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Physician, Heal Thy Hippocratic Oath!
April 2, 2010 1:19 PM   Subscribe

‘If You Voted for Obama, Seek Urologic Care Elsewhere’ 'A doctor who considers the national health-care overhaul to be bad medicine for the country posted a sign on his office door telling patients who voted for President Barack Obama to seek care "elsewhere."' This is but a new twist in the continuing debate over a physician's right to refuse treatment.

The Hippocratic Oath has collided with the law before. The courts have found that anti-bias laws outweigh religion, as when state justices ruled in the case of a lesbian. New laws have shored up providers’ right to refuse treatment based on values.

This latest development pushes the debate even further. "Cassell may be walking a thin line between his right to free speech and his professional obligation, said William Allen, professor of bioethics, law and medical professionalism at the University of Florida's College of Medicine.

Allen said doctors cannot refuse patients on the basis of race, gender, religion, sexual orientation or disability, but political preference is not one of the legally protected categories specified in civil-rights law. By insisting he does not quiz his patients about their politics and has not turned away patients based on their vote, the doctor is "trying to hold onto the nub of his ethical obligation," Allen said.

"But this is pushing the limit," he said."
posted by VikingSword (164 comments total) 10 users marked this as a favorite

 
What a pisser.
posted by stevis23 at 1:20 PM on April 2, 2010 [3 favorites]


Dick doc is dick
posted by Sys Rq at 1:21 PM on April 2, 2010 [51 favorites]


I wouldn't want a doctor this demagogic coming near my privates anyway. He thinks the political views of his patients are so much more important than their health? Fuck that.
posted by rtha at 1:22 PM on April 2, 2010 [41 favorites]


Many of us really don't know if the Health Care bill does a good job of remedying the U.S.' health care problem or not. But because the Right threw such a gigantic hissy-fit about it, and tried to obscure the issue with so many things that were obvious lies, we didn't get to have that discussion.
posted by JHarris at 1:24 PM on April 2, 2010 [88 favorites]


Um, how would he know who his patients voted for anyway? Is that on the paperwork you have to fill out now?
posted by dortmunder at 1:24 PM on April 2, 2010 [1 favorite]


During the eight-year reign of the Bush administration, I kept daydreaming that I could simply not comply with the laws and reality they created. I guess you need a degree and a practice to do so.
posted by asfuller at 1:25 PM on April 2, 2010 [5 favorites]


Meh, if he wants to turn away business, that's just more for the doctors who aren't complete pricks.
posted by organic at 1:25 PM on April 2, 2010 [1 favorite]


I was going to say that this guy can suck my dick, but I guess that's out...
posted by Saxon Kane at 1:25 PM on April 2, 2010 [1 favorite]


If You Voted for Obama, Seek Urologic Care Elsewhere

OK. Let us know how that cutting-off-the-nose-to-spite-your-face thing works out for you.
posted by Cool Papa Bell at 1:27 PM on April 2, 2010 [5 favorites]


The guy is nuts.
posted by ericb at 1:28 PM on April 2, 2010 [2 favorites]


the doctor is "trying to hold onto the nub of his ethical obligation," Allen said.

He should give it a good squeeze while he's down there.
posted by Combustible Edison Lighthouse at 1:29 PM on April 2, 2010 [9 favorites]


One more sad, sad wingnut. sigh
posted by Some1 at 1:30 PM on April 2, 2010


As a urologist, he knows when someone has peed in his cornflakes.
posted by mattdidthat at 1:30 PM on April 2, 2010 [1 favorite]


GOOGLE 1962 SASKATCHEWAN DOCTORS STRIKE

(Which is to say, yes, we had some resistance up here, too, at first.)
posted by Sys Rq at 1:30 PM on April 2, 2010 [10 favorites]


I see a few possibilities here:

One: he feels the changes will negatively impact his profitability. That doesn't fly, because if he cared most about his bottom line he wouldn't be turning patients away.

Two: he feels the changes will reduce his ability to provide good medical care. That doesn't fly, because if he cared most about his patient's care he would not turn them away to potentially inferior care1.

Three: he feels his political views and rhetoric are more important than his need to run a profitable business and provide good medical care to his patients. Considering the language he's using ("morons in Washington" and "at least I can make a point"), I think this one is the winner.

From that perspective, I'd be thrilled if my doctor posted such a sign regardless of the political party he supported, because it would be a clear sign that I'm receiving medical care from someone whose political views trump his professional responsibilities. You're darn right I'd go find another doctor, even if I agreed with him.
posted by davejay at 1:32 PM on April 2, 2010 [39 favorites]


OK. Let us know how that cutting-off-the-nose-to-spite-your-face thing works out for you.

Hopefully he'll stick to the bits he's medically trained to cut off.
posted by Sys Rq at 1:32 PM on April 2, 2010 [2 favorites]


1this assumes, of course, that he's not turning people away because he knows he provides inferior care, because that would be silly.

Oh, and I wonder if he'll lament about how the health care changes were responsible for his business going under, even as he intentionally drives existing/new patients away.
posted by davejay at 1:33 PM on April 2, 2010 [5 favorites]


I always thought is was strange (but helpful) when people advertise their ideology, like say on their business cards. Like putting the little "Jesus Fish" in the corner. It makes it easier for me to avoid doing business with them. I understand why they do it. It's to let others know that they are "in" with their secret club, and might give a discount to like minded people. Churches are social networks, and even business networks. Sometimes I wish it was more of a trend that conservatives put a little elephant or something on their advertising, or mailbox, or something.
During the Bush years, I was seriously considering not providing my service to his supporters, but it would have cost me my business, I'm afraid. So, I just bit my lip, did my work, and took their money like a good capitalist.
posted by Balisong at 1:36 PM on April 2, 2010 [20 favorites]


Why doesn't this surprise me much? I mean, considering how many doctor's waiting rooms I've been in over the past few years that feature big screens playing Fox News, I can easily see a wacko doc taking things a bit further.
posted by Thorzdad at 1:37 PM on April 2, 2010


By insisting he does not quiz his patients about their politics and has not turned away patients based on their vote, the doctor is "trying to hold onto the nub of his ethical obligation," Allen said.

Heh.
posted by kittens for breakfast at 1:37 PM on April 2, 2010 [4 favorites]


The right to free speech is not a right to practice medicine. Revoke the quack's license and send him on his merry way.
posted by Blazecock Pileon at 1:39 PM on April 2, 2010 [5 favorites]


We can only hope this foolish tantrum alienates his patients who are looking for medical care, not ideology, and that the all-holy free market takes care of the rest ("Professional Building for Lease"). Also, there's a tea bagging joke in here somewhere I am not clever enough to assemble.
posted by aught at 1:41 PM on April 2, 2010 [7 favorites]


Wait, this happened in Florida? Never would've guessed that.

Mighty big brush you're waving there, mate. Don't get any on you.

Pretty much agree with davejay - we've got a guy who's more interested in making a political point than in being a professional physician, which fortunately is the exception rather than the rule with physicians (even in Florida).

The good news is this will probably get enough publicity that this poor schmuck is going to be remembered for his little tantrum long after it's cute.
posted by Pragmatica at 1:41 PM on April 2, 2010


I would rather live in world where urologic was writing out truth tables by peeing in the snow and this doctor has just told Obama supporters that he will not fix their deductions to be in line with the way republicans take the piss..
posted by srboisvert at 1:41 PM on April 2, 2010


"I can at least make a point," he said.

Yes. At least this...
posted by Hicksu at 1:42 PM on April 2, 2010


Dick doctor is a dick.
posted by Xoebe at 1:43 PM on April 2, 2010


Wait, wait, I got it..."He works for tips!"
posted by Xoebe at 1:43 PM on April 2, 2010 [1 favorite]


Um, how would he know who his patients voted for anyway?

My guess? Dark skin = Obama voter
posted by Atom Eyes at 1:45 PM on April 2, 2010 [4 favorites]


I'm at a library computer right now so can't dig it up, but I am pretty sure I read earlier today that his wife is running for office (as a R, natch), so it all seems like a bit of a politically inbred situation anyways.
posted by edgeways at 1:46 PM on April 2, 2010 [1 favorite]


Sys Rq beat me to it. That's what I get for not reading the comments first. My bad.
posted by Xoebe at 1:48 PM on April 2, 2010


The AMA should bounce his ass out so hard he leaves an indentation in the curb. Doctors should not be allowed to refuse to treat patients over their political affiliation.
posted by zarq at 1:48 PM on April 2, 2010 [2 favorites]


"Does it hurt when you urinate . . . on the Constitution?!"
posted by Skot at 1:49 PM on April 2, 2010 [65 favorites]


Or this...I can refuse to pay my doctor after receiving care based on his political affiliation? Cool beans.
posted by Xoebe at 1:49 PM on April 2, 2010


GOOGLE 1962 SASKATCHEWAN DOCTORS STRIKE

My goodness, Canada has their own encyclopedia! (How the deuce is this related to music, seeing as the subtitle for the site is "The Encyclopedia of Music in Canada"?)
posted by filthy light thief at 1:50 PM on April 2, 2010


"I can at least make a point,"

Tell that to Rob Halford's erection!

Just trying out my new MeFi sit-com catchphrase?
posted by Pollomacho at 1:52 PM on April 2, 2010


We can only hope this foolish tantrum alienates his patients who are looking for medical care, not ideology, and that the all-holy free market takes care of the rest ("Professional Building for Lease").

More likely, the story gets picked up by Fox News and results in a big batch of fresh new patients. It'll get draped in all the usual rhetoric - he'll be a "HERO DOC" who is standing up to the socialist Obama administration. Just watch.
posted by contessa at 1:52 PM on April 2, 2010 [1 favorite]


The good news is this will probably get enough publicity that this poor schmuck is going to be remembered for his little tantrum long after it's cute.

Oh, you know what? I missed a possibility: he practices in a predominantly Republican area, and he feels this move will drum up more business for him overall. If that's his game, this may or may not backfire depending on his location; country-wide disdain and disgust matters little if he becomes a hero locally within the boundaries of his practice.
posted by davejay at 1:52 PM on April 2, 2010


Or, uh, what contessa just said. :P
posted by davejay at 1:53 PM on April 2, 2010


Also: COCK DOC BLOC BLOCK
posted by davejay at 1:54 PM on April 2, 2010 [41 favorites]


It's nice when people self-identify like this. Kind of like the ones with the pissing Calvin bumper stickers, or the ones on Facebook who join "I bet I can find five million people who hate [X]" groups. It cuts down on the amount of time I have to spend discerning whether they're worth listening to or not.
posted by mr_crash_davis mark II: Jazz Odyssey at 1:54 PM on April 2, 2010 [1 favorite]


Doctor hangs sign on his door: "I am an asshole."

Okay, thanks for warning me, I'll just move on.
posted by charlesminus at 1:55 PM on April 2, 2010 [1 favorite]


yeah... I'd actually be interested in someone doing a story about him in a year or two and see if he is taking advantage of the government incentives. My bet is he will act just like all those tea baggers who protest GOVT TAKEOVER OF MY MEDICARE!!!
posted by edgeways at 2:00 PM on April 2, 2010 [1 favorite]


"On July 30, 1965, President Lyndon Johnson signed Medicare into law. In public memory, what ensued was the smooth establishment of a popular program, but in fact Medicare faced a year of nearly crippling rearguard attacks. The American Medical Association had waged war to try to stop the program, and doctors weren't about to abandon the fight against 'socialized medicine' simply because it had passed into law. The Ohio Medical Association, with ten thousand physician members, declared that it would boycott Medicare, and a nationwide movement began. Race proved an even more explosive issue. Many hospitals, especially in the South, were segregated, and the law required them to integrate in order to receive Medicare dollars..."

Atual Gawande in the April 5, 2010 New Yorker
posted by found missing at 2:01 PM on April 2, 2010 [31 favorites]


At least he didn't use Comic Sans.
posted by longsleeves at 2:05 PM on April 2, 2010 [11 favorites]


Is there any industry so important to human life that is at the same time so antagonistic to those it is intended to help as health care?
posted by tommasz at 2:05 PM on April 2, 2010 [1 favorite]


Is there any industry so important to human life that is at the same time so antagonistic to those it is intended to help as health care?

Law Enforcement, I think, perhaps.
posted by davejay at 2:14 PM on April 2, 2010 [17 favorites]


Payday loans?
posted by found missing at 2:15 PM on April 2, 2010 [1 favorite]


Some people don't think health care reform is a good idea.

He has a right to do this.

You have a right not to retain him.

It's not such a big deal.
posted by Slap Factory at 2:17 PM on April 2, 2010 [4 favorites]


This is a pretty interesting line to cross. It's one thing if a professional doesn't provide certain procedures or types of care because they feel the treatment itself is somehow objectionable, and I buy that the freedom of conscience issues on that front are important.

And I could even come down on the side of the freedom to strike for doctors who don't like the idea of their labor being part of a "socialist" society, even though I think it's loony.

But this is different. This guy isn't objecting to participating in some procedure he doesn't like, or as part of an organization he doesn't like. He's more or less saying that it's specific people he has an objection to treating.

Not that I'd want to seek treatment from anyone who doesn't really want to treat me, and for that reason, maybe I'd still come down on the side of his freedom to be a political bigot. But this is pretty ugly; there's no principle here except tribalism: I'll help people who agree with me, I won't help people who don't.
posted by weston at 2:17 PM on April 2, 2010 [2 favorites]


The Hippocratic Oath has collided with the law before.

In order for that to happen, wouldn't the law have to be saying doctors CAN'T treat people?
posted by DU at 2:20 PM on April 2, 2010 [4 favorites]


Its a good thing he put that sign up, otherwise I would have let some crazy guy touch my dick!
posted by nomad at 2:22 PM on April 2, 2010 [10 favorites]


Since it seems that none of the parties involved on that side of the fence actually read anything closely anyway, we need to tell the Tea Partiers that they were right the whole time, and this guy is just the first example of a doctor who, under the new health care bill, is turning patients away! Because of what Obama did! Just like they predicted!

See if we can get them outside protesting this guy with poorly spelled signs calling the guy a "Socialist Mulsam Baby Killer" or something.

Just so he can look out his window and wonder WTF is going on.

Seriously, throw enough dog whistles out there, and they'll all start barking in confusion at one another.
posted by quin at 2:33 PM on April 2, 2010 [12 favorites]


He says that if a person does seek help that he will trat. He also notes that the signs often scares them away. What to do?
Google for name and address (they are there), send him a postcard so others can read it before he gets it...on the card express your views on his way of treating humans in distress. Imnagine if thousands of people did this? Imagine the Post Office reaction? Imagine his receptionist's reaction? and so on...he has a sign. you can have one too.
posted by Postroad at 2:33 PM on April 2, 2010


You can read a brief (presumably self-penned) bio of Dr. Cassell here (assuming that there aren't two urologists named Jack Cassell practicing in Lake County, FL).
posted by mhum at 2:34 PM on April 2, 2010 [4 favorites]


You know, "I disagree with Obama's Healthcare Plan" is a statement. "Go get treatment elsewhere" is an instruction.

I've already heard nightmare stories of folks getting less than proper care because of their skin color, sexual orientation, etc. But straight up denial, openly? Is this just another fucking codeword for segregation? Cause it sounds a lot like it.
posted by yeloson at 2:43 PM on April 2, 2010 [3 favorites]


I think a lot of commenters here have clued into a very important point: Discrimination has a useful place in society. When somebody discriminates against others for [whatever criteria], it enables all those who have no desire to do business with him, to avoid him. This is good for everybody. Eventually, if his position is truly undesirable, the ostracism will drive him out of business, while his better competitors will thrive. Again, a good thing.

Conversely, anti-discrimination laws sweep hostilities under the rug instead of shining a spotlight on them. People lose their ability to make judgment calls about who they want to do business with and what sorts of things they wish to support. In the long run, they impede positive social progress. I don't see how that's a good thing. I'd rather let bigots shout loudly and reap the consequences, then shut them up and force them to accept clients they'd prefer not to interact with. The latter is like treating a symptom instead of the disease itself.
posted by The Winsome Parker Lewis at 2:43 PM on April 2, 2010 [1 favorite]


He looks like a narcissistic douchebag in that photo (via mhum's bio link). No shocker there.

Like that idea, quin :)
posted by symbioid at 2:44 PM on April 2, 2010


That link posted by mhum is a doozy - read that bio, and marvel. And yes, it's the same guy - in the first link of the FPP, there's a photo of him.
posted by VikingSword at 2:48 PM on April 2, 2010


i hope this guy fails. fails hard.

but unless it can be proven that he's committing a codified violation, calls for revoking his license are counterproductive. no need to give the wingnuts a martyr.
posted by clarenceism at 2:49 PM on April 2, 2010


*rereads post -- oh... "than shut them up..." I wrote "then," which changes my meaning considerably!
posted by The Winsome Parker Lewis at 2:50 PM on April 2, 2010


Penis doctor is a bad human being.

HA HA HA HA HA HA HA!
posted by drjimmy11 at 2:50 PM on April 2, 2010 [6 favorites]


Fox News' Neil Cavuto Interviews Florida Urologist With Anti-Obama Sign.
posted by ericb at 2:51 PM on April 2, 2010


I wonder what he'll do if his house catches on fire and the fire department shows up with a sign that says "We do not save McCain voters"?
posted by lumpenprole at 2:54 PM on April 2, 2010 [12 favorites]


"It's Dr. Evil, I didn't spend six years in Evil Medical School to be called 'mister,' thank you very much. "
posted by found missing at 3:04 PM on April 2, 2010 [5 favorites]


When somebody discriminates against others for [whatever criteria], it enables all those who have no desire to do business with him, to avoid him. This is good for everybody....I'd rather let bigots shout loudly and reap the consequences...

This assumes two things - first that people have accessible alternatives, and that the bigots actually reap consequences. By opening the door for people to start denying service, openly, it means a lot more folks can choose to start denying service without fear of lawsuit or legal repercussions.

My friends mentioned in my previous comment? They only got their insurance company to start providing reasonable responses to their requests for records when they asked who their lawyer should contact.

Anti-discrimination laws are repercussions. Not ideal, sure. But before we had them? It's not like folks were getting off their asses to do right on their own, anyway.
posted by yeloson at 3:07 PM on April 2, 2010 [10 favorites]


Just want to be clear. Every single doctor I know in Seattle, urologists included, were broadly in favor the health care reform bill as it passed. Only a total dumbfuck can't see where the current system is not only killing patients but is an unsustainable business model, even for those doctors who traditionally had been getting rich off the system (e.g. urologists).

In addition to being a dumb business person and politically retarded, it's hard to imagine a wit like this is a very good physician either.
posted by Slarty Bartfast at 3:07 PM on April 2, 2010 [2 favorites]


It's bizarre about "Vote for Obama" - what about those who claim (and I've seen such claims) that they voted for Obama, but are against the current HC bill? Should they too go away? What about those who voted against Obama, but do support the HC bill (those exist too)? It's just odd that he wants to discourage people from participating in the democratic process. "For Obama" makes it sound like he has problems with Obama period, that go way beyond the HC bill. Or as Frank Rich put it: The Rage Is Not About Health Care.
posted by VikingSword at 3:07 PM on April 2, 2010 [5 favorites]


Why is this certified jackass wearing scrubs during his interview with Cavuto? Did he just get through with yanking out an Obama voter's urethra with his bare hands?
posted by blucevalo at 3:07 PM on April 2, 2010 [3 favorites]


Well I have been thinking of getting my Mighty Righty fixed for a while now, and have not had insurance for over ten years. Maybe I should take a road trip down there and get the work done and then... "oh sorry, can't pay ya! Oops!"
posted by zoinks at 3:13 PM on April 2, 2010


My family doctor (partner of the doctor who delivered me, my doctor from college onward, still my mother's doctor) has been strongly against nationalized health care (like single payer) for many years and has had some information specifically about that issue in his office for years. It was there the last time I saw him before I moved out of my hometown six or seven years ago.

On the other hand, he's pretty hardcore about patient service, and hates insurance companies as much as the idea of single-payer. He provides patients with receipts that have all the codes and is happy to twiddle paperwork to deal with claims, prescribe from the insurance company formularies, etc., but he decided that dealing with the insurance companies directly was making it harder for him to give the level of patient care he wanted to give, so he stopped. The cost of an office visit with him was lower than the cost to see other doctors, but he didn't give an insurance company discount; he just passed that discount on to all his patients. He was (and still is, according to my mother) a great doctor. Once when I was in college he saw me on a Sunday night for a kidney infection that would have landed me in the hospital if I'd waited until Monday for treatment.

I can't imagine him putting up a sign like that. It's possible to hold strong positions about health-related political issues and even let your patients know your positions without telling them to shove off. Cassell's sign would make me look somewhere else for a doctor, and not just because he and I disagree on the politics: because his disagreement is delivered in a way that makes me question his ability to treat me fairly as a patient.
posted by immlass at 3:15 PM on April 2, 2010 [13 favorites]


Why is this certified jackass wearing scrubs during his interview with Cavuto? Did he just get through with yanking out an Obama voter's urethra with his bare hands?

I was wondering about that myself.

Smart publicists/PIO's usually encourage physicians to wear suits when they're being interviewed in a studio. Some doctors might insist on wearing just a shirt and tie. But nothing more casual than that. In a hospital, scrubs might be acceptable for an interview -- if he's operating. Otherwise, a lab coat is more appropriate, and has the added advantage of having one's name, and the name / logo of the hospital on it.

If you're trying to establish yourself as a respected expert, it helps to look the part. Dude needs some media training, stat.

On second thought, no he doesn't.
posted by zarq at 3:16 PM on April 2, 2010 [2 favorites]


Conversely, anti-discrimination laws sweep hostilities under the rug instead of shining a spotlight on them. People lose their ability to make judgment calls about who they want to do business with and what sorts of things they wish to support.

I'm assuming this is utilizing a generous helping of hyperbole to make your point, because what you're saying here is that anti-discrimination laws directly cause individuals to lose all capacity to discern and choose between options. If that is really what you mean, then...uh, I disagree.

The premise of your argument is that open discrimination allows a people to identify and ostracize the discriminator. This rarely actually happens, because open discrimination rarely occurs except inside a context that looks favorably on that discrimination. Further, whatever gain we get as a people in identifying discriminatory people this way is probably outweighed by the loss of good for those recipients of discrimination, who may well enjoy the demonization as much as we do but are probably more concerned with how it still burns when they pee.

Anti-discrimination laws don't and can't make people more tolerant individuals; fortunately, that's never been their purpose.
posted by Errant at 3:16 PM on April 2, 2010 [5 favorites]


Why is this certified jackass wearing scrubs during his interview with Cavuto?

As usual, Penny Arcade has the answer.

"I'm a doctor. You can tell because I have a white coat and a lot of doctor type shit everywhere."
posted by Errant at 3:19 PM on April 2, 2010 [1 favorite]


From mhum's link
There he remained until matriculating into the 1978 class at St. George's University School of Medicine in Grenada, West Indies.
So, yeah, find another urologist.
posted by Mental Wimp at 3:20 PM on April 2, 2010 [18 favorites]


Expect that the FLA authorities will put a quick stop to this.
posted by Ironmouth at 3:29 PM on April 2, 2010


WSMA ethics. Check out #9...

I once was almost treated by a urologist named Baumrucker. When he demonstrated that he didn't know what the hell he was doing (wanting to operate on my left kidney when the problem was with the right one, I refused treatment and demanded to be discharged. After he fled the country to avoid malpractice awards, I learned from his colleagues that he was known as "Prongwrecker."
posted by warbaby at 3:30 PM on April 2, 2010 [1 favorite]


Oh sure, but everyone was just fine with all the teachers who refused to teach kids who liked No Child Left Behind. You lefties are the biggest hypocrites on the planet!
posted by mccarty.tim at 3:30 PM on April 2, 2010 [2 favorites]


Wow:

Jack,” as he was called around the hospital, honed his clinical skills during the usual 36 hour periods on call while attending to thousands of victims of “drug deals gone bad.” Despite the many adverse factors that affected the author during his urologic surgery residency, he generally managed to keep a bright outlook via denial and emotional repression, much of which has not resurfaced as of this writing.

Vowing never to practice in the north, unless mandated by a court of law, Dr. Cassell accepted a urologic oncology fellowship at the University of Florida in 1987. Initially lulled into a sense of well-being by Gainesville’s lack of nightly gunshot victims and snowstorms, “Jack” gleefully embraced the new position he had with Dr. Zev Wajsman, as this gifted professor’s sole protégé.


Racist much?
posted by Ironmouth at 3:34 PM on April 2, 2010 [7 favorites]


But this is different. This guy isn't objecting to participating in some procedure he doesn't like, or as part of an organization he doesn't like. He's more or less saying that it's specific people he has an objection to treating.

This really isn't new. In the past few years, some doctors have been compiling information or retaining services notifying them about individuals who have filed malpractice claims against other doctors, so that the doctors can refuse to accept them as patients. Doctors have the right to discriminate against patients, so long as they do not discriminate on the basis of race, sex, or other protected categorizations.
posted by Slap Factory at 3:34 PM on April 2, 2010


He has a right to do this.

Just like I have the right to call him a dickweed who cares more about politics than patient care.
posted by dirigibleman at 3:35 PM on April 2, 2010


Does he refuse to treat patients paid for by Medicare or Medicaid?
posted by GuyZero at 3:38 PM on April 2, 2010 [1 favorite]


In the past few years, some doctors have been compiling information or retaining services notifying them about individuals who have filed malpractice claims against other doctors, so that the doctors can refuse to accept them as patients.

It's nice to know that the victims of "Prongwrecker" won't be able to receive medical care anymore (over and above having pre-existing conditions, that is).
posted by dirigibleman at 3:40 PM on April 2, 2010 [1 favorite]


This really isn't new. In the past few years, some doctors have been compiling information or retaining services notifying them about individuals who have filed malpractice claims against other doctors, so that the doctors can refuse to accept them as patients.

There's a key difference even here, which is that the patients in question have taken arguably adversarial directly against doctors in the past. Cassell is clearly going beyond that.

Not that a malpractice blacklist doesn't have problems of its own. I understand some people wield the legal system frivolously, an appreciate that needs to be addressed, but despite that, attempting to fence out people who would legitimately use legal means to pursue physician accountability smells strongly of an aversion to personal and professional responsibility, not to mention an end-run around a publicly created policy.

Doctors have the right to discriminate against patients, so long as they do not discriminate on the basis of race, sex, or other protected categorizations.

Perhaps it's legal; it's still very ugly.
posted by weston at 3:55 PM on April 2, 2010 [1 favorite]


He has a right to do this.

Refuse treatment based on politics? I think not.
posted by Ironmouth at 4:01 PM on April 2, 2010 [5 favorites]


Some dipshit who went to Hollywood Upstairs Medical School figured out how to get more racist white trash Floridians to come get their tiny weanuses looked at who cares
posted by Optimus Chyme at 4:09 PM on April 2, 2010 [4 favorites]


Refuse treatment based on politics? I think not.

Sure he can-- doctors 'fire' patients all the time, and he probably has even more discretion in choosing whether to take on new patients. If he's enough of an asshole to believe that political differences render him unable to provide services to his patients, fine. However, professional ethics include an obligation on his part to refer patients to a provider who can care for them if he can't or won't.
posted by monocyte at 4:10 PM on April 2, 2010


As usual, my stupid browser won't let me favorite Ironmouth's comment above. Yes, I read the same sections of his self adulating bio and couldn't agree more that this man is a racist.

Dr. Pissant.
posted by bearwife at 4:15 PM on April 2, 2010


...yet another reason why I consider any place south of Trenton, NJ, the deep south.
posted by Postroad at 4:19 PM on April 2, 2010 [1 favorite]


Why is this certified jackass wearing scrubs during his interview with Cavuto?

Don't you know? That's what all those handsome doctors wear on the teevee!

This guy needs a catchy nickname, though. Hm.

How about... McCleveland Steamy.
posted by Atom Eyes at 4:19 PM on April 2, 2010 [4 favorites]


I was looking at my chart at the doctor's office, and it said that I was difficult. Why would they write that?

“I missed a possibility: he practices in a predominantly Republican area, and he feels this move will drum up more business for him overall.”

Passerby: Yeah! Hell, yeah! Fuck Obama, I’m gonna whip out my dick for THIS guy! *suddenly struck by confused feelings*
posted by Smedleyman at 4:22 PM on April 2, 2010 [1 favorite]


Can anybody direct me to any licensing boards, or the actual processes necessary to take his fucking license away?
posted by hal_c_on at 4:24 PM on April 2, 2010


Some people don't think health care reform is a good idea.

He has a right to do this.

You have a right not to retain him.

It's not such a big deal.


No, actually he doesn't. Have you ever heard of doctors "refusing care" and not having their license taken away? Its because its neither ethical nor legal.
posted by hal_c_on at 4:26 PM on April 2, 2010


Man, the 15 year-old in me would love fucking love to go to this guy and right in the middle of some sensitive procedure say, "I totally voted for Obama." Just to get a rise out of him. I defy you to tell me that wouldn't be hilarious.
posted by Doublewhiskeycokenoice at 4:39 PM on April 2, 2010


Chapter one of his classic Better Living Through Urology is titled "Don’t Void Where Prohibited". Despite his politics, I am starting to like this guy.
posted by squalor at 4:45 PM on April 2, 2010


In September, 2009 as HCR was being debated, and Obama was on the stump was trying to sell it, Mayo Clinic in Rochester, MN was praised by Obama as offering "the highest quality care at costs well below the national norm." At that time, the Mayo Clinic (A non-profit organization) supported Obama's healthcare reform. As the bill started to take final shape, Mayo Clinic later withdrew its support.

On January 2, 2010, in Arizona, the Mayo Clinic dropped care of Medicare patients. It's not just wingnuts, it's not just right wing retribution for the passage of an unpopular law, it's also main line medical institutions questioning their own capabilities to continue care to seniors, with the upcoming cuts to Medicare, particularly in Medicare Advantage programs, contained in HCR.
posted by paulsc at 4:45 PM on April 2, 2010


Man, the 15 year-old in me would love fucking love to go to this guy and right in the middle of some sensitive procedure say, "I totally voted for Obama." Just to get a rise out of him. I defy you to tell me that wouldn't be hilarious.

He would cut off your johnson, Lebowski!
posted by squalor at 4:47 PM on April 2, 2010 [3 favorites]


It's as if a 'professional' mechanic refused to work on a vehicle that had political bumper stickers in opposition to his political positions...

(this, I say as an driver of a car littered with Democratic stickers, and also recognizing that mechanics face different regulations I would imagine compared to medical docs, but still some parallel here).
posted by JoeXIII007 at 4:52 PM on April 2, 2010


In other GRAREPUBLICANS news, Hannity calls the Tea Partiers Tim McVeigh wannabes, and they clap. I'm not even gonna joke. That's fucked up.
posted by mccarty.tim at 4:57 PM on April 2, 2010 [9 favorites]


Something something electile dysfunction.
posted by Ron Thanagar at 5:01 PM on April 2, 2010


From the bio:

For the next five years, “Jack,” as he was called around the hospital,...

LOL

...honed his clinical skills during the usual 36 hour periods on call while attending to thousands of victims of “drug deals gone bad.”

O RLY
posted by davejay at 5:05 PM on April 2, 2010


On January 2, 2010, in Arizona, the Mayo Clinic dropped care of Medicare patients. It's not just wingnuts, it's not just right wing retribution for the passage of an unpopular law, it's also main line medical institutions questioning their own capabilities to continue care to seniors, with the upcoming cuts to Medicare, particularly in Medicare Advantage programs, contained in HCR.

The Mayo clinic representatives in that article never once mention the new law as the reason they are dropping patients.
posted by Lentrohamsanin at 5:05 PM on April 2, 2010 [3 favorites]


Urologist gets pissy. Something something something.
posted by mazola at 5:08 PM on April 2, 2010 [2 favorites]


I was looking at my chart at the doctor's office, and it said that I was difficult. Why would they write that?

Were you at the dermatologist?
posted by krinklyfig at 5:12 PM on April 2, 2010


I'm no fan of the teaparty but, in fairness, the clapping started before Hannity said "Tim McVeigh wannabes" and it sounded like it may have been a retort to something said by another commentator; something that maybe should have been in quotations.

I'm leery of jumping on an out of context 20 second soundbite.
posted by The Hamms Bear at 5:18 PM on April 2, 2010 [3 favorites]


...yet another reason why I consider any place south of Trenton, NJ, the deep south.
posted by Postroad


Man, what the fuck is wrong with you? The world would be better off without this doctor AND you.
posted by Dennis Murphy at 5:25 PM on April 2, 2010 [2 favorites]


Gentlemen! Please, let's not fight. Everyone knows that both the South and New Jersey suck.
posted by ryanrs at 5:35 PM on April 2, 2010 [10 favorites]


"The Mayo clinic representatives in that article never once mention the new law as the reason they are dropping patients."
posted by Lentrohamsanin at 8:05 PM on April 2

True, but then again, they already were losing $840 million a year on Medicare patients, before the passage of HCR, with its additional $500 billion in cuts to Medicare, over the next 10 years. That's not just economic handwriting on some wall, it's the "Arbeit macht frei" sign over the HCR gate, for main line Medicare doctors and care institutions.

To say nothing much, yet, of charges to profitability of American companies, in the wake of HCR. Let's agree, it's early days still in the wake of HCR passage, and the full weight of what will be, whether celebrated in political rallys by Obama, or dismissed by those on the right, is going to take months, if not years, to shake out.
posted by paulsc at 5:50 PM on April 2, 2010


That's not just economic handwriting on some wall, it's the "Arbeit macht frei" sign over the HCR gate

lmao health care reform is like the holocaust

never change
posted by Optimus Chyme at 5:54 PM on April 2, 2010 [10 favorites]


(from paulsc's link)

Under the 2003 Medicare prescription drug program, companies that provide prescription drug benefits for retirees have been able to receive subsidies covering 28 percent of eligible costs. But they could deduct the entire amount they spent on these drug benefits — including the subsidies — from their taxable income.

The new law allows companies to only deduct the 72 percent they have spent.


Looks like it's time to call the waaahmbulance, then. Corporations were receiving a tax benefit in excess of what they provided. Now that gimme is gone. I'm having a difficult time understanding how that's a bad thing.
posted by contessa at 5:57 PM on April 2, 2010 [5 favorites]


Well there's a campaign by the right to portray this bill as a job-killer and exhibit #1 for them are the various press releases from companies like AT&T about billion dollar charges. What they don't tell you is that this is something that's due to outrageous tax loopholes and benefits created under Bushco, which Obama is simply rectifying. Nice move there. The right lies - this never fails... always, always, ALWAYS investigate any claim thrown out by right-wing propagandists... if they tell you the it's day and the sun is shining, go out and check.
posted by VikingSword at 5:59 PM on April 2, 2010 [1 favorite]


I wonder if the scrubs worn during the interview were chosen to convey that he is not a pointy-headed elitist, just an average American guy-- you know, like Joe the Plumber, only Dr. Cassell works on personal plumbing.
posted by Secret Life of Gravy at 6:03 PM on April 2, 2010 [3 favorites]


Here's more color on the shabby propaganda from the right, regarding "charges to profitability":

"The 2003 Medicare prescription drug bill, still in effect, gives a tax deduction to companies that provide prescription drug benefits for retirees. In fact, these companies, including AT&T, can deduct 100%--every single penny--of the money they spend on prescription drug benefits from their taxable income. Thus, AT&T gets to keep a whole chunk of money from being taxed, which basically means they get to pocket more of it. The government even goes one step further and subsidizes (read: pays for) a whopping 28% of those prescription drug benefits in the first place, to make prescription drug benefits as affordable as possible for the companies. The companies get both a 28% discount and a nice tax break, all to encourage them to provide prescription drug coverage.
But there's a loophole in the law big enough to drive a Chevy Suburban through. These companies get to write off the entirety of their prescription medication plan, even though they're actually only paying for 72% of it. The new health-care bill simply closes that loophole, and says that companies can still deduct every penny they pay on prescription drug benefits from their taxes--but only the money they've paid, not the 28% that the government hands them. That's where the billion dollars comes from: AT&T is no longer allowed to deduct things they didn't pay for in the first place.
So what happens from here? AT&T loses a billion dollars it didn't have any right to keep to begin with, and what do they do?
AT&T said that it was also looking into changing the health care benefits it offered because of the law. Analysts say retirees could lose the prescription drug coverage provided by their former employers as a result of the overhaul.
In other words, due to losing free money, AT&T will cut benefits for retirees. It's not the health-care bill that's resulting in retirees losing benefits--it's AT&T cutting corners in the worst possible place.
That billion dollars could affect a lot of people; AT&T employees include 160,000 unionized telecom workers. The New York Times reports that the cut won't just be sprung on retirees but is likely to be brought up at the next bout of contract negotiations between the union and the company--there's time to work out the whole mess (read: politicize it) or for AT&T to recup its loss some other way.
The actual situation here is not easy to explain. It's much easier to just say, "This health-care bill will force AT&T to cut benefits for retirees." It's a nice soundbite, right? The only problem is, it's just not true."
posted by VikingSword at 6:05 PM on April 2, 2010 [5 favorites]


"... The right lies - this never fails ..."
posted by VikingSword at 8:59 PM on April 2

And the left are the paragons of political virtue that offered Ben Nelson the Nebraska Compromise, and then jerked it out, in reconcilation? Great.

"... It's a nice soundbite, right? The only problem is, it's just not true."
posted by VikingSword at 9:05 PM on April 2

Um, it's absolutely true that AT&T is taking a $1 billion non-cash quarterly charge, and that they are considering immediate changes to retiree benefits, as a result. The reasons they put those benefits in, in the first place, goes back to the creation of the Medicare D benefit, under Bush, and the structure that was adopted, to try to keep the future cost growth to the Federal government of Medicare D under control, by getting large corporations to add prescription drug benefits to their retiree plans. The idea was, that if enough private penison plans offered prescription drug benefits, the costs of providing the benefit privately would go down with large corporate purchase power, and the Federal government would phase out the subsidies as the private sector developed experience with the drug plans. Revoking the subsidy immediately may cause a lot more retirees to elect Medicare D plans, pretty soon, if they lose their subsidized corporate benefits.

So, to save the intended temporary 28% subsidy, the Federal government takes a permanent hit on tax revenues from corporations that would have been more profitable, under the subsidy, and pays more Medicare D claims, and you think that's a win for the taxpayers, or those thrown into Medicare D when their retiree plans change, including the doughnut holes that won't be fully closed for 10 years?

Maybe OK, if you're well under 55, I guess. Sucks, if you're over, and were, or were likely to become, an AT&T retiree, with significant prescription drug needs...
posted by paulsc at 6:35 PM on April 2, 2010


Why is this certified jackass wearing scrubs during his interview with Cavuto?

For the same reason Dr. Drew wears his stethoscope around his neck during his therapy sessions on his celebrity rehab show. Because it screams I'M A MEDICAL PROFESSIONAL MOTHERFUCKER.
posted by birdherder at 6:36 PM on April 2, 2010 [1 favorite]


There he remained until matriculating into the 1978 class at St. George's University School of Medicine in Grenada, West Indies.

Another graduate of Club Med School. Hi, Dr. Dick!
posted by kirkaracha at 6:40 PM on April 2, 2010


as long as he continues to perform vasectomies for McCain supporters he can do what he wants.
posted by Hammond Rye at 6:41 PM on April 2, 2010 [6 favorites]


i can't wait til the Ceos of AT&T, Verizon, Caterpillar Inc, John Deere, etc testify before a House committee to back up their claims re: their health care costs

"Representative Henry Waxman called the chief executive officers of AT&T Inc., Verizon Communications Inc., Caterpillar Inc. and Deere & Co. to provide evidence to support costs the companies plan to book related to the new health-care law.

Waxman of California, chairman of the House Energy and Commerce Committee, and subcommittee Chairman Bart Stupak of Michigan released letters they wrote to the executives, saying their plans to record expenses against earnings as a result of the law contradict other estimates. The lawmakers requested the executives appear at hearing Stupak plans on April 21.

i would very much like to see their claims of massive expense backed up. or as the Fox News headline reads:
Democrats Accused of Trying to 'Intimidate' Firms for Airing Health Care Concerns
(fair and balanced as always)
posted by Hammond Rye at 6:52 PM on April 2, 2010 [1 favorite]


paulsc: "On January 2, 2010, in Arizona, the Mayo Clinic dropped care of Medicare patients. It's not just wingnuts, it's not just right wing retribution for the passage of an unpopular law, it's also main line medical institutions questioning their own capabilities to continue care to seniors, with the upcoming cuts to Medicare, particularly in Medicare Advantage programs, contained in HCR."

Well that doesn't make any sense at all. In January, passage of any sort of bill seemed doubtful, and the details weren't worked out, so it was hardly a response to HCR. According to the article, it was that at the time medicare covered only half the cost of treatment of seniors. But in the same article, it said that Medicare paid roughly 20% less than private insurers, which would imply that they would lose money on privately insured patients as well, which seems pretty dubious.

Obviously a better explanation is needed. Maybe it's that elderly patients are both expensive to treat and are mostly on Medicare, while privately insured patients are younger and cheaper?
posted by alexei at 7:02 PM on April 2, 2010 [4 favorites]


Looks like it's time to call the waaahmbulance, then.

This is an actual thing my Con Law professor would say to Libertarian Kid when he would start spouting off.
posted by Doublewhiskeycokenoice at 7:12 PM on April 2, 2010 [2 favorites]


I guess this guy became a doctor for all the right reasons....
posted by notsnot at 7:25 PM on April 2, 2010


The idea was, that if enough private penison plans offered prescription drug benefits, the costs of providing the benefit privately would go down with large corporate purchase power, and the Federal government would phase out the subsidies as the private sector developed experience with the drug plans.

And as I think we can all agree, that worked out splendidly.

There's a name for this, oh...what's the word I'm looking for? Oh, yeah! Corporate welfare.
posted by contessa at 7:28 PM on April 2, 2010 [1 favorite]


And the left are the paragons of political virtue that offered Ben Nelson the Nebraska Compromise, and then jerked it out, in reconcilation? Great.

Whoever would claim that? Paragons of political virtue - there are none, not left nor right. Rather I claimed - the right wing propagandists lie. As in this case.

Um, it's absolutely true that AT&T is taking a $1 billion non-cash quarterly charge, and that they are considering immediate changes to retiree benefits, as a result.

I love it: 'these companies get to write off the entirety of their prescription medication plan, even though they're actually only paying for 72% of it. The new health-care bill simply closes that loophole, and says that companies can still deduct every penny they pay on prescription drug benefits from their taxes--but only the money they've paid, not the 28% that the government hands them. That's where the billion dollars comes from: AT&T is no longer allowed to deduct things they didn't pay for in the first place.'

That's what the "charges to profitability" comes from - nice way of referring to money from the public till as "profits". But then again, I guess that's par for the course for the Bushies - nice handouts to corporations... whelp, I guess that is a profit to those corporations.

Well, I for one don't mind tax loophole abuses being curtailed even if that's characterized by the usual propagandists as a 'hit to profits'. Such "profits" we can do without.
posted by VikingSword at 7:31 PM on April 2, 2010 [3 favorites]


Zinger from the wife: "I bet to prove you didn't vote for Obama, he makes you eat a mayonnaise sandwich right there in front of him!"
posted by notsnot at 7:36 PM on April 2, 2010 [1 favorite]


"... Rather I claimed - the right wing propagandists lie. As in this case. ..."
posted by VikingSword at 10:31 PM on April 2

Except that, in this case, nobody (with the possible exception of you) is lying, and nobody is a "propagandist". AT&T really is taking a $1 billion charge this quarter, unless the Feds retroactively prohibit it, via legislation or politically influenced IRS moves, yet to come. They're not propagandists, because they reported this intent in a required financial filing, not in a paid ad in a newspaper, Web site, or magazine.

Maybe you don't understand what a "subsidy" is. Basically, it's when the government pays a person or corporation to do something, that otherwise, that person or corporation wouldn't do, because the action, unsubsidized, doesn't make economic sense for the person or corporation. The reason the government wanted private pension plans to provide drug benefits, is that the government figured that it couldn't do the job for the cost of 28% subsidy and tax benefits, and the straight tax benefits on the other 72% of the cost of such plans, that it offered companies to provide such plans. The estimates at the time Medicare Part D was being crafted were that either Medicare premiums would have to triple or quadruple, or that there was going to have to be massive new direct Federal spending, for there to be a Part D benefit, and for the rest of Medicare to remain operable through 2030 or so. Only by getting millions of people drug benefits under private plans, could demand for Part D benefits be kept low enough for Medicare to remain solvent, even with the very unpopular "doughnut holes" built into Part D, and the almost certain future increases in Medicare Part A and B premiums forecast.

Now, with the immediate end of the Federal subsidies to private plans for drug benefits, it seems we're going to see how effective Part D and Medicare as a whole is going to remain, with millions more people flocking into Part D, Real Soon Now, and $500 billion less in projected Medicare funding being available under HCR, over the next 10 years. Waxman, et al, ought to have an interesting hearing in April.
posted by paulsc at 8:03 PM on April 2, 2010


Every clinic dropping straight Medicare is doing so because of reimbursement. It is not strictly a dollars issue. It is the fact that Medicare can hold claims much longer than other companies and not pay them. It's also the fact that every year they fuck around with another threatened cut in reimbursement that most times gets overturned, eventually, but that wastes a lot of congressional time in the process. During which, again, Medicare holds the claims up again. If you are a small 1-3 doc shop, you are toast. If you are a larger clinic, you simply get tired of the stupid games and say fuck off.

Now, if there is an eventual viable government run plan, the outcome will be a transitional period where your next generation of doctors will come in expecting to make half as much, which is fine, and will work half as hard. The fear for a lot of doctors is simple self preservation right now, in the face of working longer hours and in the midst of more paperwork.

This guy is an EPIC tool. I hope he gets run out of business. I really do. I know plenty of doctors who feel this way but would sooner shit on the OR table than do what this guy is doing because it is so unprofessional. I could almost guarantee you it is a reliable litmus test for the quality and consistency of his care.
posted by docpops at 8:14 PM on April 2, 2010 [6 favorites]


I guess this guy became a doctor for all the right reasons....

The more I think about this, the more it irks me. I'm a doctor and I'd like to think I am in it for the "right" reasons. I think about all the really profound ways in which I disagree with many of my patients' world views, from political leanings, to their choices about drugs and alcohol, to the way they treat the others around them. On an almost hourly basis I take that shit and bury it deep down so that I can fulfill what I feel is a deeply serious obligation to serve that patient; not because I like them, or can pal around with them on the golf course, but because they are human beings and it's been my calling in life to be a compassionate healer to any person who seeks my help. Then I see this little shit stain -- maybe he doesn't like poor people, maybe he *is* racist, maybe he's just a sore loser, maybe he's so fucking selfish he can't stand even the possibility that he might just make a tiny bit less money that he's willing to close his practice off to about 54% of the population to make the point -- anyway, he seems to not possess even the most basic skill that every physician has to master on the first day of internship: "You, patient, your needs are more important than mine. How
can I help you today?" It's probably not legal to state on your front door that you won't treat certain people, and it's certainly not ethical. This guy is the reason why people mistrust doctors.

I hope he chokes to death on a syphilitic cock.
posted by Slarty Bartfast at 8:17 PM on April 2, 2010 [35 favorites]


You know what would be ironic? If he commits malpractice on one the tea-baggers who are always screaming about Tort Reform.
posted by ambulocetus at 8:27 PM on April 2, 2010 [2 favorites]


They're not propagandists, because they reported this intent in a required financial filing, not in a paid ad in a newspaper, Web site, or magazine.

Neat, except that misdirection won't work - the propagandists are those on the right (such as on Fox News, and all those who repeat such talking points) who scream out that closing of abusive tax loopholes represents an imposition on those companies god-given right to profit.

And we seem to be going in circles here on the "profits" question - the problem is that AT&T and such companies were deducting not merely the cost of the prescription drug benefits from their taxes. That's one thing. Fine. BUT they were also deducting money for benefits they never paid for in the first place!

And no question this is being misrepresented as a terrible cost to businesses as a result of HCR, instead of being characterized accurately as the closing of an extremely abusive tax loophole. That's the problem, and that's where the propagandizing comes from.

As to Waxman and his hearings, well, I never claimed for a New York minute that the Democrats have anywhere near the spin ability of the Republicans, so we'll have to see how that plays out. Who knows, maybe left wing propagandists can tap into the rich vein of outrage the public already feels about fatcat corporations on welfare. "That scream about 'profits, wah!' that you're hearing are the squeals of the pigs when they are removed from feeding at the public trough"... the left could play that game too - if they were as ruthless as the right... but I predict that they'll just cower as usual, and mumble instead, in the face of relentless lies from Fox News.
posted by VikingSword at 8:29 PM on April 2, 2010 [3 favorites]


Every clinic dropping straight Medicare is doing so because of reimbursement. It is not strictly a dollars issue. It is the fact that Medicare can hold claims much longer than other companies and not pay them. It's also the fact that every year they fuck around with another threatened cut in reimbursement that most times gets overturned, eventually, but that wastes a lot of congressional time in the process. During which, again, Medicare holds the claims up again. If you are a small 1-3 doc shop, you are toast. If you are a larger clinic, you simply get tired of the stupid games and say fuck off.

I really don't get this. I don't know of one person - not one - who would begrudge doctors a fair pay for their hard work. Or even "what the market would bear". The question is: how can we do it, and at the same time provide coverage for all Americans? It obviously can be done. Priorities have to change, and the way business is conducted must change - and this is where the problems start. You can't merely mandate coverage by government fiat while not be willing to pay for it - that is ridiculous. It's a political question, and we, the voters and politicians, all of us, have not been willing to face this simple math: we may need to cut many, many other things (like defense!) to find the money. Instead, it's "do the politically popular" even if it's economic or mathematical nonsense. But the other side of it is: there are powerful lobbies (insurance companies!) that don't want the best coverage at the best price, because it means cutting them out of the loop - where so far, they seem to have a parasitic role. Until we put ALL of this on the table, it'll continue to be a huge controversy. My hope: this bill is just the beginning - and down the road, we'll slowly face to the real issues and real costs, so that we end up with a rational program that can do justice to all, including getting doctors paid.
posted by VikingSword at 8:48 PM on April 2, 2010 [1 favorite]


"Neat, except that misdirection won't work - the propagandists are those on the right (such as on Fox News, and all those who repeat such talking points) who scream out that closing of abusive tax loopholes represents an imposition on those companies god-given right to profit. ..."
posted by VikingSword at 11:29 PM on April 2

How is a Federal subsidy, paid only to profitable corporations in the form of tax deductions on their actual cost of insurance policies purchased (not the benefits those policies paid to beneficiaries, which are supposed to be less than their costs, in a normal capitalist society, because, you know, the part that's not paid in benefits covers operation of the insurance company, and some insurance company profit, which is also, YES, BELIEVE IT! taxed!), in any possible reality based universe, an "abusive tax loophole," unless you're an apologist propagandist for the extreme left?

Not only is your rhetoric getting terribly tortured, Viking Sword, but your version of bookkeeping and tax accounting would be devastating even to a hippie commune.

Oh, and if something is "god-given," it's usually "God-given" with a capital G. Not always, I suppose, for children of lesser gods, but usually.
posted by paulsc at 8:52 PM on April 2, 2010


Some dipshit who went to Hollywood Upstairs Medical School figured out how to get more racist white trash Floridians to come get their tiny weanuses looked at who cares

Dude, you know, I tend to agree with a good number of your comments here, but I'm afraid I simply cannot let this stand. WHAT KIND OF PERSON MISSPELLS "WEENIS"? I am appalled, sir. APPALLED.
posted by elizardbits at 9:01 PM on April 2, 2010


Vikingsword - it's a basic issue of asking the public and government what they think a doctor oughta make. What they can take in in a private system vs. Government run is massively different. In the former you are potentially Very Well Compensated. In the latter you are making a stable living. Think 300K and up versus 100-150K. It's not that the latter is a bad income. It's that when you consider the risk and stress and debt it's an ultimately shitty way to spend a 60-70 hour workweek after 23-25 years of education and training.

If the government could pay a doc enough to gross 125-150K, take away the exorbitant costs of malpractice insurance,the massive billing headaches, and make that income reachable by seeing fewer than 30 people a day, you will see good doctors stay in the field. So far that hasn't happened.
posted by docpops at 9:09 PM on April 2, 2010


paulsc:How is a Federal subsidy, paid only to profitable corporations in the form of tax deductions on their actual cost of insurance policies purchased (not the benefits those policies paid to beneficiaries, which are supposed to be less than their costs, in a normal capitalist society, because, you know, the part that's not paid in benefits covers operation of the insurance company, and some insurance company profit, which is also, YES, BELIEVE IT! taxed!), in any possible reality based universe, an "abusive tax loophole," unless you're an apologist propagandist for the extreme left?

The abusive tax loophole is: we subsidize the benefit AND let the corporations get a tax credit for the subsidized portion. It's insane and should be closed.
posted by nightwood at 9:24 PM on April 2, 2010 [2 favorites]


Sorry I'm late - did I miss any dick jokes?
posted by Joey Michaels at 9:25 PM on April 2, 2010 [1 favorite]


elizardbits, that's a Eurasian (that we've always been at war with) spelling.
And actually it's a plural... weanuses = weni.
posted by Balisong at 9:34 PM on April 2, 2010


The more I think about this, the more it irks me. I'm a doctor and I'd like to think I am in it for the "right" reasons. I think about all the really profound ways in which I disagree with many

[...]

I hope he chokes to death on a syphilitic cock.
posted by Slarty Bartfast at 11:17 PM on April 2 [11 favorites +] [!]


Dr. Slarty Bartfast: In it for the "right" reasons, and he hopes another doctor chokes to death on a syphilitic cock.
posted by Slap Factory at 9:42 PM on April 2, 2010


You know what? This jerk walks into my office in need of care, he gets the same treatment I give anyone else and he walks away a better person none the wiser that I hate his guts. Your point?

That I'm an asshole? Everyone already knows this, dick face.
posted by Slarty Bartfast at 9:54 PM on April 2, 2010 [1 favorite]


Everyone also knows I'm full of shit and not to take me the slightest bit seriously.

*kiss*

posted by Slarty Bartfast at 9:58 PM on April 2, 2010 [1 favorite]


apologies for derail, but maybe yall hear me out.

in the case of Caterpiller Inc. (i'm not familiar with AT&T or the others) let me use MY OWN MOTHER as an example of how the corporate bookkeeping works.
here's a reprint of an article from 2004 (admittedly biased -- a couple of Wall Street Journal's winners of the George Polk Awards for excellence in journalism in 2004). it is titled How Retiree Benefits Cuts Fatten Companies' Bottom Lines
Caterpillar Inc. in 2002 added $75 million to income -- 9.4 percent of pretax earnings -- with the accounting gain it got from boosting the health-care premiums its retirees had to pay and making other changes to retiree benefits. The move will lift pretax earnings about $45 million a year for several more years.
in 2003 the Medicare D went into effect. the same article reads:
Medicare's new prescription-drug benefit is giving companies a whole new source of accounting-generated income that boosts their earnings.

And some employers may get federal subsidies even after transferring costs to their retirees.

Congress was worried that if Medicare paid for prescription drugs, companies would cut retiree health-care benefits even faster than they already were. So when it passed a Medicare drug benefit last year, Congress added subsidies for companies that retain retiree drug coverage. The U.S. will reimburse employers for 28 percent of the cost of retiree prescription-drug spending over $250, up to a subsidy of $1,330 per retiree per year.

This means companies can reduce the liability they're carrying on their books for drug coverage. They won't get the subsidy until 2006. But accounting rules let them estimate how big a subsidy they'll get over the lives of current and future retirees and deduct this figure from their liability right now -- and start dropping immediate accounting gains to their bottom lines.
flash forward to an article from the March 26, 2010 New York Times:
Caterpillar Inc. of Peoria has jumped to the forefront of manufacturing companies complaining about the cost of the federal health care overhaul. On March 18 the company sent a letter to Speaker Nancy Pelosi and Representative John A. Boehner, the Republican leader, saying mandated changes would cost it “$100 million in the first year alone.”

Caterpillar’s complaint led to dozens of headlines, but a closer look at the impact of the new law indicates it is not quite the budget buster that the company’s human resources executive, Gregory Folley, implied in his missive.

According to a regulatory filing by the company last week, the $100 million figure is Caterpillar’s estimated total cost for as long as the newly enacted Patient Protection and Affordable Care Act remains in effect. And the $100 million charge is an accounting change, a noncash cost that has no affect on the company’s operations.

In addition, the $100 million figure does not arise from changes to decades-long practices at Caterpillar. Rather, it comes about because the new law removes a tax break codified in 2003.

No company sneezes at the elimination of a $100 million tax break. But in 2008, Caterpillar had $51 billion in sales, and profits topped $3.5 billion for the third straight year. The projected profits for 2010 are a relatively weak $1.56 billion, and the $100 million tax charge would mean an additional 6 percent reduction.

the new health care legislation changes a lot but what hasn't changed is the corporate agenda to drop their insurance policies. it is sheer opportunistic gall to place the blame for this so-called burden on their balance sheet on the current health care reform.
as the NYT link further points out:
Most companies steer away from politics, but Jim Owens, left, the company’s soon-to-retire chief executive, has held forth on climate change and other controversial issues. Most notably, in February 2009, Mr. Owens contradicted President Obama’s claim that the stimulus package would help Caterpillar rehire some of its 22,000 laid-off workers.
This isn't apologist propaganda for the extreme left, PAULSC. How corporations manage their books is their business but taking away their subsidies shouldn't give them a right to shaft thier former employees and blame congress while they're at it. Personally I'm fucking fed up with the arguments in support of corporate efforts to eliminate their "debt" by cutting benefits to retirees.
posted by Hammond Rye at 10:04 PM on April 2, 2010 [13 favorites]


also thanks for this post. my brother is a urologist and he ought to get a kick out of it, seeing as how he stands to make a comfortable amount of money regardless of how health care is administrated.
posted by Hammond Rye at 10:11 PM on April 2, 2010


Oh, and if something is "god-given," it's usually "God-given" with a capital G. Not always, I suppose, for children of lesser gods, but usually.

Actually, per AP style, you only capitalize when explicitly making reference to a monotheistic deity. You use the lowercase when referring to polytheistic gods, or the concept of god in general.
posted by evidenceofabsence at 11:04 PM on April 2, 2010 [3 favorites]


This is an example of what happens when the three actors in process, (Government, Doctors Colleges, Private Instruments[like pharmaceuticals and other medical entrepreneurs]) do not have a normalized or rather formalized relation, and, possibly a reason why Britain, and Canada, who moved to accommodation and autonomy as a guiding principle in their relationship with the doctors colleges and private instruments...

The US on the other hand, has a far longer history of being slightly the loser, paying more for services, and over relying on entrepreneurial medicine, rather than treatment and care, by the other two partners doing whatever they want (like some of the 'whoops' my bad lines from pharmaceuticals after strings of deaths, and the doctors colleges being some of the strongest voices against change in the 90's). While Canada has had a clear and stable relationship with the Doctors Colleges, as has Britain [till the foolish misguided 90's reforms of "more with less" mentality ("TQM" ideas, from xerox)] The Doctors Strike in Saskatchewan (mentioned above) seems to have set the tone for the Canadian system... Accommodation by the state of the doctors colleges and private mechanisms, and most of all, Autonomy in virtually all arenas for doctors. - yet it works.


The fundamental relationship between the Three Actors has never been addressed in the US in a meaningful way... perhaps this is a sign that it is time to begin that talk... remember that once Canada and Britain had formed relationships with doctors colleges and the private mechanisms... they were able to begin building systems with planning more than "get this person with no care insurance to stabilize critical injury, and then dump them outside".

Doctors as individuals want change, want to be able to help people.. it's at the meta-group-level of the Colleges, then things get messy, with no formal agreements or even de-facto agreements. Paying ad hoc, and the "are you elligable" bureaucracy layer that come with having 'certain' people covered, 'sometimes'. It costs more this way...
For Canadian providers, moreover, the single-payer system meant less administrative overhead; in 1987, for example, office expenses for physicians in Canada amounted to about 36% of their gross billings, compared with 48% in the United States (General Accounting Office 1991;5).
-Tuohy 1999
posted by infinite intimation at 12:12 AM on April 3, 2010 [2 favorites]


RE: "the politics" surrounding the Sask. doctors strike.
No lie to preposterous for them to spread and no tactics too despicable- Tommy Douglass 1948. (and I want to say that of so many opponents of President Obama.)
Also hear him say this line... and not mess it up.
"dont let them deceive you again
if they fool you once shame on them.
If they fool you twice shame on you.
Good night and good luck.
"
That was how the 48 election went. He lost.

3 weeks later
The doctors strike was on. But the sask. government refused to buckle under

public opinion across the country rose up against the medical profession and the doctors strike collapsed.
Medicare came into being
Sask demonstrated 2 things really; one:
that you could develop and finance a universal medicare scheme, and the other was that you could face down the medical profession. And second,
if sask hadn't of done what they did, wouldn't have medical care anywhere in Canada today.

(Keepers of the Flame.) the best Tommy Douglass film/understanding of the 'context' of Canadian Health Care... @ 36-40 minutes in the doctors strike... there was a similar undercurrent of racism in the backing of that doctors strike.

posted by infinite intimation at 12:43 AM on April 3, 2010 [1 favorite]


I have to say that I would rather know in advance of actually being seen by a doctor whether or not they are an asshat. This doctor is an asshat and has made it so if I'm ever in Florida, I won't use his services (and btw, urologists do also have female patients, I have the greatest urologist ever, if you're in VA and need one, Memail for his info.)

Now, if he didn't post this sign, you went in for an appointment and you had something, anything, a button, a book, etc with something pro Obama or pro Democrat on it, and he saw it, he would very likely treat you differently. Anyone who would post something like that is someone you'd want to avoid anyway.
posted by SuzySmith at 1:25 AM on April 3, 2010


Anyone who would post something like that is someone you'd want to avoid anyway.

Indeed, about the last thing I want when I am splayed out, spread-eagled, a catheter lodged in my urethra, is to have to listen to right wing talking point from my doctor.
posted by Joey Michaels at 2:18 AM on April 3, 2010


Now wait a minute, Mr. Cocks Doc!

When a doctor makes us boggle as he panders to a rabble
who would whinge about Obama as a sound goes up their dongle,
THIS is what we call...

...a teabag fleabag drivel whinger dongle boggled
muddled duddled fuddled wuddled doc of cocks, sir!

Doc of cocks, our game is done, sir.
Thank you for a lot of fun, sir.
posted by flabdablet at 5:02 AM on April 3, 2010 [21 favorites]


Close up the thread. Flabdablet wins.
posted by EarBucket at 5:54 AM on April 3, 2010 [1 favorite]


If I'm understanding the doctor correctly, he is saying that expression of political beliefs has consequences. Or, expressing your political beliefs may have negative consequences. That leads me to wonder, since the doctor has privileges at Florida Hospital Waterman, part of the Florida Hospital group, and owned by Adventist Health System, does he feel strongly enough in his position that he would be OK with the negative consequences (say, losing his privileges) of his expression of political beliefs? Do these organizations agree with his stance?
posted by Houstonian at 8:19 AM on April 3, 2010 [1 favorite]


This behavior might be legal, but it is not ethical, and the Florida medical board should investigate. Any citizens of FL should encourage them to do so.
posted by theora55 at 9:00 AM on April 3, 2010


Due to a tragic typing error he took the hypocritic oath..
posted by w0mbat at 9:50 AM on April 3, 2010 [3 favorites]


A Cassellist version of the modern Hippocratic Oath is inevitable:
I will remember that I remain a member of society, with special obligations to all my fellow beings McCain voters. . . May I always act so as to preserve the finest traditions of my calling, and may I long experience the joy of healing those Republicans who seek my help.
More here. . .
posted by Echoed at 1:53 PM on April 3, 2010


This whole thing about doctors not refusing patients makes me mildly curious. I made a (routine) dentists appointment with a new dentist recently, and due to a couple of factors ended up missing the appointment and arriving just when it should have ended. The dentist refused to schedule me a new appointment and said I would have to find another practice. Is that normal? I thought that it may be within his rights but he was being a complete asshole.
posted by jacalata at 7:43 PM on April 3, 2010


Did you call and informed him that you're running late? So that he doesn't have to just sit there and wait for your ass to arrive? Because if you didn't, it's not the dentist who's an asshole.
posted by c13 at 6:21 PM on April 4, 2010


Shit happens and people show up late for appointments. Sure the dentist/doctor can tell you they might not see you *that day.* And certainly after a few of these, you're gonna be politely requested to go elsewhere. But refusing *any* future appointments after your first no show? No, this is prime asshole behavior, borderline sociopathic.
posted by Slarty Bartfast at 6:36 PM on April 4, 2010


That's not the question I asked. I asked whether the phone call was made. Shit does happen and certainly people may be late. But if he didn't bother to take a minute out of his day to inform a busy guy that he's running late and other patients may be seen earlier so that the dentist does not loose time and money waiting for him, to me at least this indicates that the patient is an asshole. Why would I want to deal with him, now or in the future?
Besides, we're talking about a routine visit to a dentist. Who's not an MD. So the Hippocratic oath does not really apply.
posted by c13 at 6:48 PM on April 4, 2010


We have a "three no-show and you're terminated policy." But those of us that maintain open practices against the threat of inundation are allowed to refuse a reschedule if it's a first time patient, unless there is some sort of explanation that is exculpatory. The fact that you framed your question without the slightest understanding of how much time they likely held for you as a new patient then called the dentist an asshole only confirms the paradigm as it is established. Lots of people are late or miss appointments. Being that late for your first is a red flag for a lot of people and the reason you won't be seen again. Clearly the dentist's business model values reliable patients over volume. There aren't studies to confirm it, but after sixteen years you get to know habits. Patients that are habitually late are also a pain in the ass in a lot of other ways, generally traced to a general obtuseness as to the reality that the doctor doesn't have thirty minutes to talk to them on top of them already being ten minutes late. I expect this will only confirm the general precious assholery of the medical establishment in your mind, but that's not anyone's problem but your own. Just show up on time next time.
posted by docpops at 8:47 PM on April 4, 2010 [2 favorites]


No, I didn't ring because I literally had no opportunity to, it's not like I was just sitting around at home thinking about how late I should be. I know they held time and I was actually expecting to get charged for the appointment, not to get blown off completely. I walked in and said I had an appointment but I was late and I assume I had missed it completely, I would like to reschedule, and the receptionist said no, he won't see you. I said I meant I wanted to schedule a new appointment time, and she said no, he won't ever see you, you'll have to go somewhere else. I didn't realise I was supposed to crawl in giving her all the details on why I was late and what was going on, but I don't really see any reason to believe that they would have cared.
posted by jacalata at 9:28 PM on April 4, 2010


No, I didn't ring because I literally had no opportunity to

Yeah, whatever, dude. You couldn't spare two minutes (literally) to call while the IMPORTANT THING was going on, nor before the IMPORTANT THING was about to start, and of course you couldn't have possibly predicted that you may have a problem. Just find yourself a dentist that will put up with your crap, ok? Or, you know, check your teeth yourself.
posted by c13 at 5:57 PM on April 5, 2010


Wow, fuck you. FYI, I was late because I fell asleep in the middle of the day at my desk at work. I didn't predict it, wasn't expecting to do it, and it was about five minutes from waking up to being at the dentist. I figured it would be more polite to get there in person than not, or even to hang around at work and ring and then go. So no, it's not their fault I fell asleep. It wouldn't have been their fault if I had been hit by a car on the way either, but I would still be pissed off at their response. And sure, I shouldn't be sleeping at work. I should probably also never get sick and never have trouble sleeping at night and never respond to trolls like yourself, but I'm not perfect. I'll start working on that right now.
posted by jacalata at 7:29 PM on April 5, 2010


I figured it would be more polite to get there in person than ... to hang around at work and ring and then go

I expect that most people would consider that this is where you figured wrong, and that a heads-up phone call would save you all this aggro if something similar happens again. Perfection is not required.
posted by flabdablet at 7:38 PM on April 5, 2010


I was late because I fell asleep in the middle of the day at my desk at work. I didn't predict it, wasn't expecting to do it, and it was about five minutes from waking up to being at the dentist.

Oh my fucking Christ.
posted by docpops at 7:45 PM on April 5, 2010


jacalata - on the very rare occasions when I'm going to be late for a dentist appointment, like when I'm suddenly stuck in traffic, I invariably immediately call them and tell them I'm running late, and explain why. To simply turn up, having totally missed the appointment, means they couldn't react to the impending absence, by for example taking another patient in the meantime. To them, it probably sounds like you're the type of person who either a) doesn't think through your obligations and how it impacts them, or b) doesn't care. Now, I don't judge you for falling asleep or whatever (you might have a condition like narcolepsy f.ex.) - but others may. Try role-playing - imagine you are the dentist. You have a prospective patient who is capable of missing an appointment because s/he falls asleep(!). Yes, there are such people, and yes, they are rare. If you look at it from a coldly business point of view, this is a patient who is not worth the trouble.

A little anecdote. I was a witness to the hiring process for a certain very desirable position. There were over 100 applications for that spot. The best - on paper - applicants was late by 45 minutes. They came in, and had an explanation, blah, blah. The person who did the hiring threw that application in the wastebasket immediately upon the late applicant's exit. When I asked if it's really so disqualifying to be late given all the other stuff on paper, the hiring person said: absolutely, because if it were him, he'd be there like 2 hours early given how important an interview is for this great job - and so it indicates that person didn't think it worth 2 hours extra... FAIL. What if it's an emergency? "If it can be an emergency for such an important occasion, it means there will always be some kind of reason, but there will always be failure".

Now, rather than take this as an occasion to be bitter, I think the smart thing would be to say to yourself: "hah, I learned something - this is how the world is, so if I can at all help not being late, I won't, and if I can't help it, then I will not rail against the world, because that's simply the nature of the world fair or not". I am sure of one thing: if you do that, your life WILL be better.
posted by VikingSword at 8:13 PM on April 5, 2010


Yea - I'm actually not terribly bitter, I was mostly trying to get feedback on whether the dentist acted in a standard manner, given that he had no information either on why I was late. From the responses here, it sounds like his reaction was unusual but not unheard of.

I am curious though, when people say that ringing would have been so much better, are you saying that a phone call, at the same time I arrived at the dentist, would likely have been different? Because at most it would have been 5 minutes earlier, would that have made such a difference?

doubly curious because I still know people without cellphones, what are they supposed to do?
posted by jacalata at 11:34 PM on April 5, 2010


Wow, fuck you. FYI, I was late because I fell asleep in the middle of the day at my desk at work.

Aha-ha-ha...
posted by c13 at 4:45 PM on April 8, 2010


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