PS– One last note: it was parasitic trial lawyers that got rid of the Ford Pinto, the Corvair, side-saddle fuel tanks, that got safety glass in homes and cars, and that generally expose fraud and corruption. Or did you think corporate America would do those things on their own because it has a conscience?

Whether or not I “like” your answers is really immaterial. That comment is a smokescreen. As far as your answering Okulus’ points – no, you didn’t really address all of them, such as the point Okulus raised about discontinuing insurance contracts not being equal to abandonment. It sure as hell isn’t abandonment – though obviously it is in your philosophical world view. And you certainly didn’t take issue with my point about the non-existence of the “social contract”.

And, yes, Crim, patients do have a choice, and they exercise their right to choose all the time, whether it be in South Jersey, where I am, or elsewhere. While they may not be able to financially be able to exercise their freedom to choose, that is NOT the fault of physicians, but that of the system. Just don’t try to falsely link doctors to your perceived lack of patient choice. After all, we didn’t create managed care.

As far as the sphere of “unreality” that I live in, it is the one where idolatry of humans is put in the garbage heap along with the idolatry of that which is created by the mind of humans.

And yes, patients do not have a choice. Do you really wish to get into a debate of how much choice there can be and actually is in the current system?

Crim,

You live in a fantasy world. Patients have no free choice? What sphere of unreality do you live in? And you didn’t even address Okulus’ points. As far as your bogus point about a “social contract” – actually, while physicians have continued to provide free care, and continue to provide undercompensated care (well, maybe not in your sphere of unreality), the government, insurers, the legal system, and , yes, even patients themselves, have broken that contract time and time again. So don’t even try to play that tired old cliche – it’s meaningles in this day and age.

“The curse of medical education is the excessive number of schools.”

For all of the “do no harm” and “we are special” pabulum put forth by the providers to obtain their position since the time of Flexner, we see little of upholding of the social contract when it comes to responsibility commensurate with the privileged system in which domestic allopaths operate within (competition kept to a minimum, perpetual employment and special legal privileges available to no other profession). If the providers are unwilling or unable to meet their responsibility and wish to be treated like everyone else (including the abandonment of patients because it might cut into the six figure after expense renumeration) then we can start by dismantling the market privileges of the providers. You must realize that patients have no free choice. The onerous restrictions of Flexner saw that such would be the case.

As far as picking a place where one can train equally qualified providers one need look no further than the Tijuana Techs of the world… the schools from which graduates need to simply pass Steps I-III of the USMLE (being held to a higher standard no less than their domestic counterparts) and complete a residency in order to practice domestically. Completing a residency and having higher requisite scores on the boards… actually sounds like a bit more qualified than their domestic brethren.

So supply and demand rationalizations are fine, except when you decline to sell services below what your costs dictate you should sell services for. Then it is “abandonment.”

Nothing like having your cake and eating it too.

You play very loosely with abandonment as an idea, for someone who pretends to be a rigorous thinker.

Abandonment does not mean declining to accept third-party reimbursement schemes that underpay or become unreasonable. Sorry, if I refuse an insurance plan and a patient who will not be willing to pay be out of plan decides to go elsewhere, that isn’t abandonment. Neither is it abandonment if I am the last doctor in my community to terminate a relationship with an abusive insurer, leaving those who will not see anyone else outside of that insurer’s plan to travel elsewhere for care. That is free choice, mine and my patients’. Sure it can be inconvenient; since when is finding goods and services at rock-bottom prices always convenient?

Supply restriction? That is your old canard. Show me where you can make qualified physicians quicker and cheaper. Name a place where the training is at the same level of quality or better and the true cost is any less than here. I doubt you can (and please, Mr.. “economist”, don’t forget the real costs of education in all those European quasi-socialist wonderland states that get passed on to the taxpayers. That is plenty expensive, and you know it, it just doesn’t get counted in their fictional per capita health expenditures as it does in the USA.)

My credibility is just fine. It is why I go unrefuted on my points after hearing the usual nonsense of X years of schooling or best and brightest or some other of the usual nonsense and depose it with the basic economics of why the provider class is paid what it is (repeat after me… supply side restriction). Most of the providers also do rather poorly when it comes to their defending of abandoning existing patients for purely fiscal reasons while yet claiming to be “noble” or “caring” or demanding that their privileges be retained. I am here anytime you care to take a try.

~Criminallopath~

Payment plans where the first check has “payment in full” written on the memo, trying to play the game that the single check constitutes full payment. It’s not enforceable in my state, but they try it anyway. They go on to spread the story of the evil heartless doctor.

Though I must admit, when I’ve seen the stories of medical entities taking a really hard line, it’s been the corporate entities, especially hospitals and hospital-employed medical practices. The doctors don’t have the ability to modify their billing because of their employee status.

I can modify billing ’cause I’m independent. Though MANY patients have taken advantage of it.

Oh, another trick is claiming no insurance, asking me to discount their bill, then telling me several months later, oh by the way, they really did have insurance at that time, and the insurance further discounts my discounted bill, and now I owe the patient a refund.

And they’re shocked, SHOCKED, to find out I dismiss them from the practice. They think I’m a public utility.