America Speaks The Voice Of Joyce Periscope @11am Wednesday. Jane asked about the effect of Mega Healthcare Vertical Mergers on the Primary Care Physician!




  • The Primary Physicians vs The “MegaGiants” providing Healthcare
  • Healthcare and the bottom line. 
  • My 2 cents, this is personal not policy


Major Healthcare Insurers are consolidating with Mega Pharmacies to create Urgent Care Centers staffed with Nurse Practitioners or PA’s in your area, potentially forcing your reliable GP or Internist out of business. Is this good for consumers? I don’t think so.


I know from first hand knowledge , that the urgent care centers can not replace your physician . One time I entered our local urgent care center for a “dislocated “ finger. Their ill advised attempt at resetting my joint forced me additional pain and double expense, since  I had to see a hand specialist at HSS , too. The 2 nd time , rather then being treated, I was sent to the emergency room. Other, experiences with large groups have proven equally frustrating. The staff is friendly and proficient in the single task they are taught to perform.  They are minimally paid, forcing “nurses”  onto food-stamps.   Most contractors, working for major Healthcare providers, like Northwell Health, are paid minimally, $28,000 a year, while they are more accountable for their time and conduct, then the wealthiest stewards of our Economy.


Therefore, anticipating what may be our future, I would urge everyone to have a check up with your primary care physician before he or she becomes extinct.  The qualified physician can’t earn enough to stay in business , yet, they are our advocate. Usually they know you and your family and they can refer you to professionals when necessary. I believe in the continuation of the private practice.


What’s wrong with America? We’re bottom line oriented in every business and healthcare is an industry that does not respond to bottom line profits without causing patient suffering.  These Mega Mergers are meant to be cost efficient at the patient’s expense.  We can forget the concept of low cost quality healthcare unless we insist upon it as our right.


  • Admittedly, I’ll choose my Dr. over a clinic , no matter how convenient, every time. I’ve presented articles from the Kaiser Foundation to help you make the right choices, too!



Once , the Insurance Companies (Aetna or United Healthcare)  combine with CVS or other pharmacies or out patient provider networks,  our choices will be limited along with Quality of care. Our drug choices will be limited too , since shopping around for less costly and equally effective drugs will be curtailed. Vertical integration is happening without restraint or anti trust concerns. It’s not going to benefit we the people. It will steer consumers to groups with limited creativity, time, innovation and medications. As a patient, you won’t be seen by a Dr.   Instead, you’ll be seen by a Nurse Practitioner or a PA.   Both these professionals are supposed to be overseen by a physician. Usually, the only physician present, is the the physician’s diploma on the wall.


Every time I’ve had a serious health question, I required a physician. I do believe , PA ‘s and Nurse Practitioner can help a Dr’s practice by prepping the patient , drawing blood, doing routine tests. However, nothing beats the old fashioned Dr taking an oral history, listening to your complaints and then examining you “himself”. Usually your physician will also consult with you on test results and coordinate follow up visits. A good physician will not push unnecessary tests or medications. They know you and your history. Choose wisely and when possible choose someone associated with the hospital of your choice.


However, I understand the services provided in  large urban  cities may not be available in rural communities.  PA’ s and nurse practitioners can thrive,  providing basic care and diagnosis when no Dr. exists. They also have the ability to discuss their concerns via Skype  with you or an attending physician 100’s of miles away.  They can also refer you to a more established  medical center or hospital when required. 


FYI, I recently turned down seeing a nurse practitioner in my Home which was offered on a trial basis by United Healthcare willing to grant me a $15.00 award.   I’ve had experience with large healthcare services when recuperating from hip revision. I thought, perhaps wrongly, that accepting the Nurse Practitioner, would prevent me from having my primary care physician and his network of specialists associated with  the Cornell medical Center & the Hospital for Special Surgery.  



  • Unfortunately, though my problems have been structural, I’ve experienced Healthcare when only the bottom line matters.  When I entered a renowned Rehab Center after hip revision, though the staff was attentive and as accommodating as they could be,  many patients who were bedridden and left for hours without care. I calculated, The Rehab facility was understaffed by 50 People. I never saw a physician,  until I had a wound problem,  and they dressed it incorrectly. I redid it myself.  Luckily, I’m able to be my own medical advocate, most can’t advocate for themselves and the internet can be a dangerous place for those who search for Medical Information.  Scientific peer reviewed  information exists,  as a consumer you must know where to search! This is one problem.


  • A second problem, is lack of time to communicate with you, the patient.   This is not the Health aids fault, they are given a task to perform and  a verified time limit.  Can you ask questions?  There may be time, however, if you’re not medically savvy, how would you know what question to ask?


  •  The third problem is  over medication and addiction.  It is obvious to me, many individuals do not know when they are being over medicated and I don’t see our war on medication abuse lessening when Insurers and pharmaceuticals combine.  We must be our own advocates to stop Opioid addiction , over use of anti depressants and ADHD medications. It appears, we are a Nation,  addicted.   It’s time we reclaimed the old fashioned primary care physician and started training them to stop prescription over use and offering us the counseling many of us require.  


Perhaps before we debate too long , it would pay to send someone like me , plus a team of interested citizens and professionals, to the  3-5 known countries (Switzerland, South Korea, Canada, et al)  offering quality healthcare .  Let’s understand how they manage lower costs and quality care . I’d take a team , video our talks and bring results back to America. Give Americans a choice. We need it. We’re not getting a single payer system anytime soon and consolidation of the Giants will limit our course of treatment and our lives.


See you later and we’ll chat.

“the heart and pulse of the Middle Class”


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