Monday, March 29, 2010


I hope everyone understands that I agree with the concepts in the Health Care Reform bill. My fears are in the implementation of the various segments. This is where the danger of the politician influence on the bill can ,indeed probably will, have negative effects on health care.

I have posted articles from outside sources about the changes in patient/physician relationships. How it has been changing in the past few decades from a personal one on one situation to an increasingly provider/consumer contact. Medicare, Medicaid, and the HMOs insurance companies by reference changed the physician into a "Provider" and the patient into a "Consumer". The interaction was no longer a personal one between two humans, but a commercial transaction involving the giving of services and the use of resources.

Governmental agencies attempt to make their programs affordable by increasingly reducing reimbursements and at the same time requiring more "paper work" with the threat of penalties. The insurers added the addition factor of limitations on usage and denying reimbursement for many new procedures or treatment modalities. As a side effect an increasing cost for a doctor to maintain an office went to employing additional personnel to fill out paper.

The Senate as adjourned for the Easter break-two weeks- without acting on correcting the present law which mandates a 21.5% cut in physician reimbursement on April 1. No business can continue to operate at a loss, which will be the result of this action.

There will be further closure of individuals offices and small groups resulting in the increase dependency on walk in facilities or ERs for primary care, and specialist refusing to treat Medicare patients.

I do not know how many MDs still have offices in Plainfield or North Plainfield. I would expect as the trend continues the sole "providers" of primary care will be the Health Center off Rock Ave. or the Muhlenberg ER with long waits for treatment.

I could not practice today. I felt that I had to have a relationship with those I treated; to know them as individuals not case # 2065. This was true of more than 90% of my peers. But we are now in a more materialistic world and we must live with it.

This is not the post that I was going to write. I had read in Sunday's ' Star Ledger a story form the Bloomberg News about a section of 45 pages in the2,400 page act that created a $500mil a year agency to study comparative effectiveness and value of different treatments and medications. I will opine on this shortly.


  1. On Meet the Press yesterday Senator Schummer of course defended the entire health care package. Given the liberal nature of the program I was not surprised that he was not challenged. The claim that billions will be saved by people, now having insurance will not go to the emergency room seems fanciful. The stream of illegal immigrants will continue and the free care provided to them will continue and ten years from now the same problems will remain.
    The other major issue seems to be how the Federal Government is passing some of the costs, as an unfunded mandate, down to the states. The analogy is how currently our new State govt is eliminating aid, in all forms, to towns. The old saying applies here "Sh#@t rolls downhill.

  2. One of the major costs in present day care is the overuse of facilities and providers by those with insurance because it does not come out of their pocket. There often is a fine line between who should or should not seek care. too little is inexcusable, too much unneeded is wasteful.
    This problem will increase with more on the rolls. To say no can be morally if not legally dangerous.