patrick.net

Well, you can get a Philips-GyroScan-T5-III MRI machine on ebay for $74,999.99 (note the creative pricing). This appears to be a 1995 model, but clearly these machines are not cheap, even 15 year old ones. OTOH, if a new machine costs 500k (pick a number) and you have to pay 10% interest + writedowns per year, it would be 50k/year or $200/day if used 5 days/week, just the rough capital costs.

Having said this though there’s nothing wrong with breaking down some of the barriers for health care to make things run faster. Why should someone have to see a doctor to get a perscription? Recently in my state we allowed drug stores to have walk in clinics…does it really take a doctor to tell if someone has the flu rather than a cold? Of course the AMA was against this but too bad. Doctors shouldn’t have a monopoly over the whole industry. The republicans never bitch about losing thier "FREEDOM" to doctors. they want everybody out of thier life except the doctors lobby and insurance lobby.Anybody with normal brain can cleary see that republicans only cry when they see that something has to be "shared" or if thier so called "freedom" to exploit/keep the loot/dicriminate/ is taken away.

Bap33 says

Just like the computers of 1995, they worked just fine.

I'm going to assume here that you know very, very little about technology. You wouldn't say something so stupid if you did.

As far as health care, Why doesn't anybody get doctors involved. It seem like most are unknowledgable where the money is going. Whether we privatize or socialize medicine we will still have the cost issue because of the beaucracy and overhead. But, it will just cost more being run by the government. I would love socialized medicine however. That would allow me to quit my job and do free lance work. By the way, that's the real reason why corps do not want socialized medicine.

$MoneyGrubber$ says

I would love socialized medicine however. That would allow me to quit my job and do free lance work. By the way, that’s the real reason why corps do not want socialized medicine.

Interesting. But I wonder if companies like Boeing would prefer a NHS style medical system. Airbus currently has a cost advantage over Boeing since Airbus does not have to pay healthcare for employees. Of course, taxes for companies like Boeing may be increased to cover the costs of an NHS system.

“”They don’t run those ads in California because we actually have enlightened people here and it’s unnecessary.”" I live in Cali. Thanks for the love bro. You must have been standing behind the door when they handed out "Enlightenment"

hanskung23 says : a radiation oncologist, and there are far too few of us to go around for all of the people who need radiation treatment. Until they could train enough new residents to take our places, we could hold a virtual monopology on cancer care, basically charging whatever we wanted to treat you. We would make out like bandits. Hell, we could all retire after a few years. Doctors don’t hate insurance because of all the paperwork; they hate it because the reimbursement rates are low. You open medicine to a truly free market, and the shit hits the fan. A truly free market does not contraint supply! If its a truly free market, there won't be so much red tape on training a doctor or on allowing foriegn students to come to US. There is so much red tape in the supply chain that its almost choking the industry. In any free market, when the price of a service goes up, many people start training for providing the service and cost goes down....it somehow does not happen in medical field because thier is so much licencing and restrictions on medical schools. In many countries, a primary care doctor earns the same as an engineer and specialist earn same as specialized engineers. This is not true in US because barriers to supply of engineers has been reduced ( thanks to corporations lobby ) but doctors is not. Its ridiculous that a medical service ( provided by one human to another) is not scaling with population. If there was some scarce resource in the equation, it would have been more believable. Because relative intelligence in a population does not change with time , relative salaries should not change drastically for a long time unless something is broken.

Now, granted, this does not explain why we shouldn’t let more foreign medical graduates in. Certainly, there are many quality foreign students who could fill these spots. But I think this is a separate issue that gets into issues of immigration, the role of a sovereign nation in protecting its own, and a lot more complicated political issues. I mean, yes, you could open the floodgates to physicians from other countries, but then what is going to stop the government from doing that for all sectors of jobs? And will Americans be okay when all of a sudden every doctor is a foreigner? I don’t mean this jokingly either; Americans are very xenophobic. So, I don’t know. I would say this, though: seeing what I’ve seen, I would definitely take more foreign graduates over an increased supply of new American doctors. If it can happen in engineering why not medical field ? is medical field a holy cow we should not touch OR is it because the AMA is too big to fight ? If there were no immigrant engineers in companies we would be paying $300K for an entry level engineer and thus $2000 for an ipod. The fact is that we have allowed immigrants to work for cheap for all services except doctors which makes it look like doctors are expensive relative to other jobs. If there were no immigrants in all other fields (including oursourcing ie..remote workers), all the services in US would have been expensive and nobody would have complained about why doctors salaries are so high. by opening the flood gates to all other service sectors but protecting doctors, we are creating a privileged class.

Your average obese, hypertensive, diabetic, smoker who is noncompliant with his medications has done more than enough to dissuade people from going into medicine You are free to quit going to medicine.There are many excellent doctors in another countries who would love to do that job for that salary.

well thats what happened in engineering...whats so special about medicine. BTW, we are not talking about dictatorships here. most countries cannot stop people from emmigrating.

Yes, we are free to quit practicing medicine. And then you are free to take your chances going under the knife with an underpaid, underqualified physician, once you find that all of the best talent went to another profession where they are paid appropriately for their efforts. Hopefully those excellent doctors from other countries will be able to communicate with you in a language and culture that puts you at ease, and you will somehow be able to confirm their quality of training, previous board actions etc. before you put your life in their hands. Maybe you can get a jump on things by flying to another country for that medical care. But don't use a respected US airline with highly trained and paid pilots, I understand that you can get a real good deal on some of the no frills airlines in the former Soviet Union. You may be just trying to incite an emotional response, but unfortunately your mentality is common.

August 29th, 2009 at 12:31 am | top | quote | email this Yes, we are free to quit practicing medicine. And then you are free to take your chances going under the knife with an underpaid, underqualified physician, once you find that all of the best talent went to another profession where they are paid appropriately for their efforts. Hopefully those excellent doctors from other countries will be able to communicate with you in a language and culture that puts you at ease, and you will somehow be able to confirm their quality of training, previous board actions etc. before you put your life in their hands. If somebody is uncomfortable with a doctor who cannot communicate or if cannot prove his credentials, they are free to choose american doctors...whats the problem. but we atleast give the consumers the FREEDOM OF CHOICE. If you believe that american people are too stupid to make decisions for themselves then you are going down the path of soviet union.

“Hi everybody! I’m Dr. Nick! If you want to have an exclusive surgery with me, Dr. Nick Riviera, dial 1-800-DOCTORB. The extra B is for BARGAIN” US consumers are smart enough to say FUCKOFF DR.Nick ! Its ultimately the consumers who should decide whom they want the service from not the fucking govt. Generally, when it comes to life and death most people will go for good doctors....duh ! The training and expertise automatically gets driven by DEMAND by consumers ( patients). you doctors are talking like realtors. I heard exact same arguments when we use to talk of using 1% commission realtors or redfin.gosh so much similarity. " you are talking about the biggest investment of your life and you want to use someone who not qualified enough to represent you"...etc The entire world works on the fact that most people know whats good for them.

homeowner_for ever_san jose says

August 29th, 2009 at 12:31 am | top | quote | email this Yes, we are free to quit practicing medicine. And then you are free to take your chances going under the knife with an underpaid, underqualified physician, once you find that all of the best talent went to another profession where they are paid appropriately for their efforts. Hopefully those excellent doctors from other countries will be able to communicate with you in a language and culture that puts you at ease, and you will somehow be able to confirm their quality of training, previous board actions etc. before you put your life in their hands. If somebody is uncomfortable with a doctor who cannot communicate or if cannot prove his credentials, they are free to choose american doctors…whats the problem. but we atleast give the consumers the FREEDOM OF CHOICE. If you believe that american people are too stupid to make decisions for themselves then you are going down the path of societ union.

So the goal is to design a system where we have the freedom to choose good doctors or crappy doctors? This "FREEDOM OF CHOICE" bit seems like a strange angle on the issue. Sure- you can checkout Yelp before you get your brakes changed, but when you get broadsided at high speed in an intersection, and are rushed to the ED, or collapse with a giant heart attack or stroke, or get diagnosed with an unusually aggressive cancer where treatment should be initiated within days, etc. etc. how much time and desire will you have to be start trying to figure out if your care has been entrusted to Dr. Doright or Dr. Numnuts? What will you value most at that point, freedom of choice, or peace of mind?

It's easy enough to say that the US should go to a single payer model and pay everyone medicare rates, but that would immediately bankrupt 99% of medical groups. Groups such as the Mayo Clinic who gets hundreds of millions in charitable contributions or groups in the middle of nowhere like Grand Junction where practice costs are low are constantly shown as models of groups that can survive on medicare rates. Great, that's the 1%. All groups in the Bay Area would immediately go out of business. Most private insurance companies pay 3 times what medicare pays!!! There are some private practice physicians who survive in this area on medicare rates by running a bare bones operation with no nurses(just medical assistants) and are just patient mills where they see 80-90 patients a day, spending 1-2 minutes with patients in some cases. So anyone who thinks that going to a single payer system will force doctors to spend more time with patients have no idea what their talking about. Most will go out of business and those that won't will provide crappy care.

homeowner_for ever_san jose says

“Hi everybody! I’m Dr. Nick! If you want to have an exclusive surgery with me, Dr. Nick Riviera, dial 1-800-DOCTORB. The extra B is for BARGAIN” US consumers are smart enough to say FUCKOFF DR.Nick ! Its ultimately the consumers who should decide whom they want the service from not the fucking govt. Generally, when it comes to life and death most people will go for good doctors….duh ! The training and expertise automatically gets driven by DEMAND by consumers ( patients). you doctors are talking like realtors. I heard exact same arguments when we use to talk of using 1% commission realtors or redfin.gosh so much similarity. ” you are talking about the biggest investment of your life and you want to use someone who not qualified enough to represent you”…etc No disrespect meant to you homeowner_forever, but you are starting to sound a lot like that average obese, hypertensive noncompliant guy that we referred to a few posts back...

homeowner_for ever_san jose, wow, looking at the comments you made, I can see that arguing with you is like arguing with a brick wall. So you're saying that a realtor(my aunt who never even graduated from high school-in anther country) is like a doctor, someone who has trained for 15-20 years in some cases? Ok, the next time you need a bypass surgery, I want to see you get one done by someone who's never finished high school. Yeah right, you're probably the type that will DEMAND that you get your surgery by no other than someone at UCSF or Stanford!

hey pbenson ...you are arguing like you have something to loose when there is freedom of choice Our history is littered with arguments from people like you who opposed freedom of choice when thier special status was threatened. its hard to fight a case against freedom of choice...common ( atleast not in US) the case you are describing,most people will go for a hospital with PROVEN reputation..duh ! it forces hospitals to work hard to create a brand and distinguise themselves from others. this also creates competition and reduces wastage.for silly stuff, people will go for a cheaper less trained doctors. How much are doctors struggling in this system to create a name and brand for themselves ? are they not protected by barrier of entry ?

homeowner_for ever_san jose says

hey pbenson …you are arguing like you have something to loose when there is freedom of choice Our history is littered with arguments from people like you who opposed freedom of choice when thier special status was threatened. its hard to fight a case against freedom of choice…common ( atleast not in US) the case you are describing,most people will go for a hospital with PROVEN reputation..duh ! it forces hospitals to work hard to create a brand and distinguise themselves from others. this also creates competition and reduces wastage.for silly stuff, people will go for a cheaper less trained doctors. How much are doctors struggling in this system to create a name and brand for themselves ? are they not protected by barrier of entry ?

Firstly you are referring to a *hospital* with a proven reputation, which does not always equate to the individual physician. But more importantly, you seem to be unaware of the current ED overcrowding crisis, diversion, and the fact that you often will *Not* be able to select your hospital of choice, rather you will be taken to a hospital that is not full-

Ok, the next time you need a bypass surgery, I want to see you get one done by someone who’s never finished high school. Yeah right, you’re probably the type that will DEMAND that you get your surgery by no other than someone at UCSF or Stanford! ARE YOU A MORON...don't you understand that given a choice , i would prefer a good doctor from UCSF for my bypass surgery..most people will.ALL i am saying is that there should be FREEDOM OF CHOICE.BTW, i believe you are the type of person who takes appointment with the ENT surgeon for a flu ( which i wouldn't)

hanskung23 is completely correct that even with the strict standards, there are some really really bad doctors out there so opening the flood gates will make things even worse. And I also know a bunch of people who just barely didn't get in that absolutely do not have the intelligence and moral character to take care of another human being, let alone an animal. But I disagree that most go into medicine for the money. I certainly did not. I was considering going into investment banking, which most of my college friends did and many have already retired after making literally tens, and some hundreds of millions. But one only has one life and I didn't want to devote my life just to making money. Money in medicine is good(I'm sure that I'm not making the $$ like Mr. Rad Onc-some make millions a year), but most, like myself, want to feel that helping others is a worthy goal.

DT says

hanskung23 is completely correct that even with the strict standards, there are some really really bad doctors out there so opening the flood gates will make things even worse. And I also know a bunch of people who just barely didn’t get in that absolutely do not have the intelligence and moral character to take care of another human being, let alone an animal. But I disagree that most go into medicine for the money. I certainly did not. I was considering going into investment banking, which most of my college friends did and many have already retired after making literally tens, and some hundreds of millions. But one only has one life and I didn’t want to devote my life just to making money. Money in medicine is good(I’m sure that I’m not making the $$ like Mr. Rad Onc-some make millions a year), but most, like myself, want to feel that helping others is a worthy goal.

Agree.

homeowner_for ever_san jose, I can tell your level of stupidity by having to yell and call someone a moron because you don't have the intellect to say anything creative. Good job. As a physician, I know enough to find the right specialist if I needed a procedure. But most people, like the illegal immigrants I serve for virtually nothing, would not know a good doctor from a bad one. And only very naive individuals like yourself would rely on website that rate doctors to determine who is really a good doctor or not. However, even someone like you doesn't deserve to go to some quack just because there were no standards because people like you screamed to open the flood gates.

Hey DT, I am going to go out on a limb here, and hope I won't get reprimanded for practicing over the internet without a good faith prior examination, but I am 95% sure that homeowner_for ever has just about met ICD-9 criteria for a personality disorder without even meeting him. good night to all.

pbenson says

Hey DT, I am going to go out on a limb here, and hope I won’t get reprimanded for practicing over the internet without a good faith prior examination, but I am 95% sure that homeowner_for ever has just about met ICD-9 criteria for a personality disorder without even meeting him. good night to all.

Totally agree with that!!!

agree on what ? that patients should not have the freedom of choice ? it sounds ridiculous ..isn't it ? standards should be consumer driven not somebody sitting somewhere and deciding.medical board can decide certification so that people are better informed about doctors credentials but not shove it down people's throat by licensing. licensing is a cheap and old trick abused by special interest groups through out history.

Atleast DT is honest enough to agree that he/she believes that many people don't have the intelligence to make choices for themselves.Anyway, i see a future when there will be H1b for doctors which will open the medical field in US to outside labor ( doctors) like anyother skilled labor and help drive the costs down. you guys did a good job arguing to stop US citizens access to international skilled labor pool ( doctors). interesting !

pbenson : "but I am 95% sure that homeowner_for ever has just about met ICD-9 criteria for a personality disorder without even meeting him" 95% sure by reading internet posts ...Your diagnosis style is pretty interesting..little hasty ..don't you think ? i hope you don't do this with your patients. Do some thorough analysis and evidence based diagnosis alteast with your patients before jumping to conclusions.

homeowner_for ever_san jose says

agree on what ? that patients should not have the freedom of choice ? it sounds ridiculous ..isn’t it ? standards should be consumer driven not somebody sitting somewhere and deciding.medical board can decide certification so that people are better informed about doctors credentials but not shove it down people’s throat by licensing. licensing is a cheap and old trick abused by special interest groups though out history.

Well, I may have to agree that licensing isn't just about making sure that someone is qualified or not. Certainly economic issues play a role. But it's just not that easy to know who is a good doctor or not. I knew an anesthesiologist who lost his license for drug addiction, but up until he lost his license, he had a stellar record. But I was his resident when he was a medical intern and I had major concerns about this guy and wondered how he got into medical school. Not very intelligent, lazy, very low morals, no empathy towards patients, etc. and I expressed those feelings in my evals, but he was still was allowed to go through. I checked up on this guy periodically but it always showed no violations. But one day, sure enough, I read that he lost his license.

i understand that its a fine balance ...but i honestly believe that there is protectionism in medical field in US. This is not the time to play protectionism when people are losing lives and so many people cannot get medical care. I would prefer a guy gets attention from a mediocre doctor ( more supply) than getting none (limited supply)

Although one assumes that more doctors would mean that patients pay less, that's actually not true. Even if we let every quack become a doctor, it's really the insurance company that decides what a doctor gets paid anyway. Maybe if we increased the numbers of physicians 10 fold, that may be the case. But then the 'real' physicians, or the ones who know what they are doing and not harming patients(because bad doctors truly harm more patients than they help), would demand MUCH higher rates than the bad doctors, so nothing would really change, other than for the fact that some unlucky person would end up going to one of these bad docs and getting harmed.

But then the ‘real’ physicians, or the ones who know what they are doing and not harming patients(because bad doctors truly harm more patients than they help), would demand MUCH higher rates than the bad doctors, so nothing would really change by increasing the supply , you also increase the supply of ‘real’ physicians along with bad ones...atleast there is net increase in ‘real’ physicians ( if you have H1B doctors). Supply also influences how much insurance pay's. If it was completely upto insurance, then whats stopping them from paying all the doctors just $5 a visit ?

homeowner_for ever_san jose says

i understand that its a fine balance …but i honestly believe that there is protectionism in medical field in US. This is not the time to play protectionism when people are losing lives and so many people cannot get medical care. I would prefer a guy gets attention from a mediocre doctor ( more supply) than getting none (limited supply)

As I said before, there are many many mediocre doctors already out there. And there are some bad ones. In some cases, some care is better than no care. If you have a skin infection, then a mediocre physician can take are of that. But as it is now, in some urgent care departments or ERs, PAs and NPs take care of those simple cases anyway. So why would we need more mediocre doctors to take care of those patients? But as you said yourself that you would go to UCSF for a bypass. If someone doesn't have money, should that person go to a mediocre heart surgeon? Absolutely not, because probably, the risks of the procedure would be much higher than the potential benefit. We don't need more mediocore doctors. We need more good doctors. How do we get more good doctors? We'll, we can take the best from India and China, but we shouldn't take their mediocre doctors. We could make medicine more lucrative to attract more good people to go into it, but people are already furious that doctors make too much.

I personally know many good doctors from india ( some from top 1% in thier school ) who told me that there is too much red tape in US which prevents them from landing in US as a doctor. it was easy in 80's and then AMA made it tough. BTW, these are same doctors who treat patients from US who go to india for best in the class treatment. I am pissed off that i can get a world class treatment in india for 1/10 th the cost of US but can't use the same labor arbitrage (so called globalization) in US.

homeowner_for ever_san jose says

But then the ‘real’ physicians, or the ones who know what they are doing and not harming patients(because bad doctors truly harm more patients than they help), would demand MUCH higher rates than the bad doctors, so nothing would really change by increasing the supply , you also increase the supply of ‘real’ physicians along with bad ones…atleast there is net increase in ‘real’ physicians ( if you have H1B doctors). Supply also influences how much insurance pay’s. If it was completely upto insurance, then whats stopping them from paying all the doctors just $5 a visit ?

Some insurance tries to pay that low, but no one accepts that. That's what's happening for almost all MediCal patients in the Bay Area. Since MediCal literally pays $5 a visit, those patients can't find anyone who'll see them. The reason why it doesn't happen with private insurance is this. If one bought a policy and it only paid doctors $5 a visit, no doctor would accept this insurance, and the policy holder would have bought worthless insurance. A competing insurance company would attract these policy holders by saying, if you buy our insurance, you can actually see a real doctor instead of an imaginary doctor who accepts $5 a visit. But you have to pay more. If it's an employer trying to attract an employee with an insurance plan that doesn't allow them to see any doctors, an employee may take a job with another company that offers an insurance plan that allows them to actually see a doctor if needed. So my point is, economics 101. It's not just supply. It's supply and demand.

The reason why it doesn’t happen with private insurance is this. If one bought a policy and it only paid doctors $5 a visit, no doctor would accept this insurance, and the policy holder would have bought worthless insurance. A competing insurance company would attract these policy holders by saying, if you buy our insurance, you can actually see a real doctor instead of an imaginary doctor who accepts $5 a visit. But you have to pay more. If it’s an employer trying to attract an employee with an insurance plan that doesn’t allow them to see any doctors, an employee may take a job with another company that offers an insurance plan that allows them to actually see a doctor if needed. So my point is, economics 101. It’s not just supply. It’s supply and demand. So you agree that supply and demand work even with insurance industry..then how come if we increase the supply of good doctors ( assuming same demand), then the prices they command won't go low ?

I'm not saying that all doctors from India are not good doctors. We need good doctors period. But as I said before, I know plenty of doctors from India who got through. There's plenty of family practice, pediatrics, and internal medicine programs who would be more than happy to take physicians from India. But they need to practice up to the standards set in the US. I had a medical assistant who used to be a physician in Mexico who could not become a physician in the US because he kept failing his exams. It was not an English problem because his English was fine. But he had VERY LITTLE medical knowledge. That's why he kept failing his exams. Maybe India has excellent medical schools that teach evidence based medicine, but not every other country does.

But as I said before, I know plenty of doctors from India who got through believe me, the % is very low due to the red tape.

homeowner_for ever_san jose says

The reason why it doesn’t happen with private insurance is this. If one bought a policy and it only paid doctors $5 a visit, no doctor would accept this insurance, and the policy holder would have bought worthless insurance. A competing insurance company would attract these policy holders by saying, if you buy our insurance, you can actually see a real doctor instead of an imaginary doctor who accepts $5 a visit. But you have to pay more. If it’s an employer trying to attract an employee with an insurance plan that doesn’t allow them to see any doctors, an employee may take a job with another company that offers an insurance plan that allows them to actually see a doctor if needed. So my point is, economics 101. It’s not just supply. It’s supply and demand. So you agree that supply and demand work even with insurance industry..then how come if we increase the supply of good doctors ( assuming same demand), then the prices they command won’t go low ?

There are two main factors that determine the price in a medical transaction, what is considered "reasonable and customary"(what the doctor feels his/her services are worth) and what insurance is willing to pay. Insurance prices are based on what Medicare sets. So if medicare pays $30 for a 30 minute office visit, then Blue Cross will pay $90. Whether there are 10 doctors or 1000 doctors in an area, they will pay the same. The reason is that the amount of patients are fixed in a particular area. Lets say that there are 10 doctors taking care off 1000 patients versus 1000 doctors taking care of 1000 patients. The cost to the insurance company is the same. If these 1000 patients see the doctor once, then it costs Blue Cross $90,000 regardless of whether these patients are seen by 10 doctors or 1000. Of course as you said, in a free market, if there are 1000 doctors why wouldn't they compete and offer to see patients for $85, $80, $70? There is some of that going on, but for the most part, there is a 'floor' to what the doctors will accept. And actually, often, the 'reasonable and customary' is actually ALOT higher than what the insurance company is willing to pay. So the doctor actually feels that the office visit is worth really $120, but is taking a 'discounted fee' from the insurance company to see the patient. Sometimes, if the doctor is popular, he/she, unless it is against the rules in that state, will make the patient pay the difference between 'reasonable and customary' and what the insurance pays.

When I went to get my car checked for a 50K checkup, with replacement of minor parts, my bill came out to be $1600. My car is only worth about $8,000. Despite the high cost, I was glad to get it checked up so that I could drive my car to work and go on with my life. I didn't complain that we needed more less qualified mechanics so that I could pay a lot less. My mechanic seems to be well trained. I hope there are some standards. You get what you pay for.