Are MDs diagnosing us into the poorhouse?

I can agree that a large amount of the time that people are run through the ringer for the benefit of the hospital. But there are many many levels to this problem, some of which I feel like the writer is overlooking.

First off it has to do with the fact that the medical industry is just that, an industry. While many people will not believe it, hospitals are very often barely making any profit. Let's look at why this is possible: tests cost plenty to begin with. Add in the salary of a number of doctors (there is a reason you go to school for 7+ years) and then the costs of staying on top of medical technology and equipment and simple upkeep and you have a large cost. This isn't your corner Mom-and-Pop store!

On top of this is how do we divide the costs? if lower prices and less abuse by the hospital are required, then there will be a disparity between hospitals. A very good hospital will have all the newest equipment and if their clientele can afford it, then there will be a gap between that and the other hospitals. Now if the government is to take on the costs, then obviously healthcare reform will cost the nation a huge amount and will probably cost those that have the money (the rich). Sadly, that can only be done to a degree, otherwise there will huge problems. Right or wrong, the money does talk. Finally, if the costs are put onto the people, specifically businesses, the amount of money injected back into the economy (outside of medical care) decreases and workers will probably encounter paycuts, which causes its own problems. So, where do we go? What do we do? Personally, I do feel like healthcare should be provided and I do love the idea of care for all people but we should remember that there are also other ways of being taken care of. As bad as they can be, there are free clinics available. See, I wish there was a good answer and there isn't. Hopefully our full government will figure out the answers and both increase the quality of living for all people while also helping the whole nation to survive. Talk about being between a rock and a hard place.

TO Josh, Huntsville, AL: July 27, 2009 9:13 am

What Lobbyist or special interest group do you work for

How come noone is discussing unnecessary c-sections as another HUGE unnecessary expense? First time low risk mothers are subjected to major surgery in the name of patient choice, defensive medicine or because OBs want to get home before dinner or bedtime. Don't believe me? Studies show that the number of C-sections spike at two times of the day- 4-5 pm and 9-10 pm. World Health Organization says that the actual necessary c-section rate is between 5-10% and countries with more than 15% are putting their mothers at risk- C-sections carry a much higher risk of death, infection and breastfeeding problems- not to mention a price tag 4-6 times that of a vaginal birth. US hospitals range from 25%- 35% (some in Florida are higher than 50%!). That's one in every three women that has a baby that ends up with surgery. And now- because ACOG and malpractice insurers have discouraged or "outlawed" Vaginal Birth After Cesarean (VBAC)nearly every first timer that has an unnecessary c-section has another unnecessary c-section. And this after studies show that VBAC is safe- at least as safe as a c-section and that the safest VBAC is one that uses the doctor's skill at prescribing drugs minimally.
Planned homebirth with a midwife has been shown over and over in studies to be safer for both mother and baby for healthy low risk moms, with less complications than the same types of mothers in the hospital, less risk of infection or intervention and higher patient satisfaction. All that at half the cost of a hospital vaginal birth or 1/8 the cost of an average surgical birth. Yet it's not a covered benefit for most insurance programs or govt plans for uninsured women. The US spends more on maternity care than any other Western nation, yet we rank below all of them in maternal and neonatal morbidity. The countries with the lowest maternal and neonatal death rates all have something in common- most low risk women are seen by midwives and many birth at home. Why is it that women all over the developed world are encouraged to do what is healthier, safer, happier AND cheaper, and yet US women are cut open and put at higher risks (infection and death) at ridiculous rates?
Encouraging evidence based medicine means telling pregnant women the truth- if you are healthy and low risk, the hospital is not the safest place to have your baby, and if you do want to be in a hospital, the healthiest care provider is a Certified Nurse Midwife, not an OB. OBs are for high risk women and women who need surgery.
ACOG will not stand to see women to be encouraged to use someone who is not a union member (i.e. a CNM or any type of homebirth midwife), and I'm positive they are at the table, negotiating away…

Really and what about the impact of law sues? Don't you think it plays a major role in all this mess?

obama is putting us in the poor house !!

You're darn skippy these doctors are going over-board and they don't even know anything! As a speciallist and unfortunately a patient earlier this year, I tried to tell these over-educated but no smarter gloried thugs that I did not have cancer and more tests (which in that situation would have been more cost effective for me than being forced to that Wash U cesspool in St Louis) should have been ordered and not simply go by cat scan. I only had PE of the lungs and they should have just concentrated on treating that instead of working on giving me a heart attack saying I had cancer! It is very upsetting that these mean and sadistic so-called professionals think that just because they THINK they're saving your life that they can BILL you out of house and home! What good is a life saved if the quality of it is severely threatned financially!!! And these same doctors who are so willing to help third world countries with none-life saving plastic surgeries should be BANNED from doing so if they can't even help US-grown citizens with REAL health issues free of charge. And as for the other corrupt profession, lawyers, I agree with one person's commit that losers should pay like the English system. It's time we stop screwing each other in this nation financially! Even the mafia had more
class and honor when they ran their organization!
Dr Brooks

We hear a lot about how our healthcare system is broken. What's meant by that is that the healthcare system is becoming unaffordable, leaving many, both insured and uninsured with large bills.

But the healthcare system is broken in another sense as well, and that is that much treatment simply doesn't work, yet we hear little about this. Despite the outlays for research which is supported by high drug prices, we still don't know what causes most diseases, including heart disease, cancer, M.S., Parkinsons, schizofrenia, autoimmune diseases and many others and as a result we don't know how to cure them. As for treatments, we don't understand how many of them work, and all we have in most cases are some vague correlations painstakingly filtered out in large drug trials. Most treatment only suppresses symptoms, at a cost of damaging side-effects, which then require more treatment. Thousands are killed each year by aspirin and NSAIDs and we are all aware of the horrible side effects of chemo therapy. Yet we approach the whole system very mechanically, as if we're fixing cars: test – diagnose – treat. It works fine for broken legs or T.B., but not for most the diseases of aging. Yet we keep doing it, and doing more and more of it, because we don't know what else to do.

To those who demand universal cheap health care: everyone is not entitled to the best available healthcare. Healthcare when it comes down to it is another big business. It should be regarded as just another commodity like a car. Is everyone entitled to an expensive luxury car? No, and so it should be with medicine. And all this crying over the 50 million or so people who don't have health insurance in the US? Please. Most people have insurance, why should the majority have to "bail out" the relatively few again? Just another method of redistributing wealth.

Love to see parasitic lawyers get weeded out of the healthcare cost but it'll never happen because they run the country.

It was very interesting to find Obama's personal physician doesn't believe Obama plan will work and even worse….Obama speak just like a lawyer when it comes to TORT reform.

http://www.forbes.com/2009/06/18/obama-doctor-knocks-obamacare-business-healthcare-obamas-doctor.html

The fear of being sued drives physicians to test for everything. Eliminate lawsuits eliminate over testing. No brainer.

Here’s an interesting concept that would never fly with the current administration: SOCIALIZE THE LEGAL SYSTEM. If attorneys got paid the same amount whether they won or lost, they would just work on cases based on their merit, NOT the likelihood of getting a huge payout. It would decrease frivilous lawsuits and provide a much fairer system of compensation for being on the bad outcome of negligence. Right now they get paid on contingency so that they only chase after huge lawsuits.

Why doesn’t anyone talk about that?
_________
Or how about Loser Pays like in Britain?

I am 34 years old and work for a company which does not give its employees any health insurance. This is absolutely true. Some doctors will order every diagnostic test under the sun before they make a diagnosis…and your bank account will be far overdrawn unless you are independently wealthy. It becomes clearer to me every day that health care in this country is for the rich, and those who work for companies who will give it to them for free. Everyone else can just go fly a kite – stay home, get sick, and die. Who cares? At least everyone in the White House is well taken care of…. Actually, I go to the local AIDS/HIV healthcare center to get my medical treatment, even though I am HIV-negative. Why do I get to go there? Because I'm gay and have a higher risk for HIV than Jon Q. Public, and get tested there every few months. They don't pressure me to pay my bills at the time of service, like 99.99% of other medical offices demand…I pay on my account a little at a time every month. God Bless them. If the people in the White House continue to let healthcare spiral out of control, this is what will happen – the E.R.'s will continue to be full of sick people who can't pay their bills, even though the signs posted on the door say "PAYMENT EXPECTED BEFORE DEPARTURE". But since they are E.R.'s, everyone is supposedly entitled to the very best of care….even if it means you die of a heart attack because they have only one doctor on duty who is dealing with 20 other patients. GOD BLESS AMERICA…..

I'm the retired realtor (still no axe to grind). For those complaining about the profits of drug and medical device companies, please remember that those profits not only compensate for the delivery of product and the necessary related profits in the U.S., those profits also have to constitute the bulk of the return on investment for the delivery of product – drugs and devices – in Europe and Canada as well.

Just as Medicare shifts costs to the private sector by paying twenty percent less than market, Europe and Canada shift costs to the U.S. (including for European-based drug and device makers) by limited what Europe and Canada will pay for drugs and devices. The result is that all the profit that is going to be reaped by a particular drug or device maker, including European-based companies, has to come from the U.S. consumer.

When viewed this way, it may well be that European and Canadian universal care can only continue so long as this massive U.S. profit subsidy to their expense structure remains in place, just as the private U.S. system subsidizes Medicare and Medicaid and keeps their deficits from being even worse.

We can also limit payments in the U.S. to drug and device makers as Europe and Canada have done, but the unfortunate result will only be a massive reduction in the development of new procedures, approaches and therapies. For the hospital administrator upset by the cost of particular drugs, he has to look to Europe and Canada for cost-shifting to his hospital, and to the Democrats in Congress for the Ophan Drug law which intentionally encourages the development of obscure drugs by promising massive profits if the risk to develop is undertaken.

Obama wants to essentially expand Medicare by five times to solve all our problems. But Medicare "only" has a $37 trillion unfunded liability because it has been able to shift twenty percent of the costs of the program to the private sector. By the way, what's 5 times 37? Will Obama's plan, if enacted, within twenty years, have a $185 trillion unfunded liability (completely un-adjusted for inflation, let alone health care cost increases which exceed the average rate of inflation)? Maybe that plus twenty percent on top, because there will no longer be a private sector to whom costs can be shifted.

The assumption is that Europe and Canada work and that we should adopt what they do. But Europe and Canada only work because of the massive profit subsidy which European and Canadian caps on reimbursement shift to the U.S. economy. European and Canadian taxes are also lower than they might otherwise be because they have relied on the U.S. defense umbrella to a large extent for the last sixty years. Seems unrelated, but the less they spend on defense, the more they have for healtcare without busting their economies. If they paid completely for their own defense and stopped cost-shifting health care costs to the U.S., would their economies have collapsed a long time ago due to out of control government spending?

That’s the road we are heading down right now, because nobody can afford to subsidize us from a health care standpoint, and nobody else is capable of stepping in to defend us. In the U.S., the buck stops here.

Zack in Houston your ignorance is showing. I wish in med school I could've found out where to get school paid for. Nobody offered to pay for me. I have $200k worth of debt to show for it. I have no idea what you are talking about as far as getting med school paid for. Also, our salary during the 3-6 years of residency is 40-50k/yr. Working 70-80 hours per week. Assuming 50K and 70hrs/wk thats less than $14/hr. Great. Pull RNs can get up to $50/hr. NPs/PAs with less education make much more than us.
As to flooding the US with Indian doctors, don't even get me started. I know plenty of FMGs (foreign med grads) who are here ONLY for the money. They will go ANYWHERE there is a dollar to be earned. I trained with a number of them and that is ALL they talk about. And their training may be suboptimal (many of their schools are unregulated).
Next, many studies show that most doctors DO NOT get sued and do not "screw up". It is actually a small portion who commit most of the errors/get sued.

Let me ask you all a very simple question:

Would you buy a loaf of bread if the person at check out said, "Ohhh don't worry about it…we will send you a bill in the mail." Well how much is the loaf of bread you ask? Is it .50 cents….or is it $50,000? "Don't worry…we will send you a bill and it will be somewhere in that range."

Medicine is the ONLY industry in this nation that you have absolutely no idea in the world what your bill is going to be when you walk out the door.

This is obviously a hack job, not legit reporting. It's basic paranoia to blame costs on Dr's prescribing tests for money, but when YOU or your loved one goes into the hospital LETS SEE HOW MANY 'UNNECCESSARY' TESTS YOU REFUSE IN YOUR QUEST FOR RECOVERY.
You are unenlightened and talk as if you actually knew something, hence, a hack.

Obamas trying to throw money into primary care to entice medical students. There a many reasons this won't work, but here's a big one nobodies talking about:

Under his plan a nurse practitioner (ARNP) is considered the same as a family physician (MD). When you hear the term "Primary Care Provider" please realize Obama means MD OR ARNP. The Primary Care Medical Homes will be staffed by either an MD or ARNP and Obama has legislation in place to grant ARNPs the same privileges, scope of practice as an MD as well as pay them as an MD. On top of this, nurse practitioners are now earning a "Doctor of Nurse Practitioner" license and are legally allowed to refer to themselves as "Doctor" in clinics/hospitals.

Don't get me wrong, nurse practitioners offer an enormous value wherever they work. They are a wonderful help. BUT, to a young medical student who is under $250,000 in debt and who will accumulate >20,000 hours of supervised training in med school/residence (NP programs are ~500 hours) it feels like we're cheated to be put in that position. Any thoughts?

I would like to disagree as my father is a highly respectable doctor who does his job, but it may be true that overall there are people out there diagnosing falsely to receive money for unneeded procedures. It's a sad world we live in.

I am simply amazed at many of the comments made by non-healthcare professionals-mainly because it shows the pervasiveness of the failure of our healthcare system to provide good quality information about what drives the cost of heathcare.

I am a hospital administrator for a large not-for-profit teaching healthcare system. I see every day what drives our costs, and very little is spoken about the reasons.

1) Drug companies. Drugs are a vital part of healthcare and are expensive to research and develop. The drug companies reap giant profits from their blockbuster drugs, but rarely are they required to accept less than asking price for their drugs, not are they required to provide them for free to people who can't afford them. When a Medicaid patient comes to one of our hospitals with cancer and has to have a $20000 drug that we have to provide, we'll be lucky to get paid $2000 for that drug. What does the drug company get? $20000. Who pays that?

2) Medical equipment providers. $50000 for a pacemaker? Again, these types of devices cost alot to R&D, but that much?

3) Health insurers. We spend literally tens of millions of dollars playing the insurance reimbursement game. We almost have to beg to get claims paid and waste valuable resources that could otherwise be put into patient care just to squeeze enough money out of the insurance companies to survive. Insurers routinely reject claims for no other reason than to avoid paying for them in a timely manner. Why? Cash management 101. The longer you hold the cash, the more time you have to invest it and add to your profit. By the way-the Medical equipment provider wants payment in 10 days.

4) Regulatory and accreditation compliance. Granted, it is important that a healthcare provider meet certain standards of care, but before you talk about what one thinks is the driver of healthcare costs, pick up a JCAHO manual and read it. We likely spend >10 million a year just to meet some of the standards that are exceedingly nit-picky.

5) Uninsured patients. Forget all the stuff you hear about this and focus on one thing. Uninsured and underinsured patients use the costliest method of healthcare delivery-the ER-in significantly greater purportion than the insured. Your kid has an earache? Take him to the ER. You have a backache? ER it is.

6) Medical malpractice. Our society, somewhere along the way, lost the idea that healthcare is an art form that is based in science. Not every patient is the same, not every outcome can be predicted. Human beings are complex organisms and react differently to every stimulus. I will agree, some doctors screw up and deserve to be sued. Most don't and are good people trying to do a good job. If a patient doesn't react to a treatment as they thought they would, it isn't malpractice. It's human nature. Doctors and hospitals are like slot machines to some people. One day they may get lucky and an outcome may be not as expected and they're rich. Wrong. It's an art form based in science. Think about that next time you go to file suit. The only defense that a doctor has is that they ordered every test known to man to make sure they are covered when they get sued.

That's my list-notice something missing? Physician pay. I believe we don't pay our doctors enough. They see and deal with pain, fear, suffering and death everyday. They are viewed as all-knowing and all-powerful yet they are human and work with some often gut wrenching cases. Before anyone else comments on the reasons behind doctors ordering tests for their own financial gain-please read the Stark laws. Those days are behind us.

In conclusion-it is not my belief that the provider of healthcare is what is causing the run-away costs to society of healthcare. It is society itself-Drug, Medical Device Makers, Insurance Companies, many of them publically held and required by Wall Street to return value to their shareholders (incidentally, our society) and attorneys trying to make a buck for themselves and the patient when an outcome is not what was expected. Fix these issues and we can have some debate about the next problem-providing care to patients that will not benefit from the care…such as the 85 year old patient getting a Coronary Artery Bypass Graft (CABG) as mentioned earlier.

To that neurosurgery student who feels that he is "performing" better that the general practice doctor: I challenge you as to what you mean by perform? I bet what you really mean is that you got better grades. Better grades in the real world does not necessarily translate into your patients leading longer, healthier lives.

As for all those people who think that MDs are overpaid: Med students go into debt big time to just complete medical school. A PhD chemist on the other had makes as much as a general practioner, but get a stipend that covers his living expenses and tuition. You have to be a saint to go into general practice with that kind of debt hanging over your head. Unless the governmetns wants to subsidize the training of general practioners, fewer and fewer med students will be going into that. Maybe schools need to expand their Physician Assistant programs because maybe all the GPs will soon be that.

1. I agree with the posts that people should be more responsible with their own health care and not be given multiple treatments if they continue to abuse their health.
2. Some physicians do tend to over- prescribed pharmaceuticals, especially, to the elderly. My Mom is in assistant living, and its a drug store in their rooms.
3. Has the government considered reducing the amount of money we send overseas to finance US health care reform?

Good article. My experience is that expensive tests, like CT scans, are done inappropriately not because they want to make sure the equipment gets used, but because a physician doesn't want to miss something bad, however unlikely it may be, and they don't want to get sued. Tort reform is the REAL issue.

I have been hearing this argument that doctors spend so many years in school so they deserve more money. This is crab. First of all most do not pay for their final few years of school, actually they do not pay during their residency years, they actually earn a salary. I went to a 5 years college program and will be very happy to make less than half what an average doctor makes.

The solution is to cap their salaries, and do not believe this lie about not many people will be interested in medicine anymore, what is their options? Work at McDonald?

I have no problem with flooding the market with foreign doctors from India for example, as matter of facts in any hospital at the present time most of the best doctors are foreign born anyways!

I really like how doctors see themselves as Gods !! They blame everything on the malpractice lawsuits. The way I see it, if they screw up – and many doctors do- they deserve to be sued like anyone of us.

Anyone ever heard of STARK laws? They prevent physicians from benefitting from "self referral", in other words, what the author is discussing in this article. More often, someone else owns the CAT or whatever is in the Dr.s office and the Dr. is just using it for a fee but has it for the convenience of their patients.

The REAL topic here should be tort reform- restricting frivolous lawsuits. I think Dr.s are more likely to over-test and over-complicate things out of fear of liability. If I were a Dr., I would want to order that MRI to cover my butt. THAT is precisely what is driving the system into the ground.

There is definitely a role for malpractice litigation in medicine- there are incompetent people in every profession and they should be held accountable. BUT, let's stop suing these people for every little thing and maybe they could relax and just take care of us.

I am a retired realtor (no axe to grind in this post). Using CNN's Top 500 in Business from a few weeks ago and dropping the info in an Excel spreadsheet (Microsoft return on revenues is 29.26%), the average profit (profits as a percent of revenues) of the 200 most profitable worldwide is 11.11%.

The average profit of the 27 largest insurers worldwide is 0.62% (less than one percent).

Here is the return on revenues percent for insurers using CNN's posted data. None of the 27 insurers came anywhere close to making the average of the top 200 companies:

MetLife 5.83%
Aetna 4.47%
WellPoint 4.07%
UnitedHealth Group 3.67%
Meiji Yasuda Life 3.25%
Sumitomo Life 2.86%
CNP Assurances 2.78%
Power Corp. of Can. 2.32%
Nippon Life Insurance 2.27%
Humana 2.24%
Northwestern Mutual 2.22%
Japan Post Holdings 2.12%
AXA 1.68%
Dai-ichi Mutual Life 1.66%
Manulife Financial 1.57%
Cigna 1.53%
Assicurazioni Generali 1.22%
Hanwha 1.07%
China Life Insurance 0.87%
Samsung Life 0.38%
Cathay Life Insurance -0.21%
New York Life -3.02%
T&D Holdings -3.51%
Prudential Financial -3.67%
Aviva -4.73%
Massachusetts Mutual -4.93%
TIAA-CREF -11.39%

In an effort to solve this problem, I think we need to stop blaming the profits of insurances companies or think we are going to find money by looking there. Insurance companies perform a valuable role. But if you don’t allow them to make money, capital will flow, given enough time, to other endeavors and the insurance companies will simply cease to exist. If we don’t think they are valuable, we can get rid of them much more efficiently through immediate legislation.

Dear Colleagues,

I am a nurse; I see the problems with health care, the inequalities, and the problems of the uninsured, who often just let their health go until they get so sick they need Medicaid. And, if they work, they are penalized. We just can't have it all. There, to me, should be limits on transplants, heart surgeries, etc., that is people over 85 should not have a CABG, alcoholics should not have new livers, etc. And there should be some sin taxes: more on tobacco, which we know causes us all to pay more, MUCH higher penalties for drunk driving offenses, etc. There just have to be consequences for bad behavior, not rewards. Why take care of yourself, why be prudent, if someone else will pay for it?

Thank you,

Ann Marie Brooks, RN, MSN

Funny on how no one picks up on how much that insurance companies are profitting on the relationship between doctors and patients. It is terrible for the system, the doctors are limited, the patients are limited, and we are all paying more because of it. And the government supports them! All because the average person can't be responsible enough to save money in the case that an unforeseeable medical problem comes up. I understand that there are a lot of meditcal services that are very expensive, but thats life, and you can't avoid it or repackage it to make it seem like less. If you really need something expensive, we should do what we do for other things such as cars and homes, take out a loan. We shouldn't let the insurance companies police us like children. I blame them more than I do the doctors.

sure they are. i can't find anyone who will do more than treat symptoms even with the full history and scans in front of them. rrrrrrrrrrr

s from Cleve, OH:

"doctors over-test, and over medicate because of the financial incentive…it’s all about the $$$$ and not about the patient at all…patients are faceless bags of money…"

Why don't you get you facts straight before you post such idiotic drivel. I don't know any doctors who get income from medications they prescribe or tests that they order.

There’s lot’s of money to be made in healthcare. Just ask the malpractice lawyers, and the insurance and drug company executives whose income would dry up, if doctors quit working. Unfortunately, doctors are not business men and they have wound up practicing medicine with these parasitic freeloaders on their backs. So, if doctor’s salaries are limited, don’t be surprised to discover that the outcome would be similar to killing the goose that laid the golden eggs.

Any healthcare reform without Tort reform is a joke. Many on the board has already pointed out defensive medicine is what raises the cost of medicine considerably along with insurance companies.
Are all doctors against Universal care? No, it will probably cut down on our overhead considerably. However, we are worried about rationed care in a society that won't accept this concept. Sure, point to Canada for healthcare. It's great to see you family practice doctors but you have cancer…wait 3 months just to see your oncologist ( you'll maybe dead by then). The public's expectation will need to be transformed. American people will not take no for an answer. We want 2nd and 3rd opinions and experimental drugs (that's very expensive).
The neurosurgery resident is an idiot. I wish his/her program director would read the comment kick him/her out of medicine. You are exactly why the public think doctors are greedy SOBs. BTW, I bet we'll be able to find someone to replace you in a heart beat. Someone just as talented but with a little more compassion and humility.
There are no doubt financial involvements with the medical profession. It's no different than any job or profession. Doctors are just people who at the end of the day still have to pay their bills and loans. A doctor's office is treated as a "small business" in the books of IRS. People who work for us EXPECT to get paid. There is nothing wrong with making a good living while saving lives. Most physicians I know go into medicine to do BOTH. Somewhere along the line SOME physicians lost sight of taking care of people and became greedy (you will find those in any profession). Question is how do we take excessive financial gain from physicians without penalizing them. You don't want to lose the most intelligent people to other professions but unfortunately unless you reward them, they will look else where. This is reality. Last time I checked, we pay athletes millions to play a GAME and CEO of financial companies hundreds of millions….somewhere along the line, the value of the entire country is misaligned with our beliefs.

Back to how to change a doctor's incentive and change our healthcare system.
1. You INCREASE physician pay. That's right! You need to pay someone to goes though at least 7 years of post University education with huge loans. I don't know how to get to a right formula but you increase the pay but take away other associated financial "benefits", ie. owing labs, x rays etc. You make sure the doctor is well paid for doing what they do best….DIAGNOSE, TREAT and PREVENT illnesses. You pay them well enough that they don't feel the need to do "other" things and continue to attract the brightest minds to this field. Give bonuses for treating according to guidelines.
2. Universal healthcare system run by private sector with government oversight. Other systems may works as well but this is easier.
3. Healthcare sales tax on all goods and services. Everyone consumes. Therefore, everyone pays. Wealthy consume more and will pay more. Illegal aliens will consume and pay as well. I think it's foolish to continue increase income taxes. This theory of robbing the rich to help the poor will only go so far. You want healthcare?! You'll help pay of it!!
4. Tort reform. Losing party will be responsible for all the legal expenses and income lost. The lawyers must have some financial disincentive to take bad cases. Place some type of CAP for damages.
5. Disband most of these health care insurance companies. All they do is MAKE money (the American dream). Why they never refund any of their profit to people who pay excessive premium is really beyond me? Bluecross made $2.5 billion profit in 2008. Believe it or not, insurance companies often dictate your healthcare now.
Why does Government only take the old and the sick and leave all the healthy patients ($$ profit) for the private insurance companies is really beyond me.

Funny that Pres. Obama (a lawyer) is willing to decrease the reimbursement for physicians, but not willing to limit litigation against physicians.

Pretty amazing that the only ones making a decent living in healthcare are the ones who know nothing about healthcare.

A physician can treat 100's of patients, save 100's of lives and get sued (sometimes without committing malpractice) and be ruined for life.

The lawyer who helps a single patient in a malpractice suit can be set for life!

NOT GOOD HEALTHCARE

Wow! To the neurosurgery resident, who do you think takes care of your patients who develop complications, you know the ones you do elective surgery on, then go on to develop a spinal hardware infection, then which you ignore until the medical subspecialists then tell you to remove yet you do so at your own pace as the patient gets septic. Oh yeah what about that elective 65 year old you decided to do a microdiskectomy on, but then develops post op afib and goes in to pulmonary edema. Sound familiar? Yeah you're a neurosurgeon but when you're a gomer you'll pray for the medicine team because frankly they will be the only one who gives a damn. PS I am not a family practioner, but double boarded and taking care of your patients on a daily basis.

"Nothing is going to help healthcare if the U.S. don’t do something about what they let doctors make.Also doctors and drug company’s have a long standing arrangement to sell drug’s this also has to stop or nothing will help healthcare reform.Any one seen a drug ad on tv there trying to sell stuff with more side effect’s then the sickness itself this also has to stop.

health care reform and what it means to you

1)limit what doctors can make as a salary or what they can charge.

2)make all payments made to doctors tax credits so everybody has to turn them in

3)limit what drug company’s can charge for meds and make them tax credits for the person paying for them."

I have to respond to this post. I am a physician and know nothing of any "agreement" doctors have with drug companies to prescribe medicine. I make no more or less on what I prescribe, and only prescribe what I deem necessary for the patient. Why would I prescribe a drug with side effects for fun? The answer is: I never would. If you want to limit what doctors make even more (we are already limited), then guess what, you won't have people entering medicine of the caliber they are now. We are already greatly limited by contractual agreements with all insurance companies, including medicare and medicaid. So, for number 1, your comment is invalid. I would love to have all medical expenses tax deductible, but it will never happen, because the government then gets less money and then can't fund all its programs for the so-called "crisis" we are in. About 48 million are uninsured, one third of which are illegals, and one third of which are young and don't want health insurance and choose not to have it. That leaves about 16 million uninsured, which still receive care and either pay out of pocket or don't pay for numerous reasons. Are we all willing (about 250 million of us) to give up what we have for government run rationed care for the small minority of people? I am not, if you are, then you can pay for the uninsured masses by yourself. Guess what, I and millions of others already pay for their care.

wow…the AMA certainly has paid a lot of 'doctors' to post anti-malpratice litigation comments…

doctors over-test, and over medicate because of the financial incentive…it's all about the $$$$ and not about the patient at all…patients are faceless bags of money…

This article is ridiculous. For some reason, it has become great sport to blame everything on doctors these days, but why do you think doctors order more tests than necessary? First, because doctors are not omniscient god-like beings that know exactly what's causing the health problems of every patient that walks through the door. Contrary to popular belief, medicine is as much an art as it is science. Diagnostic medicine often depends on ordering sometimes a seemingly endless battery of tests just to really nail down an accurate diagnosis. Many diseases share similar symptoms, lab findings, etc, and so on occasion many tests need to be run to rule out the possibilities. It is an art in that many diseases do not "read the textbook" and present in the traditional way. For these reasons, some cases require doctors to cast a wide net of clinical tests in the hopes of gaining useful information. Have a cough? Sure most of the time its due to allergy or asthma or something benign. Some doctors may order a CT scan, but some cynics would claim that the CT test is just an unnecessary test to line the doctor's pocket. What if that CT scan picks up a lung cancer in that rare patient, and what if that patient is you? Bet you won't think that test is unnecessary in that event. Second, don't forget those damn parasites on society malpractice lawyers that force doctors to practice defensive medicine. It's asinine that with all the talk of health care reform, no one in Washington would dare raise the possibility of tort reform. Back to the example above, what if the doctor decides not to order that CT scan, and the patient turn out to have lung cancer. Well the courts may decide that is medical malpractice because the doctor missed a malignancy. It seems that there are better ways to ensure that doctors practice quality medicine, than to sue them for millions of dollars and make the stupid lawyers filthy rich.

It makes me angry that our government isn't looking at outrageous medical costs as much as how we are going to pay for them. I was shocked to see a recent medical bill of a friend who broke his collarbone in an accident. The costs were ridiculous! His insurance forked out $92 for a foam figure eight brace. The same brace from the same manufacturer can be purchased for $8 online when you buy just one! Who is policing this?! The insurer paid the bill. Shame on the doctor first, then the clinic, then the insurer.

It seems like this is mis-titled – I wish overdiagnosis was the problem – but the real problem is over-testing.

I have a tear in something in my leg – muscle, ligament, tendon – not sure what but I'm pretty certain it requires surgery, I walk in pain and cannot run. Somehow I have been through hordes of x-rays, an ENG – my doctor even ordered an upper GI based on nothing other than my age, race and gender – NOT based on complaints I actually had – but where is the exam that says, "yes, you tore a muscle, let's set you up for surgery".

I know my error – doctors automatically dismiss anything diagnosis like that a patient does. So by insisting that I tore something I assured that my doctor would look anywhere, anyway, to find anything to show that I'm wrong.

Net effect: doctor is paid, testers are paid LOADS – but I still can't run! Just admit that I know my body and know what I'm talking about, send me to surgery and fix it.

This is the most arrogant and conceited comment on this posting. It's one of the reasons doctors are looked upon so unfavorably. I don't care how you performed in medical school or what you did on standardized tests. It is dangerous for you to assume that you are a better, more deserving physician than a primary care physician. The best doctors I know, despite a high level of brilliance, are at least humble about there profession. You should be very careful about the attitude you portray here.

"To the family medicine doctor who thinks he/she should make more and specialists should make less:

I am a neurosurgery resident. Most likely I performed much better than you in college and in medical school. I will also work well over 80 hours per week for my entire 7 year residency. You worked less than 50 hours per week for your three year residency training.

Nearly every procedure neurosurgeons do is complex and risky. You diagnose diabetes. Important, yes. But this does not exactly require much skill.

Only a few medical students (173 a year) have the natural talent and work ethic to enter a neurosurgery residency. About 10 quit each year do to the malignancy of the training.

Please, do not think about penalizing the specialists. They worked harder than you to get where they are. They have more talent, take more risks, and work much longer hours. Why should they not get payed for it."

Blame the lawyers for the high health care costs. Litigation is out of control.

Can CNN do some specials on the fear of physicians with regard to the medicolegal system and how this affects their practice of medicine and of their lives. Fear controls much of how medicine is practice, not love and hope. This is simply wrong and symptomatic of a broken system.

I agree with many of the comments. I too practice defensive medicine as much as I can only because I fear legal action. The indication for testing is often simply to defend myself in case the patient's outcome does not meet his/her expectation and they decide to sue. It is a sad reality of our medical system and I have little confidence it will ever change because the trial lawyers are an extremely powerful lobby and our politicians are mostly lawyers. Physicians like to think they control their own destiny but they really don't–the MBAs and the Lawyers control the destiny of the medical system and therefore of physicians.

Also there needs to be personal responsibility. Out of the 20+ patients I see everyday, about 4 actually do what they need to do. Everyone smokes, eats poorly, are obese and don't exercise. Its only going to get worse because we have a whole generation of unhealthy kids who will develop heart disease in their 30's. I see it now. I have patients as young as 21 who have had a heart attack. The problem is people look for someone to blame. It always has to be someones fault, now its time to targer the doctors.

I am a Cardiologist, board certified. I admit I overtest. I do this not for financial gain, but because I am afraid of being sued. I am a staff physician who draws a salary, there is no financial incentive. Primary care doctors are the same way, they refer to specialists because they are afraid of being sued, the want to "CYA". We need malpractice reform to fix health care, they go hand in hand. The lawyers control the government so this will never happen.

There are many more reasons why we are getting more tests today than years before that are completely unrelated to whether the doctor has a financial interest in the testing equipment. One big one is the practice of defensive medicine – ordering tests that properly aren't needed just in case something goes wrong and the patient sues.

Apparently, no one looks at the IRS's
filing requirements!
How can one truley estimate income, where there is no real way of knowing if you are going to hve a client come in?
So, a Dr solves that problem by getting patients scheduling a return visit, whether one needs doctoring or not!
Can we fault the Dr?

As a minimum, I must est my current yr
filing based upon Last year's basis,
even if I have no clients/income, in
my drafting service business!
Ted Harris

This discussion seems to be focused on some of the key components of Mr. Futrelle's post, but there is a question to be raised. If politicians decide that medical facilities and doctors are just squeezing money out of people or that fear of malpractice suits is driving up prices, they will inevitably try to fix it somehow.

The party in power will want more oversight. They will want to "evaluate" the care given to patients. If we start down this road, government will ration health care. It will place itself between you and your doctor.

Ask yourself some questions. Is the government good at stimulating the economy? Is the government good at running car companies? Is the government good at regulating mortgage lending? Is the government good at handling entitlements? Is the government interested in keeping itself efficient?

If you answered "NO" to all of these questions, congratulations. Your head is on straight. Do you want government to "solve" this problem too?

I, for one, do not.

Nothing is going to help healthcare if the U.S. don't do something about what they let doctors make.Also doctors and drug company's have a long standing arrangement to sell drug's this also has to stop or nothing will help healthcare reform.Any one seen a drug ad on tv there trying to sell stuff with more side effect's then the sickness itself this also has to stop.

health care reform and what it means to you

1)limit what doctors can make as a salary or what they can charge.

2)make all payments made to doctors tax credits so everybody has to turn them in

3)limit what drug company's can charge for meds and make them tax credits for the person paying for them.

Docs do increase the number of imaging studies that they order based upon whether or not they own the machine. The Stark laws are bipassed by putting the machine in their office or by "leasing" time on the machine and getting a "kickback." This has all been documented in the medical literature about overutilization. Want one way to decrease imaging utilization and costs? Stop in office imaging and "leasing" scams. I agree another way is to improve tort reform to decrease defensive medicine. It is of course multifactorial.

"I can certainly attest to the CAT scan issue. I made the mistake of fainting in a hospital while visiting a relative. One CAT scan and $6000 later, I was of course given a clean bill of health. I wanted to sue the hospital for having me sign consent to treatment even though they were testing me for mental injury/damage. After talking to an attorney, I learned that the hospital was basically untouchable since they were acting in “good faith”. That experience has left me with a healthy skepticism of the money machine called health care in America."

There is truly no way for the health care industry to win. They did a head CT to check for bleeding in your brain, a brain tumor or abscess, etc. If they hadn't done this and you'd had something serious, you'd likely have sued them for missing it.

I think you should be very thankful that they took care of you.

That article in the New Yorker has been debunked by other studies into Medicare spending. Doctors and hospitals aren't ording tests to pay for their expensive machines – the machines are built in to capital budgets and, in many cases, funded through philanthropy.

The ridiculous tests are being ordered to avoid the expense of malpractice lawsuits. Reform malpractice suits, and you will see a decrease in healthcare costs on the supply side (doctors can charge less because they pay less malpractice insurance) and on the demand side (fewer tests will be necessary).

It's such an obvious no-brainer that there's no way anyone in government will figure it out.

Hi Amy.

Thanks for the lecture. I have in fact, read all of Gawande's book. I'd have to say I really liked "Surgery" the best. I read his article as well.

But I think you missed my point.

My point was the writer of this article failed to write a balanced article that covers all the major issues that stymie our glorious quest for a better health care system. And he again seems to malign the already deteriorating image of doctors.

More care does not necessarily translate to better care, but I think it's quite obvious the opposite can be true as well.

And having worked with and spoken to many doctors, I would say, yes, there is a correlation, and judging from the posts, many doctors would agree (assuming they are doctors).

I think it's fair to say you'd have a hard time speaking for doctors or their positions and lived experiences as a nurse, no disrespect to nurses.

-Andy

Thanks,
Andy

Andy,

Yes, the problem is very complicated. But the author's article hits some key points, namely more care does not mean better care. When you consider many doctors do indeed practice defensive medicine, you make his case for him.

And even if not, more tests does NOT mean less lawsuits. I work as a legal nurse consultant. Often what tests were or were not ordered is not the issue of the case. The issue is the delivery of care–the assessment by the physician or nurses, how they interacted with the patient, and the treatment for the actual problem that was ordered/delivered and how well that care was delivered.

And a lot of times, there's nothing wrong with the care: the right tests were ordered, the right care was given. But the patient blames the poor outcome on the doctor and sues, sometimes out of simple anger. Most suits are frivolous, but providers have to defend against them all.

The correlation between tests and suits is not what you make it out to be.

And the incentive to order unnecessary tests to make more money is well and long known in the medical community. Read Dr. Gawande's article in the New Yorker. It will astonish you.

To Dr. Bagnarello: Your blame the patient for "not paying their dues" leaves me puzzled. Why did you get into health care again? Surely you know that more Americans are underinsured rather than uninsured, and that many of both are indeed hard working Americans–often small business owners or the self employed who can't afford to buy into a pricy plan.

To the family medicine doctor who thinks he/she should make more and specialists should make less:

I am a neurosurgery resident. Most likely I performed much better than you in college and in medical school. I will also work well over 80 hours per week for my entire 7 year residency. You worked less than 50 hours per week for your three year residency training.

Nearly every procedure neurosurgeons do is complex and risky. You diagnose diabetes. Important, yes. But this does not exactly require much skill.

Only a few medical students (173 a year) have the natural talent and work ethic to enter a neurosurgery residency. About 10 quit each year do to the malignancy of the training.

Please, do not think about penalizing the specialists. They worked harder than you to get where they are. They have more talent, take more risks, and work much longer hours. Why should they not get payed for it.

Here's an interesting concept that would never fly with the current administration: SOCIALIZE THE LEGAL SYSTEM. If attorneys got paid the same amount whether they won or lost, they would just work on cases based on their merit, NOT the likelihood of getting a huge payout. It would decrease frivilous lawsuits and provide a much fairer system of compensation for being on the bad outcome of negligence. Right now they get paid on contingency so that they only chase after huge lawsuits.

Why doesn't anyone talk about that?

And if a physician doesn't order a CT, MRI, etc when someone has a head ache and the person turns out to have a brain tumor or some such.. The physician gets sued. Even though 99.99% of patients who come in with a headache have nothing. Our system is broken and the biggest problem is our legal system and insurance company profit making.

Doctors often don’t give you just 1 perscription… now it’s menu of perscriptions. I rarely go to the doctor, but when I have my GP has never once mentioned how overweight I am….

He/she probably figures your husband mentions it enough.

After seeing what goes on here in amerika, the medical greed capital of the world, I now go to Costa Rica for care. In Costa Rica care is much more compassionate, far less costly significantly more accurate.

I can certainly attest to the CAT scan issue. I made the mistake of fainting in a hospital while visiting a relative. One CAT scan and $6000 later, I was of course given a clean bill of health. I wanted to sue the hospital for having me sign consent to treatment even though they were testing me for mental injury/damage. After talking to an attorney, I learned that the hospital was basically untouchable since they were acting in "good faith". That experience has left me with a healthy skepticism of the money machine called health care in America.

Dear David Futrelle,

Please read the comments below, take a step back, and take additional steps to improve your poor journalism.

I suppose there's some correlation between more tests and less lawsuits?

Thanks,
Andy

government has to capped insurance companies premium hikes and hospital charges hikes to the rate of inflation, approximately 3%. The spiral in the cost of health care is due to the greed of insurance companies, hospitals and specialists.
We, primary care physicians should be paid on the same scale as specialists and the cost of procedures slashed by 50% at least as they are overpriced.
Tort reform is needed to control the greedy trial lawyers that are responsible for defensive Medicine expenses.
Americans also need to lower their expectations about top medical care at cheap prices.
If we Americans chose a socialist president, now we have to face the consequences of socialized Medicine, or change our Congress in 2010 and stop this madness.
ObamaCare is not about our medical care. It is about their philosophical agenda of socialism , concentration of power, and leveling the field for everyone in society even for those who do not want to work or pay their dues.

Wow! This headline is a profound and malignant oversimplification of a very complex phenomenon that may indeed drive this country into an even more dire financial and social situation that it is already in. Placing the blame on doctors does not address the whole of the situation here, folks. Look at the percentage of your health care dollar that goes to the Doctor you are being examined by in the office or ER and who bears the liability for any missed diagnosis. This issue will take a lot of real journalists a lot of time and ink but when it is said and done, Doctors will not be found to be the enemy of the patient or the health care system.

The problem is not quite as easy as that. The protocols for evaluating our major ailments, such as back pain, headaches, and chronic pain, need to be updated to include diagnostic exams to find the most cost efficient and effective way to diagnose diseases. Our protocols are antiquated and include a lot physical exam findings that turn out to be unequivocal and don't really lead us down a path or diagnosis. This in itself will not save money. The money that needs to be saved can come from the big money makers of medicine…the pharmaceutical companies and the insurance companies. Plus cutting our spending on military budgets would really help. Our country need not focus on policing the rest of the world but rather rebuilding our own programs such as education and health care.

People like to think their doctor is looking out for his or her patient but it's really not true – they are only there to line their own pockets. Last time I checked, every doctor I know makes well into 6 figures and works only 4 days a week. The U.S. spends the most on health care yet ranks the lowest in quality. The AMA fiercely protects their union and own interest without a thought of actually helping people and society – restricting the number of students entering medical school, lobbying against disclosure of malpractice cases, etc. My whole family is in medicine and they will all tell you, in private, that they only became doctors to make money. It's simply a career choice, not a calling.

My spouse works in a hospital that just began using electronic medical records. At first the staff thought it would be great for efficiency and better coordination of services. THe hospital however uses the system to track utilization by the medical professionals. How many patients did they see per week?, how many drugs did they prescribe per week? How many tests did they order per week? Staff is chastized for not ordering enough tests or prescribing enough drugs. This should be outlawed but as long as hospitals make profits on their internal pharmacies and labs this practice will continue via direct or indirect incentives given and/or penalties imposed by the hospital who employs the doctors and owns the pharmacies and labs. THIS SHOULD BE FRAUD AND SHOULD BE ILLEGAL

There are several things wrong with medicine, but blaming physicians should be the last on the list. Your average physician is generally at the top of his class and could do whatever they want. Yet they dedicate themselve to medicine( approx 14 years of schooling) before they make a dime, and walkout with $150000 in student loans. There are stark laws in place that do not allow physicians to do self referals (therefore, if they own the scanner they can not send there patient there) The high cost of medicine is srongly related to physicians worrying about being sued. They teach you in med school, that if you are not sued at least twice u probably are not doing your job-quite pathetic-patients to often view there drs as lottery tickets-why not have a loser pays system(like most industrialized countries- or cap malpractice-that will surely limit costs). Secondly, every time a drug rep comes into a doctors office to promote a new drug- it is third tier on most insurances therefore, people who pay for their insurance can not afford them-however the rep always says "it is preferred on medicaid" meaning people who do not pay for insurance get it for free. the g.ovt continually says that 2/3 of the universal care will be paid for by eliminating waste and fraud. Why not prove this by doing it for one year and then passing universal care. further if our goverment is truly interested in bettering society with universal healthcare-why not slash the defense budget by 8o%-considering we spend more than EVERY COUNTRY in the WORLD combined-we should be light years ahead of everybody in defense. More people have died in the past year secondary to lack of health care than all the terrorist attacks in the past 100 years-but will anything truly change considering our government is made up of lawyers and retired generals-(OBAMA/lawyer vs McCain/retired navy)- why not go after doctors instead. This country will continue to decline until we change our legal and Defence systems-that is the people we continue to put into power

In medical school, we are taught to diagnose and treat. We don't discriminate based on whether you have insurance, your race, how wealthy you are… We are taught to conserve resources and NOT order a CT or MRI for every patient with a headache or abdominal pain. Yet, once we go out into the "real" world, making money becomes one of the main objectives, JUST LIKE IT WOULD BE FOR ANY OTHER PROFESSION. I think that taking away financial incentives to order additional tests is one huge way to decrease medical costs. But also, something must be done regarding malpractice insurance. Americans are incredibly litiginous, and unless Obama wakes up and realizes that a malpractice cap MUST be instituted in order to drive down costs, the goal of affordable universal healthcare will never be achieved. For every patient I see, I ALWAYS ask myself, "Is this going to hold up in court?" I shouldn't have to be asking myself this question, but unfortunately, this has become the greatest fear of medicine. Nobody wants to be sued, and getting sued for trying to help somebody is even worse.

it's all about the money, whethter you really need the tests or not. i had a doctor do several(breathing test and lung ct) and he still doesn't know what i have. pretty pathetic.

As I understand,hospitals and doctors are legally obliged to offer the best medical treatment to all,including in the case of hospitals, illegal immigrants and the uninsured. If they do not, then they are open to lawsuits. Congress is responsible for that situation. So while I agree that new and expensive diagnostic equipment will be used more than maybe necessary, the facility is not only getting a return on the investment, but protecting themselves in the process.

As a physician, I can agree to some extent, that medical tests-procedures may be over used. Part of the reason is the technology is available to do things that were not before and the other is that patients now expect to have a diagnosis or reason for their complaints. Many are not happy with advice to reduce stress, exercise,eat healthy etc. Some are not happy without a prescription or 'antibiotics'. Additionally, 'defensive medicine' [unfortunately] is a large reason why some test-procedures are done. If certain test and consults are not ordered/done and there is any sort of bad or unexpected outcome that could erase all the years of hard work in medical school-residency. It can be disappointing to be a target after sacrificing so much for so long.
To reduce cost, we need to cover those not insured, reduce paying for quantity of medicine and rather quality, and modify the legal environment in medicine so that so many tests-procedures don't have to be done. Finally, there has to be a better understanding between doctors and patients on expectations of the health care system can and should do.

I am an expat. but I think a good part of the over diagnosis is the threat of a lawsuit. If there is 20 tests for something and they give 19, some lawyer will sue saying because you didn't give that 20th test that's why they are sick. Stop the lawsuits or the threat and we could see prices come down!

In reference to the use of CT scanners, many doctors have come to "over-test" due to the threat of lawsuits, etc. A doctor's malpractice insurance has risen exponentially and many doctors have these premiums that are outrageous(in some cases over $30,000 per annum). To keep these premiums from going up, doctors tend to do whatever is necessary to avoid lawsuits including ordering tests that are not always needed. I believe we need to look at our overly frivolous legal system before we truly need to overhaul our health care system…just ask a Canadian how much they like their health care system.

Doctors often don't give you just 1 perscription… now it's menu of perscriptions. I rarely go to the doctor, but when I have my GP has never once mentioned how overweight I am….

In response to 'Are MDs Diagnosing us into the poorhouse?' Although the comments do hold up in regard to some percentage of Physicians, let's examine the pressures on these healthcare givers. As their expenses increase, their fees have been reduced by insurance companies that are charging their clients more and more each year. However, for some reason, people seem to blame those who are being shortchanged who happen to be the same ones who spent 11-15 extra years of their life training to heal. Is there a value that we can place on this? These are the same professionals we expect to be there for us twenty-four/seven and if they aren't, we can't understand why not.
The tests that are ordered are often ordered in an effort to stave off the tide of inappropriate malpractice lawsuits. Many times, these suits are brought because tests aren't ordered. The Doctors have to order these tests or they stand at risk to be sued. Those CT scanners and MRI's that are Physician owned may lead to extra tests but most of the time they don't. Besides, the big companies that sell these machines and service them do so at exhorbitant rates ($$$$) with huge profits and the Doctors have to cover these expenses. I'm not saying this makes extra test ordering right, just that this is another factor in the pressures of the healthcare system.
Before we blame those who have sacrificed time, effort, and dollars to be the best Physicians they can be, let's look at the big companies that make inappropriately large profits on the drugs that are prescribed, the machinery that's needed to perform the life-saving diagnostic tests, and the ease with which these care-givers can be sued through no fault of their own just for doing their best. Let's look at what this type of behavior against Physicians costs the system in malpractice premiums that add to the bottom line of what the Physicians must charge in order to make a living.
In days past, Physicians were respected members of society. They are still healers who save lives and make those lives that cannot be saved more comfortable. When did we lose respect for them and why? When did the huge profits made by insurance companies, big business, and patients and their attornies who feel that its their right to sue become more respectable than the efforts of those who heal us.

Its simple why this happens: there are newer tests to find disease/problems and if you dont order these tests you're considered a bad dr and will most likely be sued. Bottom line is that the patient doesn't have to take the medicine prescribed or go in for the test. I tell my dr. that "no, I dont want to do that" and he just documents it and that is that.

"Whether or not you get a CAT scan often depends less on your medical condition than on whether or not your doctor owns a scanner."
This statement is untruthful and completely irresponsible journalism. It provides no evidence, basis in fact, and is pure conjecture based on the point the author feels like making today. It is against the law for a physician to order a scan and send the patient to a facility he or she owns. See the Stark laws!! I wish journalists wold actually investigate facts rather than make things up that fit their personal agenda for the minute.