Obama Hires Mystery Shoppers to Spy on Doctors...What next?

@georgeob1,

And how does Medicare/Medicaid compare to Legal Aid cases in those same areas? Are lawyers compelled to take Legal Aid cases, and if so, what's the ratio?

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@Mame,

You mean, pro bono cases. I don't believe any are required to take any such cases. If there is a state or county public defender's office, they are probably required to accept whatever is assigned to them, though there would be a need requirement.

If you are speaking of representing the public in civil cases, I'm betting it would be descretionary, and done by some sort of charitible corporation.

To summarize, ask a lawyer.

You're not trying to put legal representation on the same level as medical treatment, are you?

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@Mame,

"Mame":
As far as I know, in Massachusettes, only those convicted of a capital crime ( murder ) get a superior and free lawyer ( paid for by the State ).

For those associated with a lesser crime, all Americans are entitled to a Public Defender.

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Obama has now decided that now is not the right time to engage" mystery shoppers".

It was of interest that the study was to be under the direction of the University of Chicago. As you may recall, Ms Obama was a VP at U of C prior to Mr. Obama becoming President.

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Should Docs be required to treat those on medicare / medicaid?

If those physicians used educational loans from the US to fund there medical education ( any part of the 8 years prior to receiving the MD ), then they should be legally required to treat medicare/medicaid patients.

If they've funded their own education, entirely without public support, they should make up their own minds on the matter.

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In general, there is a shortage of primary care doctors in the USA. In part this is due to the increased number of medical students wishing to enter a speciality practice.

In many of the specialities, an MD may graduate from med school at age 27 and then enter a one year intership, which is then followed by a 3-5 year residency. Thus making the MD close to 32 years of age or even greater before entering an actual practice in that speciality. I've noticed that lately, many MDs have been following up the residency with one or more fellowships ( 1-5 years long ).

Thus, very often, the MD is close to 40 years of age before finally(!) completing his/her medical education.

In the mean time, babies are being born,and the population is aging .

One way around the current primary care shortage may be to limit the actual number of MDs who are permitted to enter any speciality other than internal medicine/family practice. Back to the good -Old quota system.

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@Mame,

Just started reading this thread so I don't know if this point has already been made but I believe that the physician's lobby (AMA) does a lot to prevent that from happening.

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@Mame,

Mame wrote:

And how does Medicare/Medicaid compare to Legal Aid cases in those same areas?

Medicare is an entitlement ( usually given to those 65 years or older ), funded while a person works, via a medicare tax on their wages. Medicaid, on the other hand is health insurance for those close to or even below the poverty level who would be uninsured otherwise.

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@Mame,

Mame wrote:

And how does Medicare/Medicaid compare to Legal Aid cases in those same areas? Are lawyers compelled to take Legal Aid cases, and if so, what's the ratio?

Rules vary from state to state, but to my knowledge no lawyer is required by law to take pro bono or legal aid cases as a condition of retaining his practice. Legal aid consists of services provideg and paid by the state or juruisdiction. Even that is voluntary on the part of the lawyers.

The alternative would be forced labor on terms dictated by the government - something I think no one would accept.

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@roger,

No, not pro bono - they are paid government rates. I'm not a lawyer and have never worked for one, so I don't know all the details, but it's called Legal Aid, and people who earn under a certain amount (not to mention all the felons) are entitled to representation. It seems that most, if not all, law firms take some Legal Aid cases, but I don't know if it's a requirement of the government or not.

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@Mame,

http://intraspec.ca/law_resources.php (bottom of the page)

http://www.ncsc.org/Topics/Legal-Services/Legal-Aid-Pro-Bono/Resource-Guide.aspx (middle of page)

http://www.americanbar.org/groups/probono_public_service/policy/state_ethics_rules.html (hours required per state)

Quote:

APPENDIX B

DEVELOPMENT OF ABA MODEL RULE 6.1: HISTORICAL TIMELINE

1969 : the ABA adopted the Code of Professional Responsibility, which addresses for the first time the responsibility of the lawyer to engage in pro bono work, in Ethical Consideration 2-25. It states among other things: " Every lawyer, regardless of professional prominence or professional workload, should find time to participate in serving the disadvantaged."

1975 : the ABA House of Delegates adopted a resolution which formally acknowledges "the basic responsibility of each lawyer engaged in the practice of law to provide public interest legal services" (the "Montreal Resolution"). It defined pro bono in part by specifying areas in which the services should be rendered, namely: poverty law, civil rights law, public rights law charitable organization representation and the administration of justice.

1983 : the ABA adopted Model Rule 6.1, which states that a lawyer "should render public interest legal service." It specifies certain ways a lawyer can discharge the responsibility: "by service in activities for improving the law, the legal system or the legal profession, and by financial support for organizations that provide legal services to persons of limited means."

1988 : the ABA adopted the "Toronto Resolution," which, among other things, resolves to "[R]ecognize and support the professional obligation of all attorneys to devote a reasonable amount of time, but in no event less than 50 hours per year to pro bono and other public service activities that serve those in need or improve the law, the legal system or the legal profession."

1993 : the ABA revised Model Rule 6.1 to include a quantified aspirational goal (i.e. at least 50 hours per year), a more refined definition of pro bono, and more specific ways to discharge the pro bono responsibility. The substantial majority of the 50-hour responsibility should be discharged through the provision of legal services to low-income people and groups that serve low-income people.

2002 : the ABA revised Model Rule 6.1 to add a sentence at the beginning of the Rule to give greater prominence to the proposition that every lawyer has a professional responsibility to provide legal services to persons unable to pay. A new Comment [11] was also added that calls upon law firms to act reasonably to enable all lawyers in a firm to provide the pro bono legal services called for by this Rule.

Last Updated: 06/23/2011

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@georgeob1,

georgeob1 wrote:

Rules vary from state to state, but to my knowledge no lawyer is required by law to take pro bono or legal aid cases as a condition of retaining his practice.

not required by the state, but required by the American Bar Association

1 Reply

@ehBeth,

The ABA requires (and very loosely enforces) a certain level of pro bono work as a condition of membership. However law firms get around those requirements very easily by counting thebills to clients that don't get paid and other devices. Doing this is not a condition of practicing law.

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Is it possible that part of the problem is that many believe that the patient/doctor examination needs to be face-to-face? I mean that with the advent of video conferencing, a doctor in a specialty can be "virtually" present, while the hands of a physician assistant does the hands on examination. This would allow many in rural areas to get the expertise of a specialist, while the specialist does not have to be living in the hinterlands, so to speak. A possible win-win situation?

This could even be expanded to have a "team of specialists" diagnosing a patient that could be across the country, literally. In other words, for all the time and effort to become a specialist, many such a doctor might not want to live where a strip mall might be the highlight of a night out.

Another solution might be putting young people on a medical track early on in their education, meaning that not everyone has to be "well-rounded" in the proverbial "core curriculum"? Big deal that a specialist never read certain "classic" novels in high school, if he/she was busy taking an advanced course in biology instead? In this way, a specialist could be functioning in his her specialty by his/her mid-twenties, perhaps. This could be part of a commitment for military service? Where does it say that doctors should be perennial college students?

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@georgeob1,

gotta love the loose American approach to ethics

at least the consistency is admirable

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@Foofie,

I heard a story on remote specialists a couple of days ago. Interesting take is that although the patient gets better care and it is easier, insurance doesn't cover the visit unless it is in person. Apparently this is a fraud prevention clause.

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@engineer,

Quote:

Apparently this is a fraud prevention clause.

Snort

It's a profit maximization clause. Anything they pay out cuts profits; ergo, limiting what they pay out raises profits. Any other justification insurance companies put forth is complete bullshit.

Cycloptichorn

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I don't see any connection between the so-called mystery shoppers and any requirement on doctors to accept Medicare or Medicaid. This is routine market research. Consumer advocacy organizations such as "Consumer Report" and "Good Housekeeping" do it all the time. Why is it so terrible when the government does the same thing to assess the availability of healthcare? I'm not getting it.

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@ehBeth,

ehBeth wrote:

gotta love the loose American approach to ethics

at least the consistency is admirable

Is it really a question of ethics? Perhaps we should also require (say) school teachers to provide some free remedial instruction to their failing students; or government workers to work extra days for nothing; or .. you can come up with as many examples as you like.

Do you do those things in Canada?

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@Thomas,

I agree with that. However, the report suggests the Possibility that the government may have some other purposes in mind.

It is only a possibility, and there is no direct evidence for it (of which I am aware) , however, the Administration is faced with the prospect of widespread practicioner resistance to potential large reductions in reimbursement rates for Medicare and Medicaid. Moreover it appears the Administration has recently woken up to the problem of a shortage of general practitioners amng Medical Doctors relative to the new entitlements they have created.

Some interesting contradictions and follow-on issues there....

1 Reply

Obama Hires Mystery Shoppers to Spy on Doctors...What next?

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