patrick.net

Obamacare will fix that by making the doctors underpaid employees controlled by overpaid executives.

Doctors save lives with their hands. They should be paid highly.

Furthermore, the real cost of healthcare comes not from doctors, but from hospitals. Private practitioners are quite reasonable. Only hospitals are ludicrous in their prices. And you can blame that on the business people and executives at hospitals, not the doctors. Hell, the junior doctors make peanuts while working 20 hours straight.

We could offset some of that impact by helping doctors out with medical malpractice reform and more government funding for medical school tuition.

Wrong. As noted in prior threads, hospitals almost never, ever lose a lawsuit and the vast majority of people don't even bother trying since there is like a 0% chance of winning a suit no matter how good it is. The whole system is rigged to protect big money interests, and that means the hospital, not the patient.

Also, subsidizing anything without putting in strict price controls only benefits the sellers by increasing the price of that thing. Just look at college. More subsidizing of medical school will simply increase the price of medical school.

The real solution is a single-payer, central clearinghouse and every hospital, clinic, and practice must publish its prices for all goods and services to this clearinghouse before practicing any medicine. Any outlandish prices are simply rejected by the clearinghouse. No discounts for special parties are allowed either. The exact same price for everybody.

Do this and hire someone like me to lead a team of kickass developers to streamline all administration of medical care and we can cut medical expenses by 90% without compromising quality at all. And doctors can still be paid six figures to do a job that the vast majority of human beings cannot do.

Dan8267 says

Furthermore, the real cost of healthcare comes not from doctors, but from hospitals. Private practitioners are quite reasonable. Only hospitals are ludicrous in their prices.

You should try to gain more insight into the modern health care profession and the huge conflicts of interest in which some doctors are involved.

Like doctors who jointly own radiology centers and routinely send their patients to their own center for expensive and unnecessary MRIs.

Like surgeons who jointly own surgery centers - - - where they send their patients for surgery, even if there are much cheaper alternatives.

The docs will try to point fingers at fat cat health care provider executives, and that's definitely a problem, but there is a massive amount of double-dealing in the health care profession with doctors as willing participants.

Naturally, there are unethical people in all professions. But quite frankly, there are far easier ways to make lots of money than being a doctor. Being a stock broker for instance.

Now if you have a study that shows what percentage of doctors unethically send patients to unnecessary or dangerous surgeries when better alternatives are available, I'd be interested in reading that.

In any case, I suspect that hospitals, health insurance companies, and the pharmaceutical industry have far more influence on government and health care costs than individual doctors.

more accurate to say that most of the rest of us are underpaid.

Dan8267 says

Being a stock broker for instance.

Dan, stock brokers do not make a mint.

What you're talking about are certain money manager and prop trader types. Sure, the ones in on the game are doing quite well, but it's not like they get these jobs by getting A-'s in organic chemistry classes and scoring greater than a 30 on the MCAT. There's a lot of you-scratch-my-back and I'll do the same for you, in the world of finance, management consulting, and other like professions. Right now, I'm in on the field and let me tell you, it's mostly a type of sales maneuver than a career.

In contrast, those who become doctors, tend to be good memorizers and exam takers. Those are the same traits which many engineers have but unlike doctors, engineers tend to believe in the free market, and thus, get screwed by those with MBAs above them, with minimal talent outside of Powerpoint slideshows. Doctors on the other hand, trust the AMA to restrict international doctors from entering their fields and keeping other scientists out of their work.

This:

marcus says

more accurate to say that most of the rest of us are underpaid.

And this:

Rin says

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

Are not mutually exclusive.

Those professions that do not have a "union" collectively bargaining on their behalf are more susceptible to wage arbitrage in the global economy.

The AMA restriction is the reason why they are now scrambling to establish more medical schools in the United States and 25% of Doctors in the United States graduated from a foreign medical school with some states like NY and NJ being about 45 and 42 percent, respectively.

Medical schools artificially restricted the numbers for so long that there are not enough doctors to replace the baby boomers who are retiring and imported the difference to work in less desirable locales (South and Midwest)

http://www.ama-assn.org/resources/doc/img/img-workforce-paper.pdf

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.

If the Doctors owned the Hospitals, the bill would be 70% cheaper.

I have paid (well, not me, my insurance), $500 for a 2 minute visit, and I hade to ask for 75% of that time. (It was a post-operatory basically asking if "everything good?). Private practice.

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

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.