patrick.net

Just let everybody die. It's cheaper.

ja says

I have paid (well, not me, my insurance), $500 for a 2 minute visit

I can almost promise your insurance did not pay $500. Probably more like $50, at most.

The fictitious rates quoted on the "explanation of benefits" have no basis in reality.

If doctors were paid $500 for even 10 minutes, that is $3000 per hour. Let's say they recover 1/3, with the rest going to administration, hospital profit, insurance, etc. That would be $1000 per hour.

Considering a 2000 hour work year (and that would be low for most docs, many work at least 12 hour days at least 45 weeks = 2700 hours)

Anyway, $1000 per hour for 2000 hours is $2 million per year. I don't know many docs who make that....

Going with the insurance paying $50 for 10 minutes is $200k for a doc working 2000 hours per year, which sounds about right...

We know that

http://en.wikipedia.org/wiki/Public_Finance_Balance_of_Smoking_in_the_Czech_Republic

But I still want to pay a fair market price for living

Interesting article illustrating overutilization in both inpatient and clinical settings

http://www.managedcaremag.com/archives/0912/0912.utilization.htm

"The most important [controllable] contributor to the high cost of U.S. health care is overutilization. It can take two forms. The first is higher volumes, such as more office visits, hospitalizations, tests, procedures, and prescriptions than are appropriate. The other is more costly specialists, tests, procedures, and prescriptions than are appropriate."

.....Why do people make frivolous trips to the doctors office? Because insurance gives people a false idea that someone else is paying for it.

.....Why are there a lot of tests and procedures? 1) Defensive Medicine 2) The business necessity of Drs to bill aggressively because the insurance companies make money by denying care. Doing many treatments and seeing what 'sticks', if you will

"As an example from the Dartmouth Atlas, cardiac bypass surgery rates exhibit about a 4:1 range of variation, from 3 per 1,000 (adjusted for age, sex, and race) in Albuquerque, N.M., to more than 11 per 1,000 in Redding, Calif. The rates are strongly correlated with the per-capita number of cardiac catheterization labs in the regions, but not with illness rates as measured by the incidence of heart attacks in the regions, according to Wennberg."

......Doesn't necessarily qualify as a 'study' per se, but is it reasonable to assume that people in Redding have 4x as many cardiac complications as people in Albuquerque?

As per the original assertion, I do agree that it is probably correct that the reason for healthcare costs being out of whack are insurance companies and the government more than individual doctors.

If people were paying for procedures based on a pre set cost that was evident to all involved parties and were being charged a reasonable cost that they were paying out of their pocket (not a 3rd party intermediary), what effect would that have on overutilization/overtreatment?

ja says

Now.. How do you subject this to the offer/demand laws?

By not going to the post op visit if everything is fine.

Percentage of Doctors who think the AMA represents their views.

http://thinkprogress.org/health/2011/09/07/313211/77-percent-of-doctors-say-ama-does-not-represent-their-views/?mobile=nc
Rin says

Doctors on the other hand, trust the AMA to restrict international doctors from entering their fields and keeping other scientists out of their work.

zzyzzx says

By not going to the post op visit if everything is fine.

How 'bout not going back for the $5k lower molar implant after wisdom teeth were yanked? Yep, it's the New Third World: you, too, can make twice the median salary in LA and still not afford teef. Just another toofless redneck, now.

david1 says

Considering a 2000 hour work year (and that would be low for most docs, many work at least 12 hour days at least 45 weeks = 2700 hours)

Outside of residents, who do not make up a large percentage of practicing physicians, very very few doctors work at least 12 hours/day, 5 days/week. So your numbers are completely wacky.

I know doctors who work 4 days/week or less and do very well for themselves.

MMR says

"The most important [controllable] contributor to the high cost of U.S. health care is overutilization. It can take two forms. The first is higher volumes, such as more office visits, hospitalizations, tests, procedures, and prescriptions than are appropriate.

I had ankle surgery late last year, and my doc is a poster child for overutilization. Three office visits to diagnose the problem. An MRI before surgery that didn't show anything more than what the x-rays already showed, and of course another office visit after the MRI to tell me that the MRI didn't show anything new. One post surgery office visit to remove my sutures, and then another office visit a month later for the doc to tell me everything looked okay, which I already knew. I don't think any of the office visits lasted more than 5-8 minutes and each was billed at $350-500.

Sorry to hear it man. It's a big problem for sure.

Some quality reading, in case you're interested. Hopefully some of the information presented can help you out if you are unlucky enough to be in the same situation another time.
http://www.kevinmd.com/blog/2011/06/mri-overuse-widespread-dangerous-patients.html

ducsingle5313 says

One post surgery office visit to remove my sutures, and then another office visit a month later for the doc to tell me everything looked okay, which I already knew. I don't think any of the office visits lasted more than 5-8 minutes and each was billed at $350-500.

MMR says

Sorry to hear it man. It's a big problem for sure.

I forgot to mention my > $3000 emergency room bill from Sequoia Catholic Hospital in Redwood City for about 8 minutes of a PA's time with Dermabond after a 1.5 hour wait. That included a $1600 emergency room surcharge for just walking in the door. I was shocked that my insurance (AETNA) paid the bill. I'm filing a small claims suit against Sequoia to "encourage" them to waive the co-pay.

ducsingle5313 says

Outside of residents, who do not make up a large percentage of practicing physicians, very very few doctors work at least 12 hours/day, 5 days/week. So your numbers are completely wacky.

I know doctors who work 4 days/week or less and do very well for themselves.

Are they?

http://www.medfriends.org/specialty_hours_worked.htm

Lowest specialty on this list is 45.5 hours for a dermatolgist. Assuming a 46 week work year, that is about 2100 hours per year.

I said 2000 hours at 1/3 of $300 per hour was a $200k salary....

The salary numbers at that link tend to back my math up.

APOCALYPSEFUCK is Shostakovich says

Most doctors would agree, they're are not making the dimes on the dollars they should be really making and should be able to retire to Caligulan splendor on a nine figure estate after two years in practice. If ACA costs any doctor a dime they'll empty a revolver in the nearest patient's head, rip out his internal organs and get on the phone with a broker in a heartbeat.

Welcome back

Health care in America is the laughing stock of the world.

david1 says

Are they?

http://www.medfriends.org/specialty_hours_worked.htm

I trust work hour data promulgated by the Journal of the AMA about as much as I trust California police and firefighter unions telling me that their members are underpaid and need better pension benefits.

The average physician makes $150,000. They save lives.

The average professional basketball player makes $5 million. They throw a ball around for entertainment.

Most Drs work those hours. Based on all the people I've spoken with over the years, it's sounds accurate, although I definitely understand the urge to view anything presented by the AMA with a grain of salt. However, the more and more Drs. become salaried shift workers, it will be interesting to see how that trend changes.

The average Dr works about 60 hrs a week and 15 hrs is spent on paperwork. Working in a hospital system will absolve these private practitioners of the responsibility of having to do that paperwork, so I predict that they will work slightly less hours moving forward.

ducsingle5313 says

david1 says

Are they?

http://www.medfriends.org/specialty_hours_worked.htm

I trust work hour data promulgated by the Journal of the AMA about as much as I trust California police and firefighter unions telling me that their members are underpaid and need better pension benefits.

Best of luck to you. It's a draining process I imagine
ducsingle5313 says

I was shocked that my insurance (AETNA) paid the bill. I'm filing a small claims suit against Sequoia to "encourage" them to waive the co-pay.

MMR says

Best of luck to you. It's a draining process I imagine

The co-pay amount isn't a big deal, but I'll fight it on principle.

MMR says

Most Drs work those hours. Based on all the people I've spoken with over the years, it's sounds accurate, although I definitely understand the urge to view anything presented by the AMA with a grain of salt.

The two docs in my immediate family don't work those hours. And the other three docs in my extended family don't work those hours either.

My guess is those hours include total "on call" time, which isn't what most folks would consider to be actual work since a doc is only working if they get called in. Otherwise they are doing normal free time activities or sleeping at the hospital in a spare private room.

It's not about lives...it's about attendance..

Homeboy says

The average physician makes $150,000. They save lives.

The average professional basketball player makes $5 million. They throw a ball around for entertainment.

Homeboy says

The average professional basketball player makes $5 million. They throw a ball around for entertainment.

The federal government doesn't require you to watch, or buy a ticket, or attend a game. Some municipalities subsidize stadium construction, which is lemon socialism at the local level, but Obamacare is the equivalent of requiring everyone to buy a season pass and attend too.

david1 says

I have paid (well, not me, my insurance), $500 for a 2 minute visit

I can almost promise your insurance did not pay $500. Probably more like $50, at most.

My apologies. I went through my 2009 records and it looks he got paid only $100.

But still, it's a lot of money for almost just saying hello. The point is that he is not deterred to charge as much as the insurance is going to give him.

ducsingle5313 says

The two docs in my immediate family don't work those hours. And the other
three docs in my extended family don't work those hours either.

You're telling me the five doctors in your extended family each don't work 9 hours a day five days a week? (or 4 days a week 11 hours a day) with 6 weeks vacation a year? Not a single one?

The three doctors in my extended family work probably 65, 60, and 50 hours per week. So how is that for anecdoctal evidence? One radiologist, one surgeon, one research neurologist.

I would bet huge amounts that the average doctor works at least 2000 hours per year, which was my original argument.

Homeboy says

The average physician makes $150,000. They save lives.

The average professional basketball player makes $5 million. They throw a ball around for entertainment.

One could argue that basketball players entertain people, giving them something to do instead of killing each other. So they save lives...

Unfortunately, the one life that Kris Humprhries saved appeared to be Kim Kardashian. My friend's daughter is obsessed with her. What a role model!

Homeboy says

They save lives.

some pimp for the drug companies and kill a lot of people in the process too.

You don't even need to see the doctor, just send in your insurance. They will diagnose you from what is covered, starting with the most expensive procedures first and working their way down the list.

You want free, that's free, and you will generally get the doctors you deserve, laserjet diplomas and all.

They will be well rested and extremely cheerful, until they get the payments, and then you will cease to exist, just like real estate agents and car salesmen!

david1 says

I can almost promise your insurance did not pay $500. Probably more like $50, at most.

Don't be too sure about that. I had a 30 minute appointment that cost $440, with an add-on of $960 for a 5-min simple procedure that was done as part of the 30-min office visit.

I called the insurance company and they confirmed that $960 was the negotiated rate. In fact they claimed I was "lucky", because they had seen other people being billed even higher for a procedure with the same name.

So this guy is basically billing $1400 per hour for routine stuff. If you go by the 5min procedure, he's billing $11520 per hour for procedures. I'm highly trained, probably more than most doctors, but there is no way I could charge these kinds of rates from a client.

In summary:

I know it is popular to blame hospitals and executives for high costs, but I'm pretty sure that doctors are an equally big part of the problem. People do not want or like to complain about the billing rate of "their" doctor, but I think they are going to have to.

I'd say a fair price for the whole thing would be $150 for the consult and another $150 for the procedure. I can't see how any doctor can complain if making $600/hour, even if they have expenses to pay. If they cant make an excellent living on that, there must be too little work for them to do. Lower the prices and people will come.

Homeboy says

The average physician makes $150,000. They save lives.

They make considerably more than that. This survey from 2011 shows no specialty averaging less than $199k [clarified], and many make LOTS more. And keep in mind, these are NATIONAL averages. Bay area doctors make considerably more.

http://www.profilesdatabase.com/resources/2011-2012-physician-salary-survey

Note, the number you see are net of any-and-all kinds of expenses and fake writeoffs.

They pay very low income taxes because they overcharge uninsured patients 3x-10x, and then use debt forgiveness/writeoffs as deductions against their income, and therefore get very low net tax rates.

I don't feel sorry for them at all. They are part of the racket.

justme says

Homeboy says

The average physician makes $150,000. They save lives.

They make considerably more than that. This survey from 2011 shows nobody making less than $199k, and many make LOTS more. And keep in mind, these are NATIONAL averages. Bay area doctors make considerably more.

http://www.profilesdatabase.com/resources/2011-2012-physician-salary-survey

Here's the other aspect ... how many professions out there, can one move to let's say Des Moines Iowa, pay $600/month in rent (or mortgage for a nice condo or house), earn over $250K/yr, and fly to a more happening city like Chicago or wherever, once a month on weekends, and be able to pay off one's school loans in a few short years?

Most other fields force one to move to high cost locales: Silicon Valley, NYC, DC, Boston, and use up a bigger chunk of a $100K salary, just for housing and general costs of living. In Iowa, a physician is the next big thing to being the landed owner of the corn fields.

Once those loans are paid off, it's goodbye to the corn fields and hello to an east or west coast city.

justme says

They make considerably more than that. This survey from 2011 shows nobody making less than $199k, and many make LOTS more. And keep in mind, these are NATIONAL averages. Bay area doctors make considerably more.

http://www.profilesdatabase.com/resources/2011-2012-physician-salary-survey

Note, the number you see are net of any-and-all kinds of expenses and fake writeoffs.

They pay very low income taxes because they overcharge uninsured patients 3x-10x, and then use debt forgiveness/writeoffs as deductions against their income, and therefore get very low net tax rates.

I don't feel sorry for them at all. They are part of the racket.

I saw that page, but it doesn't contain an overall average, so I didn't cite it. Another source cited $150K as the overall average. You are trying to compare an average with individual data points. Apples and oranges.

Anyway, doesn't matter if it's $150K or $200K, those aren't exorbitant salaries for what they do, especially if you compare it to a professional athlete, an investment banker, or a CEO of a large corporation. There are even computer programmers that make more than doctors.

elliemae says

One could argue that basketball players entertain people, giving them something to do instead of killing each other. So they save lives...

You're really reaching, there.

justme says

I don't feel sorry for them at all. They are part of the racket.

I don't "feel sorry" for them. I just don't harbor an insane hatred for them as you guys do.

Homeboy says

You are trying to compare an average with individual data points. Apples and oranges.

I'm comparing the *lowest* paying specialty listed at $199k with your "average" of $150k. The numbers do not agree at all. I'm sure you must be aware that the average cannot be smaller than the minimum.

Homeboy says

I don't "feel sorry" for them. I just don't harbor an insane hatred for them as you guys do.

I don't know who "you guys" are, but since you quoted me when you wrote that, I'll take exception to your notion of "insane hatred". Pointing out that some doctors charging $2800 per hour are overpaid, and by a LOT, in no way constitutes "insane hatred". That is pure hyperbole.

Homeboy says

Anyway, doesn't matter if it's $150K or $200K, those aren't exorbitant salaries for what they do,

Most doctors are making considerably more than that. You are just hyping again.

Homeboy says

Anyway, doesn't matter if it's $150K or $200K, those aren't exorbitant salaries for what they do, especially if you compare it to a professional athlete, an investment banker, or a CEO of a large corporation.

It seems like you don't understand the difference between the labor "working" classes and that of the ownership. Of course, the owners of a hedge fund or partners at IB, are making a mint but that's because they have proprietorship of hundreds of millions to billions of dollars of capital. And likewise, an NBA player has a collective bargaining union which has guaranteed that no NBA player will ever not be at least a single time millionaire, all paid for by advertisers and ticket sales. However, leave the main organization and play for the D-League and those guys earn as much as a regular working Joe.

And yes, a profession with a mean above $200K is a big deal, esp when you can train the soon to be laid off 4000+ NASA engineers to do that work, at half price.

Professional athletes should make a lot of money, they entertain the population, provide alternative avenues of focus and generate discussions in various interpersonal settings. And it is more profitable to enroll children in sports while emphasizing their education than lets say enroll them in useless piano lessons while emphasizing education in terms of diversifying their career options and earning potential not to mention the plain old benefits of excercise and fun. I will never understand why ahem "tigers" pay all that money for music lessons other than to instill some sort of sadistic discipline to teach their kids to sit on their ass and perform monotonous tasks.

Homefool's doctors are overpaid to keep him addicted to the "not habit forming" pills upon which he has become physically dependent. Everyone is required to pay them, thanks to the "Mental Health Parity and Addiction Equity Act" (mandatory coverage regardless of actual benefit) and Obamacare. Emergency doctors who save lives for $30/hour are probably underpaid. If we had a national health service for vaccines and true emergencies, and a truly free market for everything else, we could save money even if emergency doctors got paid more, because we wouldn't be stuck overpaying Homefool's pushers. But that's why Congress enacted that legislation: our "Representatives" are controlled by PhRMA and other industry lobbyists, and they do what's most lucrative for themselves.

dublin hillz says

Professional athletes should make a lot of money, they entertain the population,

I'd say that they deserve it simply because there are so few that make it to that echelon. Even when they do, their careers are often short due to strain and injury.

So, the best in the world compete and win repeatedly to get highly paid for a short time. Sounds fair. Maybe even less fair for them if you think about it.

CL says

I'd say that they deserve it simply because there are so few that make it to that echelon. Even when they do, their careers are often short due to strain and injury.

You have a point, but there is a big problem with professional sports in the US: They are monopolies that have specific antitrust exemptions.

And not only are the major sports leagues monopolies, but they manage at the same time to be the most socialist institutions in the country.

Why? Because the WORST performing teams are rewarded for their failings by getting the top draft picks of new players. That is, teams are awarded better new players according to their need.

(that ought to make some right-wingnut sports-fans heads explode, after all, what is more American than NFL, NBA and MLB?)

CL says

I'd say that they deserve it simply because there are so few that make it to that echelon. Even when they do, their careers are often short due to strain and injury.

I'd rather a thousand doctors make $300,000/yr than one CEO make $300,000,000/yr. At least doctors do something useful for society.