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To fix healthcare, pay doctors less


By tovarichpeter   Follow   Thu, 13 Dec 2012, 6:08am PST   1,704 views   23 comments
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http://www.bloomberg.com/news/2012-12-12/to-cut-health-care-costs-pay-doctors-less.html

As Democrats and Republicans argue about how to spread the pain of health-care spending cuts, one group has been curiously excluded from the discussion: doctors. Theres good reason to change that. Everybody likes doctors. They deliver our babies, treat our ailments and often save our lives. In surveys of public trust, they rate higher than college teachers, police, even clergy, and vastly higher than journalists or politicians. Norman Rockwell painted doctors as kind, patient and wise. You probably hope your child marries one. That public adulation is one reason why the 2010 health- care law, which imposed immediate and heavy...

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upisdown   Thu, 13 Dec 2012, 6:12am PST   Share   Quote   Permalink   Like (2)   Dislike     Comment 1

tovarichpeter says

Everybody likes doctors. They deliver our babies, treat our ailments and often save our lives. In surveys of public trust, they rate higher than college teachers, police, even clergy, and vastly higher than journalists or politicians.

And a recent 60 Minutes story tells us that they overtreat, prescribe and do other unethical things to boost profits too.

To the tune of roughly $210 billion per year.

Suburban Gal   Thu, 13 Dec 2012, 1:05pm PST   Share   Quote   Permalink   Like (1)   Dislike     Comment 2

upisdown says

And a recent 60 Minutes story tells us that they overtreat, prescribe and do other unethical things to boost profits too.

While I think some do, NOT all do. There are really good, ethical doctors out there.

bob2356   Thu, 13 Dec 2012, 2:42pm PST   Share   Quote   Permalink   Like (2)   Dislike     Comment 3

It’s worth asking whether doctors, who account for almost one-fifth of health spending, really need the special treatment.

So if doctors weren't paid at all the cost of health care would only drop 20%? Yet the rest of the first world delivers health care for half the cost and pays their doctors very nicely. What's wrong with this picture and why didn't bloomberg notice?

zzyzzx   Fri, 14 Dec 2012, 3:31am PST   Share   Quote   Permalink   Like (1)   Dislike     Comment 4

tovarichpeter says

Everybody likes doctors.

I don't like doctors.

upisdown   Mon, 17 Dec 2012, 8:12am PST   Share   Quote   Permalink   Like   Dislike     Comment 5

Suburban Gal says

upisdown says

And a recent 60 Minutes story tells us that they overtreat, prescribe and do other unethical things to boost profits too.
While I think some do, NOT all do. There are really good, ethical doctors out there.

$210 billion is quite a few, and the health care conglomerant that the 60 Minutes story was about was rather large and spread out.

Ya ever know anybody on Medicare, and how the bi-weekly to monthly trips to a doctor are rather common? ya ever see the week long pill-boxes with a lot of pills in them by those same people?

Meccos   Mon, 17 Dec 2012, 10:39am PST   Share   Quote   Permalink   Like (1)   Dislike     Comment 6

upisdown says

And a recent 60 Minutes story tells us that they overtreat, prescribe and do other unethical things to boost profits too.

To the tune of roughly $210 billion per year.

not all doctors are perfect. Surely some do unethical things. A lot of overtreatment could be attributed to lawsuits. Have you ever heard of defensive medicine?

Meccos   Mon, 17 Dec 2012, 10:40am PST   Share   Quote   Permalink   Like (1)   Dislike     Comment 7

bob2356 says

It’s worth asking whether doctors, who account for almost one-fifth of health spending, really need the special treatment.

So if doctors weren't paid at all the cost of health care would only drop 20%? Yet the rest of the first world delivers health care for half the cost and pays their doctors very nicely. What's wrong with this picture and why didn't bloomberg notice?

hey bob. physician pay makes up about 7-8% of costs depending on what you read...

http://www.medicalnewstoday.com/releases/226768.php

Funny how everyone focuses on doctor pays instead of the other 92% of health care costs...

everything   Mon, 17 Dec 2012, 2:20pm PST   Share   Quote   Permalink   Like (2)   Dislike     Comment 8

The only real check & balance I can think of is the lawyer, 50% of the health care cost is administrative, it's not like they are actually out to help anyone in particular. Many of the doctors are pretty specialized and don't really know much about prevention or even healing. Then again, what do you expect?, you go to the store and they have an entire isle dedicated to potato chips.

Disease = profit.

Meccos   Mon, 17 Dec 2012, 2:34pm PST   Share   Quote   Permalink   Like   Dislike     Comment 9

chanakya4773 says

Meccos says

Funny how everyone focuses on doctor pays instead of the other 92% of health care costs..

Funny how you quote from a website run by AMA. Do you expect AMA ( doctors union) to report that physician pay makes up 20 - 30%

Its like asking a barber whether you need a haircut.

Why does it matter if I quote from one website or another as long as it is fact? doctor salaries are about 8% of health care costs... BTW the website was not run by the AMA...how in the world did you get the idea the website was run by the AMA?

Other websites may quote the number 20%, however this calculates other costs such as other professional fees and overhead, which really shouldn't be calculated into physician incomes.

bob2356   Mon, 17 Dec 2012, 2:36pm PST   Share   Quote   Permalink   Like (1)   Dislike     Comment 10

chanakya4773 says

Funny how you quote from a website run by AMA. Do you expect AMA ( doctors union) to report that physician pay makes up 20 - 30%

Its like asking a barber whether you need a haircut.

Feel free to provide a more accurate source. I'll buy 20% on your say so. Again, if doctors weren't paid at all the cost of US healthcare would still be 60% higher than the rest of the first world even though they pay their doctors quite well. What's wrong with this picture and why wasn't bloomburgs reporters smart enough to notice?

bob2356   Mon, 17 Dec 2012, 2:39pm PST   Share   Quote   Permalink   Like   Dislike     Comment 11

Meccos says

BTW the website was not run by the AMA...how in the world did you get the idea the website was run by the AMA?

Because any facts that disagree with chana's argument must be from the AMA.

Meccos   Mon, 17 Dec 2012, 2:43pm PST   Share   Quote   Permalink   Like   Dislike     Comment 12

chanakya4773 says

Even though i hate AMA, i like doctors because they people just like us.

Who gives us the authority to limit their pay. Doctors pay should be market driven not some govt agency deciding.

If you want to reduce doctors salary, go after AMA not doctors.

AMA is a Frankenstein gone out of control.

I would argue that there are other much more powerful lobby groups and organizations out there who are the ones actually out of control.
for example the ANA.

upisdown   Tue, 18 Dec 2012, 2:49am PST   Share   Quote   Permalink   Like   Dislike     Comment 13

Meccos says

not all doctors are perfect. Surely some do unethical things. A lot of overtreatment could be attributed to lawsuits. Have you ever heard of defensive medicine?

Yeah, because the added income/profits have nothing to do with it at all. Hmmm, wasn't the lawsuit amount capped somewhat recently, and yet the prices or amounts charged haven't decreased?

Have you ever been charged for 3 rooms, 2 for a 24 hour rate, and yet nevr spent more than 6 hours there because it was an out-patient surgical procedure?

errc   Tue, 18 Dec 2012, 2:57am PST   Share   Quote   Permalink   Like (1)   Dislike     Comment 14

zzyzzx says

tovarichpeter says

Everybody likes doctors.

I don't like doctors.

You and me both. I avoid them like the plague, that's how I stay healthy. A wise, old doctor gave me that advice. He said if you go looking for a problem at the drs office, they'll make sure to find one. Often, my friends that work in healthcare tell me that they haven't been to the doctor in years, or even decades

I thought it was well known that end of life care eats up most of our health care dollars. Stop torturing the dying by extending their painful last days, and healthcare could begin to find a level of affordability

bob2356   Tue, 18 Dec 2012, 7:45am PST   Share   Quote   Permalink   Like (1)   Dislike     Comment 15

That's a great chart. I said I would agree with 20% of the cost, did you not understand that somehow?

Again, again, again if doctors weren't paid at all the cost of US healthcare would still be 60% higher than the rest of the first world even though they pay their doctors quite well, almost as much as US docs. What's wrong with this picture?

Meccos   Tue, 18 Dec 2012, 9:38am PST   Share   Quote   Permalink   Like   Dislike     Comment 16

upisdown says

Yeah, because the added income/profits have nothing to do with it at all. Hmmm, wasn't the lawsuit amount capped somewhat recently, and yet the prices or amounts charged haven't decreased?

DO you think doctors get paid more to order more tests? Lawsuit amounts are capped in some states... I never suggested that defensive medicine is what causes high health care costs, although it does contribute to it.

upisdown says

Have you ever been charged for 3 rooms, 2 for a 24 hour rate, and yet nevr spent more than 6 hours there because it was an out-patient surgical procedure?

Um... do you think doctors make money off the rooms you got charged for?

Meccos   Tue, 18 Dec 2012, 9:50am PST   Share   Quote   Permalink   Like (1)   Dislike     Comment 17

chanakya4773 says

bob2356 says

TW the website was not run by the AMA...how in the world did you get the idea the website was run by the AMA?

Because any facts that disagree with chana's argument must be from the AMA.

YOu realize that the 20.04% for "physician" is actually physician costs PLUS the cost of clinical services which include all the overhead including things like nursing/medical assistant costs, etc, etc. IN actuality what you find is that the ACTUAL doctor's costs is about 8% or so.

zzyzzx   Wed, 19 Dec 2012, 10:44am PST   Share   Quote   Permalink   Like   Dislike     Comment 18

Meccos says

YOu realize that the 20.04% for "physician" is actually physician costs PLUS the cost of clinical services which include all the overhead including things like nursing/medical assistant costs, etc, etc. IN actuality what you find is that the ACTUAL doctor's costs is about 8% or so.

I'd also like to see costs for insurance and lab tests broken out from whatever category they were grouped in.

bob2356   Thu, 20 Dec 2012, 12:44am PST   Share   Quote   Permalink   Like   Dislike     Comment 19

zzyzzx says

I'd also like to see costs for insurance and lab tests broken out from whatever category they were grouped in.

That's pretty much impossible. How do you break out all the people doing medical billing in doctors offices? There is usually one or two people doing billing for every doctor, plus office space, phones, computers, etc.. There is simply no way to account for it. That is currently under physicians when it actually should be private insurance admin costs. But let's not confuse chanaka with facts.

Meccos says

IN actuality what you find is that the ACTUAL doctor's costs is about 8% or so.

Are you sure your chart is gross not net? That number seems stunning. So if doctors weren't paid at all the US would actually be 90%+ higher the health care for the rest of the first world.

Meccos   Sun, 23 Dec 2012, 9:00am PST   Share   Quote   Permalink   Like   Dislike     Comment 20

bob2356 says

Are you sure your chart is gross not net? That number seems stunning. So if doctors weren't paid at all the US would actually be 90%+ higher the health care for the rest of the first world.

Gross or net? We are not talking about doctor's incomes but rather their share of the total health care costs. If we paid doctors nothing, we would save about 8%.

http://www.surgistrategies.com/news/2012/05/u-s-physician-compensation-among-lowest-of-wester.aspx

http://www.medicalnewstoday.com/releases/226768.php

bob2356   Sun, 23 Dec 2012, 9:28am PST   Share   Quote   Permalink   Like   Dislike     Comment 21

Meccos says

Gross or net?

Yes I got that, but I always thought the 20% number was what physicians actually took home. Most are independent businessmen, not salaried. I am surprised to find the 20% is the amount paid before expenses of operating the practice are taken out. Share of health care costs is incomes x number of doctors.

I'm surprised the numbers in Europe and Austrolasia are so close to the US. The salaries aren't much lower (docs in Oz actually make more than US docs), the number of docs per person isn't much lower, but the cost is half per person. . It would seem like the percentage should be higher there.

Meccos says

If we paid doctors nothing, we would save about 8%.

I keep asking about that, but no one has stepped up explain how that's going to work out.

Meccos   Sun, 23 Dec 2012, 9:35am PST   Share   Quote   Permalink   Like   Dislike     Comment 22

bob2356 says

Yes I got that, but I always thought the 20% number was what physicians actually took home.

nope. This is why arguing to decrease physician pay is pointless. They are a small fraction of healthcare costs. Public perception is that doctors make a lot and therefore lets cut them out.

I figure this would be similar in the airline industry. Pilots make a lot of money, but I bet they are a small fraction of the costs.

bob2356   Sun, 23 Dec 2012, 8:03pm PST   Share   Quote   Permalink   Like   Dislike     Comment 23

Meccos says

I figure this would be similar in the airline industry. Pilots make a lot of money, but I bet they are a small fraction of the costs.

http://online.wsj.com/article/SB10001424052702303296604577450581396602106.html#project%3DMIDSEAT0607%26articleTabs%3Dinteractive

Looks like all the airline employees together are about 20% of ticket cost. I looked up American and they have 12,000 pilots out of 90,000 employees. Can't find a breakdown by salary but if pilots took a third then they would be 7% of total expenses. Looks like you are correct.

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