patrick.net

Kevin says

Why is it that every physician that I know lives in a really nice part of town, drives a nice car, and takes nice vacations? I don’t know how much they make (I was told it’s not polite to talk about how much money you have with friends), but I know for sure that they’re making a hell of a lot more than me, and I make over $200k a year.

I know physicians who drive fords & chevys, who live in normal houses and whose children attend public school. What's your point? I also know construction workers who paid for fancy cars and huge houses who are broke as hell at the moment, can't sell their suv's and give the appearance of wealth.

Nomograph says

theoakman says

All the OB’s in NJ are retiring because they couldn’t afford the malpractice insurance anymore.

Don’t be such a drama queen, Theo. You also claimed you couldn’t get a pharma job because Jon Corzine singlehandedly destroyed the industry, or some such nonsense.
Practicing medicine remains one of the most rewarding careers there is, both personally and financially. It is certainly not for everyone, but very few I know would ever think of leaving the profession. Ever.

That was overly dramatic. What is interesting lately is more and more doc's (OB's at least) are going to cash only. They give the patient the superbill and let them file it with the insurance companies.

I don't know who hang out with, but I know a lot ob's. Many of the ones I know are going to retire as soon as they are able. Much much sooner than they originally planned when the entered the profession. I also do know several that have left the profession.

Kevin says

Why is it that every physician that I know lives in a really nice part of town, drives a nice car, and takes nice vacations? I don’t know how much they make (I was told it’s not polite to talk about how much money you have with friends), but I know for sure that they’re making a hell of a lot more than me, and I make over $200k a year.

You must know a lot of high end specialists or live in a very high end area. Bread and butter docs in the trenches don't usually make over 200k unless they work 100 hour weeks.

$300k for a medical school education. That doesn't count the many years of schooling, the sacrifices made by the doc & his family to attend school and live as a starving intern.

So the doc graduates, completes his internship (for the sake of this example, my doc is a "he") and goes into practice. Out of the $he makes he must pay office rent (medical offices aren't cheap) plus the cost of renovating the offices for his use, and dont forget plumbing for a sink in each room, counters, etc. Supplies: Medical exam tables start at $1,000 which doesn't include shipping. One is needed for each treatment room. Supplies? A good stethoscope is $150 and more than one is necessary. Files/filing system, office supplies, office furniture (it's gotta be nice or the patients will think the doc can't compete with others), copier, telephone system (always expensive, plus monthly costs that are outrageous), power that costs at least twice the cost of residential accounts, transcription service or voice activated system, computer system, billing systems plus staff that includes billing specialists, after hours call service, cellphone service, P.A., nurse or medical assistant... Unreimbursed Lab fees. The costs are astronomical.

Ongoing educational requirements and association fees are also astronmical. Journals too. Reference manuals. So far as his income, don't forget the cost of carrying charges for 2-3 months while the insurance company decides how much it'll pay and the payment finally arrives. Malpractice insurance rates are astronomical - $17,000/year in rural Oklahoma (2005) to $277,000 in Miami (http://www.med.umich.edu/opm/newspage/2005/obgyn.htm).

The cost of a house, that generally must be in an area that's nice and safe but within a quick drive to the office or hospitals - which often means gated communities or higher end homes. The cost of a car for him & his wife. The cost of education for his children. The cost of clothing for him & his family, and trips to keep him sane as he works his ass off to pay for all that.

Does a doc make more than the average educator? Absolutely. But he doesn't get off work and go home and forget about his day. He doesn't (usually) work for other people, so he's the one figuring out business stuff well into the night and he's also the one who is responsible for other people's salaries.

Doctors choose their profession because that's what they want to do and certainly aren't forced to do so, but the idea that an MD will be wealthy is a misperception. When you reduce his pay to an hourly rate, you'll find that the educator that makes $60k a year makes more.

I don't know a teacher that makes that, though. This article appears to be from 2007, before the recession hit as hard as it has which means that there are furloughs and layoffs. http://www.employmentspot.com/employment-articles/teacher-salaries-by-state/

"The most recent report included a list of teacher salaries by state. The state with the highest average teacher salary was Connecticut, at $57,760. California was a very close second, where the average teacher salary is $57,604. New Jersey teachers make approximately $56,635 per year. Rounding out the top five were Illinois and Rhode Island, with the average teacher salary at $56,494 and $56,432, respectively. The state with the lowest average teacher salary was South Dakota, at $34,039."

Insurance companies don't pay the full amount of billed charges. It's usually less than 30% of billed charges. If the patient is assigned to that MD by the HMO, the doc receives the co-pay and a set amount per patient per month - quite low actually, often $5 to $10 per month (or less). That's the amount the MD receives whether he sees the patient once or ten times.

Other insurance plans pay about the same as well. I have your standard insurance, it's a PPO. My doc is a provider so she receives in-contract reimbursement. A full physical that took about 20 minutes was billed at $250; the doc was paid $80 including my co-pay. The follow up a month later to discuss lab findings was $20 total, including my co-payment.

Most hospitals don't employ doctors, the docs admit patients there and see patients there - and the hospital courts them with all sorts of things like great parking and gourmet meals. The ER docs are contracted, usually. HMO's don't employ that many, either. Many physicians join groups so that someone takes over the day to day bullshit of running the biz, and are paid less.

If you are uninsured and you're in the hospital, if you offer them 25 to 30% of the billed charges in cash the hospital makes more money than if they billed an insurance company.

People of the belief that government and civilization are better unwound, that we could all live in harmony if only we got rid of all public employees, they should visit Somalia. I suspect however such people tend to believe that WHITE folks would be well behaved without any organization at all, and that such examples as I toss up are just indicative of "those people".

I think PJ O'Rourke said something once I vaguely recall like:
"Democrats think people are civilized because we have government, Republicans think because people are civilized they create government. People want decent functional government because they want their toilets to flush and the poop to go somewhere out of sight."

There's some truth buried in there. Government is not an external evil. It's a CONSTRUCT that we create and dynamically keep re-inventing and in motion to serve our needs. It does not need to be perfect any more than your toilet does. Some people forget that.

All the NeoCon government-haters forget that government is a utility and serves a purpose. They instead vaccillate between remembering to put on a public face where they "just want to trim 10%" then their mask slips and they rage STARVE THE BEAST reflecting their actual position which would end the IRS and just about everything else, and turn your "public utilities" over to that nice Mr. Potter the banker since privatizing everything solves all problems.

Vicente says

NeoCon government-haters

This is an oxymoron. NeoCons love big government because without it they cannot fight endless foreign wars.

I am pro-government. I think State and Local governments are great and since they can cater to the people in their area while allowing competition with other communities it is a win win situation. Big Central Government on the other hand is another story and a recipe for disaster and exploitation by corporatism and fascists.

AdHominem says

This is an oxymoron. NeoCons love big government because without it they cannot fight endless foreign wars.

You refer to their actions, I refer to their rhetoric. They *sell* the idea to their base that they are about less government at all levels. They are willing to promise the moon, and it's at the POINT OF SALE that you win or lose. Pointing out hypocrisies and that results don't match promises hasn't worked, once people have been transformed into TRUE BELIEVERS in the supposed "anti-government" party, they will wrap their heads around all kinds of rationalizations and excuses.

elliemae says

Kevin says

Why is it that every physician that I know lives in a really nice part of town, drives a nice car, and takes nice vacations? I don’t know how much they make (I was told it’s not polite to talk about how much money you have with friends), but I know for sure that they’re making a hell of a lot more than me, and I make over $200k a year.

I know physicians who drive fords & chevys, who live in normal houses and whose children attend public school. What’s your point? I also know construction workers who paid for fancy cars and huge houses who are broke as hell at the moment, can’t sell their suv’s and give the appearance of wealth.

They drive FORDS and CHEVYs because they are real Americans.....DEY TUK OUR JERBS!

AdHominem says

I am pro-government. I think State and Local governments are great and since they can cater to the people in their area while allowing competition with other communities it is a win win situation. Big Central Government on the other hand is another story and a recipe for disaster and exploitation by corporatism and fascists.

That is the biggest crock I have ever seen. How is CA doing? Are they catering to their people? Or IL? or NJ? You want to look at local governments--OK. How's Chicago? or Phoenix? And it will only get worse if you give them more power and more money...

tatupu70 says

That is the biggest crock I have ever seen.

Well, you haven't seen a lot of crocks then huh? So a few over-socialized states go broke and you want to blame local/state governments system, in favor of larger central government (which by the way is far more in debt)?

.

Nomograph says

In order to play his little game,

So this is not Ad Hominem. How can you the master of Ad Hominem have the gaul to accuse anyone of the same? You know it is your nature. You get off on it. I just send it back at you in self defense and lest you get too big on yourself (which by the way is a futile effort).

Nomograph says

nvent fictitious enemies to have pretend Internet battles with.

You think this is a battle? I thought it was a conversation. A conversation per chance with a rational individual like myself trying to talk with someone who just wants to play games (nomograss).

Nomograph says

AdHominem, who chose his name very appropriately

To defend against personal attacks by NOMo primarily with a few others mixed in for good measure.Nomograph says

You can’t please everyone, whether the situation is municipal, county, state, or federal.

But the larger the government the more lucrative it becomes for corporations to lobby and control said government.

But all of this talk about what type of government is best is mute if we don’t have people who are willing to stand up for what is right, not sell out to corporate interests or act out of personal gain while under the guise of “public servant.” If we don’t have statesman we can’t have a viable state.

Case in point, not a person here has stood up for the patriot act. We all know it is a load of crap and needs to stop. But no one here seems to be willing to lift a pinky to do anything about it, let alone all the politicians out there who “represent” us.

Nomograss says

AdHominem says

.

Without question, that is the most intelligent thing you have said yet.

wish I could say the same for you.

Nomograss says

"invent fictitious enemies to have pretend Internet battles with."

You think this is a battle? I thought it was a conversation. A conversation per chance with a rational individual like myself trying to talk with someone who just wants to play games (nomograss).

Case in point, you are just playing games NOmO. As usual. I know it is harder than having a real discussion. I know you agree with me on 99% of things as you listed above, earlier on this thread. But it is actually you who must reduce this to Ad Hominem because you would rather talk about that than ideas and what we do agree on. Which again is 99% of most things as you astutely recognize.

AdHominem says

Nomograph says

"the truth is that unregulated free markets lead to extreme wealth concentration and eventually a feudal system of lords and serfs followed by violent wealth redistribution via revolution or war. "

NOMO, I agree that we do need a measure of regulation in free markets. (By the way I never said “unregulated free markets equal freedom” though this is a true statement. Remember freedom has consequences). There need to be rules in order for a free market to run efficiently. For example, it needs to be illegal to use a scale that is not accurate with penalties for this type of fraud. There needs to be a mechanism for contract enforcement, with penalties for breach of contract. These regulations actually protect the free market.

However, I would counter your statement that unregulated free markets lead to extreme wealth concentration and eventually a feudal system of serfs and lords followed by revolution with the fact that every government and societal system has gone through collapse, revolution or hostile takeover (except maybe for a few remote tribes in Africa, the Middle East or the Amazon). Every system is eventually replaced with another. The new leaders take control, concentrate wealth and power in a few privileged elites and rule until they either collapse or are overthrown. So it is not that free markets fail, it is that EVERYTHING fails.

In other words arguing that “unregulated” free markets fail and therefore they are bad is like arguing that everyone who eats meat dies therefore eating meat is bad.

It does not follow just because a system fails that it is bad. For example, the Native Americans were overtaken by Europeans. Does that mean they are bad? The remote tribes in Afganistan have never been conquered. Does that mean they are good? Not necessarily. USSR failed, so is it bad? Ancient Israel failed, is it bad? Ancient Egypt failed, is it bad? Rome failed so is it bad? A better question to ask is WHY do certain systems fail? I think you would be hard pressed to prove that it was lack of government regulation that is causing our system to fail, when our government is larger today than it ever was. No the problems is not lack of regulation rather the fact that it is essentially controlled by the corporate lobbyists and therefore any regulation we have (and there is a lot of it) exists WITH CORPORATE APPROVAL.

My point being that it doesn’t matter how much regulation you have when the people who need to BE regulated are MAKING the regulations.

And that my friends is why government must be small enough that corporations cannot use IT to THEIR advantage. This is what they are doing, and with every expansion of government the corporate lobbyists/elites power grows with it. That is why American Patriots fought the Revolution, to establish a government that would be DIFFERENT than the British Empire. The United States today is more like the British Empire it fought for independence from, than it is like the original American union of independent states.

Wow Nomo. You astutely say alot.

AdHominem says

But the larger the government the more lucrative it becomes for corporations to lobby and control said government.

Exactly--and if you give more power (and more money) to local, municipal and state governments, doesn't it follow that they will become even more corrupt?

SF ace says

“Doctors choose their profession because that’s what they want to do and certainly aren’t forced to do so, but the idea that an MD will be wealthy is a misperception. When you reduce his pay to an hourly rate, you’ll find that the educator that makes $60k a year makes more. ”
Wow, did I just hear that!
First, I doubt that a new MD pratitioner would start a private practice right off the bat in light of Hospitals, HMO’s private practice partnership. But for the sake of your concern, let’s say it is and I’ll just have my pediatricians to go by and see where’s the financial reward in going private. He runs a practice with at least four other MD’s (as can be seen since all the names are listed on the door), well my doctor (non-baby type so malpractice is less than 100K) probably books an appointment every 15 mins or about 30 appointments a day. Guess what, notwithstanding immune shots or special situations, the insurance bill is $185. You do that 30 time a day and (30*185) = 5,550 in fees a day and about 20 days average is 122,100 a month, four full time doctor and revenues are up to 488K a month
All that costs are leveraged with other doctors, say you have to hire 10 assistants, receptionist, billers to assist the doc and handle the paperwork and mailing @ 2,500 a month, the monthly expense is
Salary 10% 4000 = 40,000 a month

Rent = 10,000

Insurance = 50,000

Medical equipment/lease = 50,000

Other expense/overhead = 50,000
expenses 200K

revenue 488K

Equity per month 228K a month

4 partners 57,000 a month per partner or 684K equity per year per partner.
now, there are a lot of assumptions about revenues and expenses, but doctors who run their practice expertly know how to maxamize their time into $600-$800 of billable work and should easily be making $200-$300 an hour running their own practice. Afterall, this is ultimately the reason why people choose to go private over doing salary work anyway.

As someone who used to do medical office management software and medical office management consulting work I can tell you your expense numbers are way, way off to the low side. If you can hire medical coders for 2500 a month then you have found the key to great personal wealth. Open a coding business today, don't hesitate. On the revenue side, as several people have pointed out, the insurance billed amount is a meaningless number. It's just part of the game of negotiating with carriers. What is paid is always a lot less.

Doctors make damn good money, but they more than earn it. It's more than fair compensation for 12-17 years of training, including 4-8 years of residency at 100+ per hours per week, racking up student loans for 8 years, giving up 8-12 years of retirement contributions while going to medical school and residency, being on call constantly, being called into the hospital at 2 am for 4 hours then going to the office all day, making life or death decisions frequently with poor or incomplete information knowing an error or even bad luck will land them in court with a gaggle of lawyers second guessing them.

Sure there are doc's out there making 500-600k. They are the guys who went to the brutal 6-7 year residencies, followed by 2-3 years of fellowship, followed by years of developing their skills and reputations. The vast majority of doctors, the bread and butter GP's and Ped's and OB people, are making in the 100's to low 200's. Like the man said ass, gas, or grass no one rides free. You want to give up another 4-6 years of your career you can earn a lot more.

I do think the docs who own medical related business and refer to their own business are in a very serious conflict of interest situation that is probably unethical. The highest cost of medical care is in area's where a lot of these arrangements proliferate. South Texas comes to mind. The lowest cost of care is were the doc's are employed by the hospital and the hospital manages costs carefully. Read up on the Mayo or Cleveland clinic sometime. The obvious question is why health care reform isn't based on these working models.

Medical school applications are way down. If it's such easy money for an easy life then apply. Otherwise don't complain. Talk is cheap.

Why do you want to talk about Germany? Do you want to live in Germany?

Germany is a parallel trial of government policy. We can analyze what they're doing right and wrong and synthesize policy changes for our own, differing, national socioeconomic experience.

All things being equal this might be an interesting avenue for comparison. However all things are not equal. For example how can you compare a country who spends a massive portion of GDP on war and military occupation to one that spends only a tiny fraction on military? How can you compare the country where most medical advancements are made to anyone else who is riding on our coatails? How can you compare the country with the largest GDP to one with a GDP a quarter of the US? What gave US the largest GDP, perhaps lack of socialized medicine for one? How much higher would Germany's GDP be if it had lower taxes/socialism?

I find your comparison of apples and oranges to be a distraction at best. Arguing that Germany can afford their welfare state (at least for now) so we should expand ours too is asinine.

And lets not forget that Germany is a competing country. It has different form of government, offering an alternative to ours. Why would we want to copy them? There is already one Germany do we need another? People who like it should try living there. Is that what made America great, copying Europe?

AdHominem says

How can you compare the country where most medical advancements are made to anyone else who is riding on our coatails?

The coattail argument is rather bogus. Big Pharma spends 3X feeding the fat compared to R&D. Read any income statement, let's take GSK:

Topline $28B
COGS $7B
SG&A $9B
R&D $4B
Tax $2B
Shareholder profit $5.7B

Germany isn't riding on our coattails wrt drugs. We're just getting screwed sixways from Sunday.

Is that what made America great, copying Europe?

Pretty much, yes. We were burning witches and busy clearing forests while Europe had its Enlightenment. Adam Smith, Thomas Paine, and the pre-Revolutionary French milieu all had their impact on the social development of the colonies and nascent US.

It was the British Industrial Revolution we copied and accepted lock, stock, and barrel, and then built from there.

Then when things got wacky in the Gilded Age it was the Bismarckian social reforms and the British Liberal movement that inspired the Progressive era reforms of the early 20th century.

If you want to look to systems we can learn from, you've got to look at Europe state socialism, since going the otherway just results in the economic destruction of oligarchy and kleptocracy of the third world.

Middle classes can only exist where the state reigns in the predations of the upper class and provides ladders for the lower classes.

AdHominem says

And which German created drugs are on the top 100? Any in the top 200? Hmmn, their socialized medicine and overly regulated economy doesn’t exactly attract the top investors and bring the most innovation does it?

Perhaps you've heard of Bayer, or Merck, if not Boehringer Ingelheim. What do you mean by top 100? Over the counter volume? Prescription volume? Quality? New drugs?

?????

Bayer is #3 ranked worldwide.

Germany is well-respected for their engineering skills as well, some people I know prefer German products over Japanese, particularly for cars.

Oh wait I forgot USA USA USA!

AdHominem says

Are you talking about our great Federal Reserve bank and the host of welfare programs that are set to go bankrupt?

Nothing a few tax raises back to Clintonian if not Nixonian levels can't fix.

Yes, socialism excels at bringing out the best in these things. It must have been socialized medicine that enabled the Industrial Revolution right?

Your railing against teh socialism is rather content-free and on the order of paranoia or something. The UK and Germany both partially socialized their economies prior to WW I -- in response to even more radical big-S Socialists who really wanted to bring private enterprise under the heel of the State.

There are two kinds of socialism. The shitty kind like under Pol Pot and the kind that Eisenhower/Nixon-era Republicans would recognize and not necessarily oppose. The French, Germans, and the rest of the Eurosocialists operate towards the latter end of the spectrum.

Are you trying to tell me what to do? I thought this was a free country. Do you want to give me any other orders captain?

No, you're free to remain your special snowflake self. Don't ever change.

How about we look at USA pre 1913. Yes that is right Pre-Fed. It was a good time.

No it wasn't. The emergent industrial economy of the late 19th century was a continual series of monetary and economic boom/bust cycles.

Life sucked for tens of millions of Americans, and it was only thanks to the Homestead Act and the millions of productive land available for the taking that the economy grew and prospered as it did.

The problem was a great imbalance between labor and capital, what the railroad gaveth the railroad barons took away.

William Jennings Bryan was the teabagger of his day. He got pretty far until coopted by the Democratic establishment under Wilson.

But if by ladders you mean free medicine, housing, and all the other necessities of life, you should live in the mobile home park I grew up in full of families just living off your dime.

Not free, just government-run insurance and financial aid such that everyone has the resources to become and remain a productive member of society. We're an immensely productive people but anyone with a passing understanding of history realizes that free market fundamentalism is suboptimal compared to the mixed economy the US established and grew under ca. 1940-1980.

The economy ran off the rails somewhat in the 1970s thanks to Vietnam, going off the unsustainable foreign gold standard, necessity to weaken the dollar and the associated oil shocks, granted.

Vincente, don't get me wrong, the Germans can make a good product. Hey, if it wasn't for us they probably would have taken over the world. Of course we are the fourth Reich dressed up in the guise of bringing democracy to the world.

And in many ways America is not just the New England it is the New Bavaria as well (english edged out german when we voted on a national language). Politics aside of course.

Well, we agree on most things Troy, so I guess the biggest difference is that I never called you a snowflake.

Troy says

government-run insurance and financial aid such that everyone has the resources to become and remain a productive member of society.

or a freeloader

AdHominem says

And can I opt out?

Well because it's YOU.... not only no but HELL NO!

Anyone else feel like they're changing diapers here?

Nomo, you always make me laugh.

Vicente says

AdHominem says

And can I opt out?

Well because it’s YOU…. not only no but HELL NO!

Ah yes, dictatorship! Hail Vincente! King of .....

AdHominem says

Ah yes, dictatorship! Hail Vincente! King of …..

I was making a feeble attempt at Ad Hominem. Now I'm a sad panda you didn't like it.

Vincente, to properly use Ad Hominem you need to actually attack the credibility of the witness, usually because you do not want to acknowledge that you are standing on thin ice with your own warped views. Ellie and Nomo are good at it. It is their bread and butter. In fact it is just about all Ellie is good at and Nomo does it just for fun, though as he mentioned earlier we agree on 99% of things so he does it just for fun too. My response of Ad Hominem is therefore reserved for those who envoke it first.

But thanks for playing it makes you feel cool to be part of the gang puttin' down the guy who is different doesn't it?

Oh, my gawd! I knew it! You think I'm COOL!

WTF is "envoke?"

http://www.glennbeck.com/content/articles/article/198/36618/

I don't usually like Krugman, but he had a good take on GOP bait-n-switch tactics.

The conservative answer, which evolved in the late 1970s, would be dubbed “starving the beast” during the Reagan years. The idea — propounded by many members of the conservative intelligentsia, from Alan Greenspan to Irving Kristol — was basically that sympathetic politicians should engage in a game of bait and switch. Rather than proposing unpopular spending cuts, Republicans would push through popular tax cuts, with the deliberate intention of worsening the government’s fiscal position. Spending cuts could then be sold as a necessity rather than a choice, the only way to eliminate an unsustainable budget deficit.

So, lacking the political directness to tackle the SPENDING problem head-on, this misdirection has benefitted them NOW. They probably delude themselves they will be the recognized adults in the room after the crackup-boom. Most historical currency and deficit crisis though, just advance the whackiest elements not the ones who thought they'd be in position to profit.

The Bankruptcy Boys

Adhominem says: "I NEVER said raising minimum wage causes layoffs. It does however cause unemployment by reducing the amount of employees that a business will HIRE. Lower the minimum wage and I guarantee more people will have jobs."

The minimum wage has more or less been undermined by inflation to the point where few employers would bother offering jobs for less. At least to legal workers. Which makes small businesses that engage in such practices little different than chemical companies that cut back on costs by dumping asbestos and PCB"s into the river. Hey! You're saving 10 cents a can on bug spray! Quit whining!

In the beginning of change, like now, true patriots are ridiculed, hated and scorned. Career politicians and their supporters claim that criticism of government policies are dangerous to the country and label critics as subversives...even "terrorists".

Rebels, traitors and enemies of the state were terms used to describe American patriots by King George III.

It's funny Honest Abe is your nickname. After all your namesake put down a secession/rebellion by people that considered themselves "patriots" and that Washington DC was no longer their legitimate government. Lincoln seemed pretty liberal/progressive, which makes it more incongruous.