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Well you also need to remember that US system provides 70% of all medical and drug research i the world whicxh the world benefits from. It higher than US subsidising somuch defense in the world.Do not expect the system to be the same in the future in that and services on demand.
There you go again. Blindly defending the ridiculous healthcare system we have in this country, despite more evidence that its out of control.
Are you clueless? Do you think Australia is a Third World Country? How about New Zealand? How about Switzerland? Any explanation for how these folks that have standards of living equal to or greater than that here in the USA manage to provide heart bypass surgery at 1/3 the cost of what it is here in this country (or even less)?
The only true statement is that if you can afford it, healthcare in the USA is pretty good. The problem is that an increasing number of people cannot afford it. This will remain the case even if as you have suggested in prior posts they give up their cell phones and other electronic toys. The cost of a private health insurance plan far exceeds what these items cost.
I, personally, have been covered under a good private health insurance plan for virtually my entirely life. However, the chinks in the armor are appearing and no one has any solutions. Every year, the plan covers less. Every year, our co-pays and deductibles increase. Every year, the employee is asked to pay more for slightly lower quality coverage. Now, the insurer is trying to force everyone who is overweight into a mandatory weight loss program. We don't smoke. We barely drink at all. Yet, costs are just killing my wife's employer. Now, whenever she gets a pay statement they tell her every month, just exactly how much the employer is paying for her health insurance.
We supposedly have some of the best private insurance in our state and you know what? Its sinking. Its sinking and no one appears to be able to do anything to stop it. All they do is try to plug the holes that keep appearing, one at a time, and its a losing effort.
The real problem, when it comes right down to its a real simple one. Health care in the USA is just too damn expensive. Its too expensive because of the technology involved, the salaries of the people who are involved in the field, consumer expectations, and billing issues because of the vast numbers of health insurance plans.
Just a few questions for you ok?
1. If half the country were unable to afford health insurance would you still be blindly defending this system the way you do? How about 75%?
2. Do you find it morally acceptable that millions of hard working people are unable to afford health insurance because they make $8 to $10 an hour? Should they just be sacrificed because they lack job skills to earn what doctors, nurses, and hospital administrators make?
3. Why should health care costs be permitted to increase at 2 or 3 X the rate of inflation?
4. If every other country in the world adopted a system or universal health insurance would the USA still be right clinging to a system which only covers 85% of its population and yet costs more per capita than any other system?
You know, I run into some conservatives occasionally who I vigorously disagree with who say the problem with our system is health insurance. The problem is third party payers. They advocate trying to go to some "cash based" model for paying for health care. I don't think for a minute that will work. However, my point is at least they are identifying a problem and offering a solution. I don't see you saying anything other that "let's just leave things the way they are, because they work for ME".
Mark - It's time that everyone stopped talking around the issue of health care costs in the US. Gosh - what do we have that places like Australia and New Zealand don't have? A large permanent underclass. That's what we have. Black/Hispanic/White - in that order. Tons of single moms with illegitimate kids - and illegals too (especially when it comes to Hispanics). And what do we also have (although to a lesser degree)? A highly subsidized class of people on Medicare. For years - the government (which provides most of the insurance to these people if they have any insurance at all) has been trying to shift the cost of underpaying providers who pay for these people to everyone who might pay for it (insurance companies and their insureds/providers/people paying out of pocket/etc.).
We also have a lot of younger healthier people who'd rather have an unlimited data plan on their cell phones than pay anything for health care insurance (who needs it - I'm healthy!).
You're in the group of people who are being asked to subsidize the underclass - the people on Medicare (whether they're poor or relatively well off - like I am) - and the younger healthier people who - given a choice - won't pay. No wonder you're feeling the pain - you're being squeezed from all sides.
BTW - if you think these issues aren't popping up like pimples in countries you might deem immune from them - think again. We were in Sweden last September - and average white native Swedes we met are furious about paying more in taxes to pay for health care for brown/black illegal (or even legal) immigrants who often have 5+ children (whereas the native Swedes are having 1-2).
I can very much understand your desire not to subsidize me (if you have such a desire - I think it's rational). And you will have to respect my desire not to subsidize a 22 year old single mom high school drop-out with 3 or 4 kids.
BTW - just curious - how much do you think a decent doctor should earn? I figure something like $150k for a well trained internist PCP - much more for doctors in more exotic specialties. Robyn
I have been required by my physician to check in with her every 3 months for blood pressure & cholesterol checks. I've been doing this for years and always felt it was just a way to bring in the $$ - unnecessary, really. Each time I have to tell them what meds I'm on - is this not in your records? There's a disconnect there.
My last visit she said, I'll see you in a year (no eye contact). So, what's change?. Not my health. My thought was - what are you all up to now.
My monthly payment went up $100.00 this year - last year it went up $60.00. This is a retirement benefit that started out at $0 per month and is now $400.00 per month. There is something very wrong with our medical industry. There's a battle going on between the Drs, ins companies and the government and we are caught in the middle - and we end up paying. I'm feeling a certain animosity building up in me toward all 3 lof them.
As Mark said, we are paying more for a dwindling level of care.
I have been required by my physician to check in with her every 3 months for blood pressure & cholesterol checks. I've been doing this for years and always felt it was just a way to bring in the $$ - unnecessary, really. Each time I have to tell them what meds I'm on - is this not in your records? There's a disconnect there.
My last visit she said, I'll see you in a year (no eye contact). So, what's change?. Not my health. My thought was - what are you all up to now.
My monthly payment went up $100.00 this year - last year it went up $60.00. This is a retirement benefit that started out at $0 per month and is now $400.00 per month. There is something very wrong with our medical industry. There's a battle going on between the Drs, ins companies and the government and we are caught in the middle - and we end up paying. I'm feeling a certain animosity building up in me toward all 3 lof them.
As Mark said, we are paying more for a dwindling level of care.
There's no requirement that anyone see a doctor every 3 months unless (at least in Florida) you need a prescription for narcotics.
I figure about once a year for younger healthier people is ok - and perhaps twice a year for older people. Perhaps more often for people with chronic conditions/issues.
If you're just dealing with a PCP for routine stuff like BP and cholesterol checks - why can't you just take your BP at home - send the results to your doc - and get some simple lab work perhaps twice a year (I've never heard of routine cholesterol checks 4x a year).
FWIW - it's not unusual for good docs - especially PCPS - to check constantly on your meds at each visit. Because different doctors can add to or change your meds. And you can do that yourself too if you're taking non-prescription stuff on your own.
Note that I assume from your message that you're not on Medicare. Robyn
Mark - It's time that everyone stopped talking around the issue of health care costs in the US. Gosh - what do we have that places like Australia and New Zealand don't have? A large permanent underclass. That's what we have. Black/Hispanic/White - in that order. Tons of single moms with illegitimate kids - and illegals too (especially when it comes to Hispanics). And what do we also have (although to a lesser degree)? A highly subsidized class of people on Medicare. For years - the government (which provides most of the insurance to these people if they have any insurance at all) has been trying to shift the cost of underpaying providers who pay for these people to everyone who might pay for it (insurance companies and their insureds/providers/people paying out of pocket/etc.).
Largely correct. I would make a couple of points.
1. I've never been to Switzerland. I have been to both Australia and New Zealand. They have their share of drug users, alcoholics, and poorly educated people. They have welfare systems that are generally more comprehensive than our own. Out-of-wedlock pregnancy is as least as well accepted in those countries as it is here in the USA.
2. The subsidies to Medicare users bother me a great deal. I actually think that since the elderly, enjoy less good health, than younger people do that any public or private insurance system (funded by taxes or premiums) is going to have to charge younger people a higher amount than those health care resources they will consume. Older people will probably pay less for the same reason. Nevertheless, its been pointed out by myself and others on several occasions that Medicare premiums are covering about 1/4 of the cost of Medicare. Those premiums need to be raised and seniors need to pay a greater share of this cost. Some seniors, like yourself, are willing to own up to it. Too many others seem to either not care or are in complete denial. Either way, that attitude has to change before the whole system collapses. (Probably the year I go on Medicare)
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We also have a lot of younger healthier people who'd rather have an unlimited data plan on their cell phones than pay anything for health care insurance (who needs it - I'm healthy!).
True, but as I pointed out $500 a year for a cell phone is not equal to $7,000 for personal health insurance.
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You're in the group of people who are being asked to subsidize the underclass - the people on Medicare (whether they're poor or relatively well off - like I am) - and the younger healthier people who - given a choice - won't pay. No wonder you're feeling the pain - you're being squeezed from all sides.
Don't leave out a health insurance plan for employees at work either. Or, as my mother likes to say "they gotcha coming and they gotcha going".
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BTW - if you think these issues aren't popping up like pimples in countries you might deem immune from them - think again. We were in Sweden last September - and average white native Swedes we met are furious about paying more in taxes to pay for health care for brown/black illegal (or even legal) immigrants who often have 5+ children (whereas the native Swedes
I can very much understand your desire not to subsidize me (if you have such a desire - I think it's rational). And you will have to respect my desire not to subsidize a 22 year old single mom high school drop-out with 3 or 4 kids.
I have a fatalistic attitude about health care. As services, medications, and the number of people employed in the industry increase, costs will inevitably increase too. We are already at the breaking point. No country is immune from it. If I were "King for a Day", I'd implement a rationing system and cut out a lot of things that are only doing marginal good. I'm getting more and more ruthless as I think about this problem. Now, I'm starting to question if the system should pay for organ transplants for anyone, but a child. The surgery is expensive, but is just the beginning. The follow-up care for kidney, heart, and liver transplants is extraordinarily expensive. Plus, the organs generally only last for about 5-10 years. Of course, I have an economics background and I understand something about concepts like "marginal cost" and "marginal utility". Most people can't and won't think like that even when its in our interest to do so.
Did Medicare pay for Dick Cheney to have his heart transplant?
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BTW - just curious - how much do you think a decent doctor should earn? I figure something like $150k for a well trained internist PCP - much more for doctors in more exotic specialties
.
IMO, it ought to depend on:
1. The cost of living where they reside.
2. Student debt they have as a result of med school and college.
3. Hours actually worked and patients actually seen.
4. Overall competence.
I read the average family doc in Utah earns about $140,000 a year. I'm ok with that as an average. My family doc lives across the street and I have a hunch he may earn a little less than that. He's not a very materialistic person. His values are family, church, and community. He has a number of kids and his wife actually seems grateful for our "handy-me-down clothing". I don't have a problem with a 140K to 150K salary for a family doc who is seeing a full, or nearly full patient load.
My greater issue is with specialist physicians. I think salaries of 300K are often too much. Most of these salaries are derived from fancy testing or surgical procedures that are simply billed and reimbursed at too high a rate.
I sometimes think the "standard of care" is too high and we should accept a lower standard of care from the medical community and not reimburse services provided at as high a rate. I believe if third party payers (insurance and government) were not involved this would probably be the case. I doubt most people would pay that much out of their own pocket for some of the things that are routinely done.
Hospitals used to be run by churches and charities on a non-profit basis. I notice today that almost all of them have gotten out of this field and now medicine is "big business" with exorbitant salaries and profits. I don't know a way to give hospitals back to churches, but that might be a good start in cutting costs.
As you can probably tell, Robyn, this is a very frustrating issue for me. I say, without intending exaggeration, it may be the very ruination of this country.
There's no requirement that anyone see a doctor every 3 months unless (at least in Florida) you need a prescription for narcotics.
I figure about once a year for younger healthier people is ok - and perhaps twice a year for older people. Perhaps more often for people with chronic conditions/issues.
If you're just dealing with a PCP for routine stuff like BP and cholesterol checks - why can't you just take your BP at home - send the results to your doc - and get some simple lab work perhaps twice a year (I've never heard of routine cholesterol checks 4x a year).
FWIW - it's not unusual for good docs - especially PCPS - to check constantly on your meds at each visit. Because different doctors can add to or change your meds. And you can do that yourself too if you're taking non-prescription stuff on your own.
Note that I assume from your message that you're not on Medicare. Robyn
I am not on medicare. I believe the only reason she was demanding I come as often as every 3 mos was to fulfill the objectives of that clinic. It's easy, fast money for them - $400.00 for 10 min. Not bad. I did go out and buy a top BP monitor and told her I would send the results in - I got no comment from her - that wasn't her objective. It's a business and she follows the rules set by her employer. I walk in, lay down a sheet of paper with the meds I take, including any vitamins, the nurse takes the BP, the Dr creeps in asks me the same questions about the meds that the nurse did - I slide the sheet of paper to her (for the second time) - she does the scope of the heart. She writes out perscriptions for 90 more days of meds and off I go for blood work. It's the same crap now for nearly 10 years. This last visit was the first change. Obviously the house rules have changed. I believe she has sensed my increasing annoyance with the whole thing.
I don't have a problem with a 140K to 150K salary for a family doc who is seeing a full, or nearly full patient load.
Maybe it's my part of the country, but an income of $140-$150k for a experienced doctor, imho, is too low. I would think more in the area of $200-$250k. Specialists, top-flight surgeons, of course, would be earning more.
About 20 years ago, I met an intern who'd just finished a residency and was hired as an ob-gyn by Aurora Health Care. His starting salary was $172k - then.
I'm comparing these salaries to many, many highly-paid attys I know here who would consider $250k insultingly low. Starting salary for first-year law associate here is about $165k. Average for law partners, after 20 years $500k, at least, and much, much higher for many of them - well into 7 figures.
Docs, in my opinion, are worth as much as attorneys. Even though I rarely see a doctor, I do appreciate what it takes to become a doctor and how hard they work. jm2c
I'm comparing these salaries to many, many highly-paid attys I know here who would consider $250k insultingly low. Starting salary for first-year law associate here is about $165k. Average for law partners, after 20 years $500k, at least, and much, much higher for many of them - well into 7 figures.
Docs, in my opinion, are worth as much as attorneys. Even though I rarely see a doctor, I do appreciate what it takes to become a doctor and how hard they work.
The hardest thing for me to evaluate with physicians is the cost of getting their training. The rate of return they get has to reflect this as it reflects any other legitimate economic cost.
As an attorney, I would be quite happy with an income of 250K. I don't make that and I am not insulted by earning in the general range of what family doctors here earn. Maybe its diminished expectations or maybe its working in a low wage state. However, anyone earning more than $150K here is probably earning in the top 2% of all incomes. Between what DW and I both earn, we can afford almost anything we want. My standards are not high. I still occasionally camp in a tent. I drive American cars rather than foreign cars. I have exactly two good suits to wear to court. One is three years old. One is five years old. Our one weakness is travel, but when we do that, we usually opt for budget hotels and such to make out dollars go further. Why do people need more than that?
...I've never been to Switzerland. I have been to both Australia and New Zealand. They have their share of drug users, alcoholics, and poorly educated people. They have welfare systems that are generally more comprehensive than our own. Out-of-wedlock pregnancy is as least as well accepted in those countries as it is here in the USA...
...I have a fatalistic attitude about health care. As services, medications, and the number of people employed in the industry increase, costs will inevitably increase too. We are already at the breaking point. No country is immune from it. If I were "King for a Day", I'd implement a rationing system and cut out a lot of things that are only doing marginal good. I'm getting more and more ruthless as I think about this problem. Now, I'm starting to question if the system should pay for organ transplants for anyone, but a child. The surgery is expensive, but is just the beginning. The follow-up care for kidney, heart, and liver transplants is extraordinarily expensive. Plus, the organs generally only last for about 5-10 years. Of course, I have an economics background and I understand something about concepts like "marginal cost" and "marginal utility". Most people can't and won't think like that even when its in our interest to do so...
...My greater issue is with specialist physicians. I think salaries of 300K are often too much. Most of these salaries are derived from fancy testing or surgical procedures that are simply billed and reimbursed at too high a rate...
I sometimes think the "standard of care" is too high and we should accept a lower standard of care from the medical community and not reimburse services provided at as high a rate. I believe if third party payers (insurance and government) were not involved this would probably be the case. I doubt most people would pay that much out of their own pocket for some of the things that are routinely done...
As you can probably tell, Robyn, this is a very frustrating issue for me. I say, without intending exaggeration, it may be the very ruination of this country.
I don't know about ruination. It depends whether people start to look at health care in a different way than they do now. Not as a waste of money that "other people" should pay for (because it's no fun to pay for health care) - but as an essential living expense. Perhaps we should treat different kinds of people differently. I'm willing to pay more for better health care - so I get more/better. If someone else is only willing to pay less - that person should perhaps get less/not as good. Obviously - the system already works that way to some extent now. People in many private health insurance plans - or Medicaid or Medicare Advantage - don't get the kind of care I get now. Although the deal isn't explicit. Perhaps things will be more explicit in the future.
OTOH - just because I get a very high level of health care doesn't mean I will always want to get everything - even if I don't - as a Medicare patient - have to pay much for it. I'm not sure I'd ever want a heart or a lung transplant or similar. They are not exactly benign you're feeling 100% 2 weeks post-op procedures. I guess I will cross those bridges if and when I come to them.
In terms of other countries - I think you have to look at demographics and health info. There's no big economic underclass in countries like Switzerland and Sweden (even if there are many unmarried couples having kids). Moreover - come on down to where I live and you will get grossed out by the number of people who are morbidly obese. I will be quite honest with you. I was always thought to be a chubby kid and young adult. When I got married 42 years ago - I was 5'0" and weighed 124. Today - I weigh 130. But - instead of being thought chubby today - and having to shop perhaps for "plus sizes" - now I am only a "large" in regular clothing sizes. I drown in an extra large. For every woman my size - there are perhaps 2 here who weigh at least 50 pounds more than I do. And many are in the 200+ pound range. I didn't get smaller - it's just that almost everyone around me got bigger! Many of these women are young - some are children. There is a shocking incidence of Type II diabetes when it comes to young women in the south. My housekeeper - who has been with me for almost a decade now - was perhaps 175 when she first started working for me. She is easily now more than 225 - and has noticeable respiratory problems when she tries to do things in my house. I don't know what the solution to this problem is - but it clearly is a problem.
When it comes to rationing - it's easy to say - hard to do. I'll give you an example. A second cousin in Israel called me yesterday about her father. He is 99 - in generally good health with some mild dementia. The circulation in his leg has collapsed (he doesn't smoke and isn't diabetic - I just think his circulatory system wore out). The options are amputating his leg above the knee or letting him die from gangrene. The first option is more costly than the second (especially in terms of post-op care) - but the second option is kind of gruesome. I honestly don't know what the health care system in Israel pays for - but imagine this person was in the US? What should we do?
Finally - I don't think salaries in excess of $300k are too much at all for highly trained specialists (quite a few of whom don't wind up practicing in their specialties until they're in their mid-30's). Both my husband and I did a lot of legal medical malpractice work - and we and the lawyers we know/knew mostly made more than $500k/year. Why should the lawyers who sue doctors make more than the doctors? Robyn
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