SoloDoc

From Candorville.com

Unfortunately, the Republican win in the Massachusetts Senate election probably means that these kinds of shenanigans will keep happening.

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Anyone who has been following my blog won't find this article from today's Rochester Democrat and Chronicle unusual:

When Dr. Linda Lee sees patients, she brings them from the waiting room, typically spends a half hour with them, cleans up the exam room and submits the insurance claims online. She's the one who returns phone voicemails, and she gives patients her cell phone number for urgent after-hours needs.

She has no nurse, no billing staff and no answering service. She only has a part-time secretary to digitally scan records that still arrive on paper at her paperless office.

The Rochester family physician's 5-year-old, low-overhead, solo practice is a stark contrast to the hurry-up, assembly-line format she found in large medical practices. "You basically had to see a patient every 10 minutes," said Lee. "How can you address the patient's medical problems in that short a time?"

What is unusual is that this article points out that there are 8 Ideal Medical Practices in this local area, which is frankly amazing considering how few IMPs there are in the entire US.

Other IMP clusters are located in Seattle, Portland (OR), Southern California, Albuquerque, Albany, St. Louis and New York City.

For a list of IMPs around the country, go to www.impmap.com. Don't forget to use the zoom in/out controls to take a closer look.

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So even though I haven't been keeping up with my blog, I thought I should point out some excellent bloggers who not only manage to write something on a regular basis, but also have something meaningful to say.

The Ideal Medical Practices Blog's focus is on the myriad problems facing America's healthcare system and especially its beleaguered primary care physicians, and what can be done to bring about real change.

Dr. Malia Reckons are the insights and thoughts of a solo family doctor in Rochester, NY, whose practice model is very similar to mine.

I just discovered that The Examining Room of Dr. Charles has re-opened after a two year absence. "Dr. Charles" is a unique voice in the blogosphere, whose tales about medicine and life in general are more like finely crafted works of art. I highly recommend his site.

Finally, while not a blogger, Dr. Atul Gawande is clearly an excellent and insightful writer who also happens to be a general and endocrine surgeon. His recent article for The New Yorker echoes my thoughts on how no single solution to our healthcare crisis is possible, namely because nobody knows which approach will work. He argues that, like in America's early agricultural industry, pilot programs may help guide us out of our national dilemma. After all, when you don't know which way to go, why not try several different directions at the same time instead of just one?

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From Sage, Ink at The Atlantic.com.

Happy New Year!

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A survey published 3 days ago in the New England Journal of Medicine says that 63% of doctors support the public option.

When you compare this to the American Medical Association's stand opposing the public option, it is no wonder that groups like Sermo, a growing online physician community, say that "the AMA does not speak for me".

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All politicians are crooks. All lawyers are dishonest. All doctors are rich. All insurance companies are greedy. All government is incompetent.

When a significant proportion of the population hold these views, is it any wonder there is no confidence among some that healthcare reform can succeed? All that the forces of the status quo have to do to keep their gravy train going is to just keeping fanning the flames of discontent and prejudice.

These types of views are prejudicial, as prejudicial as thinking that all women are inferior to men, that all blacks are poor, that all Mexicans are lazy, that all asians are nerds, that all Jews are greedy, that all whites are Nazis. These blanket stereotypes are no different than the prejudice that uninformed people hold against a particular profession or institution.

We have seen the signs of protesters saying "Get your government hands off my Medicare!" and wondered if these people were somehow so senile that they forgot that Medicare **IS** run by the Federal Government.

Even Arthur Laffer, former economist under President Reagan, champion of supply-side economics and someone who should know better conveniently forgets this fact:

“If you like the Post Office and the Department of Motor Vehicles and you think they’re run well, just wait till you see Medicare, Medicaid and health care done by the government.”

To counter this anti-government prejudice, two-time Pulitzer Prize winner, Nicholas Kristof, wrote an article in the NY Times recently pointing out that:

The part of America’s health care system that consumers like best is the government-run part.

Fifty-six to 60 percent of people in government-run Medicare rate it a 9 or 10 on a 10-point scale. In contrast, only 40 percent of those enrolled in private insurance rank their plans that high.

Even though the status quo side keeps dragging out the "Obama wants to turn our healthcare system into Canada or England" argument as if that is a bad thing, studies have shown that patient satisfaction is higher in Australia, Canada, New Zealand and the United Kingdom compared to the US.

Oh but we don't want socialized medicine, the status quo backers argue. Because we all know that anything that's socialized is (gasp!) evil.

But Kristof writes:

Until the mid-19th century, firefighting was left mostly to a mishmash of volunteer crews and private fire insurance companies. In New York City, according to accounts in The New York Times in the 1850s and 1860s, firefighting often descended into chaos, with drunkenness and looting.

So almost every country moved to what today’s health insurance lobbyists might label “socialized firefighting.” In effect, we have a single-payer system of public fire departments.

We have the same for policing. If the security guard business were as powerful as the health insurance industry, then it would be denouncing “government takeovers” and “socialized police work.”

Throughout the industrialized world, there are a handful of these areas where governments fill needs better than free markets: fire protection, police work, education, postal service, libraries, health care. The United States goes along with this international trend in every area but one: health care.

Here in Southern California, the socialized, single-payer, government-employed firefighters have been doing an extraordinary job knocking down the largest brushfire in Los Angeles County history. If the status quo backers treated public fire safety like they treat public healthcare, they'd let the free market forces figure out how to make a profit out of charging people for fire insurance and then cutting off their coverage as soon as their houses burned down.

I'm not arguing that a single payer option is the only way to go, but I would argue that we need more choices. And one of those choices should be a government-backed option that will give the private insurance companies some competition.

Kristof closes with:

A public role in health care shouldn’t be any scarier or more repugnant than a public fire department.

I heartily agree, and I have confidence that the American public can see this too. Because not everyone is stupid.

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Last night, when I drove past the corner where the anti-war protesters show up every Friday night, I saw some new signs. Instead of the usual "US out of Iraq!" anti-war signs, they were now holding up "Health Care For All!" signs. Is health care reform surpassing Afghanistan and Iraq as the most important issue right now? I see this as a good thing. Maybe something will actually get done.

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