Here’s the Future of Health Care — and It’s Not in the United States

The typical American hospital charges between $20,000 and $100,000 to perform open-heart surgery. The 1,000-bed Narayana Hrudayalaya Hospital in Bangalore, India, charges $2,000 on average — and, arguably, provides better quality outcomes.

The factory model of medical care, in which hospitals, physicians, nurses and other staff focus with unremitting attention to efficiency and quality on a narrow scope of services, is so successful that entrepreneur/heart surgeon Devi Shetty is raising $90 million in private capital to build four more “health cities” in India. He also has plans to build a 2,000-bed general hospital in Grand Cayman, an hour’s plane ride from Miami, were he plans to price medical procedures at 50% less than what they cost in the United States.

The story of Devi Shetty, recounted today in the Wall Street Journal, demonstrates in the most vivid possible way the extraordinary cost savings that could be achievable if the U.S. had a market-based health care system that focused on productivity and quality as opposed to the highly government regulated system where the emphasis is on shifting costs.

Narayana Hrudayalaya is not for wealthy Indians only. The story also shows how higher productivity translates into lower costs and greater access for the poor. One third of the hospital’s patients are poor farmers covered by an insurance plan, crafted in partnership with the state of Karnataka, costing $3 per year per person and reimbursing the hospital $1,200 for a surgery, slightly less than the hospital’s $1,500 break even.

How does Shetty do it? By paying Third World wages to his hospital staff? No, cardiac surgeons are paid between $110,000 and $240,000 annually — less than in America, perhaps, but not exactly coolie wages.

By cutting corners on quality? Well, no. Quality comparisons are difficult to make but they tend to favor Narayana Hrudayalaya. As the Journal writes: “Narayana Hrudayalara reports a 1.4% mortality rate within 30 days of coronary bypass graft surgery, one of the most common procedures, compared with an average of 1.9% in the U.S. in 2008, according to data gathered by the Chicago-based Society of Thoracic Surgeons. What those data don’t do is adjust for the morbidity of the patients treated. Because so many of the Indian patients lack access to basic health care and suffer from more advanced cardiac disease, Narayana Hrudayalaya probably treats sicker patients, making the quality disparity even more pronounced.

Shetty delivers superior productivity and outcomes by adopting a manufacturing model of process efficiency and quality control. “Japanese companies reinvented the process of making cars. That’s what we’re doing in health care,” Shetty says. “What health care needs is process innovation, not product innovation.”

Needless to say, the health care atrocity lumbering through Congress pays zero attention to process innovation. Indeed, by encumbering the health care system with more bureaucracy and more rules, health care “deform” would most likely hinder process innovation.

There’s a revolution in medical care occurring in the world, and India is at the epicenter. But it’s not the only player. The phenomenon of medical tourism is growing by leaps and bounds. The Journal quotes consulting firm Deloitte as saying that six million Americans are expected to travel to other countries next year in search of more affordable medical care, up from 750,000 who did so in 2007. In the absence of market-based reform of the health care system, we will see those numbers grow as Shetty builds his hospital in Grand Cayman and other entrepreneurs build similar facilities in locales from Central America to the Caribbean.

Thus, the braniacs in Congress, in their monumental conceit that they know better than the health care professionals how to run a health care system, will not only increase the cost of health care and accelerate the country’s rush to bankruptcy, they will succeed in hollowing out our world-class medical industry.

The question we should be asking ourselves is this: Why isn’t Shetty building his 2,000-bed hospital in the United States instead of Grand Cayman? What laws, regulations and incentives obstruct the operation of a heart hospital that would save patients millions of dollars and improve the quality of their care? For what reason, and to what ends, are we depriving Americans of superior, lower cost health care by means of process reform?

Share this article



ADVERTISEMENT

(comments below)



ADVERTISEMENT

(comments below)


Comments

36 responses to “Here’s the Future of Health Care — and It’s Not in the United States”

  1. Great article. Bangalore already has a hospital that performs thousands of hip resurfacings per year – many for international patients (including many Americans).

    The United States is failing and failing fast. The myth of "Bush was to blame" is being eroded as we see that "Change we can believe in" is no better than W.

    On a national level, I have urged two game changing ideas. First, we need a third party to play a prominent role in national elections. Second, we need a new constitutional convention – called by the states without agreement by or participation from the US Congress, the Supreme Court or the executive branch.

    It seems that perhaps I am not the only person saying these things. Larry Sabato (the real Larry Sabato) has been calling for a new constitutional convention for some time. Now, I read Morton Kondrake writing about a Third Party on the national scene.

    http://www.realclearpolitics.com/articles/2009/11/20/economy_is_weak_voters_are_angry__time_for_third_party_99222.html

  2. James A. Bacon Avatar
    James A. Bacon

    Groveton, How would a constitutional convention work? Who would attend? Who would set the agenda? Wouldn't it end up even more anarchic than Congress?

    I agree, we do need to make changes at a constitutional level. I'm just not clear on how the process would work, and how we insurgents could prevent it from being hijacked by the Business-As-Usual folks.

  3. Anonymous Avatar

    "The myth of "Bush was to blame" is being eroded as we see that "Change we can believe in" is no better than W."

    Probably true, but what has either of them got to do with heart surgery in Bangalore, Dentistry in Mexico, or Plastic Surgery in South Africa?

    ————————–

    First, we need a third party to play a prominent role in national elections.

    Yep.

    RH

  4. Anonymous Avatar

    I don't think we need changes on a onstitutional level, we just need to enforce the constitution we have.

    A new constitution would only result in less protection for everyone because the convention would be taken over by political power brokers.

    RH

  5. Jim:

    This is the wording in the Constitution (Article V):

    The Congress, whenever two thirds of both Houses shall deem it necessary, shall propose Amendments to this Constitution, or, on the Application of the Legislatures of two thirds of the several States, shall call a Convention for proposing Amendments, which, in either Case, shall be valid to all Intents and Purposes, as Part of this Constitution, when ratified by the Legislatures of three fourths of the several States, or by Conventions in three fourths thereof, as the one or the other Mode of Ratification may be proposed by the Congress; Provided that no Amendment which may be made prior to the Year One thousand eight hundred and eight shall in any Manner affect the first and fourth Clauses in the Ninth Section of the first Article; and that no State, without its Consent, shall be deprived of its equal Suffrage in the Senate.

    Two thirds of the state legislatures would have to call for a constitutional convention. I assume that each legislature could decide how it would nominate delegates to the constitutional convention. At the convention (much like in the original constitutional convention in Philadelphia) the delegates would talk, argue, draft sections of the new constitution, etc. They would either agree to a new constitutional proposal or they would not. If they agree the new constitution would have to be ratified by 3/4 of the state legislatures.

    At least that's my understanding.

    Here are some links to Larry Sabato's ideas:

    http://www.amoreperfectconstitution.com/a_more_perfect_constitution.htm

    http://en.wikipedia.org/wiki/A_More_Perfect_Constitution

  6. "Probably true, but what has either of them got to do with heart surgery in Bangalore, Dentistry in Mexico, or Plastic Surgery in South Africa?".

    From Jim's original article:

    "Shetty delivers superior productivity and outcomes by adopting a manufacturing model of process efficiency and quality control. "Japanese companies reinvented the process of making cars. That's what we're doing in health care," Shetty says. "What health care needs is process innovation, not product innovation."

    Needless to say, the health care atrocity lumbering through Congress pays zero attention to process innovation. Indeed, by enumbering the health care system with more bureaucracy and more rules, health care "deform" would most likely hinder process innovation.".

    I think Jim is right – Bush was focused on the wrong things and so is Obama. So is this Congress and the last Congress and the one before that and the one before that..

    Americans need to understand that it isn't Democrats vs. Republicans or even Conservatives vs. Liberals. The American political class has separated itself from the citizenry and become full time advocates for themselves.

    The heart surgery being done in Bangalore should be done in Baltimore. The Indian health care policies facilitate process innovation in health care. The American health care policies do not.

    One interesting side note would be the malpractice laws in India.

  7. Gee.. you'd think the BIGGEST customers of India's Medical care system would be all those folks from those "failed" European and Canadian systems – right?

    but then again.. we do have the best medical care system in the world don't we?

    so why should we be going to a country that lacks standards and regulations?

    I would ask – for someone who DOES have Insurance and IS COVERED and DOES HAVE A CHOICE between an American Hospital and the Indian version – why take the Indian option?

    It's a provocative article but it leaves lots of questions not really answered in this blog post.

    If more and more Americans went to India – wouldn't that have an adverse affect on our cost-shifting causing more cost-shifting to make up for the lost revenue?

    Maybe we should have a medical version of Charter Hospitals in this country where we remove those onerous regulations and allow them to model themselves after the Indian versions.

    I happen to agree with the opinions about the beast currently making it's way through Congress but I lay the blame for it at the feet of those who kept saying that we didn't need to do anything.. and just "let the market work" when it was clear that the market does not work.

    Of course now.. Bacon has upped the ante by claiming that it is precisely Government regulation that has screwed up the "market" and not the market itself.

    Without coming right out and saying it – he seemed to imply that had the govt not regulated the market would have "worked".

    Call me a skeptic.

  8. "but then again.. we do have the best medical care system in the world don't we?".

    I have never seen any quantitative evidence that this is true. Especially at the "system" level…

    Life expectancy?
    Infant mortality?
    Health care as a percentage of GDP?
    Percentage of population that is uninsured?

    Pick your poison. We don't lead in any category I have seen.

    If someone else has evidence to the contrary – I'd love to see it. I want to believe but I don't believe.

  9. Gooze Views Avatar
    Gooze Views

    Jim,
    Excuse me but wages do have a lot to do with it. So what if the suregeons make six figures. Any medical "brainiac" (as you put it) knows that a great deal of a successful outcome depends on the quality of the nurses, the surgical techs, and the rest of the staff. WHat are they paid? Same as int he U.S? Doubt it.
    It will be interesting toi see how the Grand Cayman experiment will work. I have been there and it is probably the most expensive island in the Caribbean. However, the medical care is pretty good. A blow fish bit off the tip of my left index finger while I was scuba diving and an emergency room doc managed to save most of the finger (which why I make so many typos).

    Peter Galuszka

  10. Anonymous Avatar

    – Bush was focused on the wrong things and so is Obama.

    Yes, but so what.

    No matter how abysmal what either of them does turns out, what could they possibly have to do with $2000heart surgery in Balgalore?

    You think the government of India has any thign to do with the price of surgery there?

    I don't see the connection between Obama and Indian surgery or what is happening in congress and Indian surgery. Indian Surgury was cheap a long time before either Obama or this bill.

    RH

  11. Anonymous Avatar

    "The American political class has separated itself from the citizenry and become full time advocates for themselves."

    Yep. That is certainly the case here in Fauquier County.

    RH

  12. Anonymous Avatar

    "I would ask – for someone who DOES have Insurance and IS COVERED and DOES HAVE A CHOICE between an American Hospital and the Indian version – why take the Indian option?"

    Because the deductible alone on your US coverage is probably more than the cost of surgery overseas. And, you get to tack on a nice vacation. In Africa they call it the plastic surgery safari.

    I had a minor procedure last year, one day in the hospital, and the part that WASN'T COVERED by my INSURANCE COVERAGE was over $2000.

    Then, of course there is the risk that if you make a claim, you will get dropped. It is like paying cash for a minor fender bender rather than paying for it five times over for five years on yur insurance premium.

    RH

  13. Anonymous Avatar

    So the production costs of health care are whatever we spend minus the benefits we recieve as measured by longevity, infant mortality, and morbidity (number of days sick).

    The external costs are the costs of the uninsured who get paid for by the insured and others. Careful not to double count here, because the uninsured probably produce some of the statistics counted for as benefits in the first section.

    Government costs are those associated with regulation, inspection, medical lawsuits, and care for the truly indigent.

    Total costs are the sum of those three groups:

    Total costs = production costs + external costs + government costs where benefits count as negative costs in each term.

    Bacon is making the same old conservative argument that we can lower totalcosts by lowering government costs and getting out of the regulation business.

    We saw how well that worked in the financial markets.

    Furthermore, Bacon generally argues the OPPOSITE way when it comes to regulation and environmental issues. In that field he seems to think that MORE regulation will lower external costs and therefore total costs.

    My position is mathematical rather than political. The only way you lower total costs is if you can lower one of the or more of the three on the right without raising the other more.

    The problem with the current bill going through the legislature is that that no longer appears to be the case.

    Why is that?

    We have plenty of opportunity to do better, as indicated in Bangalore. Rather than focusing on the mathematical problem at hand we are observing a pure party ideological struggle. Both sides are sacrificing whatever gains we might have made to political expediency.

    ——————————-

    One of the benefits to be considered in the production costs is the salaries paid.

    I suspect that a bypass in Baltimore and one in Bangalore require about the same number of stitches: their actual medical advantage can't be all that great.

    If their medical community is driving Tata's instead of Lexi, then it may very well be that their economy is missing out on a huge trickle down effect.

    With a billion people lacking elctricty and clean water, it is hard to see how we can deceive ourselves into thinking that a few cheap heart operations mean they have a better system of health care than ours, by virtue of less government interference.

    RH

  14. Darrell -- Chesapeake Avatar
    Darrell — Chesapeake

    Medical tourism? I blogged about that a couple of years ago, including on this blog. Everyone thought I was nuts when I said that someday the insurance companies would charter planes to these facilities because the overall cost was cheaper and the service was better. Still trying to find a stock I can buy here in the US. Overseas markets ban US trades.

  15. well then – this is the perfect solution!

    For those folks that cannot get insurance, we send them to India for their care.

    problem solved.

  16. Gooze Views Avatar
    Gooze Views

    Other problems with outsourcing mdical care:
    A few years ago, there was hatched the idea that X-rays taken in the U.S. could be read in India by cheaper cardiologists, cancer experts, bone specialists, etc. The X-ray imagery could be sent via ultra high fiber optics.
    The docs did a great job reading the X-rays. But an American doctor friend of mine says that their staffs did not speak American English. They constantly mispelled the patients' names, got street addresses wrong, etc. So, the wrong assessments were sent for the wrong U.S. patients.
    FYI, in a somewhat related matter, Dell Computer started to drop its offshore help desks because the people at the call centers could not understand American English or their accents were too intense for Americans to understand.

    Peter Galuszka

  17. I'm still intrigued by Bacon's concept that it's the rules and regs that has made American Health Care so expensive and the implication that if we remove them – then prices will decline.

    So I wonder..

    are the other industrialized countries health care systems that cost 1/2 as much as our devoid of regulations and standards and that's how they achieve their cost savings….

    or.. in the case of the India experience, what standards do they hew to if any?

    Are the surgeons in that country educated at Indian Universities?

    Are they "board-certified" and what exactly does "board-certified" mean in other countries like India?

    In other words are their surgeons certified by Indian standards or American Standards?

    But again.. if you are a person who is already insured by an American company that will pay all of your costs at an American Hospital with an American Surgeon – tell me again, why you'd opt to go to India for your operation?

    So you need a bypass and you have a choice between a dozens American Hospitals that specialize in bypasses and the Indian hospital – you'd choose the Indian hospitals – why?

    Bonus Question: how many folks in Canada and Europe opt for the Indian experience?

  18. Wow Jim, hope you put on your Kevlar underwear. Peter and Larry KNOW that ONLY the government can handle health care; and only if its the democrats running the government – the free market system, ha. Oh and by the way, it's all Bush's fault.

  19. Darrell -- Chesapeake Avatar
    Darrell — Chesapeake

    "But an American doctor friend of mine says that their staffs did not speak American English."

    That's why many of these operations are opening in the Philippines. They have US trained doctors and the staffs are recruited for their ability to "speak American".

    Bonus Question? Thailand, Singapore, India, and Malaysia combined service around 2 million foreigners a year. Most of them are Europeans who got tired of waiting in line or were declined service by pubic health care. The hospitals that focus on foreigners primarily use First World certified medical professionals.

    There is one more reason why Obamacare is such a terrible idea to me. If one travels or lives overseas, currently discussed plans for national insurance doesn't work for you. Much like Medicare, it is only good in the states.

    Military retirees can use Tricare standard anywhere in the world on a reimbursement basis. However DoD has made no secret of their desire to get those retirees off the government plan. When you read through these proposed bills, there is several mentions of Active Duty and dependents (including Tricare). Most of the veteran groups seem to believe this includes retirees, but I can see where retirees could be forced into the public pool by simply changing the eligibility laws for Tricare. That's just an example of the potential inadequacy of these proposed plans.

    The EU is considering allowing national health care patients to seek services in other EU bloc countries, effectively beginning the process of internationalizing their citizens care. Meanwhile American politicians are still battling over whether to even debate a debate on health care. I don't know why, it's a done deal one way or the other. The debate should be over the best value for the citizen's tax dollars. What we are getting are more fiefdoms walling out the free market efficiencies that created medical tourism in the first place.

    In an increasingly globalized workforce environment, Americans need true universal health care, not Nationalized plans that limit their options at a higher cost.

  20. Anonymous Avatar

    Who replaced Jim Bacon, the thoughtful commentator, and replaced him with a raving mad tea partier? The fact of the matter is that progressives/liberals and Democrats are far, far more open to the types of fundamental changes that Bacon and others post about here. GOPers will not support anything that may cause anyone at anytime to pay even 1 cent more in any tax.

  21. There seem to be a few myths out there regarding Medical Tourism.

    The first is that Medical Tourism is only available in Third World Countries. Countries such as New Zealand, Singapore and European nations are now offering surgery at cheaper prices than what is available in the USA, with less worries around corruption and regulatory issues.

    The second is that US Healthcare is the best in the world. There have been several reports done (The Commonwealth report) is a good place to start that simply show that this is not true.

    The simple fact remains, US healthcare is overpriced, and while Medical Tourism is not for everyone, there is a market for it and until there are drastic changes (above and beyond the proposed) it is not going away.

  22. Anonymous Avatar

    "For those folks that cannot get insurance, we send them to India for their care.

    problem solved."

    It might be cheaper than what the Senate is about to do.

    Otherwise known as outsourcing.

    EMR must be having a cat.

    RH

  23. Anonymous Avatar

    "I'm still intrigued by Bacon's concept that it's the rules and regs that has made American Health Care so expensive and the implication that if we remove them – then prices will decline."

    You don't sem to be so intrigued by my concept that if we remove the rules on housing development – the prices will decline.

    RH

  24. Anonymous Avatar

    "Most of them are Europeans who got tired of waiting in line or were declined service by pubic health care."

    I'm not doubting you, but I'd like to know the source for that data.

    RH

  25. Anonymous Avatar

    The debate should be over the best value for the citizen's tax dollars.

    Total Cost = Production Cost + External Cost + Government Cost.

    Same as anything else. The best value for citizen dollars is lowest Total Cost. Best value for citizens tax dollars is a relatively minor matter or a red herring, depending on who is doing the talking.

    Look at the left side of the equation: it is all that matters.

    RH

  26. FYI…

    I watched a piece on 60 Minutes this evening called, "The Cost of Dying".

    Here is the link;

    http://www.cbsnews.com/video/watch/?id=5737138n

    Pay close attention to;

    A) The amount of $$$ the government ALREADY pays.

    B) The need for hospitals to "keep beds filled" in order to make money.

    C) The useless tests run on people in their final days.

    Here is a link to the text version of the story;

    http://www.cbsnews.com/stories/2009/11/19/60minutes/main5711689.shtml?tag=contentMain;contentBody

  27. Anonymous Avatar

    A tremendous amount of our healthcare monwy is spent in the last five years of life.

    What else is new?

    As Larry would say, Where is the guru who decides when it is w waste?

    What if those last five years of livfe are from 20 to 25

    RH

  28. "As Larry would say, Where is the guru who decides when it is w waste?"

    That's the problem – there isn't one.

    The system rewards waste which is why the costs are going through the roof.

    Per the report, "…modern medicine has become so good at keeping the terminally ill alive by treating the complications of underlying disease that the inevitable process of dying has become much harder and is often prolonged unnecessarily."

    To me that's just another way of saying that the main reason were trying to keep somebody alive (or in treatment for any type of disease/illness) is so the hospitals and specialists can keep a paying customer…..courtesy of Uncle Sam.

  29. "… so the hospitals and specialists can keep a paying customer…..courtesy of Uncle Sam."

    actually it don't matter who is paying as long as the folks who want the services are not.

    If the family of the terminally ill don't have to pay, then many will agree to whatever options remain no matter the cost and the hospitals and doctors that make money off of selling those procedures also have financial incentives to continue treatments.

    At that point, the issue of whether the treatment is cost effective or financially justifiable is irrelevant.

    60 minutes had a segment on this and they editorialized that this kind of care has the potential to bankrupt the system but that now we're even further away from substantively dealing with it because someone, some entity would have to have the power to say "when" and that would be tantamount to the govt "pulling the plug on granny".

    So we have, as 60 minutes showed the truly absurd, doing a pap test for a 70 year old woman with days left to live and the like – a "perfectly" legitimate test and charge for it.

  30. should this Govt Agency exist and perform it's stated mission ….
    or is this a govt Agency that should not exist and instead let health care providers develop and use their own local standards?

    http://en.wikipedia.org/wiki/Agency_for_Healthcare_Research_and_Quality

    let me distill this down even further.

    should the government be the entity that sets standards?

    or is this an issue that should be done by the private sector?

  31. Anonymous Avatar

    "….actually it don't matter who is paying as long as the folks who want the services are not."

    TC = PC + EC + GC

    I believe your agument is that if the users don't pay then the costs wind up as external costs of government costs, but the total cost doesn't change.

    That's true unless one entity is able to get and pay for services more efficiently than another.

    RH

  32. Anonymous Avatar

    "That's the problem – there isn't one. "

    So you are in favor of a "Death Committee"?

    RH

  33. James A. Bacon Avatar
    James A. Bacon

    There you go, Larry, you're honing in on productivity and quality in a meaningful way. You pose a very good question. Should the Agency for Healthcare Research and Quality be given a bigger role? Should the government be the player that sets outcome-quality standards?

    I'm sure a case could be made either way, and I'm open to be persuaded. My inclination, however, is that it would *not* be a good think to house the entity that makes such judgment calls in the same executive function of government that is in charge of allocating health care dollars. As deficits and national debt mounts, the pressure to use the quality standards as a tool for rationing might prove to be overwhelming.

    I would prefer that such a function be administered by an independent, not-for-profit entity (or multiple entities, each aligned with specific disciplines perhaps) that is insulated from political considerations.

  34. well here's an interesting excerpt:

    " Politics

    The agency originally began as the Agency for Health Care Policy and Research and was tasked with producing guidelines. However, it became controversial when it produced several guidelines which would reduce lucrative medical drugs procedures. This included concern from opththalmologists on a cataract guideline and concern by the pharmaceutical industry over a reduction in the use of new high-margin drugs. When the agency produced a guideline which concluded that back pain surgery was unnecessary and potentially harmful, a lobbying campaign aided by Congressmen whose backs had been operated on changed the name of the agency and "wound down" the guidelines program"

    now.. I'm kinda flummoxed here in trying to envision what kind of an "independent" entity would be immune to such influences as alluded to above.

    Would we be looking at some sort of a Consumer Reports-type entity where voluntary donations keep it alive while it fends off any/all govt and non-govt forces who may not agree with it's findings?

  35. Gooze Views Avatar
    Gooze Views

    Jim,
    This may not track exactly with the point of your post, but it is instructive of why medical costs are out of control in the U.S.
    Today, I got an invoice from a health care company for $101.91 claiming that two helpers needed six hours at $16.75 an hour to take my 89-year-old mother a five minute drive to visit her doctor (two visits). She usually spendsd maybe 45 minutes there.
    Normally, her assisted living center calls on a local woman who charges perhaps $25 or $30 to do it. But I gather that person was not available, so they went with a more formal corporation that provides "senior care."
    Knowing that there is no way that taking Mom to the doctor twice took six hours, I complained about the bill (I have had trouble with this outfit before). "Oh, that's just the computer. It automatically spits out a three hour minimum charge on anything," I was told.
    I responded: "No way am I going to pay $101.91 for six fictitious hours. You can sue me. And I never signed a contract or agreed on any three hour minimum."
    We agreed that I would pay $50 and be done with it. But imagine how many people pay the $101.91? That is the real problem with health care costs. It is NOT government regulations that you conservatives love to trot out. It is some company's "computer" spitting out "minimums" that you never agreed to. There is no free market here, you got that part right, but the reason is PRIVATE ENTERPRISE run amok.
    Peter Galuszka

  36. "So you are in favor of a "Death Committee"?"

    I wouldn't call it a "Death Committee"….neither would the doctor interviewed in the story (check it out towards the end).

    I would be in favor of a system where Uncle Sam steps in and says, "That's it, were not paying anymore", in order to reign in costs…..useless and unnecessary costs at that.

    If it's a legitimate expense that is part of the normal course of treatment that's one thing.

    It's quite another for a patient dying of heart/lung failure to be examined by a Psychiatrist and then have the provider turn around and bill Medicare.

    Sure, they can get a visit from a Psychiatrist….they will just have to pay for it either with insurance or out of pocket.

    That applies to people on their death beds as well as people in for other treatments where Uncle Sam is footing the bill (which he is doing most of the time.)

    Rationing care would be when a person is denied care that is part of normal course of treatment for a particular illness, i.e, no antibiotics for an infection, etc.

    Denying someone Prozac because they have heart/lung disease is something entirely different and everyone…patients, doctors, providers, Uncle Sam, etc., needs to realize that.

Leave a Reply