituents, but in turn are serving as facilitators for the corporations that actually shape the medical system we have today.
Senator Ron Paul was a outlier, as well as a few of our current Congressman, but most remain silent so they are not targeted for elimination from DC by the corporations. I became aware of this in 2011, when I went to DC to ask why they are not addressing the autism crisis. Answer: Our hands are tied. Transalation, I will be targeted for elimination from DC if I spoke out on this issue.
For those interested in more of my views on healthcare, go to my website. seveninnocents . com
100% agreement!!! I've been dreaming of poisonous spiders often lately. This web of corporate entities surrounding the medical profession would seemingly be related to my nightmares.
I would highly recommend anyone checking into or needing a hospital for any number of days - have a healthcare advocate by your side as often as possible. And make sure they sign any required paperwork to be able to speak as your advocate. If no family member or close relative or friend, I understand there are outside people who can and will do that job on your behalf.
I had a physician friend who always had one of his children who were also physicians at his bedside to make sure there were no errors.
Here are some resources for protecting yourself from hospitals:
- I Do Not Consent (Laura Bartlett): https://idonotconsentform.com/
- Protocol Kills: https://www.protocolkills.com/
- More at Independent Medical Resources: https://eolson47.substack.com/i/136557135/independent-medical-resources
I have no advocates and avoid hospitals as I would a plague. My experience as my Mother's advocate is burned into my brain. Once a hospital or nursing home has a patient in their custody and control even the most credible advocate is generally ignored. Its a climb up the mountain pushing a major boulder affair. Be prepared or recognize the inevitable consequences!
My oldest daughter has been a speech therapist for 30 years. She works with children, many of whom are autistic. Most of which the parents report the child was fine until the vax. One day normal then the next day not. This is not coincidence.
Thomas Braum, bless your heart, and thank you for sharing what you know.
Outstanding summation.
Our group is committed to independence. Never will I be told by a practice owner how to treat my patients, which vaccines to promote.
Independent family practice is rapidly going extinct. Our overhead is up over 30% in the last decade while reimbursement rose less than 10%.
We did Medicare and Medicaid for years at cost or at a loss. We had to limit how many of these patients to accept to survive.
We did colonoscopies for less than half the reimbursement given to hospitals for the same service. We could not afford to continue this important service so now some patients decline to have it done.
Hospital owned practices are given “facility fees” that nearly double what we are given for the exact same service.
Electronic medical records is a nightmare of expensive poorly functioning complexity that gives insurers opportunity to require endless documentation of meetings their care requirements. We hire extra staff for this with no reimbursement to cover the cost.
To survive we went to concierge. I had to say goodbye to a large panel of patients who can not afford the annual fee. But it was this or close the doors because we will not be owned.
I believe the escalating cost of care will soon be used as justification for a government takeover. It will not surprise me if concierge is legislated away. They clearly want control.
At that point I will hang up the stethoscope.
I'm very appreciative of any and all doctors who are responding here. I know you all are out there, struggling along with the rest of us.
I'm very frustrated with the whole Medicare dictate. It's all pretend, smoke and mirrors, in collusion with the Big Pencil Pushing Lobby Fomenting Fortune Hunting Insurance Corporations.
As I said, as I walked out the door of my GP for the last time, "I applaud what you are doing, I wish I could continue on here, but Medicare is mandating my payment and I can't afford the double costs". Oh, how I wish it were not so!
I would take a Concierge setup along with Major Medical each and every day otherwise. I will do my best to explain my vision of what you are trying to achieve to any and all younger generations.
Great article, but I don't think that more "help" from the government agencies will actually turn thing around. HSA accounts can help. But I tried to get an SBI loan at one time, and it was weeks of paperwork, and no results. Everything the government touches get more and more complicated, with pitiful results.
Honestly, at this time the best we can hope for is to avoid the "medical system" as much as possible. Meantime, go make a pet calendar of your favorite dog, cat, emu, camel(?), horse, bird, etc. and enjoy it all next year! https://www.vegetable-gardening-online.com/free-printable-pet-calendar.html
Government is the exact opposite of the word Help. We are on our own. I also try to avoid the 'medical system' as much as I can. It gets harder with each passing year even as I try to come up with answers.
I have recently ordered, and received today, two Grounding Mats. I try to ground on my walks, but never sure of the ground being safe. And I have been reading that grounding all night is preferred. We will see. Each day, each experiment - win or lose. I hope more wins for sure!!!
Little Birdie is on the right tree limb. I am 78 in a couple of days. I have never been more healthy. That's not to say as I age (more) I won't need to have help/doctor. I don't have one. I would love to have a doctor to help me make decisions, but alas....perhaps in the next life.
I'm with you also, LouMcKenzie. Best strategy is to take good care of yourself, and not depend on doctors and all their prescription drugs. Most of my peers, (I'm 75 years old) are always talking about their doctor visits, how their doctors change every few months, all their tests and procedures, and long waiting times, etc. It is such a turn-off to me. I don't say anything, but I wonder why so many people participate, and don't question anything??
For anyone interested, I have had some very positive results using a somewhat new technology (music sound vibrations that heal) and instrument called the WavWatchII. I intuitively bought the first one that came out due to a friend's opinion of it. The WavWatchII is the 2nd generation of this amazing invention. It came out while covid was going on and I guess FDA was asleep or preoccupied at the time. Its quite amazing how it addresses the early symptoms of diseases that are dominant during this time. Its incredible for detoxing/cleansing heavy metals, and other environmental issues that create dis-ease.
Good job that you are trying whatever you can to avoid getting sucked into the "system", Little Birdie. I also am doing the same thing; eating carefully, getting more exercise, getting good sleep, etc.
:0) smile
agreed. There is nothing the government will do to help, other than remove regulations, get out of the way, and let people spend their money how, when, and where they want to. We can only hope that medicare and medicaid bankrupt the USA quickly so they can be scuttle, allowing patient and doctor focused practice to begin again.
This is a hot topic for me now because i am in the fat middle of it. I had hip replacement surgery last week. I could write a 2000 word treatise on the hospital experience. At least 75% of the staff spoke broken English. This is because the seasoned nurses and aides left during covid.
But I am doing okay. I've discovered a lot about the new medical system. It's been a learning curve for sure given all the conversations I've had with physicians, PTs, nurses and other medical staff in the past 2 months. On Wednesday when my PT came we got into the weeds in regards to the corporations taking over health care and what it is doing to the ones in the trenches doing the real work, hampered by new protocols.
Our long time GP is a DO. I guess some time ago his practice was bought out by a corp. I think he would quit if he could. Hubs and I went recently for our 'annual wellness Medicare check up'. He told us about his sister who is a doc and quit her corp owned practice. She bought a farm and cleaned up the barn and opened a free range practice for the locals. He said this happening more now and it's called concierge medical.
When my PT left on Friday - I sat and wrote lyrics, then made the comp, then the video and wrote the substack - all based on a story he told me.
https://meemanator.substack.com/p/for-the-love-of-money
Not only do foreign physicians come here with less debt due to heavily subsidized education but also heavily indoctrinated in socialism which is why I am bemused by Texas having having 6 that were born, bred, raised and trained in India on the state medical board...the same board that I believe censured Dr. Bowden.
My husband and I have always had some type of insurance with a large cost sharing or deductible,. Since we work in the physician billing industry we have learned to navigate through the system as cash pay to reduce our costs. Annual labs billed to insurance all seem to apply to deductible so we would end up paying $500.00 to $700.00 for labs each year. Instead we take the paper order to the lab and say we are cash pay. The full labs costs us $50.00. We do not send this to our insurance or the lab gets fined, we walk away saving $450.00 to $650.00 dollars. EACH! We do the same thing with x-rays. A client ordered a 6 view x-ray of my shoulder two years ago. I went to the imaging place, said I was cash pay and they charged me $25.00 for this x-ray. Insurance allows $300.00 for this, so I saved $275.00. We have never met any deductible or cost share in 20 years by navigating the system this way. Even though we are now on Medicare with a supplement, we continue doing this to keep our costs down. We still have 4 primary care practices in 3 states that are independent and are running their businesses like professionals. When we see that things are not running properly we work with physicians to help them be more efficient. When they make more, we make more.
why even have insurance? What is the point? It represents false security and chains that bind you. Save the monthly premium and become self insured.
Oh how I miss the independent Physician. Especially during "Covid". I had antibodies and my doc (who I worked with at an NYU primary care practice) still insisted that I get the jab. Talk about not thinking for himself! I eventually got fired from NYU for not taking it. I filed for unemployment and was rejected because (and I quote) "I was fired due to misconduct". Unreal...
I didn't get the covid shots, and had the Delta strain of covid in August 2021. My doctor told me to be sure to come get the covid shots as soon as I recovered from Delta. I asked him why I would do that when I would have my own immunity, and he told me that the shots would give me much better protection than would my own immunity. Couldn't believe my ears when he said that. Based on what? Something the government told him, I guess. My confidence in our medical system is almost zero, except for trauma injuries and repairs!
Reading the part about regulations pushing routine lab testing out of independent doctors’ offices made me think about something else.
Could the same thing happen to entire medical technologies?
For the past several months, I’ve been looking into Delbeta, an old Polish injectable multibacterial preparation. It came out of a different way of thinking about immunity — not just targeting one pathogen, but trying to strengthen the host’s broader defenses. I’m finding similar approaches in other parts of Europe.
The more documents I find, the less this looks like a story about one forgotten product. What interests me now is why the products disappeared along with the manufacturers, the know-how, the clinical experience, and eventually the ability to make them at all.
Your example with office labs gets right to the point. A rule can make sense on its own, but the combined cost of complying with enough rules can eventually make something disappear from practice.
Maybe that happened on a much larger scale with entire classes of medical technology.
Independent medicine may need more than independent doctors. It may also need independent medical technologies.
And maybe the oldest “biological shield” was never just the drug. It was the host.
Could be wrong but think Ted Kennedy was behind that law that effected lab tests by docs. Also wiped out sideline business of folks who prepped bacterial culture plates for hospitals at much lower cost than commercial sources. And you can believe no degree of altruism was involved in his doing so.
Why was it possible to have good health care in Europe, Especially in Germany (where even spas were being paid by the insurance) until Europe became EU? Then all of a sudden it went down hill in a hurry. Group practices, no more house calls, cost going up, people having to drive hours to get the right care. At the time the doctor was just the doctor. No nurses, no aids, no paperwork. The only independent group practice hereabouts is more than one and half hours driving away, no weekend service, 1500 $ before you I even get a foot inside... that is not what we want either is it?
Robert, Well done. There are nuances here, especially regarding data, that are important and that are underrepresented in this analysis. Such nuances become far less nuanced, far more expensive, and far more dangerous in the burgeoning generative AI/ambient listening world. This is worth a chapter in itself.
The role of pre-authorization is broadly misunderstood...it should be a good thing for all, but is always painted as a noxious burden. You should see some of the malpractice I have seen and you would appreciate it more -- it just needs to be done differently. That is largely data driven as well.
And one of the key points you mention, the difference in pricing between hospital outpatient and real outpatient is perhaps the single biggest drag on the overall health budget -- I could give you numbers that would boggle your mind. This is nothing but a money grab for the large provider organizations which are largely responsible for not only the diminution of good medical practice but for the entire cost crisis in health care.
We should spend half a day going through some of this stuff -- it would make your analyses even better. R
I entirely agree Dr. Malone and would desire your vision come to pass. I just don't share your faith in our big corporate captured big government to do something antithetical to their greed unless left with no choice. I frankly am not sure what "no choice" would look like although I suspect this way it comes. In the meantime individuals have to take responsibility for understanding their own medical needs, having a primary is critical in this regard and Concierge can be very helpful if it is an option for you. AI also has lots of potential to be helpful. But, in the end one should not let the Government or Corporates stand in the way of being healthy and unfortunately too many do today particularly if they are on the Medicare train.
This was an excellent statement. The comments were all worth reading and I believe represent the opinions of professionals in the field of healthcare as well as mere patients. I have been the beneficiary of the US healthcare system when exceptional docs took the time to repeat tests and biopsies because the results could not be fit into categories: I needed personalized medicine when what I had was medicare and fortunately received it.
When I worked, I worked for a strategic planning firm, and many of the problems he lays out were those we forsaw almost 40 years ago as possible threats to a planned system. It is not too late to begin eliminating those threats. It will just take time.
Thank for this, I am with you entirely. I have a lot to say about this, anecdotally, but no time now. I may come back to add it later, but for now thank you.
I have so many reactions to this thought provoking article. I've been retired for 8 years after a long career in health care. I've been an army medic, a hospital nurse, worked in the managed care insurance world (the dark side!), a physicians organization (created in response to the managed care craze during the Bill/Hillary years)and then as an executive of a hospital owned clinic network. Most of my career was focused on quality and operations.
Here's what I have observed:
1. Over the years we built our network by building clinics, recruiting physicians (many from our FP residency) and sometimes buying practices. Often, the physicians we hired were seeking a better lifestyle, less stress from having to hire, fire, manage contracting, billing, marketing, property management, etc. The practices we acquired thought they knew what they were getting into, but the reality was always a shock--their employees had to join the union (higher wages and impossible to fire), work according to their license (often they staff performed tasks they were not credentialed for), manage their office spaces and practices to comply with accreditation standards (which were sometimes incredibly stupid), give up their autoclave (couldn't meet the quality standards), implement the EMR, comply with reporting requirements (which drove compensation), have their practices flooded with medicaid patients, see their manager attend hours of meetings rather that support the practice, and on and on it went. So it was a shock to them. My administrators would ask, "When are the clinics going to make money?" And I'd say, as soon as we don't have to take medicaid patients, don't have to pay union wages and deal with chronic absenteeism--which the union protects, & don't have to have the expense of accreditation (in other words, act more like a private practice). Not a popular answer.
2. Private practice had its down side, too. Our organization was probably like nerve gas to these practices, but they were cleaner and safer in the end (and more expensive). Private practice was after a profit, too ("eat what you kill" is what they called it.), and they benefited from having in house (physician owned) labs-which included additional reimbursement and incentivized unnecessary testing. It incentivized building physician owned surgery centers & imaging services. That could be good, bad or just redundant.
3. After 5 years in managed care, I came to see that as a sink hole for money and resources. We dutifully built our medical management department, full of nurse case managers, referral specialists, and utilization review staff. For every nurse we employed, there was one less at the bedside. Ugh. And I'm not sure we had any impact on quality or utilization.
4. In the clinics, we built elaborate measurement systems to provide feedback, support the physician compensation system, promote quality and meet insurance requirements. We tracked the usual stuff, A1c's, messaging turn-around times, patient satisfaction, it was endless. In the end, it encouraged a lot of gaming (send your out of control diabetic to a specialist, close your messages at the end of the day to beat the 24 hour turn around goal, and re-open it the next day). It was shocking, but to me it meant that the physicians (and staff) did not trust the measurements or the people doing them.
5. Many, many physicians wanted autonomy, and by that they meant "I want to do things my own way." But it's hard to support 5-6 individual practices/processes and still have efficiency, consistency and quality. We had one practice that simply would not standardize their order sets. The staff never knew exactly what they should be doing and when. A vital order was omitted and a grave medical error occurred. This is where the checklist manifesto would have helped.
I loved the work that I did and the people that I worked with, but sometimes I wonder, did it do any good?
Both Big Pharma and Big Medicine have been US Government corporacracies for decades. Their interest is for-profit facilitated by frequent treatment; ergo, the sicker we are, the more profitable.
However, I'd be happy just to have naturopathic services reimbursed by my insurance and by Medicaid/Medicare. But it'll never happen because the former will recommend Mediterranean and Lyon Diets, and NO sugar/HFCS consumption that will both cure morbid people of their highly-profitable pathologies.