Most US doctors now support a national health plan

[ShawnD]

That right there would prevent insurance reaching several million of the of the US 46million uninsured figure that is so often quoted. A large portion of that figure are illegal aliens and hence would not be covered under Canadian rules.

Good. Illegals don't have a SS (US) or SIN (Canada), which means they don't pay taxes. If you're not paying taxes, you should not receive tax-funded benefits. It seems like a very simple concept.


Thanks for the Frontline link.

 

[drankin]

The problem in America is that insurance outside work is incredibly expensive - if small companies don't have much bargaining power, how much does an individual have. Especially since individuals with no insurance are bundled in with all the un-insurable. In Canda even without benefits you are basically just paying the extra bit of tax ( $50/month for me in BC) yourself instead of through the payroll.

It is interesting that British doctors were the main campaigners against the NHS in the 40s, then in Canda they went on strike in the 50s to prevent an NHS there - now it seems American doctors have learned from history.

What do you call expensive? I insure my whole family outside of my work offered insurance for $250/mo. It's part of the new HSA system we have in the US. The reason it is low is because my deductible is high. Since it is high I can put my pretaxed income into a HSA savings account with my bank where it can collect tax free interest. I can use that money towards any health needs when I have them, including dental and vision. If I have a medical emergency I pay the first $5000 (using my savings) my insurance pays the rest up to 1 million dollars (or maybe it's 2). I love the program because I no longer pay a high premium for insurance I never use but if I have a major emergency I'm only out a few grand that I have in my tax shelter. It's new, simple, and I have control of where I want to spend my money on medical needs. I'm not restricted by my insurance as to where I get my health care and I'm insured for the kind of care needed that can be financially devestating. I can build my savings as quickly or slowly as I want and it isn't taxable. It depends on how much of a medical needs consumer you are but if you are like most families, you don't use as much as you would typically pay in premiums.

 

[quadraphonics]

Good. Illegals don't have a SS (US) or SIN (Canada), which means they don't pay taxes.

Not true. In order to work, you have to supply a Social Security number, which is then used to withhold taxes from your paycheck. Illegal immigrants simply supply a false Social Security number, and so pay the same taxes as everyone else (actually, they tend to pay even more, as they are typically too afraid of being found out to file for refunds). Also, illegal immigrants tend to consume much less public services than citizens/legal immigrants with the same income (again, fear of being caught and deported but also because they can't ever collect Social Security). All of which adds up to them being a much lower burden on tax-funded services than comparable legal workers.

Note that I say "comparable legal workers," as it is the case that pretty much everyone in the bottom income brackets consumes more in government services than they pay in taxes. In all cases, it's people in higher tax brackets who are ultimately paying for most of the services that everyone uses, and illegal workers are actually less of a burden than legal workers with comparable incomes.

 

[edward]

What do you call expensive? I insure my whole family outside of my work offered insurance for $250/mo. It's part of the new HSA system we have in the US. The reason it is low is because my deductible is high. Since it is high I can put my pretaxed income into a HSA savings account with my bank where it can collect tax free interest. I can use that money towards any health needs when I have them, including dental and vision. If I have a medical emergency I pay the first $5000 (using my savings) my insurance pays the rest up to 1 million dollars (or maybe it's 2). I love the program because I no longer pay a high premium for insurance I never use but if I have a major emergency I'm only out a few grand that I have in my tax shelter. It's new, simple, and I have control of where I want to spend my money on medical needs. I'm not restricted by my insurance as to where I get my health care and I'm insured for the kind of care needed that can be financially devestating. I can build my savings as quickly or slowly as I want and it isn't taxable. It depends on how much of a medical needs consumer you are but if you are like most families, you don't use as much as you would typically pay in premiums.

Your plan looks good because you haven't used it yet. You don't get much medical care for $5,000 these days. The 5g's wouldn't even pay for an outpatient appendectomy. Then you would have to start worrying that another illness or injury may strike the family before the $5000 is replaced.

Testing labs and imaging centers expect the co-pays up front. All of them accept credit cards and a lot of people are having to use them.

That is exactly the point where your plan won't look so good anymore.

 

[edward]

Note that I say "comparable legal workers," as it is the case that pretty much everyone in the bottom income brackets consumes more in government services than they pay in taxes. In all cases, it's people in higher tax brackets who are ultimately paying for most of the services that everyone uses, and illegal workers are actually less of a burden than legal workers with comparable incomes.

True to some extent, but when it comes to medical care they are sucking the life out of Arizona's medical system. The money they pay into the federal government never makes it back to the individual states.

 

[drankin]

Your plan looks good because you haven't used it yet. You don't get much medical care for $5,000 these days. The 5g's wouldn't even pay for an outpatient appendectomy. Then you would have to start worrying that another illness or injury may strike the family before the $5000 is replaced.

Testing labs and imaging centers expect the co-pays up front. All of them accept credit cards and a lot of people are having to use them.

That is exactly the point where your plan won't look so good anymore.

That $5000 is good for an entire year and then they reset your deductible. I can save up as much as I want in my HSA and the beats traditional insurance. My money stays mine, not to an insurance company. If I'd had started this 20 years ago it would still be there collecting interest because I haven't had any medical emergencies for that long. To think of all that money I was throwing at insurance companies in the past.

If I had a bunch of emergencies and didn't have to pay for it because of socialized health care, then my fellow tax payers would have to pick up the tab. Someone has to pay for it, I think it's only right that I pay my way and determine where I get my medical care.

 

[devil-fire]

That $5000 is good for an entire year and then they reset your deductible. I can save up as much as I want in my HSA and the beats traditional insurance. My money stays mine, not to an insurance company. If I'd had started this 20 years ago it would still be there collecting interest because I haven't had any medical emergencies for that long. To think of all that money I was throwing at insurance companies in the past.

If I had a bunch of emergencies and didn't have to pay for it because of socialized health care, then my fellow tax payers would have to pick up the tab. Someone has to pay for it, I think it's only right that I pay my way and determine where I get my medical care.

in socialized health care systems the cost of care is always cheaper then in the USA due in part because the system isn't trying to suck a profit out of sick people and the administrative costs are much lower. the current American health care system is inefficient at providing care for the unhealthy.

a quote from the frontline report- "...but here's the thing. these capitalist countries don't trust health care entirely to the free market. they all impose limits. There are three big ones. First, insurance companies must accept everyone and can't make a profit on basic care. Second everyone is mandated to buy insurance and the government pays the premium for the poor. Third, doctors and hospitals have to accept one standard set of fixed prices. Can Americans accept ideas like that? Well the fact is that these foreign health care ideas arn't really so foreign to us. For American veterans we're just like Britain's NHS, for seniors on Medicare we're like Taiwan, for working Americans with insurance we're Germany and for the tens of millions without health insurance we're just another poor country"

 

[quadraphonics]

True to some extent, but when it comes to medical care they are sucking the life out of Arizona's medical system. The money they pay into the federal government never makes it back to the individual states.

Well, they pay state taxes as well, both in paycheck withholdings, sales taxes, property taxes and so on. But it does bear mentioning that the issue is concentrated in certain states, those on the border obviously being the most impacted. And the federal government should probably compensate border states for this in some way. My point was simply that the tax burden of wealthy Arizonans would be even *worse* if they had a similar population of legal workers. No matter which way you slice it, a bottom-heavy workforce is a drain on government benefits, which in turn have to be funded by wealthier workers. The strains are a product of the demographics of the state, not the illegal status of whatever segment of the workforce (again, that they're illegal means they're *less* of a burden than a comparable legal worker).

 

[mheslep]

Your plan looks good because you haven't used it yet. You don't get much medical care for $5,000 these days. The 5g's wouldn't even pay for an outpatient appendectomy. Then you would have to start worrying that another illness or injury may strike the family before the $5000 is replaced.

Testing labs and imaging centers expect the co-pays up front. All of them accept credit cards and a lot of people are having to use them.

That is exactly the point where your plan won't look so good anymore.

These HSA plans can be just as good or bad as you want them to be. That is, given a first class cover-everything PPO Blue Cross Blue Shield plan, one can get the exact same HSA plan from BCBS except you pay the high deductible.

And BTW, $5000 will get you a great deal of medical care if you tell the provider that you are paying out of pocket and you care what they charge you. If you just hand them an insurance card then, yes, it gets you very little and that's no surprise.

 

[mheslep]

Not true. In order to work, you have to supply a Social Security number, which is then used to withhold taxes from your paycheck. Illegal immigrants simply supply a false Social Security number,

True, for the legit jobs & employers that do withholding.

and so pay the same taxes as everyone else (actually, they tend to pay even more, as they are typically too afraid of being found out to file for refunds).

False, as a great deal of illegal alien income is off the books.

Also, illegal immigrants tend to consume much less public services than citizens/legal immigrants with the same income (again, fear of being caught and deported but also because they can't ever collect Social Security). All of which adds up to them being a much lower burden on tax-funded services than comparable legal workers.

Note that I say "comparable legal workers," as it is the case that pretty much everyone in the bottom income brackets consumes more in government services than they pay in taxes. In all cases, it's people in higher tax brackets who are ultimately paying for most of the services that everyone uses, and illegal workers are actually less of a burden than legal workers with comparable incomes.

This is highly debatable as the evidence is hard to collect. Illegals send children to public schools, use emergency rooms for medical care under the EMTALA law, criminal aliens make up a large share of the prison population, and so on.

 

[mheslep]

in socialized health care systems the cost of care is always cheaper then in the USA due in part because the system isn't trying to suck a profit out of sick people and the administrative costs are much lower.

Note that most all of the former socialist health care countries are rapidly increasing the use of private/market based medical care - Canada, France, Netherlands, etc.

the current American health care system is inefficient at providing care for the unhealthy.

Yes, exactly right. Doesn't make economic sense to use 'insurance' to cover the chronically ill, as is.

 

[edward]

And BTW, $5000 will get you a great deal of medical care if you tell the provider that you are paying out of pocket and you care what they charge you. If you just hand them an insurance card then, yes, it gets you very little and that's no surprise.

Actually the insurance companies as well as Medicare have a set amount that they will pay for any given treatment or procedure. As far as I know individuals don't have the option to bargain for a lower price at for profit medical facilities.

I had a Kidney CAT scan last week and I saw a woman with no insurance trying to bargain for a lower price. The office manager could only suggest that the woman use her credit card.

 

[quadraphonics]

True, for the legit jobs & employers that do withholding.

False, as a great deal of illegal alien income is off the books.

Only a small percentage is off the books (and mostly consists of people hiring day-labor to clean their houses or help with yardwork). Meanwhile, every restaurant, hotel and farm in the United States is withholding taxes from the paychecks of illegal aliens. And there's no way for them to avoid sales and property taxes (you know, the ones that actually pay for those schools and roads?), regardless of where their income comes from.

Illegals send children to public schools, use emergency rooms for medical care under the EMTALA law, criminal aliens make up a large share of the prison population, and so on.

All those statements are equally true of American high-school drop-outs. Like I said, "comparable American workers."

 

[drankin]

Actually the insurance companies as well as Medicare have a set amount that they will pay for any given treatment or procedure. As far as I know individuals don't have the option to bargain for a lower price at for profit medical facilities.

I had a Kidney CAT scan last week and I saw a woman with no insurance trying to bargain for a lower price. The office manager could only suggest that the woman use her credit card.

Usually there is more than one hospital to chose from. But, if you are already in one then you are pretty much stuck with that unless you want to manage a transfer to another. Not something you are in the position to do in an emergency. We definitely need some changes to where everyone can be insured, kind of like everyone needs car insurance. Someone told me Ron Paul had a well thought up plan something like this.

 

[mheslep]

Frontline just did a show on the health care systems in other countries, http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/

Don't waste your time on the folksy T.R. Reid video. Read the interviews by the experts.

http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/interviews/
A for instance, not found in the video:

Reinhardt: Well, if I were to do a balance sheet of the system, the good things are that we[the US] have an extremely well-trained labor force, particularly physicians; I don't think any nation trains doctors better. We have the latest technology, simply because we throw so much money [at it]. ... We are really technology-hungry in this country. That's a good thing.

More and more, our system treats patients like customers, which is actually a good thing; that it's very, in general, customer-friendly -- not always, particularly if you're poor, which is a different story, but that is, by and large, a good thing.
And it's very innovative, both in the products we use, in the techniques we use and the organizational structures we use. Those are all very good things, highly competitive.

Better yet see M. Tanner's
The Grass Is Not Always Greener
A Look at National Health Care Systems Around the World
http://www.cato.org/pub_display.php?pub_id=9272

I believe you'll find in general that a) if you get sick and have access the US is the best bet in the world, b)the US system is too expensive and drops many through the cracks.

Americans generally pay too much for too little of something many other countries consider to be a basic human right.

Not long ago urban governments around the world considered housing 'a right' and used rent controls to provide it creating a housing disaster. Now that's all gone.

 

[mheslep]

Only a small percentage is off the books (and mostly consists of people hiring day-labor to clean their houses or help with yardwork). Meanwhile, every restaurant, hotel and farm in the United States is withholding taxes from the paychecks of illegal aliens.

I'm skeptical of how 'small' the income tax evasion is. The statistics are hard to get, but we know at least that the IRS estimates tax evasion done by everybody in the US is 1http://www.npr.org/templates/story/story.php?storyId=15111003" of 'independent contractors' report no income. Thats a lot of guys standing on the corner working for cash.

Back to health care ...

 

[mheslep]

Actually the insurance companies as well as Medicare have a set amount that they will pay for any given treatment or procedure. As far as I know individuals don't have the option to bargain for a lower price at for profit medical facilities.

I had a Kidney CAT scan last week and I saw a woman with no insurance trying to bargain for a lower price. The office manager could only suggest that the woman use her credit card.

http://online.wsj.com/article/SB120813453964211685.html"
Dr Jonathan Kellerman, clinical professor of pediatrics and psychology at USC's Keck School of Medicine

...Several years ago, I suffered a sports injury that necessitated an MRI. The "fee" for a 20-minute procedure was over $3,000. My insurance company refused to pay, so I informed the radiologist that I'd be footing the bill myself. Immediately, the "fee" was cut by two thirds. And the doctor was tickled to get it...

Kellerman's article is the best yet that I've seen in sizing up the current economic model for US health - Tony Soprano Care:

...The health insurance model is closest to the parasitic relationship imposed by the Mafia and the like. Insurance companies provide nothing other than an ambiguous, shifty notion of "protection." But even the Mafia doesn't stick its nose into the process; once the monthly skim is set, Don Whoever stays out of the picture, but for occasional "cost of doing business" increases. When insurance companies insinuate themselves into the system, their first step is figuring out how to increase the skim by harming the people they are allegedly protecting through reduced service...

So hopefully soon the US can break free of big Tony's 'protection' racket. And BTW, this is not a reason for a federal takeover, any more than ridding the garbage business of organized crime was a reason the nationalized garbage service.

 

[adrenaline]

I've never understood why America's outstanding talents in so many other market forces is so dismally incapable of fixing our medical system as it exists now.


I believe it comes down to our expectation. For the last 30 years, health-care costs have been rising 6 percent to 8 percent a year—more than double the inflation rate in the rest of the economy—because demand keeps outstripping supply.

As people's real income rises, they expect more medical care; our society is aging, so people need more care; and with new technologies treating formerly intractable conditions, people want more care.

In practice, almost everyone, insured or not, has access to health care, especially in emergencies. (By law, an ER in the US cannot turn away a sick patient.) Insurance affects how much people actually use health services:

The access of the uninsured involves inconveniences and costs that encourage them to underconsume medical services, sometimes with grim results.

By contrast, some people with insurance often have such broad access that many overconsume those services. People are running to the doc after two days of dealing with a viral upper respiratory infection. (I see this a lot) . Or they want a 1000 dollar MRI for a sprained achilles tendon or rotator cuff. These consumption patterns drive the price increases that ultimately shrink insurance coverage.


As a society we determine how much health care we want . Unfortunately, our desires have no relation to what we would spend. This is what makes us different from socialized medicine. The current system has no balances.


Our health care insurance system is broken and other countries do get more bang for their buck when it comes to medicine . The first step is to admit our health care system is in shambles and needs fixing, but some people still have their heads stuck in the sand!


Like most of the doctors in that survey I favor a national health insurance (Heck we already have it for the elderly and the poor in the form of Medicaid and Medicare) and tort reform so physicians can go back to practicing medicine, not legal medicine (ie: overordering tests to cover your A$$) in addition, any real medicine reform ( wether it is national health insurance or otherwise) we also need to be talking about making medical education cheaper, (so doctors aren't saddled with huge debts), tort reform so doctors don't have to garner a certain wage just to pay malpractice premiums etc.

Turbo-1 hit the nail on the head. Our 4 physician practice has an army of 32 , most of whom are not medical employees, who have to deal with the morass of insurances and and their different rules,full time coders, full time medicare insurance billers, full time medicaid billers, full time collections filers, 6 check in / check out people who have to figure out if we can run their blood work in house, or send to quest labs or can we do a treadmill test in house or do we send to the hospital, can i do a skin biopsey or do i have to send to derm etc. etc. One national insurance would save me the expense of hiring so many personell who need health insurance, dental, retirement planning, workman;s comp, disability, unemployment tax etc.


Besides, there is truly no such thing as Universal Health care system that does not involve a healthy private paying sector where if you have the money , you can purchase the type of health care you want. In Britain, there is a healthy private sector that employs almost half of the health care workers.http://www.medrants.com/index.php?s=...&submit=Search under British NHS. In Canada, you just drive over to America!

 

[mheslep]

I believe there is little or no market system in play due the government's intervention in the system via the employer based health care tax exemption, and regulations that restrict nationwide portable insurance.

After reading Adrenaline's post and the physicians study I believe that what physicians really want is all of the billers, coders, filers and other expensive time wasters time to go away; its ancillary that many believe Universal Care is the way to make this happen.

adrenaline: Do you have an opinion on the proposed application of anti trust law to hospitals and doctors? By this I mean anti trust remedies to these current practices:
- Mergers among hospitals that lead to very high concentrations of market power
-The practice of doctors and hospitals colluding to boycott patients and their health plans to obtain anticompetitive concessions .
-The barrier to entry of new physicians by the Accreditation Council for Graduate Medical Education (ACGME). ACGME enjoys complete control over the number of residency programs and residents.
-The barrier to new medical schools created by the AAMC. As Adrenaline mentioned med. school costs I am particularly interested in opinions here.

 

[mgb_phys]

We are really technology-hungry in this country. That's a good thing.

I would be interested in knowing how many lives MRI has saved?
As far as I can see the possible scenarios are:
1, We thought it was a minor injury and the MRI confirmed = no save
2, We thought it was serious and we are treating it = no save
3, We thought it was minor but it's really serious AND we can treat it = save
It would seem that the last one is not a majority of cases!

Meanwhile (in the UK at least) hospital infections kill twice as many peoples as road accidents - it would seem a good idea to use all the money put into airbags, drink driving and speed cameras to persuade doctors to was their hands!

 

[mheslep]

I would be interested in knowing how many lives MRI has saved?
As far as I can see the possible scenarios are:
1, We thought it was a minor injury and the MRI confirmed = no save
2, We thought it was serious and we are treating it = no save
3, We thought it was minor but it's really serious AND we can treat it = save

I expect the wins are
4. We know it is serious from the obvious problems but it is perhaps due to one of 3-4 things, we determine which one w/ the MRI - win
5. We know it is serious and we know the type of problem (like a tumor) but we need to know where it is; the MRI tells us - win.
6. We know it is serious, we have been treating you but now we need precision feedback on the on the results of the treatment in order to more narrowly tailor future treatments - win.

 

[adrenaline]

I believe there is little or no market system in play due the government's intervention in the system via the employer based health care tax exemption, and regulations that restrict nationwide portable insurance.

Agree completely

After reading Adrenaline's post and the physicians study I believe that what physicians really want is all of the billers, coders, filers and other expensive time wasters time to go away; its ancillary that many believe Universal Care is the way to make this happen.

No. Just showing the waste of the private insurance sector that goes to paperwork and non medical related personnell. I volunteer at a free medical clinic and hospitalize and treat "gratis" very ill uninsured patients who now must face bankruptcy and future strings of failed safety nets for their health. Many doctors like myself on the front lines see the ethical travesty and the social and economic consequences of leaving a good portion of our society uninsured.

Do you have an opinion on the proposed application of anti trust law to hospitals and doctors? By this I mean anti trust remedies to these current practicees. -mergers among hospitals that lead to very high concentrations of market power.

I agree, studies show mergers do not save money. I also, along that lines propose better regional planning to reduce duplicated services such as every hospital in the area having the same expensive new scanner or open heart surgery program. This will produce separate interdependant hosptials that share the costs and burdens of the newer technologies. A monopoly system would not allow that.

-The practice of doctors and hospitals colluding to boycott patients and their health plans to obtain anticompetitive concessions .

I boycotted a private insurance that did not pay me a dime for providing 500 of their members with medical care for three years.That is not collusion. I still have to pay my nurses a salary and pay my $250,000 dollar rent etc. . My hospital stopped taking aetna after 99% of their claims remained unpaid after 9 years. By default , I had to stop accepting Aetna since I could no longer take care of my patients in the hospital or order any ancillary service testing without sending them across town. I tried in the beginning, but begging other hospitals to admit my patients for me when they became sick became a liability when many of them refused. I still take medicaid even though it is a losing profit game because these folks don't have the ability to purchase their insurance by encouraging their company to look for other insurance alternatives. ( 450 of these patients remained after they convinced their company to purchase humana instead.)

-The barrier to entry of new physicians by the Accreditation Council for Graduate Medical Education (ACGME). ACGME enjoys complete control over the number of residency programs and residents

This is mute. Due to the following...so many residency slots no longer get filled, Internal medicine residencies, general surgery and other surgical specialites are almost 50% unfilled. Only select high competative slots like dermatolgy aand radiology ( which there is no shortage of doctors for these fields ) have filled their slots.

http://www.insurancenewsnet.com/article.asp?n=1&innID=398236378

Also, almost all the residency training slots are funded by medicare, and medicare has not expanded it's budget for this . Without the funding, new residency positions cannot be created, ( unless you want private pharmaceuticals/biotech companies to sponser them which brings up some ethical dilemmas).

http://www.slate.com/id/2121755/

Because the total number of residents funded by Medicare has been fixed by the Balanced Budget Act since 1997, a particular hospital or specialty that wants more residents of a given sort must either pilfer some of the slots of another specialty—a difficult trick—or find outside funding for them

-The barrier to new medical schools created by the AAMC. As Adrenaline mentioned med. school costs I am particularly interested in opinions

Did not know there was a barrier when their official goal is to create positions by expanding existing class sizes and creating new medical schools.

https://www.amsa.org/news/release2.cfx?id=271

AMSA agrees that the proposed AAMC strategy of expanding the physician workforce through both the expansion of existing schools and the creation of new allopathic medical schoolsis the most effective way to quickly and economically address the significant shortage of physicians expected early in this century.

I come from a poor family. If had had my first choice ( georgetown university) i would have owed half a million dollars in student loans with interest over the course of the loan payback. I was lucky enough that one of the ivey leauges gave me a $ 80,000 dollar grant. I still had to borrow but it was less than it could have been ( I still lived on $7,000 a year as a student in 1990s which was just astounding ...I learned to bike 15-20 miles quickly since i did not have a car )

 

[mheslep]

Thanks for your thoughtful response

I boycotted a private insurance that did not pay me a dime for providing 500 of their members with medical care for three years.That is not collusion.

Quite right. I'm talking about agreement among competitors/peers to set prices and ... well, collude.

This is mute. Due to the following...so many residency slots no longer get filled, Internal medicine residencies, general surgery and other surgical specialites are almost 50% unfilled. Only select high competative slots like dermatolgy aand radiology ( which there is no shortage of doctors for these fields ) have filled their slots.

http://www.insurancenewsnet.com/article.asp?n=1&innID=398236378

Also, almost all the residency training slots are funded by medicare, and medicare has not expanded it's budget for this . Without the funding, new residency positions cannot be created, ( unless you want private pharmaceuticals/biotech companies to sponsor them which brings up some ethical dilemmas).

I didn't know Medicare was responsible for all US residency positions. How was that done before Medicare?
Anyway, here's the basis for my question:
Barriers to Entering Medical Specialties, Sean Nicholson, 2004

Abstract
Non-primary care physicians earn considerably more than primary care physicians in the United States. I examine a number of explanations for the persistent high rates of return to medical specialization and conclude that barriers to entry may be creating a shortage of non-primary care physicians. Entry barriers exist due to cartel behavior by residency review committees, regulation that until recently required residents in all specialties to receive the same wage, and/or scarcity of teaching material. I estimate that medical students would be willing to pay teaching hospitals to obtain residency positions in dermatology, general surgery, orthopedic surgery, and radiology rather than receiving the mean residents’ salary of $34,000. In the simulation, the quantity of residents in these four specialties would increase by an estimated six to 30 percent, rates of return would fall substantially, and teaching hospitals would save an estimated $0.6 to $1.0 billion per year in labor costs.

www.ftc.gov/be/workshops/healthcare/nicholsonpaper.pdf[/URL]

Got to go now, more later ...

 

[adrenaline]

Thanks for your thoughtful response
Quite right. I'm talking about agreement among competitors/peers to set prices and ... well, collude.

With that strict definition I agree on ethical principles that it should not be allowed. However, since this country allows the medical industry ( rightfully or wrongly) to operate under free market principles, I think this is a natural consequence of such economic freedom.

I didn't know Medicare was responsible for all US residency positions. How was that done before Medicare?

Honestly, don't know how it was done before medicare. Remember, back in the "old days" any doctor could set up shop after medical school ( without undergoing the rigors of residency) as a general practioner. And since many general practioners did the work of the many specialists, ( delivered babies, take out appendix , even administered anesthesia etc.) there may not have been a huge need for residency positions in these other sub specialties.


First of all, I agree with limiting residencies for non -primary care specialties where there is an over supply of these overpaid specialties. ( Our country has more dermatologists, ent practioners, plastic surgeons and radiologists than it needs). Non primary care specialties that have shortages are geriatricians, rheumatologists, oncologists, thoracic and general surgeons who cannnot even begin to fill their slots.
The non primary care sspecialties that are well reimbursed are much more highly paid primary care docs because the current system rewards procedures and not thinking and time. ( not because residency slots are limited.) Medicare pays me more for doing a skin biopsey or take out a hang nail over spending one and a half hours addressing complicated medical problems and diagnosing someone with gluten enteropathy and early supranuclear palsey. Medicare pays a radiologist more for reading an abdominal cat scan and pelvic cat scan than a general surgeron who spends four hours doing a difficult bowel obstruction surgery and then has to follow that person in the ICU for weeks on end. I believe this country needs to limit the residency slots for such non primary care specialties. My friend is one of 500 applying for one of two opthalmology residency slots here and the internal medicine residency program of 90 has only 100 applying. We don't need 500 opthalmolgists who get paid 5 times the salary of a internist who works more hours and puts in more time and thinking.

Thus, if you were a valedictorian of a medical school that could make $350,000 dollars doing cosmetic dermatology or radiology working five days a week vs. $120,000 dollars a year for an academic thoracic surgeron working 90-100 hours a week, which would residency position do you think most of these valedictorians go into? ( I'm sorry but the generation X values quality of life above a lot of things ( not that it is wrong). I'm damn glad we only have 5 dermatology positions here. Who needs that many dermatologists?

 

[mheslep]

They don't support this national health plan. AMA opposes.

Doctors’ Group Opposes Public Insurance Plan

http://www.nytimes.com/2009/06/11/us/politics/11health.html

WASHINGTON — As the health care debate heats up, the American Medical Association is letting Congress know that it will oppose creation of a government-sponsored insurance plan
...
While committed to the goal of affordable health insurance for all, the association had said in a general statement of principles that health services should be “provided through private markets, as they are currently.” It is now reacting, for the first time, to specific legislative proposals being drafted by Congress.
...
But in comments submitted to the Senate Finance Committee, the American Medical Association said: “The A.M.A. does not believe that creating a public health insurance option for non-disabled individuals under age 65 is the best way to expand health insurance coverage and lower costs. The introduction of a new public plan threatens to restrict patient choice by driving out private insurers, which currently provide coverage for nearly 70 percent of Americans.”
...
If private insurers are pushed out of the market, the group said, “the corresponding surge in public plan participation would likely lead to an explosion of costs that would need to be absorbed by taxpayers.”
...
The medical association said it “cannot support any plan design that mandates physician participation.” For one thing, it said, “many physicians and providers may not have the capability to accept the influx of new patients that could result from such a mandate.”

“In addition,” the A.M.A. said, “federal programs traditionally have never required physician or other provider participation, but rather such participation has been on a voluntary basis.”

That last bit - mandating physician participation - seems especially politically inept. What did the public plan people expect the doctors to say in response to that?

 

[Moonbear]

I don't particularly object to them mandating physician participation, but to me, it's more that there is an imbalance of which physicians are being given the mandate. Basically, those already taking in medicare patients will be given the extra burden of also taking in patients on this plan, regardless of whether they can handle the extra patient load. It seems more likely to harm than help if the only way physicians have out is to drop their medicare patients.

If, on the other hand, they mandated ALL licensed physicians have to take in some small number of patients on this plan before they can take in any other new patients (i.e., if you have a full patient load now, okay, but as soon as you can take in a new patient, you have to take in three people on this plan before you can take in another with private insurance), it would distribute the burden and be more equitable.

The biggest problem, though, is that a lot of the people without insurance also live in areas where there are physician shortages. I've been learning more about the rural communities in WV, and there really is minimal access to physicians. One of the rural clinics I visited, which charges fees based on what people can afford, with the minimum for an office visit being $5 (I don't think people there would accept anything free), their patients can drive as much as 40 min to get there. And that clinic doesn't even have an x-ray machine! If a patient needs x-rays, or more emergent care, it's another hour by ambulance to the nearest fully-equipped hospital. Providing health insurance to the uninsured living out there isn't going to do them a spot of good, because they still don't have a doctor nearby to see. Someone first needs to do something to encourage physicians to move out there...and there's not a lot of incentive to do that unless someone grew up in those areas and wants to move back where family is. We can get med students out there, mainly because we REQUIRE they do a rural rotation, but that's no substitute for a fully licensed, experienced physician. We try to admit some "high risk" med students if they come from these areas, just because we know that's the best chance the state has to get physicians into those places, but it's a gamble and those students often can't make it through med school.

So, yes, lack of insurance is an obstacle to health care, but it's the second obstacle, not the first. The first is simply having a health care provider nearby. That problem needs to be addressed before offering insurance is going to help.

 

[mheslep]

...

So, yes, lack of insurance is an obstacle to health care, but it's the second obstacle, not the first. The first is simply having a health care provider nearby. That problem needs to be addressed before offering insurance is going to help.

My first suggestion for the rural physician shortage is to break the lock the medical associations and industry have on medical schools and residencies. The cost of medical training is so high that I imagine new physicians can't help but pursue higher wages in metropolitan areas to cover the debts.
E.g.:

Abstract
Non-primary care physicians earn considerably more than primary care physicians in the United States. I examine a number of explanations for the persistent high rates of return to medical specialization and conclude that barriers to entry may be creating a shortage of non-primary care physicians. Entry barriers exist due to cartel behavior by residency review committees, regulation that until recently required residents in all specialties to receive the same wage, and/or scarcity of teaching material. I estimate that medical students would be willing to pay teaching hospitals to obtain residency positions in dermatology, general surgery, orthopedic surgery, and radiology rather than receiving the mean residents’ salary of $34,000. In the simulation, the quantity of residents in these four specialties would increase by an estimated six to 30 percent, rates of return would fall substantially, and teaching hospitals would save an estimated $0.6 to $1.0 billion per year in labor costs.

http://www.ftc.gov/be/workshops/heal...olsonpaper.pdf

 

[gravenewworld]

Hope you don't get cancer (1/3 women and 1/2 men will) 'cause insurance isn't going to pay up...http://health.usnews.com/articles/h...e-coverage-caps-hit-cancer-patients-hard.html
God I love health care in this country. It is top notch...as long as you don't become catastrophically ill.

What's worse—being diagnosed with cancer or discovering that your health insurance won't go the distance in covering your treatment? These days, with earlier detection and better therapies, cancer isn't the death sentence it once often was. But treating it is expensive, and employers and health plans are increasingly placing caps on the maximum benefits they will pay, as well as other restrictions on coverage that hit cancer patients particularly hard. If the tumor doesn't kill you, it seems, the medical bills just might.

The policy limits on coverage typically apply to all illnesses, not just cancer. But experts say that cancer patients are particularly likely to bump into annual caps on doctor visits or drugs, say, because the disease often requires intensive treatments—including surgery, chemotherapy, and radiation—in the months after diagnosis. Even if patients avoid the initial pitfall, they may eventually run afoul of lifetime benefit caps.

When will people learn that having insurance does NOT equate to having health care? Insurance companies like to take your money, but then are stingy when it comes time to pay up. Why are insurance companies dictating which procedure/medicines/doctors people can and can not have?

 

[gravenewworld]

Another interesting article I found during my hours of insomnia

http://www.latimes.com/business/la-fi-rescind17-2009jun17,0,5870586.story

An investigation by the House Subcommittee on Oversight and Investigations showed that health insurers WellPoint Inc., UnitedHealth Group and Assurant Inc. canceled the coverage of more than 20,000 people, allowing the companies to avoid paying more than $300 million in medical claims over a five-year period.

It also found that policyholders with breast cancer, lymphoma and more than 1,000 other conditions were targeted for rescission and that employees were praised in performance reviews for terminating the policies of customers with expensive illnesses

 

[bleedblue1234]

I really, really like this Ron Paul video and I think it sums it up nicely:

(he is also a well known doctor himself)

https://www.youtube.com/watch?v=<object width="560" height="340"><param name="movie" value="http://www.youtube.com/v/foXQbmZxWYY&hl=en&fs=1&"></param><param name="allowFullScreen" value="true"></param><param name="allowscriptaccess" value="always"></param><embed src="http://www.youtube.com/v/foXQbmZxWYY&hl=en&fs=1&" type="application/x-shockwave-flash" allowscriptaccess="always" allowfullscreen="true" width="560" height="340"></embed></object>

 

[mheslep]

I agree w/ 95% of what Rep. and Dr. Paul has to say there. Couple items unrelated to the healthcare problem that I could have done without
- mention of the "money supply", a reference to his back to gold rants.
- licensing for doctors? Yes antitrust action should be taken but I don't understand the libertarian take on licensing.

On the rest he's profoundly right, my opinion.
-MSA/HSAs
-Costs drop w/ 'managed care' out of the way
-Socialized medicine doesn't work well elsewhere.
-There has been less and less competition.
-Get the attorney's out of the game through arbitration.
-Freedom works, socialized medicine doesn't.
-When "third parties pay the bill, doctors labs ... charge the most, not the least"

 

[a4mula]

I do not personally agree with this concept. I feel as though our healthcare system is in the shape it is today directly because of the Medicaid act of '65. The federal government has shown an undeniable skill at corrupting and bloating everything they touch. To have faith that they can properly manage the single largest expenditure of this nation is expecting alot. As it stands the government drops over 17pct of our gdp on healthcare. That still represents less than 20pct of the total cost. For all the complaints we have about defense spending, the government spends 4 times as much on medicaid and medicare.

We already have socialized healthcare, it's a failure and a huge one at that. Are we really prepared to hand over the single largest economic issue to the same government that has failed on every level of economic management?

This isn't a left/right issue regardless of how much some want it to be. This is an issue that affects every single person in this country, and generations of people that won't have the ability to have their voices heard for years.

Public Education is a disgrace. Social Security is a complete failure. Welfare, Freddie Mac, Fannie Mae... the list just goes on and on of epic failures one after another.

I wish I would have had stronger advocates in the '60s. My voice couldn't be heard then. We went from a strong industrial nation that was coming off of WWII to the "Great Society". Those that could didn't speak up for me then. They didn't fight and oppose giving our country away. Now we face the single greatest economic challenge that we've ever seen. The adoption of government aid has lead directly to the inflation that we witness across the board. The next twenty years are either going to revive this country, or finish it off. This single conversation is the cornerstone of that balance.

To often we hear politicians abusing the rhetoric of children and our future. This isn't one of those instances. Much as the decisions of the '60s have directly influenced our society today, our choices today are going to dictate tommorow's future. We cannot continue to give away our freedom for promised security, especially when those promises have been and always will be empty.

 

[jal]

HEALTH CARE IS TOO EXPENSIVE
So what do you do?

Option #1
You save money

As an individual, you place some of your extra income into savings for that eventual day.
If your savings are not sufficient, then the banks will lend you money to pay for it.

If you cannot save and you cannot get a loan then you do without the medical service.

Option #2
You pay for an insurance.

It’s a pooling of surplus income/money from a large number of people who are putting their money in a “trust” for the day when they will need to cover medical expenses. If the individual has not put in enough money to cover his medical expense then the shortfall will come from the other contributors. Everyone will eventually get sick. Therefore, when you need medical help you will get financial help to pay for it.

If you cannot pay for an insurance and you cannot get a loan then you do without the medical service.

Option #3

You pay the government, (a tax), to administer the pool of money.

The government will pay for the specified medical expenses for everyone and collect money from those who are above a determined minimum level of income.
If you wish to take out more “coverage” then you save/pay a private insurer to administer that pool of money and to payout when you get sick for the specific medical treatment that you are paying for.

If it is too expensive for the individual then it will be too expensive for the government.

If you cannot pay for medical treatment then you do without.
---------
Can the cost of medical treatment be lowered?
NO! Not without a bloody battle with losers from the medical, (and legal), establishment.

The present systems have too many interlocking monopolies.
The systems need to remove intermediaries and break the monopolies that have set up “fee schedules”.
Since there are a growing number of people who must do without medical services because of the cost, those medical service providers have concluded that they must get the government to collect money for them so that they can continue operating without loosing any advantages.

Jal

 

[drankin]

HEALTH CARE IS TOO EXPENSIVE
So what do you do?

Option #1
You save money

As an individual, you place some of your extra income into savings for that eventual day.
If your savings are not sufficient, then the banks will lend you money to pay for it.

If you cannot save and you cannot get a loan then you do without the medical service.

Option #2
You pay for an insurance.

It’s a pooling of surplus income/money from a large number of people who are putting their money in a “trust” for the day when they will need to cover medical expenses. If the individual has not put in enough money to cover his medical expense then the shortfall will come from the other contributors. Everyone will eventually get sick. Therefore, when you need medical help you will get financial help to pay for it.

If you cannot pay for an insurance and you cannot get a loan then you do without the medical service.

Option #3

You pay the government, (a tax), to administer the pool of money.

The government will pay for the specified medical expenses for everyone and collect money from those who are above a determined minimum level of income.
If you wish to take out more “coverage” then you save/pay a private insurer to administer that pool of money and to payout when you get sick for the specific medical treatment that you are paying for.

If it is too expensive for the individual then it will be too expensive for the government.

If you cannot pay for medical treatment then you do without.
---------
Can the cost of medical treatment be lowered?
NO! Not without a bloody battle with losers from the medical, (and legal), establishment.

The present systems have too many interlocking monopolies.
The systems need to remove intermediaries and break the monopolies that have set up “fee schedules”.
Since there are a growing number of people who must do without medical services because of the cost, those medical service providers have concluded that they must get the government to collect money for them so that they can continue operating without loosing any advantages.

Jal

But, you have to convince those who think they have a freakin Constitutional right to have a doctor treat them at government determined rates.

If I can't afford a doctors services then I don't get a doctors services. If joe blow can't pay me for my technical services, then joe blow does not get my technical services. If people were more concerned about there own health, they would take better care of themselves. But not only do they not take care of themselves, they expect the rest of the world to support them in their self destructive lifestyles. If you make it easy for someone to not work, not take care of themselves and their families, then they have no incentive to survive on their own.

Blah freakin blah. Those who actually work will end up support those who... don't feel like it.

 

[mheslep]

...As it stands the government drops over 17pct of our gdp on healthcare. That still represents less than 20pct of the total cost. For all the complaints we have about defense spending, the government spends 4 times as much on medicaid and medicare. ...

Those figures are way off a4mula and easy to look up: US defense spending is ~$516B/yr (2009), Medicaid+Medicare ~ $630B/ yr (2009), though health spending is increasing at a much faster rate than defense. There are other government health programs like Veterans care, but they are minuscule in comparison. Thus govt health spending is roughly 5% of US GDP ($14 trillion). The total of _all_ health care related spending in the US economy, both private and public, is about 17% of GDP (1/6th).