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You're putting the blame on the public for trying to see a doctor again reasonable price? Do doctors not understand that if they charge too much, there won't be any patients? Yes, I know that if they don't get paid reasonably, there won't be doctors either. There is a middle ground somewhere.
Who decides what is "reasonable?" It should be decided by the market. The doctors have no say because the insurance companies have removed any market forces or reasons to be competitive. They have to accept what the insurance companies think they can get away with. Now that I am free from insurance, I have to actually compete with other docs. And I can be much more competitive because my costs are so much lower without dealing with insurance. My patients are always surprised at how low my fees are. Informal polling of my patients shows they expected fees to be anywhere from 3 to 20x what my fee turns out to be.
I wonder why there is glut of Ph.D.s "willing" to work for janitorial salaries and shortage of M.D.s willing to work many fewer hours for $100k +/- all at the same time? Powers that be made a decision to glut R&D field and split it in the two tier feudal fiefdom where lesser peons are just thrown out after short term low wage use. At the same time some invisible saints protect medical field from the above scenario. More than that American doctors etc. are traditionally well paid and it eats them alive seeing their former income peers in management and finances making a real killing, naturally grudges set in and docs try to squeeze blood form their impoverished customer base while invisible protective force helps them to screw us more and give less service, not speaking of quality service.
I'm not sure how PhDs have anything to do with this and why the comparison. If PhDs had to take on a quarter million dollars in educational loans plus another half a million to buy a practice, and be forbidden to ever make a mistake, then this would be a valid comparison.
I'm not sure how PhDs have anything to do with this and why the comparison. If PhDs had to take on a quarter million dollars in educational loans plus another half a million to buy a practice, and be forbidden to ever make a mistake, then this would be a valid comparison.
That's not even a chicken and an egg question
250k loans are necessary because all kinds of folks want to get their share of the anticipated doctor's income. Many Ph.D. students pay no tuition and receive small salary allowance precisely because the averaged anticipations of their income don't excite lending and educational institutions no matter what bls says. I bet public universities have more than enough of the trained professional to make to Medical Schools what they've done to the Graduate Schools and generic R&D career path. What's lacking is the will.
I wonder why there is glut of Ph.D.s "willing" to work for janitorial salaries and shortage of M.D.s willing to work many fewer hours for $100k +/- all at the same time? Powers that be made a decision to glut R&D field and split it in the two tier feudal fiefdom where lesser peons are just thrown out after short term low wage use. At the same time some invisible saints protect medical field from the above scenario. More than that American doctors etc. are traditionally well paid and it eats them alive seeing their former income peers in management and finances making a real killing, naturally grudges set in and docs try to squeeze blood form their impoverished customer base while invisible protective force helps them to screw us more and give less service, not speaking of quality service.
Interestingly, my child hood pediatrician/ his wife, and my parents started careers at the same time, residing in the same area. The pediatrician and nurse wife are still working. My parents have been retired for years and now traveling the world.
Who decides what is "reasonable?" It should be decided by the market. The doctors have no say because the insurance companies have removed any market forces or reasons to be competitive. They have to accept what the insurance companies think they can get away with. Now that I am free from insurance, I have to actually compete with other docs. And I can be much more competitive because my costs are so much lower without dealing with insurance. My patients are always surprised at how low my fees are. Informal polling of my patients shows they expected fees to be anywhere from 3 to 20x what my fee turns out to be.
The problem here is that a "market" doesn't really exist when it comes to health care. Too many factors keep it from functioning in any normal fashion. First, there are the high licensing standards necessary to become a physician or oral surgeon. Second, there is the fact that most medical care is provided on a basis involving some sort of exigency. To use one example, people in a car accident may literally come to a hospital unconscious. This prohibits any sort of arms length negotiation or bargaining from occurring over the cost of the care. Third, we have the presence of third party payers, insurance companies, that make some consumers totally immune to the high costs that are actually billed for the treatment that they receive.Fourth, we have a complicated service that few people really understand. Bed rest, exercise, and physical therapy may be better than expensive surgery for a patient with a herniated lumbar disc. However, expecting the patient to know or understand that is often unreasonable. The patient is at the mercy of his physician who may be highly ethical or may not be. Economists refer to this issue as the lack of information about a product or service.
What I have just done is set forth series of reasons why competition and the market have failed to give Americans affordable medical care.
I have said before and will repeat, I think its time to look at another model other than competition and free markets to provide Americans with affordable health care. The model that seems most logical to me is the one we already use with public utilities. Simply impose price regulation on fees and charges and give the utility the opportunity to demonstrate why it needs a rate increase. We are obligated to give anyone a reasonable rate of return on their capital and investment. What I don't see us obligated to do is allow health care providers and pharmaceutical companies an outrageous rate of return. That is happening all too often.
we don't have "free markets" or anything even faintly resembling market competition in our health care "market". To have that you need price transparency just as a start.
What we do have is a massive market failure, where the big players jockey for a bigger piece of the pie (looking at you, drug companies...) and everyone is spending someone else's money.
The problem here is that a "market" doesn't really exist when it comes to health care. Too many factors keep it from functioning in any normal fashion. First, there are the high licensing standards necessary to become a physician or oral surgeon. Second, there is the fact that most medical care is provided on a basis involving some sort of exigency. To use one example, people in a car accident may literally come to a hospital unconscious. This prohibits any sort of arms length negotiation or bargaining from occurring over the cost of the care. Third, we have the presence of third party payers, insurance companies, that make some consumers totally immune to the high costs that are actually billed for the treatment that they receive.Fourth, we have a complicated service that few people really understand. Bed rest, exercise, and physical therapy may be better than expensive surgery for a patient with a herniated lumbar disc. However, expecting the patient to know or understand that is often unreasonable. The patient is at the mercy of his physician who may be highly ethical or may not be. Economists refer to this issue as the lack of information about a product or service.
What I have just done is set forth series of reasons why competition and the market have failed to give Americans affordable medical care.
I have said before and will repeat, I think its time to look at another model other than competition and free markets to provide Americans with affordable health care. The model that seems most logical to me is the one we already use with public utilities. Simply impose price regulation on fees and charges and give the utility the opportunity to demonstrate why it needs a rate increase. We are obligated to give anyone a reasonable rate of return on their capital and investment. What I don't see us obligated to do is allow health care providers and pharmaceutical companies an outrageous rate of return. That is happening all too often.
I think we are saying the same thing. A market for healthcare services does not exist because insurance dictates what every provider and hospital is worth. There is no negotiation which is how insurance companies get away with lowering their reimbursement every year. Therefore there is no reason for providers to compete because the insurance pays the same regardless. Market forces have been removed by insurance companies. In the old days before insurance dominated, prices were lower and competition fueled the market.
we don't have "free markets" or anything even faintly resembling market competition in our health care "market". To have that you need price transparency just as a start.
What we do have is a massive market failure, where the big players jockey for a bigger piece of the pie (looking at you, drug companies...) and everyone is spending someone else's money.
This is not market failure. This is market absence. There is no market here because the consumers (patients) are not involved with pricing and have no skin in the game. A small number of executives in a back room are making the decisions. You are correct that insurance companies will not reveal their pricing which prevents a market from forming. This is by design from the insurance companies.
^ "no market" is the same as "market failure". It is not just insurance executives that set prices. Employers and now the Feds play a big role. After all, the Feds approved the narrow plans now offered through ACA just to use one example.
If you really think prices are set by " small number of executives in a back room " then I fear you have a bit to learn about health care economics. I'll give you the benefit of doubt, though, and take it as hyperbole.
One thing I do know to be true, however, is that the amount beneficiaries pay into Medicare via payroll deductions over their working life is far less than the actual cost of care. I remember coming across the actual statistic in an article or report just a few months ago, but can't remember the details.
Depends on earnings and whether married or single. Good analysis and charts at the bottom of the page, here:
So, in that sense, an argument can definitely be made that it is a taxpayer subsidized program, though, like others here, I don't like to use the word "welfare".
Varies by income level:
Quote:
Depending on their level of income, beneficiaries subject to the income-related monthly adjustment pay a total monthly premium of 35%, 50%, 65%, or 80% of expected per capita Part B costs for the aged. See “Income-Related Premium.”
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