Healthcare Industry to Propose $2 trillion in cost cuts

[Carmen813]

Maybe this is a dumb question, but why is medical school so expensive in the first place? Do scholarships not exist?

I understand it takes a long time to become a doctor, but it takes about the same about of time to become a psychologist, and they do not graduate with 200k in debt.

 

[Slew Foot]

Annual spending on healthcare 2.4T
Annual sum of physicians salaries- 750,000x175K=131 billion

You guys are barking up the tree if you think physician salaries are the reason your premiums are so high.

 

[kitkat22]

Originally posted by: Carmen813
Maybe this is a dumb question, but why is medical school so expensive in the first place? Do scholarships not exist?

I understand it takes a long time to become a doctor, but it takes about the same about of time to become a psychologist, and they do not graduate with 200k in debt.

Cost depends on the school and mostly whether it is state run or private. Scholarships exist but when you have thousands competing for a fairly low number it becomes difficult to get any. Many of my fellow students take the military route, which I cannot do (health condition), which pays for everything. The rest of us get stuck with high tuition.

Part of the increase in our school was all the construction they were doing around campus and professor salaries. I think they do it because they can and because everyone else is doing it. There are thousands of applicants to medical schools every year and with such high demand and low supply prices go up.

 

[Carmen813]

Originally posted by: cscpianoman

Originally posted by: Carmen813
Maybe this is a dumb question, but why is medical school so expensive in the first place? Do scholarships not exist?

I understand it takes a long time to become a doctor, but it takes about the same about of time to become a psychologist, and they do not graduate with 200k in debt.

Cost depends on the school and mostly whether it is state run or private. Scholarships exist but when you have thousands competing for a fairly low number it becomes difficult to get any. Many of my fellow students take the military route, which I cannot do (health condition), which pays for everything. The rest of us get stuck with high tuition.

Part of the increase in our school was all the construction they were doing around campus and professor salaries. I think they do it because they can and because everyone else is doing it. There are thousands of applicants to medical schools every year and with such high demand and low supply prices go up.

Well, typically an individual pursuing a PhD in Psychology will be conducting research or teaching undergrads, or both, and be able to work to pay for their school. This usually attend tuition free, and earn a stipend that covers living expenses. Do med students have those types of options?

It just seems very strange how they have setup the system.

 

[WhipperSnapper]

Whatever it is, if the private insurance companies are in favor of it, then it will probably result in increased profits for them and higher prices and worse health coverage for us. It will just be designed to "look" like it was good for the citizenry.

 

[Hayabusa Rider]

Originally posted by: abj13

Originally posted by: Hayabusa Rider

Originally posted by: RightIsWrong

I'll play along with you. But don't expect any "real-time" responses....I'm only on during the early mornings now.

1. What drives up costs? -- The lack of viable preventive care, poor decisions regarding diet/exercise and end of life treatments related to the first two.

2. It's increasing utilization of an increased standard of care. When we go to the hospital, no one says "give me the third best treatment or test, it's a lot cheaper". No patient wants that. They want the best that exists. -- Complete and utter bullshit but with some truth behind it (if that's even possible). While the patient wants that, the insurer is doing everything in their power to refuse it. They will deny treatments, force patients to get "pre-approvals" before treatments can be undertaken which often times worsens the conditions. The health care systems aren't really helping too much in this either. They run their operation more to make money than they do to treat anymore. They cut costs by eliminating staff and by providing less services. They refuse give those with no insurance any breaks either. How can a hospital charge an insurance company 60-70% LESS than what they are able to charge someone without insurance. To me, it would seem logical if that was the other way around.

3. Therefore costs to hospitals are increasing mostly because of the state of technology. Improve or die. That costs $$$$. Once again, I have to call bullshit. Technology can be and is reducing the costs of treatment. It is the incompetence of the insurance system that it driving them up. Malpractice insurance anyone? Technology can reduce the overhead costs, eliminate the need to have rooms with nothing other than files and speed up the information doctors need to make a proper diagnosis.

4. The only way the government can prevent this is to effectively lower the standard of care by restricting access to higher technology. When people find out what that really means, the politicians are going to have to give in, and the TCO of medical care will go up. Once again, complete and utter horseshit. Using this line of reasoning, countries with various forms of UHC would be receiving less care and have it cost more. The fact of the matter is that the exact opposite is true. Their costs are less than 1/2 of ours in most cases, their population's life spans are longer than ours, their infant mortality rates are less than ours and their quality of care ranks as better by the WHO and others that have done studies.

5. Perhaps we need a two tiered health care system. One for those who want cost containment, and the other for those willing to pay for it either by taxes or by private insurance. That's about the first logical and rational thing you've said.

I'm sorry,do you work in health care or did you spend a night at a Motel 6?

I work in health care, and everything he says is spot on, I wouldn't dispute anything he is saying. I've seen, worked, helped, and faced the reality of providing health care. I've personally seen patients whose health have been harmed because of the insurance system. I've watched patients walk away being unable to fill a prescription because of insurance loop-holes, knowing fully that in all likelihood, they will end up in the hospital in the next few months, costing the system thousands of dollars that could have been saved if they were covered for the medications. I've faced the reality of hospitals having to eat thousand dollar bills since there was no way the patient was ever going to be able to afford the medical bills they would have to pay. I've watched patients walk out AMA because of insurance problems.

Let's face the reality, insurance companies are middlemen who are dictating patient care. Its not the physicians, its not the nurses, its not even the patients, its the insurance companies who control the system. The insurance companies primary goal is not making the best of patient care, its to satisfy their investors. That is the fundamental issue at the heart of the problem. The people deciding health care, are the ones who are looking out for themselves first and foremost.

We know that insurance dictates medicine, whether it's private or government. Of the two, working with government is harder.

Yet for all the cost containment and denial of services, the cost of health care increases.

Something that I don't think people understand is that health care providers don't get paid what they charge. They get paid whatever the insurance or government decides they can have.

I dispensed a medication which cost us upwards of two thousand dollars last week. We were reimbursed almost $100 less than it cost us. We could have billed a billion. Wouldn't have mattered. People call us and ask "how much will my medicine cost?" I reply "I don't know, but you can call your insurance and ask them how much they'll have us charge you".

We have absolutely no control over how much we are reimbursed (which has gone down steadily for many years), nor how much the copay will be.

When our patients learn this, most can't believe it. We are indeed slaves to the insurance companies, however Uncle Sam is also an insurance company. They're just reached a higher level of incompetence.

 

[babylon5]

Here we go again: Health insurers say they support reform


The industry was gung-ho when universal coverage became a going concern in the 1990s -- and we all know how that turned out. So why should anyone believe the outcome will be different this time?

"Some of these people in the insurance industry are friends of mine," said Alain Enthoven, a professor emeritus at the Stanford Graduate School of Business who served as a consultant to the Carter administration on healthcare issues. "I like them personally. But I don't trust them."

He pointed out that when he and others crafted a plan for universal coverage in the 1970s, the insurance industry proudly announced that it was ready to compromise to serve the nation's best interests.

"Nothing came of it," Enthoven said. "The whole thing was just a joke."

Karen Pollitz, a research professor at Georgetown University's Health Policy Institute and a former health official in the Clinton administration, said insurers were similarly gung-ho when universal coverage once again became a going concern in the 1990s.

"They said they wanted to be at the table and wanted to deal," she recalled. "Then they all left. They saw that they could kill it."

So here we are again. President Obama said last week that "the stars are aligned" to pass healthcare reform legislation this year.

 

[mattpegher]

A few points on review of what has been said.

The costs of healthcare are many fold.
1. money paid to doctors for care, visits, surgery etc. Ave salary is closer to $150k/year This is the smallest amount of the pie but the easiest for government to decrease, since they are the major payor through Medicare and most commercial plans base their rates on Medicare rates.
2. cost paid to hospitals for care and testing- hundreds of people and very expensive technology are necessary to deliver the care that Americans demand.
3. Malpractice- I currently pay about $90,000/year for malpractice coverage in the ER and I have no judgements against me.
4. Insurance companies take 30% of dollars paid to them to administer your health care and are having record profits.

Where should we cut.
Although I think the last one you want to pinch pennies regarding your care is your doctor. I prefer to think that if it is reasonable that a test will help in the diagnosis of a patient that this test should be used, but I would like to not have to do tests that I am sure and evidence shows will most likely be negative just to protect my self in a court of law.

I also think accountants make poor doctors, we shouldn't let insurance dictate what is necessary.
Hospital are going under left and right. Currently it costs the hospital more to care for a patient, on average, then they get. Partly because of uninsured and underinsured, and partly because they must fight with insurance companies to get what they are owed (this cost money in wages for billing departments) OUr hospital has one of the best mixes of payors and is still in the red, surviving only on donations and fundraising.

 

[mattpegher]

As a doctor and having a wife and several family members that are PhDs, I can see how the systems differ.

First it takes 4 years of medical school and 3-6 years of residency before you are earning a decent salary, Average med student graduating today will have between 200-300K in debt. As a white male I was eligible for no grants, or scholarships, and minorities have to compete harshly for theirs.

My wife had grants and a stipend through graduate school, requiring her to teach parttime. It takes between 6-10 years to complete a PhD. Most spend another 3-6years or more doing post-doctoral fellowships(for close to minimum wage when you consider the hours) When they finish this most go into academics for about 60K and only get to about 125K after being tenured.

Now some go into industry and can get a bit more but these end up working about twice as hard.

It ultimately falls down to incentive/pay vs lifestyle.

As it is my ER is overrun by people who can't get in to see their doctors. And Medical school classes are going unfilled due to lack of qualified applicants.

 

[miniMUNCH]

Two things to cost medical expenses by about 35%.

1. get rid of malpractice altogether (back to pure medicine at risk) -- make a government oversight office (ala what the FDA is to drugs) that arbitrates cases where doctors/hospitals fuck up... settlements would be much smaller than typical civil suits awards these days and come out of the hospital/doctor bank account (no insurance even allowed) and would be supplemented by the government. Sanctions placed on the doctors/hospitals would be more severe.

2. ban advertising of prescription drugs to consumers.. create a FDA run website that contains drug information for various maladies, etc.

 

[Stunt]

$2 trillion over 10 years?
Health care spending is at 15.2% of GDP...$2.1 trillion a year.
They are basically offering a 9% cost reduction...which isn't bad considering...

However most of the industrial/developed world administers healthcare for $2000-3000 a person and the US is at $7000.
I think with a well run single payer public healthcare system would be able to save the US economy $1.3trillion annually in maintaining the health of its citizens. Due to increased coverage, I estimate an increase in productivity...people will be able to contribute rather than live off social safety net, charity, relatives, etc.

 

[Hayabusa Rider]

Originally posted by: Stunt
$2 trillion over 10 years?
Health care spending is at 15.2% of GDP...$2.1 trillion a year.
They are basically offering a 9% cost reduction...which isn't bad considering...

However most of the industrial/developed world administers healthcare for $2000-3000 a person and the US is at $7000.
I think with a well run single payer public healthcare system would be able to save the US economy $1.3trillion annually in maintaining the health of its citizens. Due to increased coverage, I estimate an increase in productivity...people will be able to contribute rather than live off social safety net, charity, relatives, etc.

It might, but you aren't going to get one which is well run, unless you know something we don't. Uncle Sam has screwed up Medicaid, Medicare, HIPPA- you name it. If they can't get the "little" things right, what evidence do you have that they'll do any better?

 

[Stunt]

Originally posted by: Hayabusa Rider

Originally posted by: Stunt
$2 trillion over 10 years?
Health care spending is at 15.2% of GDP...$2.1 trillion a year.
They are basically offering a 9% cost reduction...which isn't bad considering...

However most of the industrial/developed world administers healthcare for $2000-3000 a person and the US is at $7000.
I think with a well run single payer public healthcare system would be able to save the US economy $1.3trillion annually in maintaining the health of its citizens. Due to increased coverage, I estimate an increase in productivity...people will be able to contribute rather than live off social safety net, charity, relatives, etc.

It might, but you aren't going to get one which is well run, unless you know something we don't. Uncle Sam has screwed up Medicaid, Medicare, HIPPA- you name it. If they can't get the "little" things right, what evidence do you have that they'll do any better?

Even the most poorly run publicly funded single payer system would need to be extremely inefficient to hit the cost levels currently experienced. We are talking all the inefficiencies in the Canadian, UK, French, and German system and doubling and tripling them.

I would take the opportunity to have a more efficient system any day. Not like it needs to be perfect tomorrow, the current system is seriously messed up and not getting better by any means. With time, effort and focus, there is the potential to have a very effective support for the most productive economy in the world. Your health care system is seriously holding you back in terms of poor care for those who are no longer contributing to wealth and economic growth and an enormous financial liability in the future.

I know this is a poor example but in all honesty the American Military is one of the most well trained, organized and effective institution in existence. If as much time, effort and focus was put into health care, I think you'd be surprised with the results. I am a small government man myself and I just can't find any reason why a private health care system is more efficient... Most of the costs are consumed in relatively small towns where competition isn't worth while, monopolies are inherently most efficient especially when profits are non-existent, and the reduced productivity from having uncovered people not working.

I want to think privatization is the solution but in this one case, condition of the individual...it needs to be mandatory...not a nice to have.

 

[quest55720]

Originally posted by: Stunt

Originally posted by: Hayabusa Rider

Originally posted by: Stunt
$2 trillion over 10 years?
Health care spending is at 15.2% of GDP...$2.1 trillion a year.
They are basically offering a 9% cost reduction...which isn't bad considering...

However most of the industrial/developed world administers healthcare for $2000-3000 a person and the US is at $7000.
I think with a well run single payer public healthcare system would be able to save the US economy $1.3trillion annually in maintaining the health of its citizens. Due to increased coverage, I estimate an increase in productivity...people will be able to contribute rather than live off social safety net, charity, relatives, etc.

It might, but you aren't going to get one which is well run, unless you know something we don't. Uncle Sam has screwed up Medicaid, Medicare, HIPPA- you name it. If they can't get the "little" things right, what evidence do you have that they'll do any better?

Even the most poorly run publicly funded single payer system would need to be extremely inefficient to hit the cost levels currently experienced. We are talking all the inefficiencies in the Canadian, UK, French, and German system and doubling and tripling them.

I would take the opportunity to have a more efficient system any day. Not like it needs to be perfect tomorrow, the current system is seriously messed up and not getting better by any means. With time, effort and focus, there is the potential to have a very effective support for the most productive economy in the world. Your health care system is seriously holding you back in terms of poor care for those who are no longer contributing to wealth and economic growth and an enormous financial liability in the future.

I know this is a poor example but in all honesty the American Military is one of the most well trained, organized and effective institution in existence. If as much time, effort and focus was put into health care, I think you'd be surprised with the results. I am a small government man myself and I just can't find any reason why a private health care system is more efficient... Most of the costs are consumed in relatively small towns where competition isn't worth while, monopolies are inherently most efficient especially when profits are non-existent, and the reduced productivity from having uncovered people not working.

I want to think privatization is the solution but in this one case, condition of the individual...it needs to be mandatory...not a nice to have.

This is the united states government we are talking about the worst run in the world. You can bet your ass it will be the worst case scenario like everything else they run. Every single thing this government touches they screw up plain and simple. We spend the most money per child for education in the world yet have a horrible education system. This government has not earned the right to manage my healthcare.

 

[Slew Foot]

If you look at the VA system, I have little faith that healthcare run by the government would be high quality.

 

[mattpegher]

Originally posted by: Slew Foot
If you look at the VA system, I have little faith that healthcare run by the government would be high quality.

Having dealt with the VA, as an outside physician, I would agree. It took me all day trying to contact a patients primary doctor at the VA to inform him that his patient would need further workup due a possible tumor on chest xray. The poor fool had no other doctors and it was not in my capacity as an ER to do a complete workup. It took two hours just to find a person then I had to wait until the office was back from lunch then give a message to a nurse who had the doctor call me back another 3 hours later. This after telling the people that I was the ER doctor. Not to mention the fact that the poor guy said that he had had 6 primary doctors though the VA in the last 5 years. There's continuity of care for you. I probably new the guy better than his primary doctor.

 

[Slew Foot]

I used to work at the VA. I once came to work at 7 AM and heard an intern yelling at a nurse that his patient died overnight and no one even checked in on the patient until shift change in the AM.