Ramblings by Aaron Levine MD


Anthem purchases Cigna, and Aetna buys Humana. We have the big three left. The younger readers may not recall the days of the Clinton Health program which believed in managed competition. This was to be a reduction of the number of health insurance companies to control redundancy and therefore costs. Prudential, Travelers, The Hartford and others no longer provide health care. Health care costs did not drop. The report in the LA Times cited in the Houston Chronicle on 7/25/15 said that the CEO of Anthem reported this “as a way to eliminate unnecessary costs and offer more affordable benefits…”  The paper further stated “Anthem may also use its increased clout to exact lower prices from hospitals, doctors and rug makers.” It also noted that “health policy experts warn that there’s no guarantee that savings would be passed along to consumers.” Does this sound familiar?

This was the reason the airline industry used for its consolidation. I have not seen airfares drop. There are more seats per plane, fewer sitting space for passengers per plane, more fees for baggage, snacks, etc. And there are fewer flights. Too many similarities exist. There were monopolistic organizations in the past. Ma Bell split up and had competition. Phone service became competitive and costs dropped. Just the opposite of what is likely to happen now. Further, remember the big 4 automakers (I include American Motors)? They were unchallenged until first Volkswagen and then the Japanese cars arrived. They won not only on price, but on quality. They forced American companies to become leaner, but also to improve quality. Will we have such a white knight in healthcare? Although I fear not, Public Radio disagrees. They did a report discussing the rise of hospital operated insurance companies and how they will offer quality care and lower costs. Someone forgets the profit is taken out before the quality goes in (pardon me Ford).

I was watching the Best Exotic Marigold Hotel (not the newer second one). In the first few minutes, Maggie Smith is told she needs to wait 6 months or more for a hip replacement. She said at her age, she could be dead. She was told her options were to be outsourced for the surgery. She wound up in India. (I am not meaning to offend the Indian Doctors. It is a plot of the movie). I was at Baylor when the Netherlands sent their cardiac patients to Houston for surgery. History comes around.

Oh, and a couple of days after the announcement, Anthem and BC/BS announced eliminating a whole group of PPO patients (mainly Obamacare patients) for cost reasons and offering them HMOs. More details will follow this fall.


I received an email that I misplaced. It notes that 25% of doctors are over 65 and need to be evaluated for competency. After all, this is done for pilots. It suggested there be a means of biannual testing of knowledge, physical and cognitive skills before physicians be allowed to practice.

Most medical school graduates finish training at about 30, So at each decade of life to 60 would be about 25% (30-40, 40-50, 50-60 60+). Second, most hospitals do require biannual assessments for staff privileges that usually address physical and mental status. I thought the CMEs and then board recertifications would be enough for the knowledge factor. Then the MOCs came on site. It is interesting as this suggestion developed as there is push back against the MOCs. Is this a back door approach to reinstate them?

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]

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3 Responses

  1. Kurt says:

    Dr. Levine, I don’t know any primary care physician who wants to practice in this environment into old age. This is a moot point. I’ve heard 40 year old FP’s who are sick and tired and would quit right now if possible. I have 6 years 2 months to go and as soon as I am done and certain I don’t have to practice anymore due to financial issues, the certifications go to the shredder.
    MOC and the fact that the heads of academic service organizations make
    $600,000 a year more than I do has me apoplectic that I can talk no further without Doug having to censor me. (Sorry Doug, I try to hold it down but I can lose it because I see there is going to be no hope for the state of practice in this country.)

  2. Lynagh says:

    Monopoly has never been beneficial, but is the accepted manner of business today. “Small is Beautiful: A Study of Economics as if People Mattered” by E.F. Schumacher should be required reading by everyone.

  3. Steve O' says:

    Sadly, American medicine is structured around the Underwear Gnomes business plan (see South Park.)
    Step 1 : Collect (Steal) Underwear.
    Step 2: ?????
    Step 3: Profit!!
    The plan is – Doctors cost Healthcare Money. Get rid of the doctors, and then…Profit!!
    DPC is such a threat to this model, I fear for its very existence.
    The assumption by Retail Medicine is that no matter how much pressure you put on doctors, they will keep doctoring because…they are doctors, dammit! They do that naturally, like birds fly!
    Horrifically bad thinking is not only seen in the Medical Retail business. It’s the backbone of our economy, sadly….
    To quote the Mogambo Guru…
    “In short, it’s a repellent inbreeding of false economic signals with corrupt stupidity, such that it can only, by the mathematical necessities of an exponential function that must one day zoom asymptotic, end in the grotesqueries of catastrophe and war, as far as the eye can see.”
    Yep. That’s medicine. Sorry for the mathiness.

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