Yes it’s known. But I was referring to a specific description of a kickback, not the legal seminars, lunches, promotions, etc. But it conflated into that, so oh well.
Wow. Had to look up Dunning-Kruger, eh? Well done. Bless your heart againOh sweet summer child (as GTG says)...... I just showed you how they get around the law lol. Dunning-Kruger in full effect here eh?
We all know a direct payment or commission is illegal, however whether you like it or not, no matter who you say you talked to via convenient anecdotes......Pharma gives incentives to doctors for writing scripts. Which is the same exact thing as paying them with cash. Well..... they pay them cash, but they say it's for another reason. "Continuing Education"
I don't think anyone is saying you're wrong that direct cash payments, aka "kickbacks" are illegal and not happening. I think they're saying your pointed defense of this distinction is, well, pointless!
There's a symbiotic relationship between pharmaceutical companies and the prescribing doctors within the establishment medical systems. There's a reason Big Pharma advertises to patients, not doctors. They've already bought the doctors by all those other means that don't qualify as kickbacks under criminal statutes. The ads are simply instructions to the sheep to go ask for those meds, which the doctors have been let's say "enticed" to write. They're writing those Rx's as much for the pharmaceutical companies as they are the patients. That's the distinction that deserves attention, not yours.
My time is worth a lot to me as well. To wait consistently 30 minutes for a scheduled appointment and be expected to show up 15 minutes early is just bad. Is it worth the wait, absolutely. It says more about the bureaucratic nature of healthcare. What is one hallmark of socialized healthcare, long waits...
My personal opinion:
I worked as a hospital based ‘Registered Respiratory Therapist for 39 years (last 31 in Oklahoma) with my final 24 years as the technical Director of Respiratory Care Services in cooperation with a physician Medical Director: Respiratory Therapy; Pulmonary Laboratory; Bronchoscopy; Sleep Laboratory; Hazmat and Medical Waste (LOL). During this time, I served 20+ years in Safety, Medicine and Accreditation Committees where I collected and reported my areas' operational data, reviewed medical records, investigated and reported variances in patient care. Routine patient care under my direction involved: administration and documentation of respiratory medications oxygen and mixed medical gases; set-up, operation, documentation, disinfection and maintenance of mechanical ventilators in the ICU, ER and Neonatal ICU; emergency manual resuscitation; CPR; and chest physiotherapy.
During this career (I loved my work), I observed numerous drastic and detrimental changes in our country’s healthcare system. I'll try to enumerate: intrusion in patient care processes between physicians and their patients by Federal (CMO), State Agencies (State Department of Health); Health Maintenance Organizations (HMOs); Preferred Provider Organizations (PPOs); Hospitals and Medical Clinics; Health and Liability Insurance Corporations; JCAHO (Joint Commission on the Accreditation of Hospitals) all purportedly functioning in the best interests of patient care, safety and cost control. All of these entities have aggregately created a disparate constellation of documentation requirements consequent to government regulations; accreditation standards; medicare/medicaid reimbursement requirements; insurance allowances and reimbursement rates; insurance liability demands with individual institutions devising policy guidelines attempting to comply with them all. This situation has created a monstrous bureaucratic minefield where physicians and healthcare workers attempt to provide patient care despite the ridiculous, counterproductive interference.
The conundrum of competing interests that must be served by physicians are so burdensome that individual practices have nearly become extinct causing the majority of doctors to seeking employment from one of the entities listed above. The Employer/Employee Relationship inherently creates an overwhelming influence on physician practices by limiting their income, autonomy and once sacred rights to choose diagnostic procedures, interventions and pharmaceuticals they believe appropriate for the care of their patients. These agencies and organizations have become more and more prescriptive (controlling) forcing physicians to follow scripted protocols, algorithms and mnemonics, regarding diagnostic, treatment and pharmaceutical options physicians must follow and precluding the off label use of pharmaceuticals empirically demonstrated to perform beneficially in order to remain in compliance and to remain employed. This situation has caused many, many excellent older doctors to retire early.
The counterargument supporting these controls on physician practices appears logical. Patient Safety and Peer Reviewed Evidence Based Patient Care Practices sound like they are good things. However, Peer Review is not what it used to be as evidenced by its deliberate misuse in Education, Environmental Science, Anthropology, Atmospherics, Social Services, and most grievously in Medicine during the Coronavirus Panic. The financial and personal interests and political agendas acting in the background all too often shape the methodologies and procedures used in order to produce desired outcomes. The system has been restructured in such a way as to stifle the process of independent discovery outside of the ‘authorized’ large corporate arena. I would much prefer medical care from a wiser, older, more knowledgeable, experienced physician that is free to function without distractions or interference as traditional doctor as opposed to the servant of a committee comprised of conflicted masters.
I believe that the significant majority of physicians are excellent, trustworthy people whom are trying to function in a complex, ever-changing environment. However, I also believe that the selection, education and training of physicians as it has evolved do not come near to producing the quality of these professionals as they once did; and, I firmly believe an individual's ability, not equal opportunity, should be the only criteria for selection.
I worked as a hospital based ‘Registered Respiratory Therapist for 39 years (last 31 in Oklahoma) with my final 24 years as the technical Director of Respiratory Care Services in cooperation with a physician Medical Director: Respiratory Therapy; Pulmonary Laboratory; Bronchoscopy; Sleep Laboratory; Hazmat and Medical Waste (LOL). During this time, I served 20+ years in Safety, Medicine and Accreditation Committees where I collected and reported my areas' operational data, reviewed medical records, investigated and reported variances in patient care. Routine patient care under my direction involved: administration and documentation of respiratory medications oxygen and mixed medical gases; set-up, operation, documentation, disinfection and maintenance of mechanical ventilators in the ICU, ER and Neonatal ICU; emergency manual resuscitation; CPR; and chest physiotherapy.
During this career (I loved my work), I observed numerous drastic and detrimental changes in our country’s healthcare system. I'll try to enumerate: intrusion in patient care processes between physicians and their patients by Federal (CMO), State Agencies (State Department of Health); Health Maintenance Organizations (HMOs); Preferred Provider Organizations (PPOs); Hospitals and Medical Clinics; Health and Liability Insurance Corporations; JCAHO (Joint Commission on the Accreditation of Hospitals) all purportedly functioning in the best interests of patient care, safety and cost control. All of these entities have aggregately created a disparate constellation of documentation requirements consequent to government regulations; accreditation standards; medicare/medicaid reimbursement requirements; insurance allowances and reimbursement rates; insurance liability demands with individual institutions devising policy guidelines attempting to comply with them all. This situation has created a monstrous bureaucratic minefield where physicians and healthcare workers attempt to provide patient care despite the ridiculous, counterproductive interference.
The conundrum of competing interests that must be served by physicians are so burdensome that individual practices have nearly become extinct causing the majority of doctors to seeking employment from one of the entities listed above. The Employer/Employee Relationship inherently creates an overwhelming influence on physician practices by limiting their income, autonomy and once sacred rights to choose diagnostic procedures, interventions and pharmaceuticals they believe appropriate for the care of their patients. These agencies and organizations have become more and more prescriptive (controlling) forcing physicians to follow scripted protocols, algorithms and mnemonics, regarding diagnostic, treatment and pharmaceutical options physicians must follow and precluding the off label use of pharmaceuticals empirically demonstrated to perform beneficially in order to remain in compliance and to remain employed. This situation has caused many, many excellent older doctors to retire early.
The counterargument supporting these controls on physician practices appears logical. Patient Safety and Peer Reviewed Evidence Based Patient Care Practices sound like they are good things. However, Peer Review is not what it used to be as evidenced by its deliberate misuse in Education, Environmental Science, Anthropology, Atmospherics, Social Services, and most grievously in Medicine during the Coronavirus Panic. The financial and personal interests and political agendas acting in the background all too often shape the methodologies and procedures used in order to produce desired outcomes. The system has been restructured in such a way as to stifle the process of independent discovery outside of the ‘authorized’ large corporate arena. I would much prefer medical care from a wiser, older, more knowledgeable, experienced physician that is free to function without distractions or interference as traditional doctor as opposed to the servant of a committee comprised of conflicted masters.
I believe that the significant majority of physicians are excellent, trustworthy people whom are trying to function in a complex, ever-changing environment. However, I also believe that the selection, education and training of physicians as it has evolved do not come near to producing the quality of these professionals as they once did; and, I firmly believe an individual's ability, not equal opportunity, should be the only criteria for selection.
Here's a nightmare with waiting. My wife was having severe abdominal pain, so rather than calling an ambulance I drove her to the ER myself. Waiting 30 minutes for an ambulance when I can get her to the ER myself should make sense, right? Not in this fracked up monster big health and government have cooked up.
Got her to the ER and ended up in the waiting room with all the snifflersminor aches and pains and small cuts and they took 30 minutes to get her to triage and take her vitals, they told us that there are no spaces in the ER since they only put People in ambulances in the ER. They said to wait, all this time my wife is having more and more pain. After 20 minutes they called her in, put her on a cart then took her for a Cat Scan, which took another 20 minutes, then called me to go into the ER.
I was surprised to find her sitting in a chair outside an office, a nurse came and started an IV and gave her a shot of demerol, and sent her with the IV and no wheelchair back to the waiting room to wait for the Doctor. Every 1/2 hour I waited and calmly and politely asked when the Doctor would see her and when would she get a cart to lay down on in the ER, they said any minute after 1 1/2 I asked if we would be seen at all, the demerol was wearing off and she was starting to feel it. I asked them at that time if I could take her to another ER or if I could call an ambulance to another ER and they told me yes, but you will be signing out AMA (you do that and your insurance will not pay and you will be on the hook for the whole bill at non insurance costs.)
After 4 hours in the waiting room, 6 hours after getting there they finally got her in, on a cart and saw a nurse. Never saw the Doctor, but we were told the diagnosis was small bowel obstruction.
She was admitted, was seen regularly by Doctors after that. Fortunately for her no surgery was needed.
Why did we go to this ER? The other ER we went to prior was even worse. My wife had sepsis (we know the symptoms) and passed out while waiting to be triaged, I couldn't wake her. They told me that they would be with her when they could. I walked into the triage and told them she passed out, they told me she'd have to wait, I told them she needs to be seen by a doctor immediately or she will end up dead, I told them she will die and I will sue them, we know she is sick most likely sepsis. They asked me to step out again, I told them not until you see her (I was in no condition to carry her to a car and drive her 20 minutes to another hospital.) They came out to the chair, took her BP, and then stuff began to happen. Within 10 minutes a Doctor saw her, and had IV's started and within an hour or so they started IV antibiotics. 14 hours later she was sent to the ICU.
So, please do not tell me that waiting is no big deal. I worked in health care as an ER Secretary and ER Coordinator (a public relations type position.) If either of two scenarios played out in the ER I worked at, people would have been fired.
Large modern health facilities have become a joke. Bureaocracy over speed, ambulances first over who needs Healthcare first, the ambulance visits are where the money's at.
My advice, want to be seen fast, call and wait for an ambulance. Stay with your loved one, don't leave them in the ER alone.
Got her to the ER and ended up in the waiting room with all the snifflersminor aches and pains and small cuts and they took 30 minutes to get her to triage and take her vitals, they told us that there are no spaces in the ER since they only put People in ambulances in the ER. They said to wait, all this time my wife is having more and more pain. After 20 minutes they called her in, put her on a cart then took her for a Cat Scan, which took another 20 minutes, then called me to go into the ER.
I was surprised to find her sitting in a chair outside an office, a nurse came and started an IV and gave her a shot of demerol, and sent her with the IV and no wheelchair back to the waiting room to wait for the Doctor. Every 1/2 hour I waited and calmly and politely asked when the Doctor would see her and when would she get a cart to lay down on in the ER, they said any minute after 1 1/2 I asked if we would be seen at all, the demerol was wearing off and she was starting to feel it. I asked them at that time if I could take her to another ER or if I could call an ambulance to another ER and they told me yes, but you will be signing out AMA (you do that and your insurance will not pay and you will be on the hook for the whole bill at non insurance costs.)
After 4 hours in the waiting room, 6 hours after getting there they finally got her in, on a cart and saw a nurse. Never saw the Doctor, but we were told the diagnosis was small bowel obstruction.
She was admitted, was seen regularly by Doctors after that. Fortunately for her no surgery was needed.
Why did we go to this ER? The other ER we went to prior was even worse. My wife had sepsis (we know the symptoms) and passed out while waiting to be triaged, I couldn't wake her. They told me that they would be with her when they could. I walked into the triage and told them she passed out, they told me she'd have to wait, I told them she needs to be seen by a doctor immediately or she will end up dead, I told them she will die and I will sue them, we know she is sick most likely sepsis. They asked me to step out again, I told them not until you see her (I was in no condition to carry her to a car and drive her 20 minutes to another hospital.) They came out to the chair, took her BP, and then stuff began to happen. Within 10 minutes a Doctor saw her, and had IV's started and within an hour or so they started IV antibiotics. 14 hours later she was sent to the ICU.
So, please do not tell me that waiting is no big deal. I worked in health care as an ER Secretary and ER Coordinator (a public relations type position.) If either of two scenarios played out in the ER I worked at, people would have been fired.
Large modern health facilities have become a joke. Bureaocracy over speed, ambulances first over who needs Healthcare first, the ambulance visits are where the money's at.
My advice, want to be seen fast, call and wait for an ambulance. Stay with your loved one, don't leave them in the ER alone.
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I'm honestly not judging, I'm saying it exists.
A Kickback by definition doesn't have to be illegal.
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