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I'm for it if we can start regulating prices. A non-profit approach instead of for profit care. Pharma and healthcare related companies price gouge the U.S. It's time to put an end to that crap.
Most US hospitals are not for profit.
This does not preclude them from profiting. Some report $ hundreds of millions in profit each year. Just means they cannot use those profits to declare a dividend to shareholders.
Doc should be paid whatever the free market will pay them.
But we should focus on training more docs as there aren't enough of them. That's why their salaries are so high.
More docs does not necessarily mean lower salaries. The main reason is that much is always left undone in medicine, and docs if not making their salary goals have many options in their field to expand their practice and income. Mostly legitimate, some not so.
Docs can be more mobile and go where there are more demands for their services. More docs means more areas get covered, means more gets done for more patients, and overall HC costs go up. The little bit that competition might lower doc salaries is way far counteracted by the increased HC spending. Because most docs control much more of HC spending than the value of their salary.
More docs does not necessarily mean lower salaries. The main reason is that much is always left undone in medicine, and docs if not making their salary goals have many options in their field to expand their practice and income. Mostly legitimate, some not so.
Docs can be more mobile and go where there are more demands for their services. More docs means more areas get covered, means more gets done for more patients, and overall HC costs go up. The little bit that competition might lower doc salaries is way far counteracted by the increased HC spending. Because most docs control much more of HC spending than the value of their salary.
If you train more docs, the salary will go down because that's how the free market works. So unless I'm missing something, if we flood the market with 2x the doctors, I'm guaranteeing their salaries will go down, probably not by 50% since there's a higher demand but it will go down. So if your argument is the above, let the free market pay them whatever. But raise income taxes on the higher earners to a much higher percentage say 45%-55%.
Because that won't be fair to the doctors to control their salary based on some arbitrary number and neither is it for anyone else. But your argument can be also applied to anyone also at the highest incomes. Whether they're worth the salary or not. I'd argue most of the large corporations pay their executives excessively and aren't worth it. So to get rid of the middle ground: tax everyone the same. With these new tax dollars, we can fund the national health insurance program.
Interestingly Obamacare was basically a half assed attempt at the Swiss model.
Not really.
The Swiss have no public option. Everyone is mandated to buy private insurance in Switerland and being a risk adverse culture the do. All Swiss insurance is guaranteed issue. no one can be denied insurance by age or condition. All pay the same premium.
Many also maintain supplimental insurance to help pay for what the basic plan will not.
Unlike the US, the Swiss do not allow private insurers to profit off the sale of basic plans.
Unlike the US, the Swiss Government owns/ operates most hospitals.
Unlike the US, the Swiss negotiate/ regulate the price of prescription meds.
Unlike the US, the Swiss have Compariative- Effectiveness panels to determine common courses of treatment.
The Swiss have a healthier population and are nowhere near as violent as the US population.
What works reasonably well in a country of 8 million in a country with 16,000 square miles would not work as well in a country of 360 million in a country with 3.8 million square miles.
More docs does not necessarily mean lower salaries. The main reason is that much is always left undone in medicine, and docs if not making their salary goals have many options in their field to expand their practice and income. Mostly legitimate, some not so.
Docs can be more mobile and go where there are more demands for their services. More docs means more areas get covered, means more gets done for more patients, and overall HC costs go up. The little bit that competition might lower doc salaries is way far counteracted by the increased HC spending. Because most docs control much more of HC spending than the value of their salary.
You have other weird factors as well. Interesting story out of Silicon valley last week. They have the highest healthcare costs in the country. A local business group fed up with premium increases started looking at it. They noticed more and more Docs were dropping private practice and joining one or two large provider groups. They interviewed the docs and found the insurance companies were reimbursing members of the large providers almost double private docs. Because the large providers had so much market share they negotiated better payments for themselves when the little 2 DR practice went in to negotiate they said no way. So the docs sold out to get the higher pay. Which meant the insurance companies were raising their own costs be refusing to negotiate.
The example they gave was 2k for a birth with a independent DR vs a provider getting 4k. The independent wanted to get closer but not the same as the provider say 3k. Insurance says no way so she sells out and now gets higher reimbursement driving up cost.
The Swiss have no public option. Everyone is mandated to buy private insurance in Switerland and being a risk adverse culture the do. All Swiss insurance is guaranteed issue. no one can be denied insurance by age or condition. All pay the same premium.
Many also maintain supplimental insurance to help pay for what the basic plan will not.
Unlike the US, the Swiss do not allow private insurers to profit off the sale of basic plans.
Unlike the US, the Swiss Government owns/ operates most hospitals.
Unlike the US, the Swiss negotiate/ regulate the price of prescription meds.
Unlike the US, the Swiss have Compariative- Effectiveness panels to determine common courses of treatment.
The Swiss have a healthier population and are nowhere near as violent as the US population.
What works reasonably well in a country of 8 million in a country with 16,000 square miles would not work as well in a country of 360 million in a country with 3.8 million square miles.
Right that's why I said half assed. Swiss was one of the inspirations.
Every one required to have insurance check
No pre existing conditions denial check
Government supplements to low income people check
The issue was they have none of the cost constraint controls the Swiss have.
I agree I also don't think the model would work here but it would have been better if they made a more whole hearted attempt.
Medicare is Gov't administered and paid, but delivered in the private sector. As a doc involved with Medicare for over 40 years, I don't consult with Gov't in treating my patients.
But, but, but....
Death panels and all that.
Thank you once again for injecting facts into the discussion.
If you train more docs, the salary will go down because that's how the free market works. So unless I'm missing something, if we flood the market with 2x the doctors, I'm guaranteeing their salaries will go down, probably not by 50% since there's a higher demand but it will go down. So if your argument is the above, let the free market pay them whatever. But raise income taxes on the higher earners to a much higher percentage say 45%-55%.
I haven't seen it happen in 36 years, and we have many more docs here than when I came. More docs than population growth.
It is not reasonable to assume that one day, 100% more docs suddenly come here. It is not reasonable from a med school output standpoint, and it not reasonable from a local medical business standpoint.
All those new docs will go here, there and elsewhere for a whole host of reasons. But by and large they will go to where there are demands. New docs are very flexible on where they can and do go. Much more freely than most occupations. My daughter just decided to practice here instead of where she is in Portland. Easy peasy!
Free markets have very little to do with docs salaries, because by and large third parties set the reimbursements, and docs are very liberal and creative in their practices. There is always a whole lot more that can be done medically. There is much more potential upside leeway with docs take home pay than with most occupations.
Of course no one is talking about how to pay for it. We'd have to raise taxes. A lot. It's probably worth it, but a whole lot of people won't like that.
We should address all of the inefficiencies and robber-barons in the medical industry first before we agree to give them more money.
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