"Doctors make too much goddamn money and they don't deserve it. that's why our healthcare costs are so high."
Wrong. You need to clarify your argument, because, this generalization is flatly ignorant. First, Specialists make much more money than say an Fp (family practice physician) even though the fp does a large majority of the work with a patient and is responsible for the large majority of guidance and documentation of care. Which daily becomes more and more of their job while still trying to see a patient every 15 minutes.
Now, that difference of subspecialties and their inflated rates aside, one would have to also understand that the average american medical student comes out of medical school with more than 100,000 dollars of debt...from medical school alone. In say Canada, most have their medical educations paid for...so, one can make due being paid less due to the lack of longterm debt load.
The sad reality is that most american students are forced to focus on making money as opposed to focusing on their particular medical focus, or inversely choosing a practice such as fp knowing that they will get paid less and work longer than someone making three times the money. To be fair to the specialists, they also attended extra years of school. 3 extra for many, that is beyond the standard 3 year residency (where they are making around 25k at best and they had to move to matched city without any true choice...a match is a match)
That said, I do believe man specialists are over paid. But, guess why the reason is...the way the insurance companies charge and bill. It encourages the use of these doctors in this way. A fully holistically managed system where specialist where tied to general practice and doctors were paid by keeping patients healthy and not how many patients they can cram through the door in one day.
Another problem with the medical industry is the infrastructure of the medical industry-- rent is expensive... and most of the things Doctor's do can't just be written in a typical client-vendor relationship.
There's two big issues here: quality of real estate and quantity of real estate.
When there was more relaxed rules on where you could practice medicine, it was easier to find an appropriate office as you didn't have to find some place with a certain kind of ventilation, a certain kind of finish and a certain size of office.
To put it in perspective... a general practitioner and a car salesmen deal with similar amounts of revenue. The difference here is the car salesman can generate that revenue in a 120 sq ft office. A doctor moving similar revenue would require at least a 2500 square foot office.
More so, if we look at micropractices, they depend on highly urbanized offices. A doctor's office, regardless of actual rent, can handle a lot of customers-- factor in that every expense comes directly out of his salary... paying 3500 a year in real estate taxes for a parking lot does not seem to enticing.
Which brings us to point three, entitlement. Doctors believe they are entitled to nice lives filled with nice things. They want to work in nice buildings, drive nice cars and live in nice neighborhoods.
Which is fine and all-- they are "heroes." But this is often an unnecessary burden passed onto the patient.
Doctor's offices can't compete with hospitals in urban arenas. Hospitals can't functionally run in rural-to-suburban areas. Rural doctor's "fair better."
But what it comes down to is that housing doctors, hospitals and other medical institutions is expensive.... and if we're sick, do we really care if our Doctor's office is in Class A office space?
Dustin, I'm agreement with everything you've said.
And there you are: an educated, taxpaying citizen who will never consider a move to the US where we might want you because of the health care issue.
My personal version of that is wondering how many people DO NOT start their own business because they can't afford to insure themselves. One would think the push to be entrepreneurial - a founding notion of our country, really - would have separated employment and health care years ago. There is absolutely no reason for them to be linked.
Where did I read it recently about the Conservative views towards this topic (and I'm NOT blaming this on one side or the other): What's "pro-life" about denying healthcare to people? What's "pro-business" about forcing businesses to pay for healthcare?
I can't see your logic there hillandrock. RE is the same price for whoever rents it. That car salesman needs an entire lot, hence why they are on the outskirts of town.
Dr's don't need more space than an ad company. They get to choose where they want to work, either paying high rent (and charging appropriately to cover the costs) or not, up to them.
Your point three makes no sense, either. They make what the market will pay them. Imho, they easily deserve it. Without high pay, you don't get motivated people entering the profession, which takes away the talent pool (just take a look at architecture and the percentage of talent that goes to other professions due to low pay).
The fact remains that high costs and large risk requires TONS of overhead. That get's passed onto us. Insurance companies wield all the power, over us and the doc's. Until they are eliminated or controlled, we won't see any improvements.
I'd like to think there will be positive change, but just like the UAW and GM, I think there are too many people with too much power to let much change. I hope I am proven wrong.
I'm not point out that it is a main cause but I am pointing out that is probably in the top 6.
This is one of the ways HMOs function is they often buy up tracts of office space and delegate who, where and what.
The fact is that if a lot of medical practices... do not actually bare the full load of their real estate costs. You know who does? The taxpayer. There's an unbelievable amount of local public bonds being floated in attempt to attract the best and brightest doctors to an area.
My point was if you're not doing this, you're on the other side of trying to make ends meet.
Not all dealerships sell cars out of their lots. And a lot of dealerships are moving towards a storage and shipping method-- you buy a car and it 2 to 3 days it gets dropped off... I believe Mini, BMW and VW rely on this model.
Most Drs need an incredible amount of space, specialized equipment and so on. If a doctor doesn't have an autoclave in office.. every single patient cost about 15-20 dollars just for sterilization.
The medical profession to a certain extent seems to be treating real estate like it is disposable too.
Urban Planning for the 5th wheel to every conversation!
"I've thought about it. I think that there's always going to be paperwork, so that's a non-issue really."
First sentence out of the gate proving that you're not getting it. The administrative costs, one of the TOP THREE three forces that make healthcare expensive, isn't dismissible. Just a bump in the right direction: This "paperwork" thing is not referring to the clipboard of questions about your family history.
kurt, you realize that "paperwork" is universal among all countries providing health insurance, right?
except it's similar forms instead of 40 forms for 40 different robber co's that need to be filled out in triplicate so they can deny the needed heart surgery but approve your viagra prescription
No, Kurt, as holz pointed out, you don't get it. (You went there first.)
When I say paperwork in that context, I'm referring to the paperwork that all doctors (and assistants) need to do. THEREFORE, it's a non-issue in comparing US and Canadian costs because that paperwork is universal (ie docs in both countries have to do it).
I wasn't referring to the paperwork that patients have to do.
KURT: "pro-life", and "pro-business". These are both commonplace descriptive terms for stereotypically conservative views. Though parsed out, of course, they're meaningless buzzwords.
holz: don't forget when they fill out that Viagra scrip form they have to also fill out a different one that denies coverage for birth control. Gettin' it up is clearly far more of an inherent right than is protecting oneself from the consequences of someone else gettin' it up.
I once had an unbearable roommate who was constantly convinced that she had some life-threatening disease. First, she had hormonal imbalances, then heart problems, then food allergies, and latest colon cancer. Rather than considering the likely causes (stress, lack of exercise, etc) that a 20-something would be suffering from some set of strange, but benign symptoms, she was constantly going to the ER and receiving unnecessary medical treatment. Moreover, her doctors were prescribing costly and superfluous drugs and methods. At one point, she was walking around the apartment for the better part of a month with a Halter monitor. My grandmother, who has heart problems and had a pacemaker put in, was given one for a day. Among the many, almost unending problems in our health care system is this enormous imbalance: a relatively affluent, healthy person with good insurance coverage is given an outrageous amount of attention at an enormous expense while a relatively poor, unhealthy person with poor or no insurance is neglected to the point that their health is irrevocably affected, and eventually taxing the medical system through ER visits. In the end, both are rendered a disservice: the latter is obvious, but the underlying problems of the former are still left unaddressed. Rather than taking the time to consider possibilities beyond prescribing drugs or treatment for the worst but most unlikely cause of discomfort, doctors treat well-insured patients quickly, unholistically, expensively and often ineffectively, while leaving under-insured patients untreated altogether.
LB, my girlfriend told me about the birth control vs. Viagra paradigm awhile ago, and it really is unbelievable.
At this point, I cannot be convinced that anything but single-payer is a viable solution. I'll accept a public option among private plans as a starting point if we must, but frankly, I have very little faith in the system or the government's interested in reforming it.
Holistic healing and approach to health is necessary for a balance. But I think we all know how freakin' lazy people are.
FLM - the problem with the single payer strategy is that those with preexisting conditions are kept out. Only the healthy can get reasonable coverage.
Obama has stated he will not allow selective coverage like this, but I can't help but think insurance companies will win.
Basically, if you the average person you are fine, but everyone else get's screwed (I know this, as one that has been screwed). Even though I work out 5 days a week and have been for more than 20 years, eat extremely well, etc., etc., etc.
There is disturbing evidence that many do a lot more than is medically useful — and often reap financial benefits from over-treating their patients. No doubt a vast majority of doctors strive to do the best for their patients. But many are influenced by fee-for-service financial incentives and some are unabashed profiteers.
All Americans are affected. Those with insurance are struggling to pay ever higher premiums, as are their employers. If the government is going to help subsidize coverage for the millions of uninsured, it will need to find significant savings in Medicare spending, at least some of which should come from reducing over-treatment. In the long run, if doctors can’t be induced to rein themselves in, there is little hope of lasting reform.
A glaring example of profligate physician behavior was described by Atul Gawande in the June 1 issue of The New Yorker. (His article has become must reading at the White House.) Dr. Gawande, a Harvard-affiliated surgeon and author, traveled to McAllen, Texas, to find out why Medicare spends more per beneficiary there than in any other city except Miami.
None of the usual rationalizations put forth by doctors held up. The population, though poor, is not sicker than average; the quality of care people get is not superior. Malpractice suits have practically disappeared due to a tough state malpractice law, leaving no rationale for defensive medicine. The reason for McAllen’s soaring costs, some doctors finally admitted, is over-treatment. Doctors perform extra tests, surgeries and other procedures to increase their incomes.
Dr. Gawande’s reporting tracks pioneering studies by researchers at Dartmouth into the reasons for large regional and institutional variations in Medicare costs. Why should medical care in Miami or McAllen be far more expensive than in San Francisco? Why should care provided at the U.C.L.A. medical center be far more costly than care at the renowned Mayo Clinic?
After adjusting for differences in health, income, medical price and other factors, the Dartmouth researchers’ overall conclusion is that the more costly areas and institutions provide a lot more tests, services and intensive hospital-based care than the lower cost centers. Yet their patients fare no better and often fare worse because they suffer from the over-treatment.
The Dartmouth group estimates that up to 30 percent of Medicare spending is wasted on needless care.
Health Care - How do you afford it and why is it so expensive?
"Doctors make too much goddamn money and they don't deserve it. that's why our healthcare costs are so high."
Wrong. You need to clarify your argument, because, this generalization is flatly ignorant. First, Specialists make much more money than say an Fp (family practice physician) even though the fp does a large majority of the work with a patient and is responsible for the large majority of guidance and documentation of care. Which daily becomes more and more of their job while still trying to see a patient every 15 minutes.
Now, that difference of subspecialties and their inflated rates aside, one would have to also understand that the average american medical student comes out of medical school with more than 100,000 dollars of debt...from medical school alone. In say Canada, most have their medical educations paid for...so, one can make due being paid less due to the lack of longterm debt load.
The sad reality is that most american students are forced to focus on making money as opposed to focusing on their particular medical focus, or inversely choosing a practice such as fp knowing that they will get paid less and work longer than someone making three times the money. To be fair to the specialists, they also attended extra years of school. 3 extra for many, that is beyond the standard 3 year residency (where they are making around 25k at best and they had to move to matched city without any true choice...a match is a match)
That said, I do believe man specialists are over paid. But, guess why the reason is...the way the insurance companies charge and bill. It encourages the use of these doctors in this way. A fully holistically managed system where specialist where tied to general practice and doctors were paid by keeping patients healthy and not how many patients they can cram through the door in one day.
Another problem with the medical industry is the infrastructure of the medical industry-- rent is expensive... and most of the things Doctor's do can't just be written in a typical client-vendor relationship.
There's two big issues here: quality of real estate and quantity of real estate.
When there was more relaxed rules on where you could practice medicine, it was easier to find an appropriate office as you didn't have to find some place with a certain kind of ventilation, a certain kind of finish and a certain size of office.
To put it in perspective... a general practitioner and a car salesmen deal with similar amounts of revenue. The difference here is the car salesman can generate that revenue in a 120 sq ft office. A doctor moving similar revenue would require at least a 2500 square foot office.
More so, if we look at micropractices, they depend on highly urbanized offices. A doctor's office, regardless of actual rent, can handle a lot of customers-- factor in that every expense comes directly out of his salary... paying 3500 a year in real estate taxes for a parking lot does not seem to enticing.
Which brings us to point three, entitlement. Doctors believe they are entitled to nice lives filled with nice things. They want to work in nice buildings, drive nice cars and live in nice neighborhoods.
Which is fine and all-- they are "heroes." But this is often an unnecessary burden passed onto the patient.
Doctor's offices can't compete with hospitals in urban arenas. Hospitals can't functionally run in rural-to-suburban areas. Rural doctor's "fair better."
But what it comes down to is that housing doctors, hospitals and other medical institutions is expensive.... and if we're sick, do we really care if our Doctor's office is in Class A office space?
Dustin, I'm agreement with everything you've said.
And there you are: an educated, taxpaying citizen who will never consider a move to the US where we might want you because of the health care issue.
My personal version of that is wondering how many people DO NOT start their own business because they can't afford to insure themselves. One would think the push to be entrepreneurial - a founding notion of our country, really - would have separated employment and health care years ago. There is absolutely no reason for them to be linked.
Where did I read it recently about the Conservative views towards this topic (and I'm NOT blaming this on one side or the other): What's "pro-life" about denying healthcare to people? What's "pro-business" about forcing businesses to pay for healthcare?
It's a huge clusterfuck.
I can't see your logic there hillandrock. RE is the same price for whoever rents it. That car salesman needs an entire lot, hence why they are on the outskirts of town.
Dr's don't need more space than an ad company. They get to choose where they want to work, either paying high rent (and charging appropriately to cover the costs) or not, up to them.
Your point three makes no sense, either. They make what the market will pay them. Imho, they easily deserve it. Without high pay, you don't get motivated people entering the profession, which takes away the talent pool (just take a look at architecture and the percentage of talent that goes to other professions due to low pay).
The fact remains that high costs and large risk requires TONS of overhead. That get's passed onto us. Insurance companies wield all the power, over us and the doc's. Until they are eliminated or controlled, we won't see any improvements.
I'd like to think there will be positive change, but just like the UAW and GM, I think there are too many people with too much power to let much change. I hope I am proven wrong.
I'm not point out that it is a main cause but I am pointing out that is probably in the top 6.
This is one of the ways HMOs function is they often buy up tracts of office space and delegate who, where and what.
The fact is that if a lot of medical practices... do not actually bare the full load of their real estate costs. You know who does? The taxpayer. There's an unbelievable amount of local public bonds being floated in attempt to attract the best and brightest doctors to an area.
My point was if you're not doing this, you're on the other side of trying to make ends meet.
Not all dealerships sell cars out of their lots. And a lot of dealerships are moving towards a storage and shipping method-- you buy a car and it 2 to 3 days it gets dropped off... I believe Mini, BMW and VW rely on this model.
Most Drs need an incredible amount of space, specialized equipment and so on. If a doctor doesn't have an autoclave in office.. every single patient cost about 15-20 dollars just for sterilization.
The medical profession to a certain extent seems to be treating real estate like it is disposable too.
Urban Planning for the 5th wheel to every conversation!
That is all hospitals... ohh yeah.
oops
Well, Dustin, at least LB agrees with you.
"I've thought about it. I think that there's always going to be paperwork, so that's a non-issue really."
First sentence out of the gate proving that you're not getting it. The administrative costs, one of the TOP THREE three forces that make healthcare expensive, isn't dismissible. Just a bump in the right direction: This "paperwork" thing is not referring to the clipboard of questions about your family history.
LB -- what conservative views are you referencing?
kurt, you realize that "paperwork" is universal among all countries providing health insurance, right?
except it's similar forms instead of 40 forms for 40 different robber co's that need to be filled out in triplicate so they can deny the needed heart surgery but approve your viagra prescription
No, Kurt, as holz pointed out, you don't get it. (You went there first.)
When I say paperwork in that context, I'm referring to the paperwork that all doctors (and assistants) need to do. THEREFORE, it's a non-issue in comparing US and Canadian costs because that paperwork is universal (ie docs in both countries have to do it).
I wasn't referring to the paperwork that patients have to do.
KURT: "pro-life", and "pro-business". These are both commonplace descriptive terms for stereotypically conservative views. Though parsed out, of course, they're meaningless buzzwords.
holz: don't forget when they fill out that Viagra scrip form they have to also fill out a different one that denies coverage for birth control. Gettin' it up is clearly far more of an inherent right than is protecting oneself from the consequences of someone else gettin' it up.
Can't agree with you there, LB.
I honestly don't know what you're referring to, KURT, and I'm not sure it would be an interesting discussion anyway.
Unless it's the Viagra hypocrisy you want to discuss, of course.
I once had an unbearable roommate who was constantly convinced that she had some life-threatening disease. First, she had hormonal imbalances, then heart problems, then food allergies, and latest colon cancer. Rather than considering the likely causes (stress, lack of exercise, etc) that a 20-something would be suffering from some set of strange, but benign symptoms, she was constantly going to the ER and receiving unnecessary medical treatment. Moreover, her doctors were prescribing costly and superfluous drugs and methods. At one point, she was walking around the apartment for the better part of a month with a Halter monitor. My grandmother, who has heart problems and had a pacemaker put in, was given one for a day. Among the many, almost unending problems in our health care system is this enormous imbalance: a relatively affluent, healthy person with good insurance coverage is given an outrageous amount of attention at an enormous expense while a relatively poor, unhealthy person with poor or no insurance is neglected to the point that their health is irrevocably affected, and eventually taxing the medical system through ER visits. In the end, both are rendered a disservice: the latter is obvious, but the underlying problems of the former are still left unaddressed. Rather than taking the time to consider possibilities beyond prescribing drugs or treatment for the worst but most unlikely cause of discomfort, doctors treat well-insured patients quickly, unholistically, expensively and often ineffectively, while leaving under-insured patients untreated altogether.
LB, my girlfriend told me about the birth control vs. Viagra paradigm awhile ago, and it really is unbelievable.
At this point, I cannot be convinced that anything but single-payer is a viable solution. I'll accept a public option among private plans as a starting point if we must, but frankly, I have very little faith in the system or the government's interested in reforming it.
Holistic healing and approach to health is necessary for a balance. But I think we all know how freakin' lazy people are.
FLM - the problem with the single payer strategy is that those with preexisting conditions are kept out. Only the healthy can get reasonable coverage.
Obama has stated he will not allow selective coverage like this, but I can't help but think insurance companies will win.
Basically, if you the average person you are fine, but everyone else get's screwed (I know this, as one that has been screwed). Even though I work out 5 days a week and have been for more than 20 years, eat extremely well, etc., etc., etc.
From the Sunday NY Times Editorial page"
There is disturbing evidence that many do a lot more than is medically useful — and often reap financial benefits from over-treating their patients. No doubt a vast majority of doctors strive to do the best for their patients. But many are influenced by fee-for-service financial incentives and some are unabashed profiteers.
All Americans are affected. Those with insurance are struggling to pay ever higher premiums, as are their employers. If the government is going to help subsidize coverage for the millions of uninsured, it will need to find significant savings in Medicare spending, at least some of which should come from reducing over-treatment. In the long run, if doctors can’t be induced to rein themselves in, there is little hope of lasting reform.
A glaring example of profligate physician behavior was described by Atul Gawande in the June 1 issue of The New Yorker. (His article has become must reading at the White House.) Dr. Gawande, a Harvard-affiliated surgeon and author, traveled to McAllen, Texas, to find out why Medicare spends more per beneficiary there than in any other city except Miami.
None of the usual rationalizations put forth by doctors held up. The population, though poor, is not sicker than average; the quality of care people get is not superior. Malpractice suits have practically disappeared due to a tough state malpractice law, leaving no rationale for defensive medicine. The reason for McAllen’s soaring costs, some doctors finally admitted, is over-treatment. Doctors perform extra tests, surgeries and other procedures to increase their incomes.
Dr. Gawande’s reporting tracks pioneering studies by researchers at Dartmouth into the reasons for large regional and institutional variations in Medicare costs. Why should medical care in Miami or McAllen be far more expensive than in San Francisco? Why should care provided at the U.C.L.A. medical center be far more costly than care at the renowned Mayo Clinic?
After adjusting for differences in health, income, medical price and other factors, the Dartmouth researchers’ overall conclusion is that the more costly areas and institutions provide a lot more tests, services and intensive hospital-based care than the lower cost centers. Yet their patients fare no better and often fare worse because they suffer from the over-treatment.
The Dartmouth group estimates that up to 30 percent of Medicare spending is wasted on needless care.
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