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Aren't you ashamed Dr. Frascino?
Aug 22, 2008

I asked you a question about my dr. now giving better treatment for those that can pay cash. Your response was political. Is this an hiv forum or just a forum for you to express your political views? I've voted democrat my whole life (I'm 46). I've survived hiv for over 22 years EVEN THOUGH I have had to hassle with insurance issues that whole time. The whole thing isn't fair but why the patients have to live shorter lives just because the insurance companies aren't making you doctors rich enough? Is that why you became a dr? I would think you would want to care about your patients more than money. Obviously your attitude is that we should let only the wealthy people with hiv live a long life - after all it's their fault the insurance is the way it is right? In the future I would recommend you lighten up on the political views. I am so dissapointed in you Dr. Frascino.

Response from Dr. Frascino

Hello,

WHOA! Hang on there a minute hothead! You completely misunderstood my point.

First, a few facts. As for how much money I get for my efforts, none! That's correct: nada. My efforts are completely voluntary. My comments about our broken health care system were meant to point out that it isn't fair on many levels, particularly for the 47 million people without any insurance or the additional 25 million who are underinsured. Just Netflix Michael Moore's film "Sicko" for vivid (and entertaining) documentation of just how unfair and broken our system is. I know a great many HIV doctors and I can assure you they are not rich. Many are having difficulty staying in practice, due to low reimbursements, HMOs and overhead costs. I have helped train postdoctoral fellows at Stanford University Medical Center for many years and it has become increasingly difficult to encourage young doctors in training to specialize in subspecialties, like HIV medicine, due to these economic realities. I worry that we don't have enough HIV specialist physicians to care for all the patients in the system now, let alone the 250,000 HIV-positive U.S. citizens who don't even know they are infected today plus the 56,000 folks newly infected annually. So if Doctor X needs to get creative with cash-paying patients in order to continue seeing you and fighting with your crappy insurance carrier for payment, well, don't you think we should cut him some slack? I don't know for certain the specifics of your doctor's practice. I merely wanted to point out a different perspective on the issue you raised. Most folks assume all doctors are rich. We aren't. They also assume doctors get well paid from HMOs and insurance companies. This often is not the case. Most doctors do what they do out of compassion, rather than greed.

You can be disappointed in me if you like, but I'm certainly not ashamed of myself or my profession.

Dr. Bob

Cash for better treatment? Aug 19, 2008

I recently found out that my dr. (an hiv specialist) is now offering "better treatment" when patients pay by cash instead of insurance. Such things as longer visits, priority for referrals, more options for appointments. Is this legal? Is this ethical? I'm not sure how I feel about it but I don't have the funds available to pay cash for my healthcare (drugs are bad enough). There also aren't that many choices for hiv specialists in my area. Is this what the medical profession is coming to? You have to have cash to stay alive?

Response from Dr. Frascino

Hello,

The U.S. healthcare system is a total mess. Nothing about it is fair or equitable. Is what your doctor doing legal? Yes. It is. Is it ethical? That depends on one's perspective. Is it ethical for insurance companies to deny payment to physicians or reduce payments to levels that make providing care difficult for some doctors, particularly cognitive specialists? Cognitive specialists are physicians who "think" more than "do." For instance, surgeons can charge a reasonable fee for performing surgery. Fine. However, an HIV doctor who needs to interpret complicated resistance tests and figure out complex drug regimens and deal with difficult psychosocial issues often cannot charge for his expertise, time and service. The insurance companies refuse to pay. So the ethical question is complex. The answer is to elect Obama and get universal healthcare for everyone, like every other civilized industrial nation on the planet.

Talk to your doctor about your needs, but don't fault him for trying to stay in business within a healthcare system that is terminally flawed and presently surviving only on life support!

Do you have to pay cash to stay alive? No. You have to vote Democratic.

Dr. Bob


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