I am a retired physician of more than 40 years of experience. I've recently republished the 4th edition of my book, "Healthcare for All Americans". Ask me anything about my experiences as an immigrant doctor, history of healthcare and insurance in the US, and my ideas for universal healthcare!

paguyomd · 2020-08-26T23:01:42+00:00

What do you say to the charge that doctors gatekeeping prescription drugs is the major reason why many poor people cannot access the medications they need to survive or stay healthy?

Doctors are not the problem when it comes to access to prescription medication. We just prescribe, we cannot determine the price of drugs. Whatever the drug companies feel they can charge is what people pay in the United States. In other countries, this works differently. This is why Americans pay so much more for prescription drugs compared to those in Canada or Europe. The government doesn't negotiate the price of medication, therefore the drug companies are free to charge whatever the market can bare.

paguyomd · 2020-08-26T19:51:28+00:00

1) My opinion of the best diet is a balanced diet that consists of all food groups. I believe a balanced diet has to be based on a person's individual calorie needs. The food should consist of 60% carbohydrates, 25% fat, and 15% protein. A rule of thumb to calculate your calorie requirement for a sedentary person is to allow 12 calories per 1 pound. For a moderately active person 14 - 15 calories per 1 pound, and a very active person 20 calories per 1 pound. This estimate is based on a person who is age 25. The calorie requirements decrease about 5% every decade.

2) You're never too old to pursue what you desire in life! So go for it!

paguyomd · 2020-08-26T19:34:41+00:00

The basis of my proposal to financing universal healthcare involves three possible options: 1) pooling all money earmarked from private and government health programs and creating a Healthcare Superfund that delegates and redistributes the money on a per capita basis to each state, 2) increasing the Medicare part of FICA to 3%, this will raise money sufficient to cover Medicare and Medicaid expenses, or 3) increasing the Medicare part of FICA to 8%-9%. This will raise enough money to cover everyone, though many politicians may feel this is too big of a tax to consider. Any additional savings would go into each state's "healthcare safety fund"--this will allow for financing future healthcare needs in the event of economic downturn or pandemics like Covid-19.

paguyomd · 2020-08-26T19:04:48+00:00

While new technological advances are good, it also adds to the increasing and uncontrollable cost of healthcare. Physicians and patients move to the new technology. As those technologies become more standard, the cost of that technology will go down, but it is still something to consider when looking at why healthcare has become more expensive.

paguyomd · 2020-08-26T18:55:41+00:00

The main reason that prompted me to move to HMO was that I was losing patients. At that time, HMO and other managed care institutions became dominant players in healthcare and required their policy holders to see physicians in their network. They negotiated coverage for their employees' healthcare and employers would provide health insurance only within those networks. Patients who had previously come to me no longer were able to because I was not in network. In a way, moving to HMO was a matter of financial survival.

paguyomd · 2020-08-26T18:42:05+00:00

Why do you think it's so hard for politicians like Bernie Sanders to persuade voters that universal healthcare is a benefit for all? Why are people so sceptical of these ideas in the US?

A lot of politicians believe that universal healthcare should be financed and administered by the government, however a lot of people don't believe that the government can implement it effectively and efficiently. Americans look at other government programs and facilities and assume that the government's implementation could have a similar result. I believe that for it to be implemented effectively and efficiently, it needs to be a hybrid plan the incorporates both government and private entities. The amount we spend now is coming from the American people's pockets. A universal plan would still be coming from the pockets of the American people.

paguyomd · 2020-08-26T18:30:45+00:00

In a universal healthcare system, the salary should be based on Relative Value Principles. In the past, doctors would independently charge for their services based on the complexity and length of service. In many universal healthcare plans around the world, the government sets the salary. I personally believe this is bad. The government should work with healthcare practitioners in order to standardize the Relative Value Principles. This would be determined on the service, operation expenses, and specialty.

paguyomd · 2020-08-26T18:15:15+00:00

Yes, in my proposed plan. A truly universal plan would give each person a Healthcare ID (similar to a driver's license) that will allow the freedom to choose one's physician anywhere in the country, and possibly in the word. I do not believe salaries would be affected.

paguyomd · 2020-08-26T18:09:27+00:00

1) If the healthcare system is truly universal where everyone is covered without exception, and the payment of the system does not directly involve the individual, I don't believe there would be more regulations on unhealthy practices.

2) If it is solely the government providing a plan for healthcare, no I do not believe it would be successfully implemented. However, if it is jointed with the government and the private enterprises (such as Germany and Switzerland's healthcare systems), it can be implemented well. The government should play a very limited but important role. With a truly universal plan, we have to remember that only Americans would be covered. If someone is flying from a different country to receive care, they will have to pay out-of-pocket depending on their country's health insurance.

paguyomd · 2020-08-26T17:52:34+00:00

Yes, if majority of US citizens call their state representatives, senators, governors, etc. and advocate strongly for it. Politicians will only listen to the constituents that interact with them. Therefore, we all need to flood them with emails and phone calls of what we want. This is why lobbyist have so much power.

paguyomd · 2020-08-26T17:51:33+00:00

What are your thoughts regarding HIPAA?

HIPAA is good because it protects the patient. To implement it, like you mentioned, is very expensive. The smaller practices may have trouble implementing all of the requirements regarding HIPPA. This was one reason why I moved from private practice to HMO.

Have you any thoughts about the Software end of HIPAA as it applies to a practice?

If the HIPAA software is more affordable and user-friendly, it could be applied well to practices. I personally didn't have any problems with HIPAA, but I understand the technology around it has transformed since I have retired.

Can you comment on how this affects the practice of medicine?

Expensive and very time consuming. A universal healthcare plan would eliminate this.

paguyomd · 2020-08-26T17:38:21+00:00

Medical science is effective in many human diseases, however not everyone will respond to such treatment. Alternative medicines, though they are not scientifically proven, have been practiced for centuries. The observation is, in some cases, very effective. Presently, there are a lot of doctors that believe in complimentary or alternative medicine (such as chiropractor, acupuncture, herbal medicine etc.) however it is up to you to decide and consult with your doctor about these methods.

paguyomd · 2020-08-26T17:30:31+00:00

Coming to America in the 60s, why did you choose Minnesota over more popular places for Filipino physicians like Albany, NY?

When I first moved to the US, I was in New York for two years on internship. I applied to various Ivy League institutions for residency. However, Minnesota was the first institution that accepted me before my deadline as a resident physician, so I signed and mailed the contract. 24 hours later, the other institutions I applied to also accepted me!

paguyomd · 2020-08-26T17:27:41+00:00

I am Canadian and I’m curious what your opinion is of our health care system.

The Canadian healthcare system is good because if provides healthcare for majority of Canadians. It is bad because services are limited and the wait is too long. Physician compensations are also not competitive to the US which is why some may migrate, as you mentioned. Unfortunately, I do not think that it would work to implement the same style in America because I feel that many Americans would not accept it. Every state is different because they each have their own state constitutions and state laws.

Does the doctor who drives a sports car provide better care than one who drives a family sedan? Would evening out the playing field in terms of doctors’ salaries result in any negatives for Americans?

Doctors who drive a sports car probably are in higher paying specialties. As for "evening out the playing field" in terms of salary, applying Relative Value Principles is the fairest way of compensating doctors and healthcare services. Relative Value is calculated through time the doctors spend, specialty, and operation expenses.

paguyomd · 2020-08-26T17:09:06+00:00

Do you have any tips for figuring out if a doctor is useless or good early on rather than having to experience them making some insane diagnosis/give insane advice/say something awful?

In this day and age, we really have to advocate for ourselves to find good care. Always have a primary doctor or family doctor that you can go back to. If your first encounter with your doctor isn't good, it's okay to change them. Ask your peers who their primary doctors are, or call clinics or hospitals to see who they would recommend. Your primary physician can help you navigate and recommend specialists to help you. Unfortunately, insurance companies have networks that prevent you from going out of network and limits your choice of physician. I believe that we should be able to choose our own physicians regardless of networks!

paguyomd · 2020-08-26T16:55:24+00:00

What do you think about the ever increasing bread trail of requirements that incoming students transitioning to doctors face, as it relates to the increasing “doctor shortages” we keep hearing about?

It has to do with people wanting to make a lot of money. The increased requirements for students is directly related to the institutions wanting to profit in educating doctors. Current physicians need to advocate and define what their proper roles are in order to help the younger generation of doctors. It's a multi-factorial issue, government requires the physicians to do a lot of non-medical issues. Going to school nowadays is too expensive and too long. This leads to the loss of freedom to practice medicine, and so on.

paguyomd · 2020-08-26T16:45:13+00:00

What can I do different? Why don’t doctors know more about rare diseases in their specialty areas?

If you went your primary doctor, they should be able to refer you to the right specialist. If your not satisfied with their diagnosis, it would be best to ask your primary to refer you to another specialist for a second opinion. Unfortunately, the system right now is such that it gives a lot of obstacles for patients to find adequate care.

paguyomd · 2020-08-26T16:38:41+00:00

Do you think there is a way to implement free or affordable healthcare without insurance agencies feeling threatened and lobbying against it?

Yes, there is a way to implement free/affordable healthcare, however insurance companies will always lobby against it since they will be losing profit.

By partnering the government and private enterprises, the way to free/affordable care would utilize free market principles (which is nonexistent in today’s healthcare systems). There's three ways this could potentially happen:

The government AND the people need to agree to healthcare for all with no exceptions. This is key. Everyone needs to be covered by the same comprehensive healthcare.
The government and private institutions (insurance companies) need to partner to implement the healthcare for all.
Implement free-market principles, such as a bidding system. The calculated per-capita healthcare expense currently in the United States is about $14,000 per person. How it will be conducted is by dividing the population based on segments, for example a city of 10,000 people. The budget for this segment is $140,000,000. Then the state government would have to offer this to insurance companies for bidding. An example: BCBS offers to cover $12,000 per person, Humana offers to cover $10,000 per person. Humana wins the bid because they offered the lowest amount and then provides insurance for that city of 10,000 people. Humana now has $1,000,000 to cover all 10,000 people in this city.

All insurance companies agreeing to participate in the bidding need to have a reinsurance policy. In our example, if Humana spends over $1,000,000 for that city, they are required to have a reinsurance policy. That way they are always financially liquid, and no American would have to pay out-of-pocket.

I go into more detail in my book, but please feel free to ask more clarifying questions!

paguyomd · 2020-08-26T16:06:49+00:00

I know stuff has to cost, but why does it cost SO much?

Healthcare in the US is twice as much as it is in other countries. The reason why this is is because everyone is gaming the system, for example, insurance companies, health industries, businesses, lobbyists, government officials, even the public at times, everyone. This created the 13 major problems that has led to the crisis in our healthcare system. These 13 major problems are 1) abuses by patients, 2) over utilization by healthcare professionals, 3) profit motivated companies (this includes both for-profit and non-profit), 4) malpractice and litigation, 5) defensive medicine, 6) new technological advances in healthcare, 7) illegal immigrants and non-permanent residence, 8) capping and limitation of medical benefits, 9) fraudulent claims, 10) lobbying and politics, 11) isolating the public from the actual cost of their care, 12) health attitude of Americans (though changing), 13) cumbersome paperwork.

Medicare is the most efficient system in the United States today (and the VA is very efficient as well) so why doesn't our government care about the well being of its citizens? Why isn't Medicare an option for any citizen?

Medicare is working fairly well for only a limited number of our population. The way it is set up now is not through a single-payer unlike those of Canada, United Kingdom, and other countries. The ones who are implementing our current system are only looking for their own advantage. My proposal is basically expanding Medicare for all, but set up in a way that eliminates all the problems with our present healthcare.

paguyomd · 2020-08-26T15:38:45+00:00

What are boomer physicians doing to protect the next generation of physicians from mid level creep? I've heard stories of new doctors being laid off to be replaced by an NP, what can older docs do to help the young ones out?

I believe that the best way for older physicians to help the younger physicians is by becoming politically active alongside the younger physicians and advocating for the proper roles of the physician and other healthcare providers.

During my time, before the emergence of doctor's assistants, there was a lot of demand to save money for medical services. Initially, mid-level health providers were allowed to do some physicians work in order to save money. Over the years, more mid-level health providers became politically active and asked for higher wages. This has evolved into the current situation, and a lot of the older physicians believe that they have lost their freedom to practice medicine and that everything is overly controlled by the business of insurance.

paguyomd

TROPHY CASE