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You know damn well Obama choose his lifestyle. In fact he made it well known he decided to take a path of semi poverty to become a community organizer. You think a doctor pays their loans off in 6 months? Seriously? Quit playing games...
Well, maybe 6 months is an exaggeration but if their loans are on average $157K, that's not so bad. They can pay it back quickly -- did you see the link to physicians' average salaries posted on the earlier page?
Obama...? Obama was a community organizer during the time in his career when a medical student would be a resident. Obama wasnt and isnt in it for the money. Ive been to doctors who obviously are only in it for that reason and it shows a mile away, from their crammed scheduling and dependence on insurance (and I suppose, reluctance to take Medicaid) to the care they give their patients.
You seem to think a doctor is well off because he's good at his job. That's a dangerous assumption.
Well, maybe 6 months is an exaggeration but if their loans are on average $157K, that's not so bad. They can pay it back quickly -- did you see the link to physicians' average salaries posted on the earlier page?
Obama...? Obama was a community organizer during the time in his career when a medical student would be a resident. Obama wasnt and isnt in it for the money. Ive been to doctors who obviously are only in it for that reason and it shows a mile away, from their crammed scheduling and dependence on insurance (and I suppose, reluctance to take Medicaid) to the care they give their patients.
You seem to think a doctor is well off because he's good at his job. That's a dangerous assumption.
You don't have to be good at your job to be well off as a doctor. It certainly helps.
I hope you excised all of that sarcasm, wouldnt want any to remain. (Zero Mostel voice) Feeling better...?
You're presuming prices will stay where they are now, that hospitals and the med. equipment industry and the health insurance industry (and so on, and so on) wont adjust to a level that's new but still comfortable for themselves. They're not going out of business.
What do you think of the Medicare Payment Improvement Act?
I am not so sure. I think that there is "fat" in the med equipment industry and pharmaceutical industry. However, many hospitals are literally going budget to budget every year. If the profits for the hospital fall to where they are losing money every year, of course they will close. Many hospitals will be able to remain open, however, they will remain open by cutting costs- i.e. current level of care. I know that currently, even at our two "rich" local hospitals, they have cut nursing staff to the point that families are compelled to stay in thier relatives room to help out with the nursing care. What is next?
With medicare reimbursement, we lose money on every medicare patient. Ironically, our state is one of the top five in the US for quality of care and cost with medicare. Quality high-complications low- they pay us less. We are the lowest reimbursed state in the US for medicare. They are now changing reimbursement to "reward" those states with higher quality of care. But again, the increase will still make treating medicare patients a loss for practices. An increase is better than a sharp stick.
Part of my "sarcasm" was actually more tounge in cheek humor, such that I really think all those things will happen over time. Really. The "national" system that is being proposed will go bust fairly rapidly, as taxing a few of the rich will not be able to sustain it. Cost will fall due to cuts in available drugs, procedures, surgery, and provider reimbursement. The result- lower quality of care. You really can't have it both ways. We really got a good laugh when the politicians said they were going to cut costs with technology- electronic medical records (EMR). We have used EMR for three years- it is junk. It makes your notes unreadable and increases paper consumption as everything needs to be printed off. It slows us down and makes us less efficient with less time devoted to the patient. It increases costs by making practices less efficient. The only good thing- it improves provider reimbursement. I guess the feds would have known that if they tried it out first.
The contention that people do not come to the US for healthcare is very inaccurate. Even in our state, which is a distance from the border, we have many Canadians traveling to the US principally for orthopedics and oncology. Why? Short waits and good quality. Mayo Clinic has built themselves on foreign patients. At our university hosptial, we had people traveling from all around the world for specialized care.
Some of these national healthcare countries are not what they are cracked up to be. I loved Michael Moore's "Sicko", which made it look like Cuba is a medical nervanna. In reality, Cuban healthcare is very poor. I have been there. The hospitals we visited (and these were apparently the best) were dirty and poorly staffed. Patients had to bring in thier own bed linens. In some instances, patients literally had to buy thier own surgical instruments to have surgery performed. I don't think I would want that care, even if it was free.
I would recommend Canada. A friend on vacation had to have to prescriptions wriotte3n and he was charge $200.00 with no exam for the prescriptions being writen from his refill bottles.Then the cost of teh medicine.this was because he was delayed gwetting back to Houston because of a hurricane.
That sounds like a good idea. No physical exam and no patient interview, yet a medicine was prescribed. That is what we call "malpractice" in the US. Why not just prescribe yourself?
I have zero problems with anyone's salary if the marketplace demands it. The only beef I have is their guild that restricts the amount of new doctors admitted to universities, keeping salaries artificially higher and distorts the marketplace. A capitalist system with much more lax admission standards or not requiring accreditation would greatly reduce salaries. In a true marketplace environment, a doctor would make half of their distorted salary. As a member of the Ph.D. "club" do not retain the benefit of a guild to restrict new membership.
Again, on my earlier post, I actually pointed that out. Let high school grads with two years of training be docs. That would be great.
Did you ever wonder why there are high academic admission standards? Well, I guess it was to keep the quality high and keep idiots from becoming docs. Would you rather have an undergraduate with a 2.0 GPA or a 4.0 GPA admitted to med school? How about MCAT scores? Which guy would you want treating you? Medicine is a little more tricky than you guys are making it out to be. There is 13 years of education after high school and current residency grads come out with an average debt of $250,000. Work for 13 years for little or nothing with that debt? Today you would have to be a little crazy with declining reimbursement around the corner. Us older guys will be fine, but the new grads will have alot of trouble.
Many Doctors in America are now soiling their underpants because they are afraid that if a Govt. health plan is brought in they might have to become just rich and not filthy rich. No wonder they are saying how awful a uhc in America would be. Awful for them!
Frankly, most of us do not care, as it is out of our control. Everyone realizes that we will paid less. For those of us who have paid off thier loans, it is not that big of an issue. Here are the problems-
1. New grads with $250,000 of education debt will not be able to pay off thier loans. How many people do you suppose will go into medicine with that debt with low pay and very long hours? Good luck there. Smart people who have a keen interest in medicine will find something else to do out of financial necessity.
2. Office practices run 40-50% overhead. Cut reimbursement 50% and your profits are zero. I can quit practice now, if I choose, but continue to work. However, I will quit if I have to work for nothing. I do not know of anyone who would practice for nothing, besides periodic charity work. Would you?
3. Medical education is LONG. 4 years undergrad, 4 years med school, 4-7 years residency, with 1-2 year fellowships on top of that. You get paid nothing in med school (you pay ALOT) and very little in residency. Who is going to go 13-14 years with alot of debt, very little pay, only to be greeted with a job with low pay and long hours? No one.
4. I wish they would post medical salaries in dollars per hour. How many of you work 70+ hour weeks? How many of you are on call every day? How many of you drag your butt out of bed at 3 a.m. to go in and treat a drunk who has injured themselves? It is a dirty, hard job which most people cannot do.
I really don't care one way or another whether national healthcare comes through or not. I just don't want to be held personally responsible by patients for the cuts and waits that will result. I currently work part of the time in a national health care system- the VA. The waits are very long and the patients are angry at us for the restricted pharmacy. I don't people realize what they are getting, but they will- soon. Don't hold me responsible for what you "want", as it will be hard to change back.
Again, on my earlier post, I actually pointed that out. Let high school grads with two years of training be docs. That would be great.
Did you ever wonder why there are high academic admission standards? Well, I guess it was to keep the quality high and keep idiots from becoming docs. Would you rather have an undergraduate with a 2.0 GPA or a 4.0 GPA admitted to med school? How about MCAT scores? Which guy would you want treating you? Medicine is a little more tricky than you guys are making it out to be. There is 13 years of education after high school and current residency grads come out with an average debt of $250,000. Work for 13 years for little or nothing with that debt? Today you would have to be a little crazy with declining reimbursement around the corner. Us older guys will be fine, but the new grads will have alot of trouble.
The poor and middle class can "take their chances" with a lesser qualified graduate (and the difference won't be a HS grad with 2 years of education as you are simply pointing out a strawman). Did you ever notice the long queues for dental work being done by university students under the direction of licensed dentists? Before I got my work done overseas, I investigated this "substandard quality" procedure and I'd be waiting for many months before I got care. So, I got my SUPERIOR care overseas in less time, with less money. Since you work in the industry, I don't fault you for trying to bash overseas visits as well as trying to block more people entering the industry.
I've worked for 13 years with nothing but debt and don't make anywhere near as much as doctors. I've only become richer than most of them because I'm a much more successful investor. The amount of time it takes to get your education is immaterial. What about the classical studies Ph. D. graduate who gets paid 40-50K as a professor or working at a museum? Don't they deserve a raise to be on par with medical graduates? The market rate for doctors is half the current rate, or certainly no more than 60-70%. Cut their salaries, and medical school costs will be cut as well as universities will seek to cut their bloated bureaucracies. It is the same as any other market.
Folks, do not believe this person with regards to quality of overseas care. If you don't go to Mexico or some other dirtbag country, you'll actually get BETTER care than in the States for much less $$$. Just do your homework and you'll be golden, and whatever you do, don't tell your doctor in the US about it.
Hospitals make money off of each procedure that they perform. Despite the fact that they blame doing the procedures on defensive medicine they do it because they make money off of each test.
Having an X ray of your chest, which takes 5 minutes at the cost of $900. I agree that it is expensive, but why. You give no explanation as to why all of the procedures are expensive.
57,000 for knee replacement surgery. How do you explain that. It is performed in several hours. Why does it cost $57,000
The fact is that the cost of doctors is the smallest chunk of the cost, but it is certainly a factor.
1. Residency space is "restricted" for a few reasons. They must have adeqaute staff and facilities to be able to train residents well and become a recognized training facility, such that you can sit for your boards. Many hosptials "apply" for new residency programs, but do not meet quality criteria.
2. Limiting foreign grads to some residency. I hate to say it, but the only counrties that have the level of quality in medical training seen in the US is the UK and Canada. The other foriegn countries do not cut it. That is why John Vangilder prevented anyone who did not do a US medical school and US residency from practicing neurosurgery in the US. The result- very high quality of care in that speciality.
3. Hospitals lose money on every medicare surgical patients. The reason an x-ray, which should be cheap, is to balance the cost for losses in treating the un-insured, medicare, and medicaid patients. We are ALREADY paying for those who cannot pay.
4. Docs salaraies make up 3% of health care costs. Our salaries will be cut, but it will do nothing. However, these decisions will be made by politicians and is out of our control.
Some of these national healthcare countries are not what they are cracked up to be. I loved Michael Moore's "Sicko", which made it look like Cuba is a medical nervanna. In reality, Cuban healthcare is very poor. I have been there. The hospitals we visited (and these were apparently the best) were dirty and poorly staffed. Patients had to bring in thier own bed linens. In some instances, patients literally had to buy thier own surgical instruments to have surgery performed. I don't think I would want that care, even if it was free.[/quote]
If EMR does not work, why have you used it for 3 years. I would think if something does not work you stop using it.
In case you missed the topic of this thread it was about going overseas because it cost less. So far you have been trying to poke holes in the arguments; however, you have not told us how to reduce the cost of medical care. Don't say tort reform. I have already addressed in detail in other threads.
A lot of hospitals do close. A lot of businesses close. The number 1 reason...poor management. It also may be that there are too many hospitals in that area. I know the one in area is having problems because of very poor management. In the hospital industry...and it is an industry, there is a huge amount administrative costs associated with working with the insurance companies.
You threaten poor quality if Obama's plan goes into place. Ask most people on the board how much time they actually spend with a doctor when they actually go to see him right now. Lets talk about costs. Please explain why each procedure cost so much money. Please explain why the cost of the procedures have gone up exponentially in comparison to the growth rate. Please explain to us how the AMA has lobbied and manipulated congress to reduce the number of residency spaces available so that the amount of doctors is scarce, thereby driving up costs.
Please explain or justify how a specialist can make 800K a year and a general practictioner only makes 250K a year thereby reducing the amount general practictioners and creating scarcity for the doctors that we need the most.
It is not just about Doctors. I will admit that doctors are only a small part of the problem. Hospitals and insurance companies are a much larger part. But please explain why India can do a procedure at 20% of the cost when they are using american trained doctors. Please explain if our system is so much better why don't other countries change to our system.
Just admit that this is a money thing for you. We can accept that. At least you would be honest about it. This condescending attitude is a little annoying.
1. Residency space is "restricted" for a few reasons. They must have adeqaute staff and facilities to be able to train residents well and become a recognized training facility, such that you can sit for your boards. Many hosptials "apply" for new residency programs, but do not meet quality criteria.
You are stating the obvious. Yes but why do you not adequate staff and facilities to be able train residents. You know the reason but you just won't say it. Congress controls the supply of physicians by how much federal funding it provides for medical residencies. In 1997, to save money and prevent a doctor overflow, Congress capped the number of residents that Medicare will pay for at about 80,000 a year. Veterans Administration and Medicaid finance another 20,000 residents. Teaching hospitals pay for a small number of residents without government assistance. The AMA lobbied Congress and convinced congress that there was going to be an overflow of doctors and that this was somehow a bad thing. The AMA is either grossly stupid to think that the demand for doctors would go down because baby boomers are getting older or they were manipulating the system to drive up the cost of providers. I think we can rule out the former. If a school receives the money from the fed they will create more space. They are in it for the money.
2. Limiting foreign grads to some residency. I hate to say it, but the only counrties that have the level of quality in medical training seen in the US is the UK and Canada. The other foriegn countries do not cut it. That is why John Vangilder prevented anyone who did not do a US medical school and US residency from practicing neurosurgery in the US. The result- very high quality of care in that speciality.
The problem is that foreign students may not be able to come and train in U.S. facilities because of the reason stated above.
3. Hospitals lose money on every medicare surgical patients. The reason an x-ray, which should be cheap, is to balance the cost for losses in treating the un-insured, medicare, and medicaid patients. We are ALREADY paying for those who cannot pay.
If a hospital loses money off of medicare patients. Then why do private hospitals take them? Private hospitals have a choice of who they can take and they have substantially fewer non pays so why is the cost of an X-ray the same price at both a public and private hospital? I spoke to private hospital administrator who was just wanted any patients. His hospital is having problems with getting enough patients and it is a private hospital. In business if you are only going to get so much for a product you have to adjust your costs. HOw many pay cuts have you taken? Do you know any doctors who have been laid off for lack of work.
4. Docs salaraies make up 3% of health care costs. Our salaries will be cut, but it will do nothing. However, these decisions will be made by politicians and is out of our control.
This is true. Finally. The larger costs are made up of hospital costs and insurance profits. Having said that it is disingenious of the AMA and doctors to blame Torts and malpractice insurance which only make up 1.5% of health care costs.
You never really answered the question. HOw do you drive down health care costs.
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