Please register to participate in our discussions with 2 million other members - it's free and quick! Some forums can only be seen by registered members. After you create your account, you'll be able to customize options and access all our 15,000 new posts/day with fewer ads.
For some reason, the quote feature seems to be broken on my computer and I'm reduced to making my quotes look like yours above. I hope it will be fixed soon.
Looks like it's fixed.
Quote:
Be that as it may, I think you present a real problem. Compensation for any line of employment is determined by market forces in America. The problem is what happens when the market is completely broken. I'm not going to bore everyone by rehashing all the reasons I've given why market forces do a poor job of containing prices when it comes to health care. I think I have made it clear that it functions poorly and except for die-hard free market conservatives who can't accept there could ever be a situation where the market doesn't work satisfactorily, most people here at least get what I'm talking about.
I think things are slowly changing in that area. For a few reasons. Consumers - who never had a reason to "comparison shop" in the past - are seeing their OOP costs - deductibles and co-pays - going up. Insurers and insurance plans are starting to push things like "reference pricing":
These are baby steps to be sure. But they're steps in the right direction IMO.
Of course - these changes will have consequences. For example - providers that charge normal patients high "retail" prices to subsidize other people/things (the uninsured/underinsured - teaching programs - whatever) will be at a competitive disadvantage vis-a-vis providers that don't do a lot of cost-shifting. But such is life.
Quote:
My objection to the high salaries we see in health care is along these lines:
1. Because the market doesn't function well the salaries are higher in health care than virtually any other field. Its the rare lawyer where I live that earns an income of $300 K or $400K. Ninety-eight percent of us earn less than that and I read that the state average for attorneys is about $100 K.
I think the simple answer to that is that provider incomes will vary on the basis of geographical income variations. And also the cost of living in the area you're talking about. I have a cousin who practices medicine in Wisconsin and earns X. He could earn double in New York - but his cost of living would triple. So he stays in Wisconsin.
They will also vary in accordance with the laws of supply and demand. I don't know about Utah - but there are way way too many lawyers in Florida (there were 15k in the state when I started practice in 1973 - now there are 96k - the population here has increased - but not that much). So lawyers - especially newer lawyers - are making less (although the better/best lawyers are still doing fine). If we have too many doctors in a particular area competing for the same business - their prices will tend to come down too - especially as patients are forced to become more intelligent consumers. There will be the kind of price competition we currently see in medical areas where people are paying for services themselves (everything from lasik surgery to botox injections).
Quote:
2. Doctors have no more education than many people like scientists, researchers, and college professors, but generally earn multiples of these salaries.
Many scientists - researchers and college professors are very well paid. Especially the scientists and researchers who go to work for high-tech companies and receive a big chunk of compensation in the form of stock options. Also - professors are free to add to their (often) generous salaries by doing outside work.
What doctors earn in private practice varies considerably depending on their specialties (a lot of those variations are the result of reimbursement rates). When it comes to the lower paid specialties - doctors are increasingly moving to places like the Mayo Clinic - where they can earn as much or more than they could in private practice - without all the headaches of running a small business. In the last couple of years - my PCP closed up shop and went to work for a big rehab hospital company. My brother left the private practice of medicine and went to work for a Fortune 500 company. Large health care organizations are buying up physician practices all over the country. IOW - the medical landscape is shifting under our feet.
Quote:
3. The high salaries do not necessarily draw the people we want into health care. I'd be more interested in someone who genuinely liked and empathized with people than someone who was simply trying to land a 400K a year salary and who understood nothing but math and chemistry.
I don't want a doctor who has good "people skills". I want an internist with good diagnostic skills - a surgeon with "good hands" - a dentist with good "spatial sense" - etc. I'm not looking for a "friend" - I'm looking for good health care. I have twin nieces. The one with good "people skills" went into public relations - the one with an aptitude for things like organic chemistry went into medicine. Good career choices IMO.
Quote:
4. When you say an excellent doctor should receive $1,000 an hour its really quite arbitrary. Why not a $10,000 a hour? After all, what they do is "life saving". If that were the criteria than why are paramedics and police officers generally underpaid?
5. If we compare these salaries to what doctors and medical professionals earn in virtually any other country in the world, America tops the list. In fact, we have more specialist physicians than just about any country does per capita as well. The fact that we are at the top is one of the things that tells me these salaries are out whack.
6. Your fees for the other occupations you cite are high as well. I would suspect they are "top end" for big cities in this country. Its hardly typical of what goes on in America's heartland.
That is why routine surgical procedures cost 3 X more in this country than they do in other nations.
All this is not "doctor bashing" or jealousy. What it is an honest attempt to say that if we are going to get a handle on health care costs than we have to take a look at what components jack up medical costs. The truth, although some really don't want to face it, is that these high salaries are the major reason. Although, we have to also add in the salaries of hospital administrators and insurance company executives.
Not welfare recipients, but people who earn $15 an hour or less (and there are plenty of them) are simply being pushed aside and priced out of the market. We have a system that seems hellbent on providing ever more care to a smaller segment of the population at higher prices.
You're right that someone earning $15/hour can't afford the same type of medical care that I and many other people can afford (and other things we can afford too). Which gets us to the road we're on today - a road to basically a 2 or 3 tier medical system. I will see my internist PCP who will get me to a specialist ASAP without jumping through a lot of hoops. The $15/hour person may wind up with a PCP nurse practitioner who has to jump through a lot of hoops to set up a physician consult of any type. The $15/hour person may wait longer to get certain services than I do (and that happens in many other countries too - like Israel). When they do see doctors and/go to hospitals - they may wind up with ones I and others wouldn't choose for ourselves.
As for physician pay/working conditions - doctors - like many people - have some freedom to move to other countries. Those who aren't happy with their home countries sometimes decide to leave. I am seeing an increasing number of doctors from Canada at Mayo (they came from Canada to Mayo Rochester and wound up in JAX). Africa has seen a large migration of health care professionals from Africa - mostly to Europe (especially the UK). When our US residency match program can't find enough US doctors to fill a particular specialty - it will fill that specialty with doctors trained outside the US.
I could go on - but my overarching POV today is these situations aren't static. And they're probably changing more rapidly now than they've been changing at any other point in my lifetime. So - instead of looking in the rear-view mirror - I'm trying to get a sense of how this will all shake out in the future. Robyn
Being non-profit is a joke!
To become non-profit you pay your administrators a obscene amount of money plus bonus, you purchase other hospitals and/or do building expansions to sop up that extra cash. Folks that don't have insurance you charge them the Charge Master price, then either write that inflated amount off or sell the account for pennies to a collection agency them write off the difference. All charity work is done at Charge Master prices then buy big ads telling who generous they are, all tax deductable of course!
I'm sure there are additional methods to make the profit go away but these are ones that come to mind.
It's interesting to note that one of the reasons "non-profits" will charge tremendously more for procedures on an uninsured person, is if that person cannot pay fully, the "non-profit" can write the difference off as a tax deduction while possibly not "losing" any money on the procedure itself.
Non-profit hospitals in recent years have been increasing CEO pay at a higher percentage than for-profits--although for-profits are already through the roof. For further information about how non-profits are one and the same as for-profit hospitals read the entire article linked below. This REALLY is only a short excerpt:
Quote:
One of the arguments often cited by proponents of turning all health care institutions into nonprofit entities is that they provide more charity care. According to data from the American Hospital Association, there is little difference in the amount of uncompensated care provided between the two different hospitals. This suggests that nonprofits are not providing as much care as they should given their tax exemptions.
While non-profits are viewed as more honorable organizations, this perception is not based on actual data. A study from 10 years ago argues that somewhere between 20% to 80% of all non-for-profit hospitals fail to make societal contributions equal to the amount of taxes they are exempted from. This view has alarmed many communities and officials who are now investigating whether non-for-profit hospitals should qualify for tax-exemptions.
Legal action has been taken in some cases. Texas has passed a law that requires nonprofits to offer charity care that equals in value their tax exemptions.The Utah Supreme Court has interpreted the state’s constitution as having a similar mandate. Policy makers and health-care advocates have also expressed concern over the tax exempt status of non-profits. For example, the US House Ways and Means Committee made an investigation into the matter in 2004 and concluded that a revocation of the tax exemption would lead to substantial revenue for the federal government that would be more beneficial than their charitable care. Consumer groups have launched suits arguing that not only do certain non-profits not offer enough charitable care, they also engage in aggressive collection methods and charge uninsured patients inflated prices.
There has been a misconception in the public’s perception of the two types of hospitals that is based on factless arguments. Non-profits are viewed as charitable organizations with community centered missions while for-profits are viewed as compassionless and opportunistic. This perception fails to take in consideration the growing number of convergence between the two types of ownership. Many studies focus on the behavior of for-profits and nonprofits by making the assumption that they have different objectives. This is often not true, as more nonprofits are behaving more business oriented
Just watched a news report where they were interviewing a woman who was "losing" her $50/month health plan....um, no, what she had was a plan that reimbursed her $50 if she went to the doctor. That is NOT an insurance plan, nor is it a health plan....this is the kind of CRAP the media NEEDS to clarify...
Just watched a news report where they were interviewing a woman who was "losing" her $50/month health plan....um, no, what she had was a plan that reimbursed her $50 if she went to the doctor. That is NOT an insurance plan, nor is it a health plan....this is the kind of CRAP the media NEEDS to clarify...
Indeed. So much baloney all over the airwaves. The devil is in the details and the media loves sound bytes. Very lazy reporting. Sadly, a lot of these reporters don't know any better and/or don't care.
I think you should watch CNBC. The people they're interviewing seem pretty knowledgeable and articulate to me - and none was paying $50/month for health insurance before. Robyn
I think you should watch CNBC. The people they're interviewing seem pretty knowledgeable and articulate to me - and none was paying $50/month for health insurance before. Robyn
I think you should watch CNBC. The people they're interviewing seem pretty knowledgeable and articulate to me - and none was paying $50/month for health insurance before. Robyn
Oh, I did see a young girl w/Sue Herrera, today. She maybe spends $650/yr visiting her neighborhood clinic. Policy under the ACA will cost her $2,100/yr, plus she'll still be stuck with payment for her sick visits - unless Dr. can code these on something under preventive - because her deductible is $2k or something like that. I sympathize with her. I never had any money as a single person. Remember those days very well. At her age, $250/mo. for health care is a budget-buster, probably putting her in the negative. Guessing, she's not earning all that much maybe $60k, if she's lucky - and does live in NY with all the attendant expenses and taxes. Glad I'm not that age and single, anymore. It's not easy. Only time I had any financial cushion was after I married. I do feel for the young people.
Oh, I did see a young girl w/Sue Herrera, today. She maybe spends $650/yr visiting her neighborhood clinic. Policy under the ACA will cost her $2,100/yr, plus she'll still be stuck with payment for her sick visits - unless Dr. can code these on something under preventive - because her deductible is $2k or something like that. I sympathize with her. I never had any money as a single person. Remember those days very well. At her age, $250/mo. for health care is a budget buster, probably putting her in the negative. Guessing, she's not earning all that much maybe $60k, if she's lucky - and does live in NY with all the attendant expenses and taxes. Glad I'm not that age and single, anymore. It's not easy. Only time I had any financial cushion was after I married. I do feel for the young people.
When we were young and single we lived in affordable housing with roommates so we could afford things like medical insurance, etc. Also, if she works at a job making 60K/year, she probably has access to an employer plan for less then $250/month...
When we were young and single we lived in affordable housing with roommates so we could afford things like medical insurance, etc. Also, if she works at a job making 60K/year, she probably has access to an employer plan for less then $250/month...
C'mon, gg. NY is NOT MN or WI. She has roommates, I'm willing to bet. As far as employer insurance, she says not, or she'd be on it.
C'mon, gg. NY is NOT MN or WI. She has roommates, I'm willing to bet. As far as employer insurance, she says not, or she'd be on it.
With roommates and affordable housing a salary of 60K should not be a budget buster with a $250/month insurance premium...
Please register to post and access all features of our very popular forum. It is free and quick. Over $68,000 in prizes has already been given out to active posters on our forum. Additional giveaways are planned.
Detailed information about all U.S. cities, counties, and zip codes on our site: City-data.com.
Please register to participate in our discussions with 2 million other members - it's free and quick! Some forums can only be seen by registered members. After you create your account, you'll be able to customize options and access all our 15,000 new posts/day with fewer ads.
You are correct!
