What is the current state of healthcare? How would you summarize the healthcare crisis?

  • The healthcare costs are rising. A significant chunk of the healthcare dollars go to administrative costs in the health care reform. I only see that increasing. We have gone overboard. Most of the docs, many I have spoken with, feel like they are sitting ducks in the legal system. Any potential outcome even if it has nothing to do with the care, just the disease process, may result in the doctor being sued. Defensive medicine and stress. There are bad docs and malpractice is out there and has to be looked at. Beyond that there is a lot of defensive medicine.
  • Confusion. So many rules and regulations it takes away time from the patients because I am watching to make sure that I am in compliance with all of this stuff.
  • Frightening. Abysmal. It will never be what it was. The pharmaceuticals are dying. They can’t survive because the ACO’s are demanding generics. It is so multi-tiered. The providers are wiped out and stressed. The insurance companies and pharmaceuticals are stressed. The hospital systems are stressed. They are buying up practices. I don’t know what will happen. The last 7 or 8 years have been horrible. The last 2 years have been grotesque. The pre-authorizations are too time consuming. Obamacare meant well but it is not the problem. The insurance companies are the problem. How to make it fair to everyone? Patients do not understand.
  • Lots of physician burnout. The insurance companies seem to be the only ones making any money. The status of our current health is declining, not improving. We are so specialist driven. Lack of good primary care. Resources are being over utilized for some and underutilized for others. That is worse now than it used to be. Doctors are afraid of legal repercussions. So we have created a culture of just doing one more thing. We are afraid of sticking by our opinions. So we send people on to one more specialist and one more test to prove the one in a million chance. It makes me afraid to stick with my opinion as patients will just seek another opinion. It erodes the doctor patient relationship. The stress of what’s on us every day. The weight of carrying the burden of your health and the fear of repercussions is you think that we have made a mistake. People don’t have insurance. Or they are tied to an employer. Having to ask for permission for meds or a test affects my day to day operations and the ability to refer a patient. There is a lack of information. People pay a lot of money and they think that should take care of it. They paid already.
  • Because of the economics a lot of people have trouble paying. Costs go up. Keep trying to buy a cheaper and cheaper form, it limits your access to doctor or the doctor won’t get paid and cannot afford to give the same amount to time. They can’t afford to. If you run your office like an HMO mill with no choice, it will impact care and the doctor patient relationship. PA’s and office extenders and you may never see a doctor or never hear about your case. It’s dangerous. Many patients accept it. Many patients who downgrade understand. The malpractice situation has a lot to do with it. If you pay less and worry less about being sued over stupidity and wasting time, all costs could come down. Lawyers don’t want to curb it. A huge problem. Also we give health care away for free to people who are not here legally. A family injured in Mexico, they would not let this family leave until they put $50K on their card. Other countries don’t do that. They don’t give it away for free. This is a huge a huge drain. Giving more and more for free when you can’t afford to is a problem.
  • It is rapidly becoming unaffordable. We are creating a class of uninsured–10’s of millions of people are underinsured. They have insurance, but it is not adequate to preventive basic care. We don’t yet understand how to use technology and computers because we are spending incredible time documenting what we did and it is still hard to share with other providers. It is frustrating. Payment discriminating discrepancies that do not jibe with policy. So we have more of what we don’t need and less of what we do need. Also medical education is too damn expensive.
  • Unstable.
  • The incentives changed. There is a financial incentive. We are not paid to think for office visits. The only thing that keeps afloat is testing costs. Equipment. And fancy things we do for people. But we want to cost contain. So they keep ratcheting us down, for example for office visits and professional fees for interpretation and thinking. Increases incentives to tests. There is no in between. Let’s ratchet down testing by explaining and getting justification from insurance companies. This creates more positions in my department to make all of those phone calls and make it happen. It also makes patients unhappy. They have to wait days for the testing. Stressing about pre-authorizations. There is no care of the patients, it’s all about money. There were abuses, from doctors, but this isn’t working. It’s bad.
  • Abominable and it’s immoral.
  • As physicians we have made remarkable advances in our abilities to diagnose and treat human disease. With the financial crisis, and the current restrictions on practice caused by insurance companies, many physicians have changed the way they practice medicine. The healthcare crisis has affected, or limited in some cases, the tests we would like to order, the referrals we would like to recommend or the treatments we would like to suggest. If I recommend an MRI and the insurance company refused to pay for it, this is a problem. Although another test can cause cancer in children, but the insurance company will not pay for the MRI unless we do it first. How should I tell the child’s mother? Send the child for PT so see if maybe they will get better. What if the best one is out of network. And the parent chooses someone who is not very knowledgeable. It happens. This started changing 5-10 years ago. This is wrong. We should be able to recommend the diagnostic tests the therapeutic interventions and the procedures that we think are necessary.
  • It’s a mess. I can’t really summarize it easily. Probably it centers around quality of care and access to care. Most people put cost in there and that is part of the crisis. But you cannot control costs by getting people to do less. You have to cut out the middle men.
  • In a nutshell: The destruction of the practice of medicine by 3rd parties who profit from it. In my opinion, to centrally control, to ask a bureaucrat what someone is feeling is impossible. But if government controls medicine, that is necessary.
  • Healthcare remains strong. But the business of healthcare is in turmoil. And if this crisis is not fixed, we will begin to see a worsening of the care provided. We are already seeing some degrading of care provided to patients across the country. Wait times are up. It is harder to schedule appointments. Patients are still flocking to the ER. Healthcare is sick. The management is in turmoil. Like any business, there is only so efficient one can be, until the services have to be compromised. We are at a point in healthcare where service is starting to be compromised. Unlike a dry cleaner or a plumber or an electrician, who may be able to cut corners, healthcare should never cut corners.
  • The insurance companies have too much power. That needs to change.
  • The computer makes it worse. It doesn’t make it better. We don’t use the computer in the room and so we run slowly and so the patients get pissed off. The insurance companies are in charge. They make everything so hard.
  • I think that we are not delivering a good a product as we think that we are. There are some very discouraging statistics like the infant mortality rate, that show us that access is a problem. It comes down to money and the insurance companies having too much power over the processes. Some of the problems reflect larger problems in society like poverty and education. We have a lot of work to do. Doctors and people going in to specialties the cost associated with medical school is insane and choices after medical school are related to this. Or people don’t want to go work in underserved areas when they have to pay their loans back. The education needs to be subsidized more.
  • Malpractice needs reform. This is where all the money goes. Can’t take care of people when worried all the time about being sued. We need to subsidize medical education. Not coming out of education with $200,000 in debt. We need to start subsidizing education so what we attract good candidates. Good people are going into business. People are angry because they are paying and they don’t know where the money is going. If you are really sick and go to the hospital your doctor from the office will not be there. When the doctor was making enough money it made sense. We don’t get paid enough now to work that hard and lose all of that quality of life. Our salaries are down. We gain quality of life. Patients pay less but they lose some continuity of care. The hospitalists are good and the patients will be well taken care of. They will be well taken care of medically but they will lose that personal touch and we are not going to get it back.
  • What is the current state of healthcare? We are in deep doodoo. 700 million dollars is taken after Medicare for Obamacare. It will hit the vulnerable the hospitals are hit the worst. Unfunded with liabilities and requirements. It’s like any Ponzi scheme. The first guys do well.
  • The bureaucracy is swallowing medicine. I would like everyone to have adequate health care insurance. There is a way to do it. But doctors are caught in the middle of a hijacking of medicine by people who don’t understand medicine.
  • It’s such an overwhelming problem. Everyone wants a Mercedes. No one wants a Honda and everyone wants the government to give it free. People think that they are entitled to health care for free. Highly trained people taking care of them shouldn’t cost them anything. Doctors got their fees cut, so they turned us into businessmen. Lots of labs tests trying to make up for the fact that fees are cut to ¼ than what they should be. Regulations and the people who practice good medicine get hurt. The people who can get around it still do it and still bleed the system. Targeting reforms at the doctors but not the insurance companies. Or pharmaceuticals. Before HMOs people understood that if they want to the doctor they had to pay. So they made a decision to go or not. This vision of health care as an entitlement is different from 30 years ago.
  • Troubled.
  • It is a nightmare. From every angle. It has to change. Nothing even makes sense right now. What Obama has done. Christie screwed the state by expanding Medicaid. We can’t even take it. People don’t get jobs and they are one of the millions on the dole. We can’t afford it. We are in dire straits financially. He should have stood with the other governors. These patients are so complicated and so sick. The clinics have closed.
  • Trying to provide good healthcare for a large number of people in an affordable way that still reimburses the providers a fair rate for their work. Hospitals and doctors. When I went into private practice in 1972, it was around the time the HMO’s came in. they were horrible and they we came to a happy medium. Then the federal government came in with Obamacare and totally upset the apple cart. Now we are trying to figure out how to work with that. Meaningful use, ICD-10 an PQRS all at ones and adopting EMRs and all of this is outside of patient care.
  • Fragmented. Different rules about medicine for different people. You get what you pay for. If you have a good job and insurance, you are entitled to good care. With Medicare, if you are coerced into buying a managed care Medicare and cannot afford a supplement. You have fewer options with doctors and medicines. People don’t know this and don’t know what they are being sold.
  • Insufficient providers of primary care in a world of increased specialization.
  • Best healthcare system in the world but not for long.
  • Not great when we compare outcomes with other countries.

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