Nibblers by Ted Bacharach MD (retired)

Nibblers on the healthcare dollar!


In the forefront of the nibbles is the physician who actually provides some type of service which may be good bad or indifferent. To justify the extent of his nibbling he provides longer reports, shorter visits to justify seeing more patients, and he or she provide some type of diagnosis. To judge how best to justify his access to the healthcare dollar he is judged by the insurance company and the government and so infrequently by a paying patient that he forgets there actually are a few left so that there is no sense in trying to please these rare specimens.


The hospital has tried to justify their nibbling by pointing to the increased efficiency making less hospitalization needed for almost all illnesses. The increased number of facilities and tests the hospital can provide is also stressed even though it may actually be an added expense duplicating services that were already available in nearby facilities. but did not contribute to the hospital’s bottom line. Improving the appearance and stressing the ambiance is also a prominent factor in justifying the increase in revenue. Treating less patients because of efficiency is also stressed and it is pointed out that although less patients are being cared for, the intensity of the care they receive is much better.


Drug companies relied to a considerable extent on the “Drug Rep” who called on the individual physician to acquaint him with the drugs the manufacturer made and convince him of the benefits these new drugs provided. The insurance companies who paid for these drugs and the government as well as the HMO’s and Companies that hired physicians did not like this. In the first place it took the doctor away from his primary job which was to see patients and it also might induce him to prescribe a newer more expensive drug and this was not good for their profit.
To counter these moves the pharmaceutical industry has spent more money courting legislators with their lobbyists and convincing them that the cost of their medications is justified because of the tremendous amount of research and testing that was required to bring a drug to the market.
Advertising on TV and newspapers has been extensive.
No longer is the physician informed of a new product but its benefits are touted in all of their advertisements directly to the patient. One other method of presenting a drug that occurred recently is a drug company sponsoring a presentation for patients with a specific illness.

These entities say they have no control of the cost. They just pay what all of these nibblers and their “Justified Charges” demand and adjust their rates accordingly. The percentage is justified because of all of the people required to monitor expenses and determine where this money goes. They have been fortunate because the Governmental programs have added factors that permit them to curtail spending on some items.


Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected] 

  1 comment for “Nibblers by Ted Bacharach MD (retired)

  1. Marco Costa
    July 19, 2012 at 11:02 am

    Actually the burocracy including CEOs of private as well as goverment health insurances/programs do add to the cost of health care through salaries/bonus, meetings, trips etc. All that is added to the consumers cost or removed from the providers payment.

Comments are closed.