On Wed, 17 Mar 2010 21:15:08 -0700 (PDT), projectile vomit chick
> wrote:

>Get the whole story......you're presenting the "bleeding heart".......

OK -- try this recent posting from a health care provider in Florida:

Greetings,

I write as a semi-rural healthcare provider in an occupational health clinic.
The crushing demand for healthcare in small towns similar to this one (35,000
residents) is moving. The lack of access to care is beyond any debate; the
battalions of "medical homeless" swell in their ranks at a an astonishing rate.
We are witnessing the unraveling of a very infirm system. Ultimately, for me,
It has become an issue of conscience.

A large portion of the patients I end up caring for as primary care patients
come to me for a pre-employment physical to be cleared for an unskilled labor
position. They earn about $12 per hour, and are not offered health insurance,
or are not offered health insurance until after 90 days of employment, or are
offered health insurance at a premium equal to 20 hours of work after taxes per
month, and double that to cover a spouse or child.

The three physician groups in my town charge over $100 for a new patient to
be seen in their clinics. The local hospital will not see non-emergent cases in
the ER without a $150 deposit. The health department shut its primary care
clinic. There simply is no option for care.

So, I try to provide primary care myself, as well as the patients can
afford. I generally prescribe from the $4 generic medication list at Wal Mart
even though medications under patent are shown in clinical trials to be
superior. I often recommend a diagnostic or laboratory test that my patients
cannot afford. I carefully explain the necessity of the indicated test and
watch grown men and women dissolve into tears because they can't take care of
themselves. I have no capacity to refer these patients to specialists. These
patients are getting disease-specific treatment for diabetes, depression,
recalcitrant sinusitis, generalized anxiety, hypertension, and elevated
triglycerides and cholesterol. They are not getting screening tests for cancer,
heart disease, eye disease, and dental decay. Many of them have skin cancers
and pre-cancers which they cannot afford to have removed.

I see them for $35 each, and charge my cost plus 10% for laboratory tests. I
draw their blood for free. My charges do not cover my expenses, but I try not
to dwell on that thought. I try not to let neglected chronic illnesses cause
these patients to be rejected from the hiring process because I know they will
be less able to care for themselves if they are unemployed. But it is not a
sustainable business model. As the need is burgeoning, the ratio of working
poor arriving to seek care continues to climb, and a disproportionate fraction
of my office visits are taken up by the medical homeless.

I do this all autonomously. I have a "supervising physician" in a nearby
town, but we never speak to each other. He is busy with thousands of patients
of his own. Frankly, I don't need to speak to him. Primary care is well within
my scope of practice for which I am educated, certified, and licensed. And no
one objects. I'm sure the physicians in town would object if I was placed on
private insurance provider panels and if I were true competition to them for
more than the medical homeless. And I suspect that, if health reform gives
sudden health market value to these working poor people, my practice will become
"unsafe" in the eyes of those physicians.

What I really need are the silly restrictions on my practice lifted. I need
to be able to prescribe controlled medications so I treat anxiety more
effectively. I need to be able to treat coughs and pain. I need to be able to
order physical therapy and durable medical equipment for these patients. I need
to be listed on private insurance panels so that my patients don't have to leave
me when they finally get insurance. I need to have my hands untied so I can do
the job I'm educated for. The irony is that nurse practitioners with the exact
same education and certification and licensed to practice in other states have
had all this red tape cut. But none of those other states have a corrupted
legislature which is, effectively, bought and paid for by the state medical
lobby.

Sometimes I want to video tape my patients crying after I tell them that
the law won't let me take care of them even though I know what to do. I want
the legislators to hear the patients as they tell me, "they never care about the
little people like us. We don't matter to them because we don't have any power.
We don't have any money, so we are nothing." I want to tell the patients that
they do matter. That the law considers them. But I mostly just stand there
quietly or am forced to tell them the truth, that the legislators seem not to
care about them as much as power and reelection.

NP, Florida