Cutting the cost of healthcare: can we afford it?

[IBMer]

Healthcare profits are probably less than 5% of the systems total cost.

The reason the left uses them has a Boogeyman is because 5% of $2.5 trillion is a LOT of money. But converting every hospital and insurance company to non-profit would only cut our costs by $125 billion. An improvement, but not the solution to our problems.

Stop using profit as a measure.

When you start putting in the 6 million dollar executive bonus, the corporate jets, the lobby money and all that extra shit that doesn't belong, that's an expense and doesn't count as profit.

 

[ProfJohn]

Other nations with universal healthcare seem to be able to pay Doctors less and have no problems from it.

So let me see if I get this right...

Doctors should be willing to take huge pay cuts for the good of the country...

Does that mean that union workers should take huge pay cuts too?

 

[JohnnyGage]

This is the best paid practice I have ever heard of and the secretary the best paid in the nation. Precisely what do these specialists do and how did you acquire this information because they sure as hell didn't tell you.

Shens.

Yeah, complete shens. No one is making a million out of school unless you are Cam Newton. Let alone a GI guy. I know a bunch, how about way more than four and none of them make a mil. Even the guys I know that are partnered don't make that much. Yeah they make a boat loat. But some weeks(weekends included) they don't see the light of day. We are talking 10 to 12 hrs a day, everyday--sometimes longer. One of the nephrologists I work with is alone in his own practice and he hasn't had a day off in 6 months. He is taking Monday off for the birth of his baby then back to work on Tuesday. Yeah, these guys are money grubbing a holes....

And not addressing you, but the OP...FYI

 

[dullard]

So let me see if I get this right...

Doctors should be willing to take huge pay cuts for the good of the country...

Does that mean that union workers should take huge pay cuts too?

Yes to both accounts. Get artificial barriers out of the way (AMA for doctors, union contracts for the union workers) and let the market choose the proper salary.

 

[dullard]

But some weeks(weekends included) they don't see the light of day. We are talking 10 to 12 hrs a day, everyday--sometimes longer. One of the nephrologists I work with is alone in his own practice and he hasn't had a day off in 6 months. He is taking Monday off for the birth of his baby then back to work on Tuesday. Yeah, these guys are money grubbing a holes....

That is why we need MORE doctors. We just don't have the money to pay more doctors. Thus, we need them to work closer to 40 hours per week than 80 hours. In exchange, they'll still be quite well off financially but not quite make as much. Without all that overwork and exhaustion, they'll probably do their jobs better too.

 

[Slew Foot]

That is why we need MORE doctors. We just don't have the money to pay more doctors. Thus, we need them to work closer to 40 hours per week than 80 hours. In exchange, they'll still be quite well off financially but not quite make as much. Without all that overwork and exhaustion, they'll probably do their jobs better too.

Does it really make a difference if one guy make 600K, than if two guys make 300k?

 

[OrionAntares]

Does it really make a difference if one guy make 600K, than if two guys make 300k?

Yes.

You need to consider the human factor and fatigue. One person working 80 hours for 600k or two people working 40 hours each for 300k. The latter is preferable.

 

[dullard]

Does it really make a difference if one guy make 600K, than if two guys make 300k?

It does make a difference for availability of doctors and thus prompt and better care (no rationing of care arguments), for their own stress levels, and the level of mistakes when they are better rested. That could have minor ripple effects on savings.

The real money savings come in when you go from 100,000 each making $600k to 180,000 each making $300k. Those are just rough numbers of people, not a specific number that we have right now. Do the same with general practictioners and we'll be up to about $10 billion per year in savings on salary alone. More saving if you are more stringent on the increase in doctors.

 

[Slew Foot]

It does make a difference for availability of doctors and thus prompt and better care (no rationing of care arguments), for their own stress levels, and the level of mistakes when they are better rested. That could have minor ripple effects on savings.

The real money savings come in when you go from 100,000 each making $600k to 180,000 each making $300k. Those are just rough numbers of people, not a specific number that we have right now. Do the same with general practictioners and we'll be up to about $10 billion per year in savings on salary alone. More saving if you are more stringent on the increase in doctors.

OOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOO $10 billion in savings in a 2.4T field.

Yeah, lets let every idiot into medical school so we can save peanuts.
We can make it just like law school! Of course, then the newbies who cant find work will start making up random disease to stay in business and will end up costing more money.

 

[OrionAntares]

Of course, then the newbies who cant find work will start making up random disease to stay in business and will end up costing more money.

I'm pretty sure that already happens right now....

 

[dullard]

OOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOO $10 billion in savings in a 2.4T field.

Yeah, lets let every idiot into medical school so we can save peanuts.
We can make it just like law school! Of course, then the newbies who cant find work will start making up random disease to stay in business and will end up costing more money.

Since when did I say let everyone in? I said straight As or nearly straight As. That isn't nearly everyone. But then, what I didn't say and should have said is that medical school shouldn't have a near 100% guaranteed pass rate either. I'd want medical schools to give out plenty of Cs, Ds, and Fs and then those people can't get residencies.

I'm not going for trillions of savings in that post. But it is a step in the right direction for many reasons.

You can tweek the numbers as you see fit. There are about 700,000 doctors and specialists in the US. I used 100,000 specialists in my post. I gave a 1.8 to 1 increase, you could less of an increase. I didn't include any of the savings from fewer mistakes, quicker medical care, and the lower insurance costs associated with that. You can easilly come up with more than $10B that way.

The biggest medical savings come from being realistic. Stop sending 90 year old grandpa to get his 4th opinion about gout. Stop sending 95 year old grandma to have major surgery to put in a feeding tube when she voluntarilly stopped eating and wants to die. But that is a topic for another thread.

 

[Hayabusa Rider]

I am a PhD myself and with both my wife and myself in the medical field, we have enough money not to be envious of anyone.

This is simply about the facts: We have too few doctors and not enough money to hire more. Both are solved by a lower but still quite comfortable salary.

You clearly didn't read or at least understand my post. I'll try to retype it here so maybe I can help you understand it.
1) The cost of the education should be drastically lower.
2) The requirements are unnecessarilly high.
3) The education time is far too high.
4) The number of hours and stress they take on is far too high.
In exchange their salary is too high.

Please try to understand before flat out lying (saying I omit things, look back at my first post and it isn't omited). I said that they should drop the 4 years of undergraduate school. That will mean they lose fewer years (and save debt). I said to lower the tuition, again so they don't have debt. I said to give them the real work and experience sooner (they earn their salary sooner and have less debt).

Now that hopefully you understand me, what does your paragraph quoted above have to do with ANYTHING I said? Imagine if my suggestions came true: They'd have low costs of education, less rigorous requirements, less stress, more years of earning salary, and less debt. Now reread your paragraph quoted above.

Congrats, my wife and myself also have doctorates, so perhaps this will be a bit easier to get across. I have no problem with what doctors are being paid. I also know that the undergrad portion is important since it tends to weed out those who are unsuitable and provides an education, not a vocation.

Let me go back a couple decades when my wife was a grad student getting her doctorate in molecular genetics at Dartmouth. During this time we attended a multiple day conference on circadian rhythms, which was the subject of my wife's research. I'd gotten to be friendly with her academic adviser who was a marvelous example of a socialist Canadian. That's not said in any negative way, just to note because we had many enjoyable and spirited discussions about a great many things over some good brews. It also got me into discussions at these conferences that by right I had no business attending. Having the respect of this fellow and more than a passing familiarity and interest got me seated next to a researcher of note, Woody Hastings who you can look up.

Now being part of the "in" crowd I was able to observe and socialize as an accepted if unofficial peer. If you have attended such events you will have noticed that everyone is dressed in very casual attire. Woody was in a beat up flannel shirt which made him typical. The presenters usually dresses a bit better, but not by a lot except for a few notable exceptions.

In one case we had a researcher who worked for a large pharma corporation present. We knew he had an MD. How? His clothes must have cost more than the cars most of us drove. No matter, we weren't impressed and that's just what they do.

Unfortunately for this speaker he had misjudged the caliber of those in the audience and showed data typically reserved as a sales pitch, or that's how it came across. Obviously we weren't expected to appreciate his best efforts so he gave us second best. Bad mistake.

Once he finished it was time for questions and by the time we were finished with him he must have felt that he was back in grade school. His presentation was really that awful. He left fairly fuming and I could see him gesturing to someone with him and nodding in the direction of the fellow to my right. It was clearly a case of "who does he think he is". That person was Woody, and he obviously was informed of that because he shut up as fast as you please.

What does that have to do with physicians salaries you may well ask. Nothing directly, but when all was said and done we had a good laugh about his overdressing, his ego and his poor preparation along with questionable data. Know what never came up? How overpaid these folks were. Why? Because each of us knew that having your hands in someone else's guts is a qualitatively different thing and none of us wanted to do it or begrudged a qualified physician his compensation. That from the best there are.

Regarding increasing the supply of physicians I agree that is desirable as long as the standards are not relaxed. One does not need to be a genius to be a competent practitioner as that is one component of what is required. The emotional tenacity and ability to accept that killing someone is what you are one day going to do. You may not be at fault in any humanly accountable way but it will happen. This is not changing a tire, or flipping a burger. This is not running a corporation of mere billions. This is life and death and it takes an extraordinary person to do the job well.

What we need to do is stop running around and examine just what is required to provide the best patient/provider relationship possible. From that cost savings come, not trying to get the most people seen per unit time. We aren't cars on a lift.

Sad thing? That's so basic to the health care equation and it's completely ignored. We want someone to dictate how things will be and that is how it is. Well the people making those decisions are to borrow a word are idiots. No, that's not fair. They are making choices and influencing policies in complete but honest ignorance. Unfortunately they have one thing you and I do not and that is power and an audience willing to support them at all costs.

There are opportunities for savings, but cutting salaries isn't going to do a thing but make people who are envious of their bank accounts happy.

 

[WhipperSnapper]

How many jobs does that represent? I see it expressed repeatedly on these forums that we need to spend, spend, spend, and spend some more if we're going to get out of this economic slump. If we stop spending during a recession we'll kill the country! So why the rush to cut medical spending? Seems to me that medical spending is helping keep the US economy alive. What would millions of people currently employed in private healthcare industry do if they were suddenly out of work?

Basically, it would be similar to ending a make-work program. The money that people and our nation would save on health care could then be spent on productive activities that have real value, such as infrastructure construction or the production of other goods and services.

 

[Hayabusa Rider]

Basically, it would be similar to ending a make-work program. The money that people and our nation would save on health care could then be spent on productive activities that have real value, such as infrastructure construction or the production of other goods and services.

Well why don't we start with not providing health care to you and fill a pothole instead?

 

[dullard]

What we need to do is stop running around and examine just what is required to provide the best patient/provider relationship possible. From that cost savings come, not trying to get the most people seen per unit time. We aren't cars on a lift.
...
Sad thing? That's so basic to the health care equation and it's completely ignored...
There are opportunities for savings, but cutting salaries isn't going to do a thing but make people who are envious of their bank accounts happy.

You are correct that what is required to provide the best care is a proper patient/provider relationship. What we have now is a few minutes with a nurse and even less with a doctor. The son of my boss is a neurosurgeon resident. When he does his rounds, he has just enough time to get 2 minutes per patient per day (and he works about 120 hours per week). These are people who just had brain surgery and they get 2 minutes per day! These are patients that need more attention than most.

As it is, that is terrible care. Sure, he'll get compensated handsomely in a year or so, but he'll still be overworked and the patients will have insufficent doctor visitation time.

We simply need more doctors, more specialists, more nurse practictioners / pharmacists with more power to do minor things (address patients with the common cold for example) so doctors can focus on the more important patients. What is stopping this? Basically the AMA and indirectly the NIH (after tons of AMA lobbying to restrict residency openings). Why are they stopping it? More doctors mean more competition and lower salaries. I can't think of any other logical reason. Congress could ignore the AMA, but it doesn't show any desire to do so yet (lobbying and donations).

It all comes down to money. And in this case, I personally believe the pursuit for the most money is not in the best interest of the patient. I'll leave my argument at that.

 

[Hayabusa Rider]

You are correct that what is required to provide the best care is a proper patient/provider relationship. What we have now is a few minutes with a nurse and even less with a doctor. The son of my boss is a neurosurgeon resident. When he does his rounds, he has just enough time to get 2 minutes per patient per day (and he works about 120 hours per week). These are people who just had brain surgery and they get 2 minutes per day! These are patients that need more attention than most.

As it is, that is terrible care. Sure, he'll get compensated handsomely in a year or so, but he'll still be overworked and the patients will have insufficent doctor visitation time.

We simply need more doctors, more specialists, more nurse practictioners / pharmacists with more power to do minor things (address patients with the common cold for example) so doctors can foucus on the more important patients. What is stopping this? Basically the AMA and indirectly the NIH (after tons of AMA lobbying to restrict residency openings). Why are they stopping it? More doctors mean more competition and lower salaries. I can't think of any other logical reason. Congress could ignore the AMA, but it doesn't show any desire to do so yet (lobbying and donations).

It all comes down to money. And in this case, I personally believe the pursuit for the most money is not in the best interest of the patient. I'll leave my argument at that.

I believe I better understand your point now and while I disagree on some things we agree on more. Money is indeed key and a better allocation of appropriate resources is much needed. Higher skilled practitioners reserved for more difficult things than a basic sprain. The downside to this is that the single greatest predictor of positive patient outcomes is the initial assessment/workup/history. It's been found that if highly skilled people are used to just sit down and go over things with the patient then things unrelated to the complaint will be noticed. An obvious example would be a skin discoloration indicating cancer. More subtle conditions would be recognized. I think the cost savings because of early detection and treatment would be obvious. Does that mean an MD has to do it? I think not. PA's specially trained for this could do it. The caveat is the very very best practitioners need at least one and a quarter hours. Don't think about speeding up this process because mere mortals take longer. This completely goes against the trend which is increased "production" meaning more people in less time or speeding things up with technology. Certainly the latter is important but it does and will not replace human interaction.

Anyway some random thoughts.

 

[senseamp]

So let me see if I get this right...

Doctors should be willing to take huge pay cuts for the good of the country...

Does that mean that union workers should take huge pay cuts too?

If they are making 300+K, yes.

 

[Hayabusa Rider]

If they are making 300+K, yes.

Actually we should do that and make politicians work for free and you pay us. Now that's getting our money's worth!

 

[Naeeldar]

If they are making 300+K, yes.

The funniest part of people like senseamp is that if they actually got their way... we would all leave the US.

The absolutely jealousy from some people on this board around people who make 100k, 200k, 300k+ or more a year is absolutely sickening.

It doesn't matter what profession it is - medical, engineering, tech, business anything really. All these people can talk about how it's so wrong for these people to make that kind of money.

They seem to ignore the fact that what this nation was built upon was people being free to go out and earn a living. Instead half the liberals (I'm conservative when it comes to finances but liberal otherwise) out there seem to want to go in and take from peopel who have made something of themselves and redistribute it to others.

It's really sickening what is happening to our society.

 

[ElFenix]

And where would hundreds of thousands of paper pushers work? WalMart?

Some of you seem to be missing the point of this thread. We as a country have spent hundreds of billions of dollars on "stimulus." Why doesn't healthcare just get called stimulus also? Instead some people think of it as something to be fixed. Is it not just another make-work program for the US and our fundamentally flawed economy?

might as well just pay boys to break windows. the glaziers will be doing a hell of a business.

 

[BoberFett]

might as well just pay boys to break windows. the glaziers will be doing a hell of a business.

That seems to be our current economic mode, does it not?

 

[IndyColtsFan]

If they are making 300+K, yes.

What is it you do for a living exactly? Please tell us so we can assign an arbitrary salary cap to your profession.

Do any of you guys (well, obviously, besides Dr. Slew Foot and the other MDs here) have the slightest idea what it takes to be a doctor? Do you guys understand the debt most of these guys end up with after school and the expenses they have when they hang their shingle? This isn't a case of some dumbass going $200K into debt to get a worthless liberal arts degree. These are people making tremendous sacrifices to save lives and improve the quality of life for others.

It's really sickening what is happening to our society.

This. It really is a case of jealousy. I seriously considered becoming a doctor at one point and in college, I had the grades to do it. Two things changed my mind: 1) Seeing the incredible stress and work my cousin went through when she went through med school a few years earlier 2) My own doctor advising me that medicine was changing and it was not worth getting into because it was heading towards a socialized model in the future (the wet dream of many here). I knew I didn't have the dedication to do it and that is what impresses me about doctors more than anything -- their dedication, and I am so glad that there are individuals who have this extreme level of dedication.

 

[Hacp]

If we're spending too much money on healthcare, its easy to solve. Just stop spending the money!

 

[Hayabusa Rider]

FOAD!

That fixes everything.

 

[WhipperSnapper]

Well why don't we start with not providing health care to you and fill a pothole instead?

Did you read the thread? I didn't say stop providing health care. I said that we should remove the huge amount of waste that's in our health care system--the inefficiencies that make our system the world's most expensive and dysfunctional system, costing about 17% of GDP.

I suggested that if we could eliminate the insurance company CEOs, executives, employees, medical billing specialists, health insurance brokers, company benefits plan managers, and all other people in the health care industry who don't actually provide health care that the money could be spent on other things.