March 24th, 2010 by AlanDappenMD in Primary Care Wednesdays
Tags: Dr. Alan Dappen, Family Medicine, Health Insurance, High Deductible Plans, HSAs, Out-of-network providers, Preferred Providers, Primary Care, Primary Care Wednesdays
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Many companies and consumers are turning to higher-deductible health care plans (HDHPs) in order to keep their insurance policies more affordable. The rational basis of these plans is that since you’re using your money and you are in control, you will pay more attention to what is really being offered to you as well as to the cost relative to value. You will be more likely to challenge your doctor to provide the rationale for an expensive test or drug, and to encourage your doctor to innovate to provide lower-cost alternatives.
A trap of these new health plans, as currently structured, is that you’re herded into in-network ‘preferred providers.’ The rationale of the insurance company is that they can control doctors’ prices, thus brokering a better rate for you. They also want to use your loyalty to the network to control physicians’ practices. “Preferred,” in reality, does not refer to quality; rather it just means the doctor has signed an agreement with the insurance company, binding them to the insurance company rules, which favor the insurance company, not the patient.
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March 17th, 2010 by SteveSimmonsMD in Primary Care Wednesdays
Tags: DocTalker Family Medicine, Dr. Steve Simmons, Healthcare reform
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In my last post I encouraged everyone to watch the health care debate at Blair House mediated by President Obama. For this, I must apologize — I ignored the maxim that one should neither watch sausage nor laws being made. I had arranged to work from home that February 25 since I planned my next post to be a review of this much touted debate. As the proceedings began, I felt cautiously optimistic as I watched our politicians gather to supposedly mediate their differences; yet as the sun set that day I was incognizant of any path towards meaningful reform that our elected leaders could set upon as a result of their interaction.
Webster’s online dictionary lists two meanings of the word debate, with the first being: “a variance of opinion on a matter,” which best describes my recollections of that day. However, the other definition: “a careful weighing of the reasons for or against something,” may better explain my hopes of what would transpire because of the debate, but fails to describe what really occurred that day. The realization of this fact only deepens my disenchantment with what Washington has created and now dubs “Healthcare Reform.” When I try to recall the actual debate, I hear within my mind lots of static and background noise yet I can recall nothing of significance. What I hear reminds me of the voice of the schoolteacher from the Charlie Brown cartoons I watched during my childhood. Read more »
March 10th, 2010 by AlanDappenMD in Primary Care Wednesdays
Tags: DocTalker Family Medicine, Dr. Alan Dappen, Health Insurance, Patients, Primary Care
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Introduction: Here’s a recap of the scenario to date: Mrs. Doctor, a primary care physician is in marriage counseling to determine the fate of her marriage with Mr. Insurance. While she loves her career (medicine), dealing with Mr. Insurance’s increasingly abusive financial and administrative demands are crushing her soul. Yet leaving preferred provider protection guaranteed through the marriage would be devastating too. And Mrs. Doctor doesn’t want to lose her kids (the patients); decades of historical indicators show that 95% of kids (patients) stay with Mr. Insurance and refuse to see Mrs. Doctor ever again.
Last time, the therapist performed a therapeutic technique on Mrs. Doctor akin to psychological judo. When she claimed she was helpless under the power of Mr. Insurance’ ability to pay the bills, the therapist pointed out that Mrs. Doctor has many more powers than he does, including education and training as a doctor, the ability to order labs and meds, and the understanding and trust of each patient. Why, then, would she abandon the kids without a battle? Mr. Insurance wants nothing to do with the kids, and creates hundreds of games to reduce or eliminate his financial obligation to them.
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February 24th, 2010 by SteveSimmonsMD in Primary Care Wednesdays
Tags: Avandia, DocTalker Family Medicine, Dr. Steve Simmons, Healthcare reform, Primary Care, Primary Care Wednesdays
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I don’t know if I can do it this time. A month ago, when it appeared that Congress had backed out of passing Health Care Reform legislation, I felt neither happy nor sad. I didn’t know how I felt but this past Monday, after the following triad of events had unfolded, it became clear to me that I feel weary towards the whole healthcare reform process:
- First, several states temporarily halted a rapacious rise in health insurance premiums from companies with quarterly profits last year in the billions of dollars. Seriously, don’t these companies have PR firms?
- Second, the Senate Finance Committee actually issued a drug warning and in this one act illuminated either a glaring problem with Congress or – far more concerning and unfortunately for us, more likely in this instance–some type of bias at the FDA.
- Thirdly, the President called for a televised debate on health care between ‘both sides.’ Then, within days, he posted his own plan on the White House website. It is a ten page summary I found hard to follow that left me with a troubling sense of déjà-vu.
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February 17th, 2010 by AlanDappenMD in Primary Care Wednesdays
Tags: DocTalker Family Medicine, Dr. Alan Dappen, Health Insurance, primary care wednesday
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Introduction: As we pick up with this ongoing series, here’s a synopsis for those of you new to the story: Mrs. Doctor, a primary care physician, has been going to marriage counseling alone since here husband, Mr. Insurance, has refused her pleading to attend the sessions together. He claims she is too spoiled and is threatening to find a new partner and a happier union, not to mention to find someone new who can help take care of their children (Patient 1, Patient 2, Patient 3 …).
Previous therapy sessions went well — until the last one, when the therapist seemingly accused Mrs. Doctor of being to blame for her marriage crises. At this point in time, the therapist asked her to return explaining why she should be at fault, and this is where we pick up:
Mrs. Doctor: I’m upset with you. I don’t know if I’ll continue therapy.
Therapist: I’m sorry you feel that way. Let me get this straight, you can’t decide whether to stand up for your kids (Patient 1,2,3) or abandon them … or whether stand up to your husband, Mr. Insurance, or abandon him … or whether to stay with therapy or not.
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