Doctors solution to health insurance

[Athena]

Originally posted by: alchemize
Looking for something that goes from 97 to 09

According to this analysis of BLS data, physician income did drop almost 3% in 2004...then climbed just under 10% from there through 2008.

That of course was at the same time that the average worker's income was stagnating or actually decreasing as employers were using potemtial raises to maintain health coverage.

 

[Hayabusa Rider]

Originally posted by: Athena

Originally posted by: alchemize
Looking for something that goes from 97 to 09

According to this analysis of BLS data, physician income did drop almost 3% in 2004...then climbed just under 10% from there through 2008.

That of course was at the same time that the average worker's income was stagnating or actually decreasing as employers were using potemtial raises to maintain health coverage.

You seem to have missed the whole point of the article you linked to.

Let's suppose the "average" worker got a 10% raise, but had to spend 12% more to do their job. How much would their real net income go up?

I suggest going back and reading that again.

 

[Athena]

Actually, that's a bad analogy. The physician's income already includes allowance for what it costs him to do the job -- income=revenue-expense.

What the article said was that physician income didn't keep up with inflation during the period coverd. That is different from slewfoot's assertion that physician salaries dropped by 80% since 1980.

In any case, Shadowfax's real point was that physician income could hardly be fueling rises in overall healthcare costs.

 

[Hayabusa Rider]

Originally posted by: Athena
No, I do understand the point of the article -- that physician income (which is revenue - expenses) didn't keep up with inflation over in that period. That though is different from saying that physician salaries dropped by 80% since 1980.

Shadowfax's real point though was that physician income could hardly be fueling rises in overall healthcare costs.

Well, yeah I have no idea where 80% came from. After expenses, physician salaries have been pretty flatline.

 

[SirStev0]

Originally posted by: alchemize

Originally posted by: Slew Foot

Lies. Inflation adjusted, physicians salaries are down 80% since the early 1980s.

LOL, seriously when you post something on this forum that's complete bullshit, there should be a mandatory ban.

Google sez:
Table 190
1985 - 1997
Mean net income
1985 $112.2K
1997 $199.6K

Looking for something that goes from 97 to 09

I think someone forgot to adjust!

 

[SirStev0]

Originally posted by: Hayabusa Rider

Originally posted by: Athena
No, I do understand the point of the article -- that physician income (which is revenue - expenses) didn't keep up with inflation over in that period. That though is different from saying that physician salaries dropped by 80% since 1980.

Shadowfax's real point though was that physician income could hardly be fueling rises in overall healthcare costs.

Well, yeah I have no idea where 80% came from. After expenses, physician salaries have been pretty flatline.

Interesting theory.

When you say expenses did you take in account the increased cost of school? I came out of undergrad debt free but will be $280,000 in debt after medical school. Wonder how much I can rack up in the 10 - 15 years or so it takes to pay that off?
How about malpractice insurance and it's skyrocketing? What about medicare and insurance companies and dictating treatment costs. Did you know that if my patient gets a bacterial pneumonia due to a ventilator, medicare will not pay for the treatment and puts the cost on the hospital, which then puts it on the doctor?

Now here is a fun one for everyone. Jolly old England, you know that has psuedosocialized medicine, the average General Practitioners (NOT specialists like cardiologist, etc.) makes over 100,000 pounds ( that is over $202,000 a year) average in the US - $160,000. More than 10% of GP's in England make over 150k pounds, which is almost $305k. http://www.dailymail.co.uk/new...f-figure-salaries.html

Interesting ain't it.

 

[miketheidiot]

Originally posted by: Nebor

Originally posted by: Modelworks

Originally posted by: KB
I know some older people who are a part of this program with their doctor. Problem is they still have to have insurance for work their physician can't do, like heart surgery. So their costs have just risen by nearly 50% a year. Being older and wealthier they can afford it in the name of staying healthy, but this isn't a solution to the health care problem.

How many times a year do you need heart surgery though ? The solution to health care is a non profit system, but there is too much corruption and greed for that to be put into practice .

Non-profit = mediocrity. I don't want mediocre health care. I want a doctor that demands he's paid more because he's the best. And I want the best medical care because I can afford it, thus I deserve better care than someone who can't.

yet instead of mediocre medicine, you have low quality for-profit medicine.

 

[miketheidiot]

Originally posted by: piasabird
It is pretty bad when a doctor has to hire 2 admins just to keep track of all the health insurance. The last time I had back problems I went to see a doctor who only accepts cash. It is like $45.00 a visit. No paperwork, No copay. He is a great guy from South Africa.

or we could just fix paperwork problems, which is an easy solution.

 

[miketheidiot]

Originally posted by: QuantumPion

Originally posted by: sportage
All that the insurance co is, is the middleman.
A middleman out for profits.
Since gov ran healthcare would not be a profit organization,
everyone would see cost reduction and personal savings.

Your chain of reasoning is completely illogical.

First, you make the presupposition that the reason why health care is expensive is because insurance companies are trying to make a profit. This is wrong on so many levels, the least of which just being a gross oversimplification of the issue.

Then, you make the leap to saying that because the government is not for profit, costs would be reduced. Government programs have a proven history in every economic sector of simultaneously ballooning in expenses while providing far inferior service. For example: USPS, Medicare, Medicaid, Social Security, Public Education, AMTRAK, etc. What makes you think adding up the worst of the bunch into one giant combined program could possibly be successful?

really? try the VA, or any foreign socialized service, all of which are much better than their american public equivalent. Amtrak has to compete against heavily subsidized air and car industries. usps still exists inspite of two private competitors, ridiculous government standards, and generally does a (much) better job.

healthcare reform should be successful because it has been enormously successful everywhere it has been tried.

 

[miketheidiot]

Originally posted by: CPA
I have been an advocate of a cash-based healthcare system for years. competition will push prices lower.

unlikely unless providers can turn people away or bankruptcy law is repealed.

 

[miketheidiot]

Originally posted by: nealh

Originally posted by: Athena

Originally posted by: nealh
Athena where do you get your info?

From 10+ years of working in the UK, France, and Austria -- supplemented with extensive study after I returned to the US.

My experience in the UK was that, while the facilities were utilitarian, the care was quite good. For various reasons, I much preferred the French system where all my medical needs were covered in full with reimbursement typically paid within a week.

For the record, before I went to Europe, I was employed by two different Fortune 100 companies and had the best employer-paid coverage available (no co-pays for surgery, drugs fully covered, etc.). I now pay 100% of my own insurance premiums for skimpier coverage than anything I had in the Europe. I am very happy with the care I get from my providers...I think the way we organize and pay for care is awful.

I am a physician, I have seen numerous patients from Canadian and the UK..

You realize of course that there is nothing in your message that contradicts what I said about the effect insurance companies have in the escalation of health costs.

I'm sure your stories are anecdotes are factual as far as recounting what those patients have told youl I admit though, that I'm rather skeptical about the story from the UK having had direct experience with opthamology care there. In any case, patients in those the UK and Canada are consistently more satisified that patients here -- as are patients in France, Germany, the Netherlands, Switzerland and everywhere else that has some form of universal care. In survey after survey, doctors are more satisfied too. Most significantly, they have better overall outcomes than we do here. Something is just not right when the outliers determine what kind of care we all get.

People who are sick in these countries with universal health care are not getting care as fast as they need

Canada and the UK are not the only countries with universal health care. The waiting times in UK simply do not exist in other countries in Europe and they aren't nearly what they were 5 years ago (I wonder whether your UK patient has actually tried to see anyone).

...again I see VA patients, they routinely wait 4hrs for appt and have delays for almost all elective surgeries.

The VA is an example of an excellent system that has been starved of resources by legislators for whom its success is an affront to their personal ideology. There are unfunded, vacant positions all over system. The Indian Health Service is in even worse shape; it's constituency is not nearly as powerful as veterans.

Medicare is so poorly run...

Since I am not a "Medicare for all" advocate, I'm not sure what this has to do with my comment. I will say though, that if Medicare had not been specifically designed to be compatible with the in place, supplier driven system, we probably wouldn't have the same sorts of problems.

Here's a good one for you. In june medicare approved use of a drug I adminster in a patients eye....

Isn't that an argument for the ability to negotiate with pharmaceutical companies more than it is an argument against Medicare?

You would be wise to keep the gov't out of your healthcare. ...I dont want them telling me who, what ,when, and where I take my wife or child. They will.

Why would you say something like that. There isn't a system in the industrialized world that dictates your provider. Why would you inject such a statement in a rational discussion?

In any case, I don't have a problem with the fact that you don't want any government involvement in health care. The problem I have is that you want to deprive me of my choice. Why does your preference trumph that of the majority of voters -- who want the option of a non-profit, public system? And once again, public does not necessarily mean "government-run".

I dont care whether you believe my experience with my patient from the UK. It is fact and reality. Geez, now you are suggesting this poor lady who has had several procedures over the last several yrs was lying about seeing anyone just because you think it could not be possible.

Just as you say above, why should I believe your experience elsewhere was the norm and not the exception. Did you have a major medical illness?

Please show me your medical data showing their outcomes are better for the same disease and population types as in the US. I am sick of this comment without basis. I find it funny because I have pt that travel to see me from out of the country for care. It's not just the big universities, they seek out.

Funny how many pts and families, we doctors see from other countries....while my sample is small, I have not had a single example where they wanted their system over ours..does this means ours is perfect..Not a chance.

VA patients are not happy with th system in so many ways its amazing..yes they get free care so toospeak..but these guys earned. They have delay in treatment and wait untold hours to get stuff. Is it better than paying, for most yes. I was a medical student and resident and I took pride in treating veterans and I saw the system firsthand..it sucks. The waste is awful and many staff at the VA hospitals could careless.

Why did I talk about Medicare above its because it is a gov't run system, that has wonderful benefits and is terrific insurance BUT the cost we pay for it is huge since it is gov't run. They do not neg. with drug companies and if anyone noticed the Senate Democrats decided late last week..not to squeeze more out of them. Yea!

Hmm...lets see it took medicare 3 yrs to pay for that $25 drug...they would pay for the $2000 drug only. Why, because it went through a national trial.(these drugs are Avastin and Lucentis). Retina guys like me have been using it for 3yrs plus and there was more than enough clinical data to show it worked. In fact, ophthalmology went to CMS to get the mto sponsor a study comparing both drugs, which will save medicare $30million during the study. A non-gov't setup would have reassessed this after a year.

Why do I bring this up...because our congress is hell bent on redoing the whole system....at huge expense. It can be fixed cheaper. The more the gov't is involved the more waste and cost....

and YES they will ultimately dictate who, what, when and where....I am sorry but if you listen carefully the liberal congress that is pushing so hard for "reform" does want a single payer system..the govt.

The majority of of voter do not seem to want a "public option"..or have you missed the recent polls showing the popularity for these things are dropping below 50%

Remember, what was promised was to provide insurance for those without..not to revamp the whole the system. I have no issues helping those who need insurance. I can bet you, no one here gives away as much as I do in reduced and free care. I proudly do it because it is the right thing to do.

A portion of the uninsured do so by choice...I see plenty of people who are employed that choose no insurance. They do not want ot pay for it. I do not want them supplemented. This is different from those employed but can afford the insurance from the employer.

There is no doubt we need to FIX the system, the cost is too high. Many need and deserve care but congressional leaders are making a mess of this process trying to rush and get something out. There is no time frame that requires this, if they really want it they could through out all the bills. They keep saying it needs to be done fast or it will fail..why?

Go to the parties involved and start by looking for the problems and wayt s ot fix them. IMHO it is like building a skyscrapper without plans and then later decide we need sprinklers, windows, exits etc.

I have no faith that anyone in congress sat down and looked first at what is broken, then worked on solutions.

its funny that you are an american doctor and trying to use that for credibility, when American doctors are among the worst in the world. I may as well consult wikipedia.

Lies. Inflation adjusted, physicians salaries are down 80% since the early 1980s.

lol this could use some proof or stfu.

 

[Hayabusa Rider]

Originally posted by: miketheidiot

Originally posted by: piasabird
It is pretty bad when a doctor has to hire 2 admins just to keep track of all the health insurance. The last time I had back problems I went to see a doctor who only accepts cash. It is like $45.00 a visit. No paperwork, No copay. He is a great guy from South Africa.

or we could just fix paperwork problems, which is an easy solution.

Every time someone tries to fix the paperwork problem, the result is paperwork increases. We have this really neat cost saving measure. It's called "prior authorization". It theoretically saves insurance and government money by making health care practioners justify their treatments. It used to be reserved for extreme cost items, but now it's gotten to the point that many formerly routine things now require it. It's gotten so bad that one pediatricians office I know of had to cut nurse hours to hire paperwork pushers. This "cuts cost" by passing the burden onto the provider, and that cuts into their ability to provide service. HIPPA? The cost savings weren't. It cost more to comply than was saved.

My experience has been that people who come up with these ideas are like King Midas, except everything they touch turns to crap.

 

[dmcowen674]

Originally posted by: Hayabusa Rider

Originally posted by: Athena

Originally posted by: alchemize
Looking for something that goes from 97 to 09

According to this analysis of BLS data, physician income did drop almost 3% in 2004...then climbed just under 10% from there through 2008.

That of course was at the same time that the average worker's income was stagnating or actually decreasing as employers were using potemtial raises to maintain health coverage.

You seem to have missed the whole point of the article you linked to.

Let's suppose the "average" worker got a 10% raise, but had to spend 12% more to do their job. How much would their real net income go up?

I suggest going back and reading that again.

I'm :shocked: This site used to push that people were making more money.

 

[Hayabusa Rider]

Originally posted by: dmcowen674

Originally posted by: Hayabusa Rider

Originally posted by: Athena

Originally posted by: alchemize
Looking for something that goes from 97 to 09

According to this analysis of BLS data, physician income did drop almost 3% in 2004...then climbed just under 10% from there through 2008.

That of course was at the same time that the average worker's income was stagnating or actually decreasing as employers were using potemtial raises to maintain health coverage.

You seem to have missed the whole point of the article you linked to.

Let's suppose the "average" worker got a 10% raise, but had to spend 12% more to do their job. How much would their real net income go up?

I suggest going back and reading that again.

I'm :shocked: This site used to push that people were making more money.

I'm about looking at what's being offered by whomever and the consequences thereof. The 100k figure was the extreme example I personally know of, but with housing bubbles bursting and such there are people who could theoretically afford health insurance who don't simply because the cash flow isn't there. The "poor" being helped wouldn't include them and it would devastate them. So instead of a few being broken by large debt and being forced into bankruptcy, many many more would. Well that's ok, because "we" want to help those who can't afford insurance by ruining them, and let's all have a good laugh while we do it.

It would be possible to craft legislation to prevent this, but that's not how it's shaping up as far as I can tell.

Government largess? Caveat Emptor!

 

[Athena]

Originally posted by: Hayabusa Rider
Every time someone tries to fix the paperwork problem, the result is paperwork increases.

Paperwork can't be "fixed" until their are standards and there are none in the US. Unlike countries that have universal care, there is no "business" case here for having a single set of electronic standards to exchange information with all the players. In the competitive marketplace we call our healthcare system, information belongs to the vendors and and is considered a commercial asset.

Contrast that with France where the medical record has always been considered the property of the patient. Before 1998, individuals carried their charts with them to office visits so the typical French doctor's office involved much less records management. Today, most French doctors have zero records to maintain. Patients still bring their records to appointments but now it's all encoded on a chip. When a doctor inserts the "Carte Vitale" in his reader, he has access to the patient's complete record. He adds his own notes from the visit and payment instructions are automatically received by the Secu as well as the patient's supplementary carrier. Doctors' bills are automatically paid -- usually within the week.

To their chagrin, the Germans still haven't caught up. They have been using automatic health payment cards for quite a while and they have an electronic records system but putting the pieces together hasn't gone smoothly.

My experience has been that people who come up with these ideas are like King Midas, except everything they touch turns to crap.

And it will get worse until every harebrained scheme that places the presevation of "free market competition" above the health of the patient has been tried ...and failed.

It's similar to astronomy in the 17th century: supporters of the traditional earth-centric view of the universe concocted more and more complicated theories to combat the observation-based proof that Copernicus had been right and that the earth revolved around the sun. It would take almost a century for the evidence-based work of Galileo, Kepler, and Brahe to triumph.

It's been 70 years since Franklin Roosevelt proposed universal health care for the US. We can but hope that it won't take us another 30 to achieve it.

 

[Hayabusa Rider]

The problem Athena is this isn't France. This is the US, and it's traditionally THE paperwork superpower. It's what we do, and there is not "change of culture" in place which will address it. The mandate has effectively been "Don't make people use more than five forms, and here are ten to use to document that your are complying".

The US government is like an elf who comes into the shoemakers shop and fixes things by making more work. Hardly useful.

 

[Athena]

Originally posted by: SirStev0
When you say expenses did you take in account the increased cost of school?

Payments on school debt are not expenses of the practice. Some people have debt and some don't. For those who do, it reduces their disposalble income but does not constitute a business expense

Now here is a fun one for everyone. Jolly old England, you know that has psuedosocialized medicine, the average ...

Most people in the US do not realize that primary physicians in the UK are not employees of the National Health Service. Hospitalists (which include almost all specialists) are employed directly by the system but primary care physicians are independent practioners who are paid a set amount to deliver all covered services to their enrolled patients at no charge. They are free to increase their income via a number of schemes.

As with most European countries, medical education in the UK is a cost to the state, not to the student. A rational health care reform policy for the US would provide incentives to increase the number of primary care (and underpopulated specialities) by subsidizing their education with loan forgiveness for service. Instead of allowing the AMA to limit places, the federal government should be expanding medical school slots and funding residencies in geriatrics and other needed areas. I would suggest something like the program for doctors in the Indian Health Services...except it hasn't been properly funded in years.

 

[Craig234]

Getting rid of medical insurance totally is a terrible idea, slightly worse than the current system in which big bugsiness dominated by Wall Street priorities is pressured to maximize profits through measures that include minimizing legitimate payments. We need insurance, but more benevolent, without the 20-40% overhead of the big business model.

 

[Athena]

Originally posted by: Hayabusa Rider
The problem Athena is this isn't France.

You're right. This is the US...which is looking more and more like an impoverished Latin American country with a very prosperous upper class and a marginalized middle class.

This is the US, and it's traditionally THE paperwork superpower. It's what we do, and there is not "change of culture" in place which will address it.

Well remember, the word "bureaucracy" is in fact French so there may be hope for us yet.

There are closed systems in the US -- the VA, Mayo, Kaiser, etc. -- that have successfully implemented integrated electronic systems. They account for a small proportion of the overall system though. The biggest problem I see with the stimulus money for electronic records is that it still doesn't call for standards. That means that much of it will go to incompatible systems and we still won't achieve as much as we could and the primary beneficiary will not be the government or even the health providers, but individual entrepeneurs.

 

[Modelworks]

BUREAUCRACY: You have two cows. At first the government regulates what you can feed them and when you can milk them. Then it pays you not to milk them. Then it takes both, shoots one, milks the other and pours the milk down the drain. Then it requires you to fill out forms accounting for the missing cows.

 

[Slew Foot]

Originally posted by: alchemize

Originally posted by: Slew Foot

Lies. Inflation adjusted, physicians salaries are down 80% since the early 1980s.

LOL, seriously when you post something on this forum that's complete bullshit, there should be a mandatory ban.

Google sez:
Table 190
1985 - 1997
Mean net income
1985 $112.2K
1997 $199.6K

Looking for something that goes from 97 to 09

My department was paying 400K/yr back in 1981, we're paying 300K/yr this year. Same goes for other hospital and fields in the area.

 

[BigDH01]

Originally posted by: nealh

Hmm...lets see it took medicare 3 yrs to pay for that $25 drug...they would pay for the $2000 drug only. Why, because it went through a national trial.(these drugs are Avastin and Lucentis). Retina guys like me have been using it for 3yrs plus and there was more than enough clinical data to show it worked. In fact, ophthalmology went to CMS to get the mto sponsor a study comparing both drugs, which will save medicare $30million during the study. A non-gov't setup would have reassessed this after a year.

Text While not being an ophthalmologist, I found this article interesting.

In October 2007, the company that markets both Lucentis and Avastin announced a strategy that limits availability of Avastin for ocular uses as of Jan. 1. The company, Genentech, cited safety issues as the reason for halting sales of Avastin to compounding pharmacies that have been dividing Avastin into the smaller quantities needed for treating the eye.

Genentech later responded to widespread protests from eye doctors and organizations including the American Academy of Ophthalmology (AAO) by announcing that Avastin can still be sold directly to physicians and delivered to destinations of their choice ? including compounding pharmacies.

At an emotionally charged AAO conference session in November 2007, eye doctors protested the original decision that they say could have severely reduced supplies of Avastin and deprived lower income individuals of a sight-saving drug.

Genentech officials say they will not interfere with a physician's choice to prescribe Avastin for ophthalmic uses. But while the drug still can be sold to physicians, eye doctors say only compounding pharmacies can deal with sterility issues involved with repackaging Avastin for injection into the eye.

Eye doctors at the AAO conference said they have seen no evidence that the FDA has expressed specific concern about off-label use of Avastin.

Joshua Wenderoff, spokesman for the International Academy of Compounding Pharmacists (IACP), told reporters at the AAO meeting he disputes Genentech's claim that the decision to stop sales of Avastin to compounding pharmacies was based on safety concerns.

"We believe Genentech is putting profit ahead of patients," Wenderoff said.

...


The New England Journal of Medicine article points out that Medicare covers Lucentis injections under Part B of the plan, but that the 20 percent co-payment required for each monthly injection still represents a significant expense. Supplemental insurance might be available to defray at least some costs involved with co-payments. Medicare and other health insurance plans do not cover Avastin for treatment of macular degeneration, because the drug is not FDA-approved for this type of use.

...

Genentech officials have said they have no intention of also funding clinical trials for Avastin as a treatment for macular degeneration, now that Lucentis has FDA approval and the need for an effective macular degeneration treatment has been met.

Instead, U.S. government funds will be used to compare effectiveness and safety of the two different treatments. In early 2008, plans were announced for enrollment of participants in the two-year Comparison of Age-Related Macular Degeneration Treatments Trials (CATT), sponsored by the National Eye Institute at about 45 study sites.

...

In the past, serious safety concerns were expressed about off-label use of Avastin as a macular degeneration treatment. This is partly because the FDA in January 2005 warned that Avastin, when used to treat colon and other cancers, significantly increases the risk of stroke, heart attack and other related adverse health events.

...

In one small study reported in 2008, Munich investigators found that Lucentis was slightly better than Avastin when used as an additional treatment for people with advanced AMD and who needed more eye injections after receiving Avastin treatments initially.

Also, in what might be an isolated incident, Genentech reported in late 2008 that off-label use of Avastin caused an outbreak of serious eye inflammation at four Canadian centers where people received eye injections for macular degeneration.

So you're blaming the government for this? Genentech obviously doesn't want Avastin used in this manner and tried to restrict access to it. The FDA had previously found that Avastin could have serious side effects, particularly effects that would be germane to this demographic, and Genentech didn't want to fund FDA approval for this use. I am glad that Medicare is now paying for this, but I am also glad they took their time to confirm that the risk posed by its side effects from its primary use will not transfer to the treatment of macular degeneration.


Better to take a few extra years to be sure than to risk causing strokes and heart attacks.

 

[alchemize]

Originally posted by: Slew Foot

Originally posted by: alchemize

Originally posted by: Slew Foot

Lies. Inflation adjusted, physicians salaries are down 80% since the early 1980s.

LOL, seriously when you post something on this forum that's complete bullshit, there should be a mandatory ban.

Google sez:
Table 190
1985 - 1997
Mean net income
1985 $112.2K
1997 $199.6K

Looking for something that goes from 97 to 09

My department was paying 400K/yr back in 1981, we're paying 300K/yr this year. Same goes for other hospital and fields in the area.

LOL...well there's proof! :roll: