Coss Effective

Imagine that you do the same job year over year, and in each year you get paid less.  This is the condition in which most physicians find themselves.  It may be difficult for some to have sympathy  for physicians because many believe that they make lots of money, though some do.  Still, physicians spent most of their 20’s and some of their early 30’s getting the training to provide services for which they are now get paid less and less to provide.

A few weeks ago I had reason to visit an Orthopedic Surgeon for a wrist injury.  Upon making the appointment I learned that this practice has done something that I believe few physicians can do, but many more will; he quit taking insurance.  As one with a  strong free market bias, I had to learn more.  A few days after my initial visit I called just to discuss his decision and what it required of him and his practice.

He admitted that his income had initially fallen, but that it is slowly on the return. He reduce his office staff by one half, and restructure his practice.  Though he continues to provide orthopedic services, he expanded his scope of offerings to include services for which insurance companies will not pay, and patients would;  he add longevity services for older patients seeking to avoid disease.  These services are largely unsupported by insurance, still people willingly pay for services they believe to be valuable, and indeed this is.

Additionally, he freely admits that had he been younger with medical school debt and kids aiming for college, he wouldn’t have been able to make this move.  But with both of those behind him, he guided his business offerings to a new audience, and one who would pay cash he loves his work as  do his patients.

There is no better example of  free-market medicine than what has been going on in the area of Dermatology.  With the introduction of Botox to remove wrinkles, and a new host of dermal fillers and lasers, some dermatologists  have evolved their practice,  in part or completely, into cosmetic or aesthetic medicine for which it’s patients pay cash.

Cosmetic medicine, is an area of healthcare where third party players have little or no influence  because neither patient or practitioner expect a third party organization to pay for the services.  These are not life saving service, they are life enhancing services.  This is free market medicine at its finest, but it’s not new.  Dentists and most veterinarians have similar transaction relationships with their customers, neither are heavily influenced by insurance companies, and they seem to be doing just fine, even arguably better than classic medicine.

So what are we to make of this.

Have you ever tried picking up mercury with your fingers?  That’s precisely how the economy works; human beings are amazingly adept at improving their lot in life through new and innovative means.  In healthcare we are already seeing changes in the physician/patient relationship and its interaction.  Quickly disappearing is the paternalistic relationship that had dominated physician/patient relationships in the past.  The new relationship is more adult to adult; one in which the physician clearly directs care, but also one in which the patient is also part customer.  For healthcare, this is exceptionally healthy.  The patient rather than the payer or insurance company has a customer like relationship with the physician, or private medical services distributor.

For some physicians with whom I’ve shared this perspective, this is troubling until they realize that a more provider-customer relationship actually produces more revenue.  This we know: physicians are smart people and know how to do math, they will certainly evolve their care practices in creative ways from which we all will benefit.  Free market medicine will grow in the future, and some innovative companies have begun to figure it out

Thomas A. Coss, RN

Timothy Treadwell had his own vision of the world, particularly in regard to wild bears.  An example of that vision can be seen in a video of Treadwell, sitting in a stream, reading to a bear he had come to know.

Few question the sincerity of Treadwell, also known as the Grizzly Man; he loved the out of doors, all its wildlife, and he surely loved bears. For over 13 years he followed them, filmed them, wrote about them, and as much as he could, lived among them.  On Monday, October 6, 2003 the partial remains of Treadwell were discovered, he had been eaten by the bears.

I’m not making light of Treadwell or his cause; still this tragic little story was, inevitable.  Treadwell’s vision of the world dramatically differed from reality, and in the end, reality prevailed.  He couldn’t help himself in wanting to be closer and closer to the bears he loved, and slowly over time, he extended that vision to his own peril and that is the lesson.

This is a great example of where we find ourselves in the healthcare reform debate.  It’s very comforting to think that there is a group of people, so smart and insightful as to be able to craft a plan to manage the healthcare of millions.   We are, it seems, eager to abandon the evidence of our senses and believe that by some means not fully understood, a group of ordinary people who, having chosen to work for  the government, will have morphed into something they previously were not.  These individuals will somehow craft a workable healthcare system in a way no one has ever considered in the past.  Within this system, diversity goals will have been met, procedures will be reduce, screening will go up, more people will be treated, innovation will thrive and costs fall.

I don’t question the sincerity, but outcomes are not bound to sincerity or good intentions, they are bound by actions; not what people think or wish, but by what people do. It is noteworthy that the end for Timothy Treadwell was also the end for his girlfriend (also eaten) and for the two bears suspected to have done the deed.  All are gone.  It seems that this congress is committed to a vision of the world around them, wholly unsupported by history or evidence, and that we the will have to suffer its consequences; how very sad and exceptionally unnecessary.

Thomas A. Coss, RN