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Has terrible pain in my back and since there is your doctor.
M I'll I hadn't happened -- I did not do I get a dermatologist hair and an -- here and -- -- -- -- -- yet have a world previous.
-- surgeon right.
Wasn't the positives that -- It's made -- and yeah.
It turns out -- pleasant there I would guess you limited government is now going to be a -- in between me and my doctor -- and doctor somebody art that.
Look I think.
You have the US task force which is I don't know what they need their responsibility is almost at a branch of this they're coming in and they're saying that.
No PSA for any healthy men out there can't say that PSAs attest that -- used for diagnosis of prostate cancer a year ago they said only over fifty year old.
Now they're saying it's really unnecessary and has created a whole confusion.
Among patients that may have -- -- it appears as a -- cancer.
This of the same thing about the mammogram -- citizen do a pap smear.
So this epic changes ordered anywhere anyway you're crazy thing was about the United States' rights to toss folks there was -- you run a test on that panel.
He advised against PSA screening for men but they did collaborate with other great -- -- -- another you always ruling that it -- be potentially dangerous -- -- but do you have the follow what does this.
Insurance companies will pick up on that -- you don't have to I don't have to follow this I would tell my patient -- you need to get your PSA.
You need to follow this over the years but then you get a call from the patients say that they're not paying for it and how your stock because that's where it's only other guys that we can set up -- I'm gonna try it apparently.
-- -- -- -- -- That's OK you don't isn't that we set up as they needed to put the mandate in place now the tax that insurance companies.
Could take on all of these people with preexisting condition that.
We wanted to control the insurance companies we haven't done that the insurance companies have gotten more control they've gone out and bought providers practices.
And hospitals all over the country you reduce competition.
You start to control the practices of what doctors can.
And can't do.
So you've changed the entire dynamic of health care delivery not docket their answering to -- insurance companies not more than they did we -- for change that the government said that we were gonna hold insurance companies more accountable.
And in fact with the ruling today.
We've just given them one more Clark in terms of control client and nothing now I'm sorry but.
Self insured employers today who who -- most of the work force.
Have zero control in terms of controlling premiums for insurance companies we've done nothing.
To empower them to keep that in fact premiums have gone up on average about 2000 dollars per family since the law went into effect and.
And might put one giant will be refunded by August thanks thanks -- and medical -- -- -- they didn't do what they were supposed to.
The launch said that they have to stay above the medical loss ratio threshold.
And because they couldn't do that.
Every dollar that you spend if you don't put eighty cents to words medical care.
Well then you've got to pay -- pay a refund so why would seem like its money back in your pocket guess what.
What it means is the end result didn't happen.
What Atlantic -- has been -- go to the dermatologist for our first move presentation.
Where we stand today -- an hour -- -- of us aren't that has been a long day.
-- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- Just over the years I don't really know much about the -- haven't been able to -- through -- I just hear the stuff that I see on the news and from my colleagues.
But what happens is now when I have a patient at the -- -- out of an insurance because I spent so much time fighting for referrals from my patients.
Then what -- -- -- the medicine I don't think oh it's the right medicine for them on think you can what insurance they have will they be able to get this when my gonna have to call -- an episode on the phone and speak with an administrator.
-- they can get this medication.
I think it'd take the medication are they gonna do what I tell them to do -- -- documenting it right because I don't document it right.
And I get audited and they look over my records and they say -- you didn't do exactly what you said so what you do doesn't even matter it's how you document what you do.
And it wasn't really look at -- we're giving me insurance companies more power with the law does that that impact that even further you know it -- I think.
That when you put more people into -- system and you don't have more money for that system.
For those of us -- private practice I have a fixed overhead I have to hire certain number of staff to get my office that.
Whether or not I'm working mother -- out of seeing patients are collecting money I still have to pay out that money so there's certain amount of pressure on me.
Plus the fact that as physicians but busy being doctors I'm studying I'm didn't doing continuing medical education I'm teaching I'm -- I'm doing these other things.
I don't really have that much time and I don't really have any interest in getting into the politics of it I just like to be able to see my patients.
Have a discussion with them and try to make things better doctor has -- -- you say you work for hospital that takes everybody doesn't matter.
I work -- a safety net hospital in and as I mentioned at the break you know the system is broken we need it affects.
But the fix is going to be different throughout the whole country what works for me in the South Bronx may not work out in suburbia.
And and that needs to be looked at and addressed I'm gonna give you an example could you were talking about the insurance companies.
I work every -- -- mercy position I was working this morning caring for patients many of our patients come in we treat them.
Two thirds of our patients we see it over in off hours between five.
In the evening and 7 in the morning when private physicians offices traditionally are close right there are some people who maintain -- hours.
A lot of these patients we treat we we treat a medical condition see them and make them better hopefully or admit them to the hospital.
Couple weeks later I'll get letters from insurance companies addressed to me stating we decide we're not gonna pay for this visit.
Because that this is -- there was rendered for for -- well yes the care was delivered the patient was treated and hopefully made made Weller -- better.
And and we get a denial letter so now I sit down all my free time and my colleagues do this just as well it's not just make.
We go through the short and we try to document and justify why we treated this person for their emergency medical condition.
We send a letter back to the insurance company and and many times they'll say well we still deny it.
The point where the points -- the point is why are we what we're doing the care no matter watt and and or patients don't have access to their primary care physicians.
So they come to -- -- department.
We still deliver the care -- but where's the reimbursement for that no one's getting paid.
And let me dash and in addition to this the western doctors have and doctor -- there was speaking to this point we're heading towards a two tiered system of health care in this country.
There's nobody looked at who's in the network who's gonna play ball and Obama Karen who is in and some doctors like doctor they do well.
So we're gonna end up if -- rich likened likened Great Britain if you're rich you pay for the best.
Yeah you pay for that technology that the insurance won't cover could you wanted and you could afford it.
That's not what we really want here and that's where we're -- we're hitting it to a to a division insurance is gonna cover basic services and if you don't like that you can pay for the -- I'm not gonna blame it on his -- because like doctor today when I was in Boston I was in private practice and as you know I'm at down parents have a salary position long before the AC may have spent.
So that was it and the -- any real problems existed prior slowly bonds.
David helped her her agony anymore issues a private insurers than I do with Medicare in terms of getting drugs the president I think that's -- prison at primary care visit.
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