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Fri Apr 6 18:38:02 BST 2007

Actually in that case hypocritical would be the term, not cynical.  I
hold those upscale hypocrites in the same light as all the others who
want to take everything from everyone and give nothing to anyone.

>>> "Offner, Patrick" <PatrickOffner at Centura.Org> 4/6/2007 1:33 PM >>>
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 would rather have a BMW or a large flat screen TV. Yes--getting
cynical. 

-----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
medical care pay for their root canals?  In fact, how many actually have
any dental care at all?  None.  They go to the free clinics at the large
city hospitals and get their free dental care (that we all pay for),
while the dentists 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.  Same with the "cosmetic surgeons" or "sports
medicine" ortho guys who do their 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 at 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%)
when 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% of 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. 
The dentists somehow seem to have gotten it right. They get 50-80%
reimbursement 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 days per week, rarely take call and make a lot more money
than I do. We on the other hand get about 30-40% of what we bill and are
contractually prevented 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 but not for their emergency appendectomy or
their elective colon cancer resection? 

-----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. 
Not part of the solution - a free lunch and an excuse for all of the
"disenfranchised" 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 afford them. Your "fix" is just the tip of the iceberg--we also
need insurance reform as well as tort reform--it is all intertwined. 

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

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

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

Of the  30 -40 million US uninsured how many are the fast driving drug
addicts, 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   
working poor, in jobs that need filling but just dońt get paid very
well , certainly not enough to part with 1,200 a month...  maybe the
receptionist 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 disabled,  the folks in the other car, the
unemployed, the unemployable, good cannon  fo dder but No FREE LUNCH.
Never mind that the free lunches are served up in  corporate board
rooms every where, provided by the moms and pops investing in  the great
enterprises that won't provide health  insurance.

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

These same individuals do not have state sponsored lawyer  aid, housing
aid, 
church aid, food aid, family counseling, cell phones,  etc.   Why must
or should 
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 alcohol every day, go to cock fights, and  have somewhat expensive
watches and designer 
glasses.   I see them  every day, and then they expect FREE medical
care.   
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  
income).   If they need to go to court, they must pay for an 
attorney.

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 provided  all creature comforts from the cradle
to the grave.  That is a family and  an individual responsibility.  The
governmental responsibility is to  protect, NOT 
PROVIDE.    

We in every society MUST also address the HUGE profits from insurance
companies, HMOs, and hospitals whose overhead and payments to upper
level  
management and stockholders are obscene.    The persons who have  been
unfairly
burdened with the financing of individual health care has become  the
employer, and 
that is the most unfair of all  systems.     

Kenneth
L. Mattox, MD
Houston

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[ccm-l] Employment and benefits manipulations