Doctors: Obamacare Is A Disaster For America

[TheVrolok]

If you run your own practice, what is your position on what is needed to get healthcare costs of expensive proceedures/tests down?

Honestly, the biggest problem with outrageous healthcare costs in the US .. is the US people. We have a culture that is lazy, feels entitled, and wants to enjoys its freedoms. Combine those qualities with years of prosperity, and an increasingly sessile lifestyle and you've got a pretty unhealthy population. How do you fix it? No clue.

.. snip ..

What the fuck are you talking about? You're making a pretty large amount of (incorrect) assumptions.

First, I'm not a psychiatrist. have never pretended to be.
Second, of course I understand how medications affect and can help treat psychiatric conditions that are pathological.
Third, of course I don't believe in any sort of magic crystals or snake oil.
Fourth, you've been suggesting that anything other than medications is simply a waste of time - this is blatantly false as CBT (cognitive behavioral therapy) is hugely successful for many psychiatric disorders.
Fifth, a doctor who is treating you for a psychiatric illness that does not ask you how you are feeling during a visit is practicing bad medicine - period.
Sixth, conditions do change, especially after years. For some stable conditions a yearly visit might be enough, I'd feel a bit better with 6 month visits for things like major depressive disorder (recurrent) since you've been talking about psychiatric disorders, or for some stable patients with multiple medical concerns (high blood pressure with diabetes, etc.).

However, I checked on the cost of medical school, and your $250,000 was off. According to this article, the average indebtedness of medical-school graduates if $160,000.

Those numbers are heavily skewed by the number of students who are legacy medical students getting their education paid for by Dr. Dad and/or Dr. Mom (quite a few), and those with scholarships reducing tuition. I can tell you that the amount of loans taken by many of my friends is far closer (and in many cases over) to 300k than 160k.

I didn't respond to your "responsibility" argument. How can you even begin to put a dollar figure on "responsibility?" All physicians are covered by malpractice insurance, so any financial risk incurred by this extra "responsibility" is already covered. So what you you left with, a psychological feeling? Is that what your argument is? Frankly, I don't think you want to go there. If you're like a typical conservative - who argues that "pain and suffering" should NOT be included in jury awards for malpractice - then arguing that "responsibility" is worth millions of dollars of extra salary is a rather inconsistent position to assume.

I'm actually a liberal, not that it really applies here. I think it's amsuing that you simply shrug off financial responsibility by "meh, you've got malpractice." You clearly have no idea how it actually works if you do fuck up - that said, if you've guilty of actual gross negligence, you deserve to have your livlihood taken away. There are far greater consequences than "meh, malpractice will cover it" to getting sued which can, and does, happen when the physician is at absolutely no fault.

And the vast majority of physicians very rarely make life and death decisions. I cited that typical salary of general practitioners, who do almost nothing in the way of "life and death." Specialists in high-risk areas are paid a lot more.

You're showing your ignorance again here, even general practitions handle "life and death" or at least "serious harm" far more frequently than you realize. Daily? Of course not. Weekly? Perhaps not, but likely. Depending on the patient population a good GP will make life saving decisions frequently.

As to those late-night phone calls, for physicians working for hospitals, the hours are quite regular. For physicians working in group practice, usually one physician is "on call."

This is all completely anecdotal from what you've "heard." Varies greatly based on speciality, location, population, etc. Even hospitalists with their quite regular hours get paged at all hours of the day/night to answer questions of varying degree. Now take it to GPs, a good GP is essentially at work 24/7 365. I know a good number of GPs who have left family gatherings at holidays, gotten out of bed at 0315, etc. because a patient called. Is my anecdotal evidence less valid than yours?

Almost none of the physicians I know - and I know many - would characterized their work as "high pressure." Almost none of them would say they feel a heavy burden of responsibility.

More completely anecdotal statements. Of course there are physicians out there who don't work too hard, who don't feel burdened. There are quite a few that do, though, also. Oh, and I'll bet I know more.

Yet the average salaries of U.S. physicians are at least double those of physicians in other first-world countries. How do you justify that vast disparity?

The problem is that else is not equal. You can't simply compare salaries in systems that are vastly different. Hell, just tuition is drastically different. Take England for example, medical school debt (tuition) upon completion is estimated around 65,000 vs the say 140,000 in the US - using the numbers in your link. I would gladly see physician salaries reduced (or perhaps equalized in so far as reducing specialist income and shifting it toward GPs) if we could get some good tort reform and other system/institutional changes.

 

[Chainspell]

want to cover more people/everyone?

well quality has to decline. can't have both. (best care and cheap/free)

What the fuck???

Cost is relative. The price for health care is so high is because of government intervention and government trying to do too much thinking it can do good.

You provide a way for all the people to come up with 50,000 dollars to buy medicine, and what you know... All the medicine suddenly costs 50,000 dollars! Go figure...

Hospitals and medical companies are businesses. when they don't have customers who can afford what they're charging... Guess what ? COSTS WILL GO DOWN... because they're businesses they need to operate and make a profit. oh what if the medicine that they use to treat patients are too expensive for them to charge less? guess what? THEYLL BUY SOMEWHERE ELSE or find a way to make it work... then because none of the hospitals are buying that EXPENSIVE MEDICINE.. So what happens? The people selling the medicine have to LOWER THE COST OF MAKING MEDICINE.

and it goes down the line until you reach an equatable cost based on actual ECONOMIC FORCES not because government is pumping money into it!!

we are seeing this everywhere...
Education
Health care
Fema
Mortgage
Banking

Oh exciting times!!!

-Sent from my phone.

 

[shira]

The problem is that else is not equal. You can't simply compare salaries in systems that are vastly different. Hell, just tuition is drastically different. Take England for example, medical school debt (tuition) upon completion is estimated around 65,000 vs the say 140,000 in the US - using the numbers in your link. I would gladly see physician salaries reduced (or perhaps equalized in so far as reducing specialist income and shifting it toward GPs) if we could get some good tort reform and other system/institutional changes.

The bolded statement is a pretty outrageous example of circular reasoning. I ask you to justify the vast difference between the salaries of American physicians and those of other first-world countries. And you tell me they can't be compared because the systems are so different! But that's exactly what I'm asking you the justify: WHY is a particular aspect of the American healthcare system so different? The ONLY relevant difference you can come up with is that there's a larger indebtedness incurred by American physicians. But do you seriously claim that even $100,000 of increased indebtedness can justify a LIFETIME doubling of American physician salaries? Ridiculous!

As to your point about torts reform: The Congressional Budget Office performed a study (you can find at least two ATPN threads with the link) estimating the contribution of medical malpractice lawsuits and defensive medicine to the total cost of American healthcare. The CBO's conclusion: less than 1/2 of 1%. In other words, "medical malpractice tort reform" is a giant red herring. It's the right-wing healthcare analog to "corporate jets" when Obama talks about reforming the tax code.

 

[Chainspell]

What the fuck???

Cost is relative. The price for health care is so high is because of government intervention and government trying to do too much thinking it can do good.

You provide a way for all the people to come up with 50,000 dollars to buy medicine, and what you know... All the medicine suddenly costs 50,000 dollars! Go figure...

Hospitals and medical companies are businesses. when they don't have customers who can afford what they're charging... Guess what ? COSTS WILL GO DOWN... because they're businesses they need to operate and make a profit. oh what if the medicine that they use to treat patients are too expensive for them to charge less? guess what? THEYLL BUY SOMEWHERE ELSE or find a way to make it work... then because none of the hospitals are buying that EXPENSIVE MEDICINE.. So what happens? The people selling the medicine have to LOWER THE COST OF MAKING MEDICINE.

and it goes down the line until you reach an equatable cost based on actual ECONOMIC FORCES not because government is pumping money into it!!

we are seeing this everywhere...
Education
Health care
Fema
Mortgage
Banking

Oh exciting times!!!

-Sent from my phone.

added:

then because none of the hospitals are buying that EXPENSIVE MEDICINE.. So what happens? The people selling the medicine have to LOWER THE COST OF MAKING MEDICINE.

and it goes down the line until you reach an equatable cost based on actual ECONOMIC FORCES not because government is pumping money into it!!

come on america WAKE UP WAKE UP!

This is what Ron Paul did to me. He opened my eyes and made me want to research these things for myself and KNOW the details.

 

[TheVrolok]

The bolded statement is a pretty outrageous example of circular reasoning. I ask you to justify the vast difference between the salaries of American physicians and those of other first-world countries. And you tell me they can't be compared because the systems are so different! But that's exactly what I'm asking you the justify: WHY is a particular aspect of the American healthcare system so different? The ONLY relevant difference you can come up with is that there's a larger indebtedness incurred by American physicians. But do you seriously claim that even $100,000 of increased indebtedness can justify a LIFETIME doubling of American physician salaries? Ridiculous!

Why are the systems so different? Look at the ideologies of the peoples of each nation, or the histories of those nations, and make your own decisions. Should they be? That is a better question. No, they really shouldn't - but that change is far more difficult to make. It's far more complex than you're willing to admit.

It's very easy to say $100,000 increased indebtedness flat. But do you have any idea what the interest rate differences are between US and European grads, or repayment options, deferment options, residency lengths, residency salaries, etc. etc. etc. That $100,000 number changes very rapidly depending on the context in which it is repaid. Hell, it may be harder for Europeans to pay back their loans (though I doubt it), again, just providing you with some complexities you clearly haven't considered.

Now, take some other data into account. The US has less physicians per capita than many of the European nations to which you're comparing salaries. The US also has less physician growth and graduates per capita. So there's a bit of a supply issue there. How about that self employed GPs in the UK actually make more (ratio to per capita GDP) than self-employed GPs in the US and the growth of remuneration in the UK is much higher than other first-world countries. However, the actual purchasing power of the UK GPs is about even to the US GPs, to be fair.

Also take into account that physicians in the US have a far greater ability for free enterprise (due to lack of a NHS keeping costs, prices, etc. down) and you have many hybrid "businessmen-physicians" making absurd amounts of money skewing data.

A rhetorical point, the US has the most advanced medicine on the planet, and it is far more accessible at a whim for all intents and purposes relative to more tightly controlled systems like those in Canada and the US. Should physicians not be paid a premium for providing a more premium service?

How about this - Electrical Engineers in the US average 99,000 per year, compared to 76k in Japan, and 72k in Europe. Should US EEs be paid about 37% more than European EEs? Why? I imagine that if you looked, you could find more income inequalities among a variety of professions. I'm not arguing whether this is good, bad, or otherwise, simply saying that you can't simply rant about physician salary comparisons without taking far, far more into account than the simple dollar amounts.

As to your point about torts reform: The Congressional Budget Office performed a study (you can find at least two ATPN threads with the link) estimating the contribution of medical malpractice lawsuits and defensive medicine to the total cost of American healthcare. The CBO's conclusion: less than 1/2 of 1%. In other words, "medical malpractice tort reform" is a giant red herring. It's the right-wing healthcare analog to "corporate jets" when Obama talks about reforming the tax code.

I was simply providing tort reform as a quick example of something that would begin to reduce healthcare costs, by no means stating it was the be all or end all.

 

[JockoJohnson]

Uhh... yeah they are. Doctors are the only people who can write prescriptions. If I need my medication refilled, I see a doctor.

The worst are the doctors who ask a bunch of stupid questions and waste my time. I've been taking this medication for 5 years and you expect it to suddenly stop working? Just give me the damn pills so I can leave.
My gf got fucked around for an hour because of a horrible shitty doctor. She booked an appointment with a doctor who listed his interest as "psychiatric disorders" (depression, ADHD, etc) and he did fuck all. He just wanted to talk. The only reason she didn't punch him in the balls (like she should have) is because she's still young.

When I turn 60 and some douchebag doctor wants to talk about my cancer instead of fixing it, I'm going to stab that fucker in the throat.

So, if your car has an oil leak, do you change the entire engine or try and get to the source of the leak?

(Edit: Pills don't fix everything. Other solutions to people's ailments could be lifestyle changes such as exercise and diet.)

 

[soulcougher73]

No way! The people who stand to possible lose money have a problem with it. Say it aint so.

 

[theeedude]

How about this - Electrical Engineers in the US average 99,000 per year, compared to 76k in Japan, and 72k in Europe. Should US EEs be paid about 37% more than European EEs? Why?

American engineers created Silicon Valley and companies like Apple, Intel, IBM, etc, which are undisputed leaders in technology. They aren't selling products that cost twice as much and deliver mediocre performance compared to their foreign competitors, which is what the US medical system is doing.

 

[fskimospy]

Shocker! Opinion piece from a member of a right wing think tank who is writing a book against the ACA...is against the ACA!

 

[fskimospy]

What's also really bizarre is that the esteemed op-ed author thinks that doctors should know the most about how to craft nationwide health care policy. I can't imagine for the life of me why that would be the case.

 

[TheVrolok]

American engineers created Silicon Valley and companies like Apple, Intel, IBM, etc, which are undisputed leaders in technology. They aren't selling products that cost twice as much and deliver mediocre performance compared to their foreign competitors, which is what the US medical system is doing.

Japanese tech is easily as competitive and more competitive in various areas. Mediocre performance of healthcare is also a complex issue, the US may provide a lower average healthcare in some regards, but it absolutely provides a much higher maximum. This is one of the biggest conundrums in healthcare, is it more important that the average level of care is more equitable, or that the maximum attainable level is of the highest quality? Unfortunately you can't have it both ways. Access-Quality-Cost are interconnected and you can't increase/decrease one without affecting the other.

 

[theeedude]

Japanese tech is easily as competitive and more competitive in various areas.

And I am sure some Japanese engineers get paid more than some US engineers.

Mediocre performance of healthcare is also a complex issue, the US may provide a lower average healthcare in some regards, but it absolutely provides a much higher maximum. This is one of the biggest conundrums in healthcare, is it more important that the average level of care is more equitable, or that the maximum attainable level is of the highest quality? Unfortunately you can't have it both ways. Access-Quality-Care are interconnected and you can't increase/decrease one without affecting the other.

Access is part of the quality metric. If you are young and uninsured, by the time you become established and can afford this care that you claim is "highest quality" you may have already damaged your health by not getting necessary care, and no amount of expensive "highest quality" care will restore it. Or if you have access to the "highest quality" care that stops if you lose your job and can't afford COBRA payments, or get dumped due to pre-existing condition exclusion, that "highest quality" care is going to do you no good, because you won't get it when you actually need it. Actual results are what matters, not potential results under ideal conditions.

 

[TheVrolok]

And I am sure some Japanese engineers get paid more than some US engineers.

.. and some US doctors get paid less than other US doctors.

Access is part of the quality metric. If you are young and uninsured, by the time you become established and can afford this care that you claim is "highest quality" you may have already damaged your health by not getting necessary care, and no amount of expensive "highest quality" care will restore it. Or if you have access to the "highest quality" care that stops if you lose your job and can't afford COBRA payments, or get dumped due to pre-existing condition exclusion, that "highest quality" care is going to do you no good, because you won't get it when you actually need it. Actual results are what matters, not potential results under ideal conditions.

I never disagreed with this at all. This is how the interplay between access/quality/cost (I typo'd earlier, should be cost instead of care) operates. I wasn't providing any commentary on how things "should" be, just the way they are.

 

[Ausm]

And I am sure some Japanese engineers get paid more than some US engineers.

Access is part of the quality metric. If you are young and uninsured, by the time you become established and can afford this care that you claim is "highest quality" you may have already damaged your health by not getting necessary care, and no amount of expensive "highest quality" care will restore it. Or if you have access to the "highest quality" care that stops if you lose your job and can't afford COBRA payments, or get dumped due to pre-existing condition exclusion, that "highest quality" care is going to do you no good, because you won't get it when you actually need it. Actual results are what matters, not potential results under ideal conditions.

Especially if they live in Tokyo the cost of living is hellacious there.

 

[gingermeggs]

the best doctors will simply take their world-class skills elsewhere, where other people are willing to pay more for the best care in the world.

Like where?
Don't let the door hit you on the way out!

Triage based on wealth doesn't make good doctors.

 

[gingermeggs]

What the fuck???

Cost is relative. The price for health care is so high is because of government intervention and government trying to do too much thinking it can do good.

You provide a way for all the people to come up with 50,000 dollars to buy medicine, and what you know... All the medicine suddenly costs 50,000 dollars! Go figure...

Hospitals and medical companies are businesses. when they don't have customers who can afford what they're charging... Guess what ? COSTS WILL GO DOWN... because they're businesses they need to operate and make a profit. oh what if the medicine that they use to treat patients are too expensive for them to charge less? guess what? THEYLL BUY SOMEWHERE ELSE or find a way to make it work... then because none of the hospitals are buying that EXPENSIVE MEDICINE.. So what happens? The people selling the medicine have to LOWER THE COST OF MAKING MEDICINE.

and it goes down the line until you reach an equatable cost based on actual ECONOMIC FORCES not because government is pumping money into it!!

we are seeing this everywhere...
Education
Health care
Fema
Mortgage
Banking

Oh exciting times!!!

-Sent from my phone.

I would of thought lawyers/judges and insurance companies did more for increasing costs then anybody else.
Pity restrictions on compensation payouts aren't a part of government intervention.
Pain and suffering needs to be cleaned up, this is where lawyers make their fortunes!

 

[Gintaras]

Everyone is a pessimist.

Pessimist can be a very good INFORMED optimist....

 

[gingermeggs]

Pessimist can be a very good INFORMED optimist....

They are never disappointed with the outcome,
either they where right or it's a better outcome then expected.
😛

 

[Ryan711]

What's also really bizarre is that the esteemed op-ed author thinks that doctors should know the most about how to craft nationwide health care policy. I can't imagine for the life of me why that would be the case.

SO TRUE! I mean, they're only working 80 hours a week in the very field. I'm sure the politicians in washington have a MUCH better idea of how to keep things efficient and free of red tape. Oh wait...

 

[theeedude]

In this country, laws are passed by politicians, not doctors.

 

[shira]

SO TRUE! I mean, they're only working 80 hours a week in the very field. I'm sure the politicians in washington have a MUCH better idea of how to keep things efficient and free of red tape. Oh wait...

By your reasoning, people who repair buses have the most knowledge on how to set up a good public transportation system.

The ACA was crafted based on the inputs on the inputs of experts in the field of public health. It wasn't just dreamed up by Democrats pulling random health policy rules out of their collective asses.

 

[Chainspell]

By your reasoning, people who repair buses have the most knowledge on how to set up a good public transportation system.

The ACA was crafted based on the inputs on the inputs of experts in the field of public health. It wasn't just dreamed up by Democrats pulling random health policy rules out of their collective asses.

Everything that the government has intervened in has caused more problems than it solved. Government is not a business, it's inefficient. Businesses try to make a profit or they close down... government just taxes more people... So they don't care about efficiency.

-Sent from my phone.

 

[mattpegher]

As many of you know, I am an ER doctor. Since I am boarded in both Internal Medicine and Emergency Medicine and licenced in three states, I have seen many different practices. From Internal Medicine, to ER, to Urgent cares. I have worked in practices that take insurance and those that take only cash.

I currently provide universal health care. I see everyone, I dont even know what plan you have. That is the nature of ER medicine.

First, the Congressional budget office published data that puts physicians salaries at about 8% of the national health care expenditures. So you could enslave every doctor and we still would be no where near paying for health care expenditures.

What cost so much. Technology, a recent publication from Medicare states that technology is the most significant factor in present and future costs of medical care.
Why is technology so expensive, in the same publication they stated that nearly 50% of tests could be reduced if not for the need to document negative result, in order to support a defense in civil litigation.

The two largest expenditures are hospitalization and longterm care. Given the average operating costs of most non-profit hospitals are about $1000/day per patient, this is unlikely to be something that can be minimized without negatively impacting patient care.

Second. Just like any other field in the US. Medical schools are competing for the best minds. Today, bright students have a large number of choices to advance. Not just law, but business, and finance are lucrative options. These fields generally lead to good pay, easy hours and relaxed lifestyle. Workloads can be heavy or light and the pay adjusts accordingly.

The US currently imports about 25% of its physician workforce per year. Some may say we are importing intellect, stealing the best from Europe and Asia.

Third, My wife chose to go the PhD route in a science. My loans were 140k, hers were 0, I still have 80K after 15yrs. Her options were low pay academic job, most with relatively lower work load vs private industry, some with pay as high as mine but with heavy workload.

I personnally believe that we underpay scientists, mostly because very few of them can practice their craft privately. This means that there are many "middlemen" business types making money off their hard work.

Lastly, I am for univeral health care. But I think that Obamacare is a step in the wrong direction. The government wants to control costs by controlling financing. This is rediculous. You cant use a system that skims 30% off the top to create efficency in a different system.

Although, I dislike the VA system, I think it should be expanded. First to accept all patients that would be eligible for medicaid. The system must be paid for. And only by taking direct control of the expenses and costs, employing the people and buying the equipment, can the effects of universal coverage be weighed and adjustments be made.

 

[TheVrolok]

... snip ...

Appreciate the insight. :thumbsup:

 

[mattpegher]

Everything that the government has intervened in has caused more problems than it solved. Government is not a business, it's inefficient. Businesses try to make a profit or they close down... government just taxes more people... So they don't care about efficiency.

-Sent from my phone.

Cant argue with this. Unfortunately there really are only two options as I see it. Government pays for everything. Or we eliminate those forces that interfere with free market forces.

As I have stated before the other way I see it is to:
1. Decouple healthcare from employement. - how can people be good consummers if they dont pay for their health care.
2. Encourage HSA eligible plans. Why pay someone to hold your money until you need it for little stuff. This works for the catastrophic "insurance" part but not the minor expenses.
3. Make group rates illegal. Every person of similiar age and smoking history should have similiar rates, anything else is just unethical.
4. Make the first 10k of health insurance premiums, a tax credit, not just a deduction. (The HSA deposit would be nice to be a credit as well as it would really encourage intelligent consumerism)