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Are Primary Care Physicians Being Assimilated By The Borg?

If you live in a small town or rural area of the United States, you may have noticed that family doctors are becoming an endangered species. Private and public health insurance reimbursement rates are so low that survival as a solo practitioner (without the economies of scale of a large group practice or hospital system) is next to impossible. Some primary care physicians are staying afloat by refusing to accept insurance – this allows them the freedom to practice medicine that is in the patient’s best interest, rather than tied to reimbursement requirements.

I joined such a practice a few years ago. We make house calls, answer our own phones, solve at least a third of our patients’ problems via phone (we don’t have to make our patients come into the office so that we can bill their insurer for the work we do), and have low overhead because we don’t need to hire a coding and billing team to get our invoices paid. Our patients love the convenience of same day office visits, electronic prescription refills, and us coming to their house or place of business as needed.

Using health insurance to pay for primary care is like buying car insurance for your windshield wipers. The bureaucracy involved raises costs to a ridiculously unreasonable level. I wish that more Americans would decide to pay cash for primary care and buy a high deductible health plan to cover catastrophic events. But until they do, economic pressures will force primary care physicians into hospital systems and large group practices. My friend and fellow blogger Dr. Doug Farrago likens this process to being “assimilated by the Borg.”

Doug offered a challenge to his readers – to customize the definition of Star Trek’s Borg species to today’s healthcare players. I gave it my best shot. Do you have a better version?

Who are the Borg:

The Borg are a collection of alien species that have turned into cybernetic organisms functioning as drones of the collective or the hive. A pseudo-race, dwelling in the Star Trek universe, the Borg take other species by force into the collective and connect them to “the hive mind”; the act is called assimilation and entails violence, abductions, and injections of cybernetic implants. The Borg’s ultimate goal is “achieving perfection”.

My attempt to customize the definition:

Hospitalists are a collection of primary care physicians that have turned into cybernetic organisms functioning as drones of the collective or hive. Hive collective administrators (HCAs), in association with partnered alien species drawn from the insurance industry and government, take other primary care physicians by economic force and connect them to “the hive mind”; the act is called assimilation and entails crippling reimbursement cuts, massive increases in documentation requirements, oppressive professional liability insurance rates, punitive bureaucratic legislation, and threat of imprisonment for failure to adhere to laws that HCA- partnered species interpret however they wish. The HCAs’ ultimate goal is “achieving perfect dependency” first for the drones, then for their patients, so that HCAs and their alien partners will become all powerful – dictating how neighboring species live, breathe, and conduct their affairs. Resistance is futile.

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To learn more about my insurance-free medical practice, please click here. We can unplug you from the Borg ship!

Does Normalizing Obesity Do More Harm Than Good?

It is estimated that 44% of Americans will be obese by the year 2030. The AMA warns that increasing obesity rates will lead “to millions of additional cases of type 2 diabetes, stroke and coronary heart disease, as well as arthritis and hypertension. Billions of dollars will be wasted through lost economic productivity and skyrocketing medical costs.”

And yet, a funny thing is happening in consumer land – efforts to normalize obesity are gaining momentum via social media platforms. Take the “beauty comes in all sizes” ad for example. This was shared with me by an old grade school friend on Facebook. And while I can appreciate the sentiment that women of various genetic predispositions are beautiful, I stopped short at the idea that obesity itself was attractive. There is a growing movement among obese men and women to promote acceptance of their size, and if they win this argument they could substantially undermine efforts to help Americans become healthy and avoid disease. I know this sounds harsh, but to me, promoting beauty of all sizes – when that includes obesity- is tantamount to promoting a “smoking is cool” campaign.

Smoking rates in the United States have dropped from 42.4% in 1965 to 19% in 2010. Although one-in-five people still smoke, we have successfully reduced the smoking burden by more than half. The reasons for this reduction are complex, but they include public awareness campaigns regarding the harmfulness of cigarette smoking, increasing taxes on cigarettes, and public policy regarding where and when people can smoke in public.

The same exact approach can’t work for obesity because while people can simply quit smoking, we can’t quit eating. And what we eat is less important than how much we eat. I personally do not favor “fat taxes” on specific food items because almost any food could cause weight gain if consumed in large enough quantities. I also don’t favor singling out obese people for portion reduction at restaurants (this has actually been proposed), or other policies that are similar to what we’ve done with smoking in public spaces. Promoting prejudice against the obese is not constructive.

So that leaves us with public perception/education and peer pressure as our primary national strategy for reducing obesity rates.  (Of course smaller initiatives can help: employers can incentivize weight loss and wellness, policy makers can encourage new housing developments that promote active lifestyles, and local groups and non-profits can promote fitness initiatives and healthy eating behaviors.)

My concern is that if too many people decide that normalizing obesity is better than fighting it, America will lose this battle. Obesity-related disease is already costing us about twice as much as smoking-related illnesses. And both smoking and obesity are nearly 100% avoidable.

Obesity is not beautiful, and we must redouble our efforts to win the hearts and minds of the public on this subject without resorting to the other extreme (idolizing anorexia). Good health lies somewhere in the middle – and keeping our middles within a reasonable range is the most important health goal we have.

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