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[Leslie <cayadopi AT yahoo.com>]

When I lived in S FL, my own personal doc and her partners didn't take 
insurance.  They worked full time, and her office was always packed.  We all 
got great care, and if your needs required it, you got a lot of face time 
with the doc - not to mention they actually phoned you at home with results 
instead of making another appt (just to bill ins co).
 
On the other hand, I had a great debate with another doc,a surgeon, who 
believed that without insurance he couldn't survive.  Shortly after the 
debate he lost his license to practice...malprractice suit/guilty.  His job 
after?  Reviewing other docs work in other malpractice cases (for 
plaintiffs...) ... ironic.
 
 
 
On 4/1/2010 2:47 PM, Leslie wrote:
> Agree, health care bill is going to worsen things in rural areas, etc.
>    

It's odd how things work out.

I'm not sure of all the reasons, and I suspect there would be many if 
someone were to make a study of it, but I wouldn't expect to see much 
change here in the way physicians' practices go.

One reason is that the upper New England area is not where one goes to 
be rich; that's pretty much a given no matter what sort of work one 
does, so while we have some doctors here who are "in it for the money", 
they are not in the majority.  Another reason is that in New England in 
general and VT, NH, and ME especially, people don't much care to be told 
what to do: independence trumps orders every time, or maybe that's 
stubborn bullheadedness, but either way, people tend to just put their 
heads down and walk into the storm.

Ever since I've been here (bit over 20 years now) there have been a 
number of doctors, PAs, NPs, etc that do not take insurance of any 
kind.  For the past 15 years or so the numbers have increased to be 
about 3-4 times now the number there were when I came here.  From 
talking to people who've been here longer than I, that seems to have 
started when insurance companies began demanding that there be time 
limits on appointment times.  Then came refusal to pay for certain drugs 
for arbitrary reasons, followed rapidly by demands for limited 
referrals, billing-structure regulations, control of specialists' intake 
of patients, etc.  None of those things went over well and over the 
years there came to be more and more folks operating independent 
practices.  Their fees are much lower, care much better, and the 
frustration and expense of dealing with insurance companies means that 
everyone stays in a better mood all the time.  I deliberately work for 
an independent practice and the difference from an employee point of 
view is profound.  There has been increased pressure from various 
insurance companies over the years to "bring them in line" but to no 
avail.  Then they (ins) began to try and pressure for legislation to 
make changes but that laid an egg, too.  Finally they seem to have given 
up in the last few years but I notice they never miss a chance to take a 
dig at the quality of care here....falls on deaf ears here.

I'm not sure what the income averages here, but I know of the several 
medical caregivers immediate to my area that they are well above the 
$100, 000 mark.  Disregarding income increases, quite a number of 
doctors here work only 2/3/4 days a week: enough for an income that they 
perceive meets their needs, and that's that.  One is a full-time farmer, 
another teaches and does some traveling for an ecology-education group, 
various others do whatever it is they do, but the common factor is that 
they are at work when they want to be, home with their families much of 
the time, whatever.  Overall, it seems to have been an equitable 
agreement and helps keep the community strong; there is much less of the 
'them vs us' kind of grumbling around here than there was where I came 
from.  I think it's the case because professional people mix right in 
with everybody else for a school activities, or contradancing, 
clean-the-beach day, potato gleaning, whatever's going on, they and 
their families tend to be part of it all, rather than what would be seen 
as "too busy" or worse yet (around here), "too good".  They drive Subaru 
or Toyota like anyone else.

We still have quite a number of doctors here who initially came to Maine 
as a part of a program that promised to pay school fees (don't know 
whether part of all) in return for X years at a rural health post.  A 
lot came here to ditch their school loans, then stayed for money to 
start a practice, and are still here many years later.

It seems to me that this model could/would work in many places but when 
I mentioned it to a midwestern friend (physician) I thought he would 
have a stroke; he strongly believes he has to have the insurance money 
or go belly-up.  Can't be the case because there are any number of 
doctors there who treat the German Baptist and Amish groups in the area, 
and none of them are taking insurance, for sure, since neither group 
believes in insurance.  I often hear the excuse that "those doctors are 
from their own churches, that's why they can get away with it" but I 
know of 5 doctors in the county where I grew up who don't take 
insurance, and only one of them grew up German Baptist and stayed in the 
church.  He went to school on German Baptist money because when he was 
in high school that church decided to send a student to medical school 
in return for the agreement that said student would return to the 
community and practice.  Seems to have worked; when I was there in 2007 
he was looking forward to retiring, which he is scheduled to do as soon 
as the next student they sent is finished school.    They just lost a 
doctor age 52, sudden cardiac failure of some sort, who was also in the 
church but did not have church-funded schooling, not sure who will take 
that practice.

As to the Amish, they simply don't stand behind that much schooling but 
are willing to pay for someone with unlike beliefs who did go to school, 
hardly a 'one of them' situation....  These guys all make house calls, 
have hitching rails (and sheds),  and cope on a daily basis with the 
fact that telephones and electricity are not part of their patients' 
lives, along with all sorts of other issues peculiar to working with 
plain people.  They all take patients who are not German Baptist or 
Amish, but none of them take insurance of any kind.  Three that I know 
of will trade for farm goods, horses, construction labor, other things, 
don't know about the others.

So there are obviously two ways to deal with medical coverage (human, 
not insurance coverage) that for the most part seem to be intensely 
regional and mostly rural, but there are other ways, too.  Why more 
people don't look around and start asking questions and initiating 
changes I don't understand, but I get the feeling that too many people 
in this society are waiting for someone else to make the decisions, and 
then they scramble to adjust to the status quo and grumble interminably 
about how it's not working for them.

I read an article in the weekend paper about how doctors somewhere are 
up in arms about the anticipated new insurance payments/non-payments, 
and knowing how many practices rely almost totally on insurance 
payments, I understand their angst.  But maybe they will be the very 
ones to make the sorts of changes that make their own lives, and that of 
those in their respective communities, both more productive and more 
satisfying.  Or maybe not, maybe they'll just go on acting like the 
victims they've allowed themselves to become.

SJ, who enjoyed the beautiful spring day by clipping19 goats 
(neighbors') and one dog (mine) today.  Hooves and nails tomorrow.....
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From: sjc <indexer AT fairpoint.net>
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sjc wrote:
>
>
>  We still have quite a number of doctors here who initially came to
>  Maine as a part of a program that promised to pay school fees (don't
>  know whether part of all) in return for X years at a rural health
>  post.  A lot came here to ditch their school loans, then stayed for
>  money to start a practice, and are still here many years later.
>
>  It seems to me that this model could/would work in many places but
>  when I mentioned it to a midwestern friend (physician) I thought he
>  would have a stroke; he strongly believes he has to have the
>  insurance money or go belly-up.  Can't be the case because there are
>  any number of doctors there who treat the German Baptist and Amish
>  groups in the area, and none of them are taking insurance, for sure,
>  since neither group believes in insurance.
Way back in the early 80's, I entered med school on one of those
'deals'.  Things may be different now, but back then, only poor kids
with a dream, like me, students who wanted to become a doctor but could
not qualify for specialty scholarships or weren't from a family of
physicians for four generations back, only those of us who fit no place
else, were willing to sign away potential profits for years to pay for
school.  Even back then, the goal was to line one's pockets, not to
provide a service.  Those of us who intended to go into research or play
non-traditional roles were usually the ones who signed up for rural
servitude.  I still think it is a great idea.  In fact, I think that all
physicians should have a year of rural practice added to their residency.



>  As to the Amish, they simply don't stand behind that much schooling
>  but are willing to pay for someone with unlike beliefs who did go to
>  school, hardly a 'one of them' situation....  These guys all make
>  house calls, have hitching rails (and sheds),  and cope on a daily
>  basis with the fact that telephones and electricity are not part of
>  their patients' lives, along with all sorts of other issues peculiar
>  to working with plain people.  They all take patients who are not
>  German Baptist or Amish, but none of them take insurance of any kind.
>  Three that I know of will trade for farm goods, horses, construction
>  labor, other things, don't know about the others.

The first time I went up north into 'Amish land' (it was actually a
little Mennonite town in southern Iowa) I saw what impressed the heck
out of me....
There in this quaint little town, where the streets were lined with
parking meters and stores you might have seen prior to WWII, was a
3-story veterinary hospital...the tallest building in town!!  That told
me that what you say is true, that while the Amish and other close knit
societies support their own where they can, they also support those who
are more educated than average.  No insurance for farm animals, but
apparently vets do quite well in a community that depends on animals for
transportation and food.   I later noticed the same phenomena in towns
in Illinois.
I guess I'm just saying that I agree that good healthcare, for animals
or people, doesn't require insurance, if the provider is in a network
where no insurance is the norm.  That's funny coming from me, the one
who relies on expensive arthritis meds to stay moving.  I can't even
reconcile that dichotomy within myself.


>  Why more people don't look around and start asking questions and
>  initiating changes I don't understand, but I get the feeling that too
>  many people in this society are waiting for someone else to make the
>  decisions, and then they scramble to adjust to the status quo and
>  grumble interminably about how it's not working for them.

You're right, and that attitude is only getting worse.  So many of us
wait around on other people to make the decisions in our lives.  No one
is proactive anymore.  It is all about grumbling over the status quo...a
competition of sorts as to who has it worse.

>
>  I read an article in the weekend paper about how doctors somewhere
>  are up in arms about the anticipated new insurance
>  payments/non-payments, and knowing how many practices rely almost
>  totally on insurance payments, I understand their angst.  But maybe
>  they will be the very ones to make the sorts of changes that make
>  their own lives, and that of those in their respective communities,
>  both more productive and more satisfying.  Or maybe not, maybe
>  they'll just go on acting like the victims they've allowed themselves
>  to become.

I don't see them as victims in the same way I don't see those
non-bonused CEO's as victims. They have lined their pockets and worked
the system for years...took their vacations to Europe, bought their kids
Porsches and college degrees, ate at the finest restaurants and played
on the best golf courses, etc.  I know how greed has shaped their
lives.  What is about to happen is kharma.  What goes around, comes
around.  They will either accept it, or quit and whine about it.


>
>  SJ, who enjoyed the beautiful spring day by clipping19 goats
>  (neighbors') and one dog (mine) today.  Hooves and nails
>  tomorrow.....

I am so glad to hear that you are up and about again.  I would ask how
the knees are, but I see you are better than ever...

Bev


--
The democracy will cease to exist when you take away from those who are
willing to work and give to those who would not.      Thomas Jefferson