PoliticsA US National Health Care System?

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To: gg cox who wrote (22720)1/4/2012 2:41:06 PM
From: Lane3
2 Recommendations   of 42078
There is a market for private health insurance in the US after age 65

I have not been able to find any coverage for seniors that doesn't overlay Medicare. If you know of some, then how about a link?

American Private health care coverage after age 65, would be astronomically expensive for Americans, based on evidence of fossilized Canucks travelling in America...period.

Of course it would be, if you superimpose that on the extant paradigm. But in the alternate universe where Medicare never was, not necessarily.

You said earlier you were ashamed to be on medicare

Huh? I said that? Don't think so. Another one of your figments. Or cognitive burps.

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From: TimF1/4/2012 2:47:18 PM
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Obamacare Abominations President Obama says his health care "reform" will be good for business.

Business has learned the truth.

Three successful businessmen explained to me how Obamacare is a reason that unemployment stays high. Its length and complexity make businessmen wary of expanding.

Mike Whalen, CEO of Heart of America Group, which runs hotels and restaurants, said that when he asked his company's health insurance experts to summarize the impact of Obamacare, "the three of them kind of looked at each other and said, 'We've gone to seminar after seminar, and, Mike, we can't tell you.' I think that just kind of sums up the uncertainty."

Brad Anderson, CEO of Best Buy, added that Obamacare makes it impossible to achieve even basic certainty about future personnel costs:

"If I was trying to get you to fund a new business I had started and you asked me what my payroll was going to be three years from now per employee, if I went to the deepest specialist in the industry, he can't tell me what it's actually going to cost, let alone what I'm going to be responsible for."

You would think a piece of legislation more than a thousand pages long would at least be clear about the specifics. But a lot of those pages say: "The secretary will determine ..." That means the secretary of health and human services will announce the rules sometime in the future. How can a business make plans in such a fog?

John Allison, former CEO of BB&T, the 12th biggest bank in America, pointed out how Obamacare encourages employers not to insure their employees. Under the law, an employer would be fined for that. But the penalty at present — about $2,000 — is lower than the cost of a policy.

"What that means is in theory every company ought to dump their plan on the government plan and pay the penalty," he said. "So you don't really know what the cost is because it's designed to fail."

Of course, then every employee would turn to the government-subsidized health insurance. Maybe that was the central planners' intention all along.

An owner of 12 IHOPS told me that he can't expand his business because he can't afford the burden of Obamacare.

Many of his waitresses work part time or change jobs every few months. He hadn't been insuring them, but Obamacare requires him to. He says he can't make money paying a $2,000 penalty for every waitress, so he's cancelled his plans to expand. It's one more reason why job growth hasn't picked up post-recession. Of course, we were told that government health care would increase hiring. After all, European companies don't have to pay for their employees' health insurance. If every American employer paid the $2,000 penalty and their workers turned to government for insurance, American companies would be better able to compete with European ones. They might save $10,000 per employee.

That sounded good, but like so many politicians' promises, it leaves out the hidden costs. When countries move to a government-funded system, taxes rise to crushing levels, as they have in Europe.

Whalen sees Obamacare as a crossing of the Rubicon.

"We've had an agreement in this country, kind of unwritten, for the last 50 years, that we would spend about 18 to 19 percent of GDP (gross domestic product) on the federal government. This is a tipping point. This takes us to 25 to 30 percent. And that money comes out of the private sector. That means fewer jobs. This is a game-changer."

He means it's a game-changer because of the cost. But the law's impenetrable complication does almost as much damage. Robert Higgs of the Independent Institute is right: If you wonder why businesspeople are not investing and reviving the economy, the answer lies in all the question marks that Obamacare and other new regulations confront them with. Higgs calls this "regime uncertainty." It's also what prolonged the Great Depression.

No one who understands the nature of government as the wielder of force — as opposed to the peaceful persuasion of the free market — is surprised by this.

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To: Lane3 who wrote (22721)1/4/2012 11:15:23 PM
From: gg cox
1 Recommendation   of 42078
You said..

<<There is a market for private health insurance in the US after age 65

I have not been able to find any coverage for seniors that doesn't overlay Medicare. If you know of some, then how about a link?>>

I say...

No link required, it was laid out for you in the just want to brush aside what was laid out for you, not very intellectually honest, huh?

You said..

<<Huh? I said that? Don't think so. Another one of your figments. Or cognitive burps.>>

I said..

<<You will thank American socialised medicine when age 80, and require major surgery, or transplant and no bill in the mail... your heirs (a new wing on the local hospital) might be thankful too.<<gg>>..>>

Message 27855615

You said..

<<You will thank American socialised medicine when age 80

No, I won't. I would be too ashamed.>>

Now start wordsmithing the figments and cognitive burps don't forget the superimposing on the extant paradigingmm...buurrrp!

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To: gg cox who wrote (22723)1/5/2012 11:54:30 AM
From: Lane3
2 Recommendations   of 42078
No link required, it was laid out for you in the post..

Huh? Where?

I write that I can't find any such insurance. You insist that it exists, indeed, that you have such insurance. I ask you for specifics, given that I can't find it. You haven't told me where I can find it, unless you have you found some way for the computer to emulate invisible ink. If you don't want to tell me in the form of a link, fine, but somehow tell me how someone would go about getting it, like maybe the name of a company that sells it and the label for that category of insurance. Either that or quit claiming that it exists. And quit telling me that you "laid [it] out" when you didn't.

"You said..

<<You will thank American socialised medicine when age 80

No, I won't. I would be too ashamed.>>"

Indeed, that's what I wrote. I wrote that I would be too ashamed to "thank American socialised medicine when age 80, and require major surgery, or transplant and no bill in the mail." Then I went on to explain just what about that would make me ashamed, three bullet points, why exactly I would be ashamed, not to "be on medicare" but to irresponsibly find myself financially needful of it, to advocate such a faulty system, and to use it with obscene selfishness.

So, then, tell me where I said that I would be ashamed to "be on medicare." You can't because I didn't.

Now start wordsmithing...

You say "wordsmithing," I say "critical thinking." There's a difference between acceding to enrollment and being thankful.

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To: Lane3 who wrote (22724)1/5/2012 9:09:50 PM
From: gg cox
   of 42078
Try harder madam.Now concentrate on the meaning below, especially the sentence in red.

<<There is a market for private health insurance in the US after age 65, and we could label it a "shadow market" of what it would cost if medicare did not exist in the US ,,,and has been around since Canadian number one citizen Tommy Douglas, <g> founded socialized medicine in Canada.>>

<<Almost every Canadian citizen, before he sets foot on American soil, purchases health care coverage while traveling in America, and these premiums for health care coverage in America, would track identical(for the specified coverage) to What an American would pay if America did not have socialized medicine after age 65, because of the similar life styles of Canadian and American citizens. >>

<<I have been buying it for years, and it is of course getting more and more expensive as we age..of course.. and no surprise there.>>

<<A few weeks back for a short 2 day trip, coverage was 58 bucks for 2... age 66 and 65 and worth every penny...and of course subject to ""claim denied stamp, always possible"" and a dreamed up extrapolation of a pre existing condition that i'd probably need my lawyer to fight.>>

<<So, expensive and risky ...What would the two day or 6 month rate be for 2,, 80 year olds ?? ...Expensive, yes.>>

<<Of course these rates, for Canadian Citizens over 65 would be even more expensive for Americans, because Canadian travellers to US, are not buying insurance, for the ailments of old age that need continuous tending...stroke, diabetes, cancer,testing etc...>>

<<So my conclusion for your ""As I have written before, there is no market for private health insurance in the US after age 65. Private insurance assumes Medicare coverage. If there is no market, then it cannot be said to be too expensive."" ..would be..

American Private health care coverage after age 65, would be astronomically expensive for Americans, based on evidence of fossilized Canucks travelling in America...period.>>

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To: gg cox who wrote (22725)1/5/2012 10:06:15 PM
From: TimF
3 Recommendations   of 42078
American citizens over 65 are covered by Medicare regulations, they can't get out of it.
Canadians (over 65) visiting the US, probably can buy some sort of specialized insurance (although I doubt "Almost every Canadian citizen, before he sets foot on American soil, purchases health care coverage while traveling in America.") , but it probably isn't very relevant to Americans over 65.

A few weeks back for a short 2 day trip, coverage was 58 bucks for 2... age 66 and 65 and worth every penny

Short term specialized insurance for visiting foreign nationals. That doesn't suggest such insurance is available for Americans over 65. American seniors can by Medigap policies (which cover what Medicare will not or reduce deductibles and co-pays for people using Medicare), or Medicare Advantage policies (insurance from a private provider, payed for, and regulated by, Medicare), but there is no true private policies (paid for by the insured individual) for basic coverage. Medicare crowds out the market for such policies.

American Private health care coverage after age 65, would be astronomically expensive for Americans, based on evidence of fossilized Canucks travelling in America...period.

If you didn't have Medicare and other government intervention, the prices would probably be lower.

Beyond that your taking short term specialized insurance, and using it to try to imagine how expensive normal 6 month or annual insurance premiums would be, neglecting to consider that short term special insurance is a very different product, probably with a much higher price.

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To: gg cox who wrote (22725)1/6/2012 4:10:03 AM
From: Lane3
1 Recommendation   of 42078
I recognize your conclusion. I have long since recognized that, were insurance companies at this point in time and under current conditions to try to make a private market for non-Medicare-based insurance, it would be prohibitively expensive, thus not viable, which is probably why the market doesn't exist. I have argued only that, were it not for the advent of Medicare, a private market would have been viable and would have existed. The advent of Medicare obviated that opportunity.

Yet you continue to insist that such a market exists. I have repeatedly asked you where it is available and you still do not tell me. Either there are companies offering it with marketing materials and quoted prices or there aren't. So please either tell me where I can find such a market or acknowledge that it doesn't exist.

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To: Lane3 who wrote (22727)1/6/2012 4:55:56 AM
From: Lane3
   of 42078
Retainer, Concierge and Boutique Medicine are Not the Same Thing

Health care is in crisis. Reimbursements from insurance companies continue to dwindle, while the expenses of running an office continue to rise. Looming cuts in Medicare are only weeks away, and many physicians may stop taking Medicare. If these cuts go into affect, it is possible that primary care physicians could lose up to 50% of their salary. Just recently CNN reported that some doctors are going bankrupt.

How to fix our health care system is an ongoing debate, but not surprisingly, many physicians have decided not to wait for the government to solve this problem and have taken matters into their own hands. One solution is to simply stop taking insurance altogether. “Cash only” doctors are now commonplace in many major metropolitan areas. Another solution is charging a regular, out of pocket fee (usually) in addition to what insurance will pay for treatment. A version of this model that is becoming popular is called retainer medicine. Sometimes, retainer medicine is referred to a “boutique” or “concierge” even by physicians and others involved in health care (as evidenced by this article in the AMA News, which prompted me to post on this topic).

However, “retainer”, “concierge” and “boutique” are not the same thing. Names are important, and the terms “concierge” and “boutique” tend to have negative connotations. Thus, it is important to describe the differences.

In a retainer model, patients pay a fee (not covered by insurance) to be part of a physician’s practice. This is similar to clients paying a retainer fee to hire a specific lawyer. With reimbursements from insurance companies being so low, the only way an insurance based physician can increase revenues is to increase the volume of patients they see. Unfortunately, when physicians increase the number of patients they see, it leads to rushed patient visits, long waits in the waiting room, and decreased access to physicians including difficulty in getting appointments or responses phone call messages. By accepting a retainer fee, the physician no longer needs to rely on insurance revenue alone, and in fact can decrease the amount of patients he or she sees on a regular basis. This allows for increased access (usually same day or next day appointments and 24/7 phone access) and longer appointment times (usually 30-60 minutes) for patients willing to pay a retainer fee. The typical insurance based primary care physician has about 2500-3000 patients in their practice, and sees about 25 patients a day. The typical retainer physician has about 500 patients and sees only a handful of patients each day. Retainer fees and the amount of access patients get for what they pay vary widely, but the average retainer fee is about $1500 per year.

Some have argued that retainer medicine is unethical because not everyone can afford $1500 a year. First, the typical retainer fee amounts to about $4 a day, which is what many Americans pay (or more) for a Starbucks coffee. Secondly, one could also argue that it is also unethical for insurance based physicians to see complex patients in brief visits and/or not being able to see them in a timely fashion due to lack of access.

Concierge medicine is somewhat different, and in my opinion, should not be used synonymously with retainer medicine.

According to Wikipedia;
“A concierge is an employee who either works in shifts within, or lives on the premises of an apartment building or a hotel and serves guests with duties similar to those of a butler. The term "concierge" evolved from the French Comte Des Cierges, The Keeper of the Candles, who tended to visiting nobles in castles of the medieval era.”

Just like the concierge at a hotel, who can get you good seats at a ticketed event, a reservation at a popular restaurant, or even run an errand; a concierge physician can get you timely appointments with the best specialists, usually doing the scheduling themselves. Many concierge physicians will even accompany patients to procedures or diagnostics tests, and some will even make house calls. Though some retainer practice physicians may perform concierge services (usually the ones charging well over the usual $1500 fee), the terms are not the same. Many retainer physicians will assist in coordinating specialist appointments, but this is as far as they go. In fact, some “cash only” physicians perform concierge services to attract more patients, and some doctors (even insurances based physicians) will charge an extra-fee for some concierge services, such as a house call.

Boutique medicine is also completely different. Again, from Wikipedia:

“A boutique is a small shopping outlet, especially one that specializes in elite and fashionable items such as clothing and jewelry. It can also refer to a specialised firm such as a boutique investment bank or boutique law firm. In the strictest sense of the word, boutiques would be one-of-a-kind but more generally speaking, some chains can be referred to as boutiques if they specialize in particularly stylish offerings.”

I think the key words in this definition are “specilalized” “stylish” and “elite.” The first word is something commonplace in medicine, but the later two words are something usually not associated with medical practice. “Luxury” is also implied in the word “botique.” Thus, in my opinion, a boutique doctor is one that specializes in unique, often luxurious services, that are not offered by others and which will therefore cost a little extra. These services include, but are not limited to, cosmetic procedures (botox, laser hair removal), medical spa services, comprehensive screenings (i.e. body scans), and herbs or supplements. Though both retainer and concierge physicians may provide boutique services, this is generally not the norm. In fact, many insurance based primary care physicians have started to add these services as a way of keeping their practice running. (Ethics could be questioned here as well).

I am not arguing that retainer medicine is the solution for all of our nation’s health care woes. It certainly is not. However, given that it solves some of the issues with 3rd party payors, is a model that continues to grow, and patients and providers enrolled seem to be very satisfied; it is something that deserves attention. Another model that is garnering some attention is direct access primary care. In this model, patients pay a monthly fee (usually about $70/month) and receive enhanced access and communication as well as primary care and urgent care services. Though the cost is slightly less ($1500/yr vs. $840/yr) and access to your personal may not be 24/7, this is a similar model to the retainer concept. (Proponents have called this retainer medicine for the masses).

Thus, using terms “concierge” and “boutique” that have connotations of elitism, luxury and unnecessary care synonymously with retainer medicine discredits a potentially viable health care model for many Americans. I would request that physicians, policy makers and journalists no longer use these terms as if they were the same.

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From: Brumar891/6/2012 7:01:31 AM
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The Promise of ObamaCare: Hospice for the Healthy

Joe Herring

I find it sadly illustrative of the liberal state of mind that liberals would see the death penalty forever banned for fear that one innocent person be executed, yet they enthusiastically support the concept of euthanasia, where there is a proven likelihood that a great number of people will die prematurely, and even unnecessarily.

In Great Britain, where the medicine has been administered by the government for nearly three-quarters of a century, a pattern has emerged that should be troubling to even the most deadened senses of decency. A recent audit by the Royal College of Physicians has revealed that in one hospital group alone, more than 50% of the patients who were put on a palliative care protocol known as the "Liverpool Care Pathway" (LCP) have had those decisions made solely by the attending physicians, without consult or notification of the patients family. In another group of hospitals, only 1 in 3 were informed of the life-ending decision.

The LCP is intended to provide terminally ill patients (in their final days) with a dignified death, free of unnecessary medical intrusion from hospital staff. In practice, however, it is becoming a greased slide to an economical exit, hastened along by the removal of nutrition, hydration, and all medications, except for heavy sedation which serves to mask the ugliest of the effects. This is not hospice care as we know it in America, where efforts are made to ease the natural transition to the end of life. The LCP is a protocol to end the life of a patient -- to hasten that moment -- in the interest of economy.

The LCP is growing in popularity with cash-strapped National Health Service hospitals, nearly doubling in use in just the last two years alone. While end-of-life care can be controversial in any system of medicine, such controversy becomes unreasonable in a socialized model, owing to the natural opposition between the state's interest in reducing budgets and the citizens' desire to prolong their own lives or those of their loved ones. In the case of a palliative care scheme such as the LCP, the process grows positively grotesque when the state chooses to hit the "delete" button without even informing the family or the patient of the patient's condemned status.

To avoid the pitfalls of ObamaCare, it's not enough for those of us in America to see the egregious abuses of government-run health care; we must also recognize the inherent limitations. For example, anyone who has been a patient of an American hospital in the last decade or so is familiar with the bar-coded wristband each patient wears. Before medications are given or tests performed, the band is read with a handheld scanner to ensure accuracy. The British NHS is only just now introducing this ubiquitous technology to its hospitals. Mind you, grocery stores in our country have been conducting business by barcode for more than 20 years.

Government will never be a nimble enough player to equal the agility and hunger of the private sector, and government always remains several steps behind when attempting to duplicate the services available in the for-profit realm. This has been demonstrated across all eras so often as to have become axiomatic, yet again and again, we allow bureaucrats to attempt to build a better mousetrap using the power of government and the funding of taxpayers.

In 2005, the British Parliament passed a monstrosity of legislation known as the " Mental Capacity Act," allowing doctors to withhold medical treatment from patients deemed incapable of making decisions for themselves. For the first time, the MCA defines " food and water" as medical treatments, enabling physicians to withhold these from the patient with protection of law. Moreover, doctors alone are granted the power to declare a patient incapable, without input from or consultation with the family, or even the patient themselves.

The Mental Capacity Act has led to a dramatic increase in the number of elderly and disabled being placed on the Liverpool Care Pathway. Once the decision has been made that the patient is incapacitated under the Act, doctors may withdraw fluids immediately via the twisted reasoning that it is "in the best interests" of the patient to die. If the patient's family attempts to intervene, the hospital can, and often does, summon the police to remove the family from the premises.

A chilling angle to this already cold picture is that oftentimes, the examination to determine "capability" under the MCA is conducted after the patient has been heavily sedated or given a drug with a common side-effect of disorientation, such as morphine. The unfortunate reality of socialized medicine is that the driving force behind treatment regimes is no longer the patient/doctor relationship, but rather the government/cost relationship. This necessitates rationing, all the while dismissing the will to live among the elderly and disabled.

The death of a family member is one of the more difficult and emotionally charged circumstances most of us face in life, and to have that process dictated by the cold crunching of an accountant's numbers transforms the experience from difficult to devastating. It is one thing to have a parent, spouse, or child die, despite our best efforts, from an accident or disease. It is quite another to have that family member discarded, considered insufficiently valuable to the decision-makers -- and possibly even inconvenient to them -- for taking up a bed that could go to another patient deemed more worthy by the rationer's formula.

This is the world of collectivist bureaucrats, giddy with their personal notions of superiority. Liberals believe deep down that they have it all figured out, or at least that they are on the right track, more evolved, better-equipped to make decisions that our culture had rightfully reserved to God alone. ObamaCare is our American gateway to this "tick-box" statist realm.

The true nature of the Liverpool Care Pathway and the Mental Capacity Act is deftly hidden behind the glowing words of promise used to sell these phenomena to the citizens. The statist bureaucrat unceasingly demands just a little more power and money, a greater measure of control, and with those he will provide an amazing wealth of peace and justice for all. Of course, should the statist fail, it means only that he was granted insufficient control and money, never that his ideas are fundamentally flawed.

Our current president, Barack Obama, is an adept practitioner of this form of snake-oil sales. Not surprisingly, he has surrounded himself with like-minded people, drawn from a myriad of left-wing think-tanks, university faculty, and activist foundations. I've written previously about Dr. Donald Berwick, the recess-appointed head of the Centers for Medicare and Medicaid Services, who has since resigned rather than face the tough questioning of a nomination hearing in the Senate.

Berwick is an architect of Britain's medical rationing scheme, and his patron organization, the Commonwealth Fund, has published numerous articles and papers touting the Liverpool Care Pathway as a fine model for end-of-life cost-containment. Berwick's replacement, Marilyn Tavenner, is by most accounts an ideological acolyte of Berwick's rationing mindset, promising little change in administrative direction. For those readers who doubt the applicability of British health care examples on our system, remember that ObamaCare is modeled as the next-generation improvement to Britain's NHS, and the Liverpool Care Pathway is considered by these "experts" the gold standard of end-of-life care. We ignore this reality at the peril of our very lives.

Read more:

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From: i-node1/6/2012 11:23:52 AM
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NEW YORK (CNNMoney) -- Doctors in America are harboring an embarrassing secret: Many of them are going broke.

This quiet reality, which is spreading nationwide, is claiming a wide range of casualties, including family physicians, cardiologists and oncologists.

Industry watchers say the trend is worrisome. Half of all doctors in the nation operate a private practice. So if a cash crunch forces the death of an independent practice, it robs a community of a vital health care resource.

"A lot of independent practices are starting to see serious financial issues," said Marc Lion, CEO of Lion & Company CPAs, LLC, which advises independent doctor practices about their finances.

Doctors list shrinking insurance reimbursements, changing regulations, rising business and drug costs among the factors preventing them from keeping their practices afloat. But some experts counter that doctors' lack of business acumen is also to blame.

Loans to make payroll: Dr. William Pentz, 47, a cardiologist with a Philadelphia private practice, and his partners had to tap into their personal assets to make payroll for employees last year. "And we still barely made payroll last paycheck," he said. "Many of us are also skimping on our own pay."

Pentz said recent steep 35% to 40% cuts in Medicare reimbursements for key cardiovascular services, such as stress tests and echocardiograms, have taken a substantial toll on revenue. "Our total revenue was down about 9% last year compared to 2010," he said.
12 entrepreneurs reinventing health care

"These cuts have destabilized private cardiology practices," he said. "A third of our patients are on Medicare. So these Medicare cuts are by far the biggest factor. Private insurers follow Medicare rates. So those reimbursements are going down as well."

Pentz is thinking about an out. "If this continues, I might seriously consider leaving medicine," he said. "I can't keep working this way."

Also on his mind, the impending 27.4% Medicare pay cut for doctors. "If that goes through, it will put us under," he said.

Federal law requires that Medicare reimbursement rates be adjusted annually based on a formula tied to the health of the economy. That law says rates should be cut every year to keep Medicare financially sound.

Although Congress has blocked those cuts from happening 13 times over the past decade, most recently on Dec. 23 with a two-month temporary "patch," this dilemma continues to haunt doctors every year.

Beau Donegan, senior executive with a hospital cancer center in Newport Beach, Calif., is well aware of physicians' financial woes.

"Many are too proud to admit that they are on the verge of bankruptcy," she said. "These physicians see no way out of the downward spiral of reimbursement, escalating costs of treating patients and insurance companies deciding when and how much they will pay them."

Donegan knows an oncologist "with a stellar reputation in the community" who hasn't taken a salary from his private practice in over a year. He owes drug companies $1.6 million, which he wasn't reimbursed for.

Dr. Neil Barth is that oncologist. He has been in the top 10% of oncologists in his region, according to U.S. News Top Doctors' ranking. Still, he is contemplating personal bankruptcy.

That move could shutter his 31-year-old clinical practice and force 6,000 cancer patients to look for a new doctor.

Changes in drug reimbursements have hurt him badly. Until the mid-2000's, drugs sales were big profit generators for oncologists.

In oncology, doctors were allowed to profit from drug sales. So doctors would buy expensive cancer drugs at bulk prices from drugmakers and then sell them at much higher prices to their patients.

"I grew up in that system. I was spending $1.5 million a month on buying treatment drugs," he said. In 2005, Medicare revised the reimbursement guidelines for cancer drugs, which effectively made reimbursements for many expensive cancer drugs fall to less than the actual cost of the drugs.

"Our reimbursements plummeted," Barth said.

Still, Barth continued to push ahead with innovative research, treating patients with cutting-edge expensive therapies, accepting patients who were underinsured only to realize later that insurers would not pay him back for much of his care.

"I was $3.2 million in debt by mid 2010," said Barth. "It was a sickening feeling. I could no longer care for patients with catastrophic illnesses without scrutinizing every penny first."

He's since halved his debt and taken on a second job as a consultant to hospitals. But he's still struggling and considering closing his practice in the next six months.

"The economics of providing health care in this country need to change. It's too expensive for doctors," he said. "I love medicine. I will find a way to refinance my debt and not lose my home or my practice."

If he does declare bankruptcy, he loses all of it and has to find a way to start over at 60. Until then, he's turning away new patients whose care he can no longer subsidize.

"I recently got a call from a divorced woman with two kids who is unemployed, house in foreclosure with advanced breast cancer," he said. "The moment has come to this that you now say, 'sorry, we don't have the capacity to care for you.' "

Small business 101: A private practice is like a small business. "The only thing different is that a third party, and not the customer, is paying for the service," said Lion.

"Many times I shake my head," he said. "Doctors are trained in medicine but not how to run a business." His biggest challenge is getting doctors to realize where and how their profits are leaking.
My biggest tax nightmare!

"On average, there's a 10% to 15% profit leak in a private practice," he said. Much of that is tied to money owed to the practice by patients or insurers. "This is also why they are seeing a cash crunch."

Dr. Mike Gorman, a family physician in Logandale, Nev., recently took out an SBA loan to keep his practice running and pay his five employees.

"It is embarrassing," he said. "Doctors don't want to talk about being in debt." But he's planning a new strategy to deal with his rising business expenses and falling reimbursements.

"I will see more patients, but I won't check all of their complaints at one time," he explained. "If I do, insurance will bundle my reimbursement into one payment." Patients will have to make repeat visits -- an arrangement that he acknowledges is "inconvenient."

"This system pits doctor against patient," he said. "But it's the only way to beat the system and get paid."

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