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Fri Apr 6 18:33:57 BST 2007

But those same upscale individuals DON'T want to pay for their routine and =
emergent medical care. In fact, many do not have insurance because they wou=
ld rather have a BMW or a large flat screen TV. Yes--getting cynical.=20

-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org=
] On Behalf Of Ronald Gross
Sent: Friday, April 06, 2007 10:13 AM
To: Trauma &amp; Critical Care mailing list
Subject: RE: [ccm-l] Employment and benefits manipulations

Lets be real here - how many of the indigent patients that receive free med=
ical care pay for their root canals?  In fact, how many actually have any d=
ental care at all?  None.  They go to the free clinics at the large city ho=
spitals and get their free dental care (that we all pay for), while the den=
tists you talked about continue to serve their upscale suburban families 3-=
4 days a week and go to their country homes the other 3-4 days per week.  S=
ame with the "cosmetic surgeons" or "sports medicine" ortho guys who do the=
ir jobs in nice self-owned and self-build private clinics and get paid cash=
 by the dentist who blew out his knee and messed up his nose while skiing a=
t Vail.

Cynical, are we???

>>> "Offner, Patrick" <PatrickOffner at Centura.Org> 4/6/2007 11:47 AM
>>>
Yes, but it was easier to justify providing some indigent care(say 10%) whe=
n reimbursement for non-indigent care was reasonable and appropriate.
Now that we have to work 3-10 times as hard to earn the same income--in the=
 face of inflation and rising malpractice fees--it seems harder to swallow =
the "forced" indigent care we have to provide. It seems that at least 50% o=
f the trauma and emergency general surgery I see in the ED is uninsured. We=
 still give them excellent care but it is getting harder to swallow.=20
The dentists somehow seem to have gotten it right. They get 50-80% reimburs=
ement on the billings and charge the patient for the rest. And the patients=
 are willing to pay for the rest. Most dentists that I know only work 3-4 d=
ays per week, rarely take call and make a lot more money than I do. We on t=
he other hand get about 30-40% of what we bill and are contractually preven=
ted from balance billing the patient. Moreover, the patients now EXPECT to =
get their care for free. Why are they willing to pay for their root canal b=
ut not for their emergency appendectomy or their elective colon cancer rese=
ction?=20

-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org] On Behalf Of Ronald Gross
Sent: Friday, April 06, 2007 8:54 AM
To: Trauma &amp; Critical Care mailing list
Subject: RE: [ccm-l] Employment and benefits manipulations

Tort reform, insurance company executive salaries, drug company "R&D"
costs, etc - all part of the solution.=20
Not part of the solution - a free lunch and an excuse for all of the "disen=
franchised" whether their condition is self-imposed or "imposed by others" =
whoever those "others" might be......

>>> "Offner, Patrick" <PatrickOffner at Centura.Org> 4/5/2007 6:46 PM >>>
Dr. Mattox,

While I agree with you almost 100%--don't you believe that insurance costs =
are also out of control--to the point that a lot of people just cannot affo=
rd them. Your "fix" is just the tip of the iceberg--we also need insurance =
reform as well as tort reform--it is all intertwined.=20

-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org] On Behalf Of KMATTOX at aol.com=20

Sent: Thursday, April 05, 2007 3:01 PM
To: trauma-list at trauma.org
Subject: Re: [ccm-l] Employment and benefits manipulations

=20
In a message dated 4/5/2007 3:48:23 P.M. Central Daylight Time, thoran at sara=
h.br writes:

Of the  30 -40 million US uninsured how many are the fast driving drug addi=
cts, or  lazy, obese cigarette smokers whom you abhor and how many of them =
are ordinary  folks, the people who are apparently easy for you to dismiss
, the  =20
working poor, in jobs that need filling but just don=ECt get paid very well=
 , certainly not enough to part with 1,200 a month...  maybe the receptioni=
st or the cleaner or the guy in the parking garage, people who just  do NOT=
 appear on your radar because they do NOT read a novel a week, do NOT  know=
 the right people, do NOT belong to the right organizations, did NOT go to =
 the best schools. Never mind Dr. Crippens friend but what about the disabl=
ed,  the folks in the other car, the unemployed, the unemployable, good can=
non  fo dder but No FREE LUNCH.
Never mind that the free lunches are served up in  corporate board rooms ev=
ery where, provided by the moms and pops investing in  the great enterprise=
s that won't provide health  insurance.

In every society, and especially at the local level, provisions are made  f=
or=20
the kind of persons you cite above.   Many local good examples  exist.

=20
These same individuals do not have state sponsored lawyer  aid, housing aid=
,=20
church aid, food aid, family counseling, cell phones,  etc.   Why must
or should=20
health care be any different.    MANY MANY of the persons you cite
above CHOOSE
to not have health dollars  available in order to pay for cell phones, send=
 money back to family in another  country, have a late model car, drink alc=
ohol every day, go to cock fights, and  have somewhat expensive watches and=
 designer=20
glasses.   I see them  every day, and then they expect FREE medical
care.  =20
WRONG.  One  cannot have it both ways.    If they go to church, the
priest
EXPECTS them to put something in the collection plate and even pay for some=
 of their absolution by giving to the church (up to and greater than 10% of=
 their =20
income).   If they need to go to court, they must pay for an=20
attorney.
  =20
=20
I have NO problem for fairness with a prorated calculation of a discounted =
bill based on disability, inability to work (real, and not just a matter of=
 a created social welfare state to pay someone NOT to work), and a feeling =
of responsibility for ones own services, whatever they might be.  It is not=
  the state or the employers responsibility to assure that everyone is prov=
ided  all creature comforts from the cradle to the grave.  That is a family=
 and  an individual responsibility.  The governmental responsibility is to =
 protect, NOT=20
PROVIDE.   =20
=20
We in every society MUST also address the HUGE profits from insurance compa=
nies, HMOs, and hospitals whose overhead and payments to upper level =20
management and stockholders are obscene.    The persons who have  been
unfairly
burdened with the financing of individual health care has become  the emplo=
yer, and=20
that is the most unfair of all  systems.    =20
=20
Kenneth
L. Mattox, MD
Houston

************************************** See what's free at http://www.aol.co=
m.
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This communication is for the use of the intended recipient only.  It may=
=20
contain information that is privileged and confidential.  If you are not th=
e=20
intended recipient of this communication, any disclosure, copying, further=
=20
distribution or use thereof is prohibited.  If you have received this=20
communication in error, please advise me by return e-mail or by telephone a=
nd=20
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[ccm-l] Employment and benefits manipulations