Don't have much time to reply to everything. Interesting discussion so far. Seems like a lot of anger in here - as there should be.
Prevailing sentiment is I should move out of the ghetto. If you look at the Downey's history you'll see it's anything but ghetto. Suburbia yes, ghetto no. Rockwell had it's huge plant there that maintained the Space Shuttles until it got move to Palmdale/Lawndale. Coca Cola has a plant there. North Downey has ridiculously large home (multimillion).
I did my training at this hospital so that's why I choose to practice there. When I entered as a medical student there were always good patients. Hell, I would work without complaint if ½ my patients off ER call had insurance. The total from last night is 8 admits, 1 insured and 7 without. So I'm making $120 before taxes on about 8 hours of work. Fortunately there's a nephrologist that's letting me do the IM for him and he has good Medi/Medi patients. Haha - that's funny. 20 years ago no physician would touch Medi/Medi cause they reimbursed horribly. Now they're gold mines here in CA.
My parent's house (where I live) is 8 miles away in Cerritos, CA. Cerritos is pretty well to do, I would say the top 15% if not 10% of national incomes (of course everybody in CA is in the top ½ usually). 8 miles from Downey in the other direction is what you would call the ghetto - Compton, North Long Beach, Bell, Lynwood, Watts. I volunteered at MLK when I was in high school during a summer. Learned a lot but did get scared shitless a few times.
With the hospital closing (MLK) the 11 hospitals in the area are now impacted. Even Kasier was forced by our Nazi state/county to take some of the MLK flow. A private company forced to handle uninsured patients by our government. That's what nationalized health care would be.
The problem is everybody who has good insurance in enrolled in HMOs. I refuse to deal with that BS. I either want cash/Medi-Medi/PPO in my outpatient office. People are stuck with their busy docs who are quagmired under HMO BS and they don't know I exist. I guess you could call me boutique medicine w/o the crazy rates. I'll see patients in office for an hour and would be happy with $60 cash (I say to hell with the government, they're not seeing this money - afterall they're not paying me their MediCal bill). What plumber do you know will work for $60/hr.
There honestly is no place to move. Downey had nice patients coming the hospital. When the bad MLK patients came in, the Downey patients went to another hospital which is closed to outside physicians. The money trail moved away kind of like animals migrating. After all, why would you pay for insurance and sit in an ER and get behind sicker people who aren't paying anything. Hello, fee for service people. You pay insurance - you get your treatment. None of this triage bullshit.
Unfortunately my wife to be is Tiawanese and I'm Indian. I want to be close to home to take care of my parents and in SoCal - well I just love being here - as does everybody else. I'm willing to pay $600K for a house that's $60K in the rest of the country. I'm not willing to work for free and not be able to afford the house though. Since my wife will make more than enough money I'll be OK.
I'm upset at the fact I'm willing to go out on a limb and help people and be an awesome doc. I give all my patients (all 5 of them my pager #). 3AM they have questions they talk to me - not some answering service. True I don't want to get busy. But with just 200 patients I could get by easily. With everybody in the country enrolled in a crappy HMO plan, I can't find any unattached patients.
And the rest of the country will only become like it is becoming here in SoCal. I don't want to blame a certain race or group for it. The nephrologist I work for is hispanic and I'm fluent in Spanish. I speak Spanish with 90% of the people I see - that's just the reality here in SoCal. That's fine - Downey has a lot of rich Spanish speaking patients. Problem is the ones from south of the border who choose not to pay for whatever reason. Yes they do make up fake address and SSN in the ER so there's no way they'll get billed. Of the 8 I'm seeing from last night, 3 are from Mexico and 1 is from El Salvador. The rest are locals. Unless you run to Beverly Hills you can't escape the wave of ininsured.
What really irks me are the locals who choose not to pay insurance. Obviously illegals shouldn't be signing up with Blue Cross - um, they're not supposed to be here - that's another issue I won't debate. This 23 year old twit (I've yet to see) is a local turnip.
If I want $, I can sell my sole and just go into vanity medicine and do Botox. Sadly, I can't see myself doing that. I turned away from engineering because it paid badly in the 80s when I dad did it out here in CA. Now it pays pretty well to be a nerd. If I feel like using my brain I'll probably go work for GE medical or assist with EMR programming. If I feel real angry I'll probably sell my soul and sell real estate or BMWs. Shit, if I convine a witness to get a blood transfusion I sure as hell can sell a 3 series to some 23 year old going to Vegas. The hell with morals - I'll have kids and a wife to feed.
Yes, I'm stubborn in choosing not to move. But the LA Basin has about 20 million people. As the primary docs get more and more fed up they'll quit and no young docs like me will choose FP. Everybody will go to the ER for care and ERs will shut down. Just look at how many trauma centers there are in LA compared to 20 years ago. The Healthcare system will collapse. States will mandate hospitals to keep their ERs open at the risk of losing their license (As mentioned above) but sooner or later the burden will fall.
If we have a socialized health care system it would help in that the useless sacks of shit who don't pay for anything would be paying. Problem I see is that nobody would use it (As mentioned above) and the goverment would not actually pay the physicians and providers. How many times has the goverment put in a tax for one thing and stolen the funds for something else. You pay taxes for Social Services that are supposed to fund things like MediCal/Medicaid but the government doesn't pay the physician. I have been paid by MediCal in over 1.5 years. They even issued a memo from the state saying the hospitals won't be paid unless money is found in CA messed up budget.
I honestly don't have a full solution to this problem or I would have written a dissertation. I think it would take a team of people including MPH/physicians/nurses/hospital administrators to actually write a plan. Problem is Congress is too busy rooting for John and Barrack to get any work done. If I had some ricin I know where I would put it :evil: