Soapbox alert! Cash vs Insurance Medical Practices

Today I read an article on CNN Business regarding the small but growing change in physician practices from traditional insurance-accepting businesses to cash-only practices.  Hooya!  I love it when a person can run a business how they chose.  The article highlighted two primary care doc’s and one general surgeon.  It talked about how each came to adopt a business model that is a cash only practice from one that accepted insurance.  Their reasons were everything you’d guess them to be, from insane hassles with insurance companies, lower payouts, higher overhead costs just to hire people who can siphon through all the paperwork required to file claims, etc.  Each of the doc’s recommended their patients have a high-deductible insurance policy to help cover potential costs outside their scope of practice such as serious or catastrophic illness/injury.  Ultimately the doc’s who switched get to spend more quality time with each patient, lower their overhead, eliminated the hassle of dealing with insurance, and were happier over all in both their practice and their personal lives.  Win-win for everyone!

Then they interview this woman, Kathleen Stoll, who is the director of health policy at the consumer advocacy group Families U.S.A.  This woman’s argument against this type of practice was, and I quote: “They cherry-pick among their patient population to serve only the wealthier ones.”  THAT’S YOUR ARGUMENT?  That’s what business is, moron!  That’s what makes people who run businesses, medical or otherwise, successful!  Do you think the company that sells Lamborghini’s or Maserati’s are marketing their product to the average “Joe”?  Hello no!  You have Ford, and Chevy to cover that market. 

She then tries to make the argument that perhaps the patients are being put at some higher risk.  Um, excuse me…being a cash-only practice doesn’t make a physician exempt from providing the standards of care set forth by the various certifying entities (OSHA, JHACO, etc.) any more than Lamborghini can manufacture a vehicle without seatbelts. 

Whether the business is medicine, cars or even food, it's no different.  Burger King has to follow the same rules set forth by the department of public health as Ruth’s Chris does, but you know what?  Ruth’s Chris “cherry-picks” among the population to market their product to the ones who can afford to eat there.  There’s nothing wrong with that.  Ever. 

Of course, I still can’t afford a Lambo…

No regrets?

As a member of the military we work with literally hundreds of people over the course of our careers.  We develop friendships with people that in other circumstances, perhaps we wouldn’t.  People that you may not have much in common with otherwise.  I have several of these friends that were part of a small group of us that spent a harrowing 14 month together in Korea.  One of them is a woman that I have spoken of to others as “one of my favorite people on the planet”.   Very few people earn that distinction from me.  She happens to outrank me, but she’s a person who I just enjoy being around.  So smart and so driven that it’s almost scary.  But also the kind of person who brightens a room, brightens a day, and brightens a life.  She’s not my mentor or professional confidant or anything of the sort.  Our friendship is not based on what she can do for me or I for her.  Its foundation was built from simply being thrown into the same circumstances.  We understood each other as only someone who’s ‘been there too’ could.

As our time in Korea drew to a close, and the day came to say our goodbyes, numbers and emails were exchanged, hugs were shared, tears were shed.  We knew that at the same time tomorrow, thousands of miles would separate us.  Careers would take us in different directions, and we may never see one another again.  Then one day out of the blue, as so often takes place in the profession of arms, it happens.  You are walking down the hallway of your building that houses 3,000 other military members and you catch each other’s eye.  All military bearing goes flying out the window as you both let out screams of delight and almost knock each other over in an embrace that was 4 long years in the making.   Tears are shed again…

We were so excited to see one another.  We only work a hallway away.  We don’t live that far apart either.  Oh the fun we will have!   We’ll do lunch! We’ll have dinner together!  We’ll go SHOPPING!  Then things come up.  We get busy.  Our intentions are always there, though.  Lots of emails, lots of hugs as we pass in the hallway, lots of plans are made and broken.  Then a couple of weeks go by and I realize that I haven’t seen my friend in a while.  Emails aren't answered, phones just ring and my senses tell me something is amiss.  Today, I see her online.  First time in ages, and I’m so excited. I shoot off an IM…”OMG, you’re alive!  YAY!!”  "Yes, Weeble", she says to me.  "I’m here".  “How are you?”, I ask…

Things are not well.  As she tells me more, my heart begins to hurt.  As she tells me more, I selfishly think how happy I am that we are “talking” on IM, so she can’t see the tears welling up in my eyes, and she wouldn't have to hear my voice crack as I tried to summon up something positive to say.  “My friend”, I type to her through IM, “we will get together, even if only for tea, the moment you are feeling well enough to do so.”  I mean those words with every ounce of my being.

I have never been one to dwell on the urgency of doing things now because ‘there may not be a tomorrow’.  I’m not a fool.  I know that no one is promised tomorrow.  I've lost enough people to know that better than a lot of people my age, I suppose.

That said, I have a couple of friends at this assignment that I have the same kind of relationship with.  I think this week I am going to go find them one by one, plant myself in their offices, and not get up until we leave together to go have lunch.  They can put the phone down.  They can log off their computers for 30 minutes.  So can I.  Something tells me we’ll all be happy we did so.

GUILTY!!! Right?

By now most of my military brothers and sisters have probably read or heard about Air Force Lt Col Krusinski being arrested and charged with sexual assault of a female here in the DC metro area.  To be honest, I didn’t see the police report so “sexual assault” may or may not have been what he was actually charged with.  Either way, with the public eye’s spotlight on all things “Sexual Assault” related in the military today, the media is having a FIELD DAY with this story.  Now, I will say this….I wasn’t there.  I don’t know who he is, and didn’t see what happened.  I don’t profess to know what happened.  What I do know is this:  The media has tried, convicted, and punished this man already.  I read this story on 3 different news outlets and people are practically screaming for this man’s penis to be hung in the town center and burned at the stake along with all the leaders in the military at large.

While I am quite sure that there are a plethora of females who will no doubt excommunicate me from woman-land for this, I have to say that today, right now, he’s judged unfairly.  Did his do this?  Perhaps.  Is he guilty as assumed?  Perhaps.  But today, this hour, this minute, he is an American citizen.  And as such today, this hour, this minute, he is INNOCENT until proven otherwise.  The day we start hanging all people based solely upon the word of another, is a sad, sad day for our country and its justice system. 

This is especially important in cases of sexual assault accusations.  There are plenty of women out there who cry “sexual assault” only after they have made poor decisions that they later regret.  This may or may not be the case here.  But you know what?  I WASN'T THERE.  Furthermore, I am not the lawyer, or judge, or a member of any jury.   

If he is found or pleads guilty, then the banshees can carry on however they chose. 

And...?

Yesterday was a bad day for Boston.  It was a bad day for America.  But you know what?  It was Boston.  Don’t fuck with a Bostonian, man.  You mess with that bull, you’ll get the horns!  Thing is, I heard the same rage from the New Yorkers in 1993 and in 2001.   Believe me.  I was one of them.  Passionate.  Angry.  Insulted.  They should be.  The bad guys smacked us in the face again.  We The People are pissed.  I promise you that.

Don’t you worry about it, though.  Our government assures us that the person(s) responsible will suffer the full consequences of their actions.  How DARE they do that to us?  AGAIN!  So what exactly will be these “consequences” that the guilty parties will suffer?  My guess is nothing.  Not a thing.  The U.S. hasn't done anything about any of the other incidents yet except bow up its chest and bark.  Lots of finger waging, though.  “SHAAMMMME on you bad bullies”, say we.  We’re REALLY mad now!  Oh, if you do it again, we’ll get even MORE MAD”, cry us.

It’s ok though,  I feel pretty sure that five weeks from now, when our government is through jerking it’s knee, all the citizens in the U.S. will have to strip down to our skivvies to enter any sporting event, TSA checkpoint, or our own office buildings.  That’ll learn us.

And furthermore...

In the same vane as my previous post about 4 minutes ago, it occurs to me that this doesn't only happen in meetings or in the corporate setting.  No, sir (and I mean NO).  It happens in restaurants too!  Think about it, it's dessert time.  Waiter comes around and asks if anyone would like some dessert.  I might say "Oh, yes please!" (especially if it's a nice chocolate dish of some kind) and my dining partner will say "No, thank you.  I'll just have some of hers. Bring two spoons."  I'm sorry, what?  So what you meant to say was, in fact, "Yes, I'd like some dessert too, please."  Even if you said simply, "Yes, we'll share one", it's better than "No" followed by all the reasons why it's actually "Yes".

What makes you think I wanna share my decadent chocolate masterpiece with you anyway???  Rude.

No. But Yes.

Why is it that-- without exception--during every meeting at the point when they ‘go around the room’ to see if anyone has anything more to add, people always say “No, just…”  For example…Colonel XX says to Major XX, “Major XX, do you have any updates for the group?”  Maj XX says “No, just one thing I want to point out…” 

Really?  If you have something to say, say it.  You’ve been asked so that’s fine.  But when you’re asked if you have something to say, don’t start off with “NO” and then continue on with your hour-long tirade.  What’s wrong with saying, “Yes, I would like to say…”?  Why does EVERYONE insist on saying “NO” followed by a bunch of crap?  It’s bad enough to hear you talking about a bunch of useless information that means nothing to anyone except for you, but to hear that nanosecond of a tease in the form of “No” followed by “just…” is downright mean.

She Should Lose Her License Completely...

There’s a news story out today about a woman who was given a ticket for going 63 in a 65.  Yes, that’s right.  She was ticketed for going too slowly in the posted zone.  These stories are being reported from the side of how WRONG it was for the cop to give someone a ticket for going too slowly.  Well here’s what I think…

This was a woman (hereto forth known as IDIOT), who was driving on the Maryland side of DC, in the LEFT LANE of an 8 lane superhighway (I know this because I’ve driven it before) endangering EVERYONE else on the road because this IDIOT chose to drive TOO slowly.  Oh, the wind and weather was a factor, say you?  Gusts of up to 40mph, you say?  Then GET IN THE RIGHT LANE AND BE A PUSSY OVER THERE.

We’ve all been behind this person before.  We’ve all wished there was a cop around to witness this hazard of the highway…this danger to all the other drivers on the road…so they can give them a ticket and stop the madness. 

The ticket should stand.  The cop who wrote it should be given a medal.