Re: the best medical system in the richest country in trh world
- From: "Jerry Okamura" <okamuraj005@xxxxxxxxxxxxx>
- Date: Thu, 3 Sep 2009 18:31:26 -1000
If the doctor could make enough money would they be getting out of the business or would they stay in the business. If young people thinking of becoming a doctor, be more inclined to make the necessary sacrifices of a whole lot of years of school followed by low paying internships, if at the end of that rainbow, they could make a heck of a lot of money, or would many young people tell themselves why go through all those years of schooling and low pay, and not make a whole lot of money, when I can go into some other field and make as much or more money, and not have to take the risks that a doctors has to take, and even if you try your best to do the right thing, you just may get sued anyway? How likely is it that and engineer, scientist, someone in the finance field, will get sued during their lifetime, vs how likely is it that a doctor will get sued?
"arthur wouk" <awouk@xxxxxxxxxxxxxxxxx> wrote in message news:1251918826.752873@xxxxxxxxxxxxxxx
Clinic Fills a Need but Faces Failure
By KEVIN SACK
MILWAUKEE -- Like many low-income neighborhoods, the north side of
Milwaukee has seen a gradual depletion of its primary care doctors over the
last two decades. One by one, they have retired or surrendered to financial
reality, rarely to be replaced.
At the few remaining practices, the wait for an appointment can make it
almost purposeless to seek one. When Martha Brown's 3-year-old daughter,
Loverree, woke up with a runny nose last Thursday, her doctor's office
told her it would be a week. "I couldn't wait," Ms. Brown said. "I had to
see what was wrong with my baby. I think she's got an infection."
Rather than heading to an emergency room, Ms. Brown took her three children
to the Milwaukee Immediate Care Center, a small nonprofit clinic that has
treated the north side's largely African-American community since 1986. The
clinic, which keeps hours at night and on weekends, is the only full-time
operation in the neighborhood that provides urgent care, luring patients
with a sign that reads, "When You Need a Doctor Today."
Ms. Brown's decision made good sense, not only for her but for the state
and federal taxpayers who support her health coverage through
Wisconsin's Medicaid managed care program. But whether the option will
remain available is an open question.
The clinic has teetered on the brink of insolvency for years, battered by
foreclosure filings, delinquent tax claims, building code violations and
the loss of contracts with two major H.M.O.'s. It has had to cut its hours
in half, significantly reduce its medical staff and mothball its X-ray
equipment.
Patient visits have dropped to about 7,000 a year from 15,000 three years
ago, before basement flooding and a leaky roof prompted the city to shut
the clinic for three months. The doors stayed open this month, said its
president, Perry Margoles, only because a board member provided a $10,000
loan.
It might seem the health care legislation being written in Washington, with
its emphases on primary care, lowering costs and improving access, would
provide answers for clinics like Milwaukee Immediate Care. But Mr. Margoles
thinks things may be too far gone in his clinic's neighborhood.
"We're having a meltdown approaching -- to use an engineering term -- a
catastrophic failure for much of what remains of the health care
infrastructure for the northern half of the city," Mr. Margoles said.
Yes, he said, covering more of the uninsured would help his bottom line,
which has been red in each of the last two years. But the bigger problem,
he said, is the below-cost reimbursement provided by Medicaid, which
insures three-fourths of the clinic's patients. For a typical office visit
for which the clinic charges $75, BadgerCare Plus, as Wisconsin's Medicaid
program is known, pays $49.
Dr. Syed H. Hasnain, the clinic's lead physician, said more was needed than
simply luring medical students into primary care with grants and loan
forgiveness programs. "There has to be some parity between commercial
insurance and Medicaid," Dr. Hasnain said. "Common sense dictates that
otherwise, who would want to work with public insurance recipients?"
The clinic often finds itself dealing with conditions like advanced
hypertension and diabetes because patients without adequate
insurance may defer care. But because Mr. Margoles has never tried to
transform the clinic into a federally qualified health center, it is not
eligible for the higher reimbursements paid to those centers. It also is
not eligible for the billions of dollars allocated to the centers in the
stimulus package, or the even larger increases that may be included in a
health care bill.
For Mr. Margoles, a 65-year-old nonpracticing lawyer, the stress of dodging
bankruptcy may be taking its toll. Three weeks ago, he said, he began
having chest pains. Dr. Hasnain diagnosed the spasms as signs of coronary
artery disease and recommended he go to an emergency room.
Mr. Margoles would not go. He is uninsured. He said that since opening the
clinic he has deferred his $100,000 annual salary, surviving instead on
modest rental income from property he owns and the generosity of family
members. Although he is old enough for Medicare, the salary deferral
has meant he has not paid enough into the system to qualify for benefits.
"I can't afford to go to the emergency room or the hospital," he said. "I'm
not going to go bankrupt to get care I can't afford."
Because any health care deal is certain to preserve the private insurance
system, Mr. Margoles said it would do little to solve his biggest
headache -- the refusal of two health maintenance organizations to
renew their contracts when the clinic reopened in 2007.
Mr. Margoles accused the insurers of paying him back for complaining
previously to the state about their billing and claims practices.
One of the companies, UnitedHealthcare of Wisconsin, said in a statement
that it declined to contract with the clinic "after thorough consideration"
and "with a consistent emphasis on providing access to quality health care
for our members." A spokeswoman for Centene Corporation, the parent
group of the other insurer, Managed Health Services, did not respond to
requests for comment.
Jason A. Helgerson, the state Medicaid director, said he had discussed the
decisions with both insurers and found no evidence of retribution. Mr.
Helgerson said he had no authority to force an insurer to contract with a
particular provider.
"In both cases, they raised serious concerns about his business practices
and were very opposed to signing a contract with him," Mr. Helgerson said.
"I know that in general the H.M.O.'s are eager to have as many providers in
their networks as they can. It's a rare circumstance for this to happen."
Mr. Margoles has at times considered trying to convert his clinic into a
federally qualified health center but is convinced that the move would be
opposed because of its proximity to one of the four centers already in
Milwaukee.
Senator Bernard Sanders, a Vermont independent who has led the effort
to expand community health centers, said there was no money for
noncertified clinics in the bills now circulating on Capitol Hill. But Mr.
Sanders said he recognized the needs of clinics like the one in Milwaukee.
"I'm well aware there are people trying to do the right thing," he said,
"and to let these clinics fall by the wayside would be a mistake."
Next: A profile of a young woman in San Diego who has received two kidney
transplants.
Copyright 2009 The New York Times Company
--
"be wary of mathematicians..especially when they speak the truth."
--sT. Augustine
to email me, delete blackhole. from my return address
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