patrick.net

Doctors, hospitals, insurance companies, healthcare attorneys, and pharmaceutical companies,etc. are all sucking from the same income pool. Your monthly premium.

beershrine says

Doctors, hospitals, insurance companies, healthcare attorneys, and pharmaceutical companies,etc. are all sucking from the same income pool. Your monthly premium.

Not true. They are sucking at the Medicare teat. The changes to the Medicare Advantage program are a long time coming, because the providers have made huge profits from the subsidies the program provided.

beershrine says

Doctors, hospitals, insurance companies, healthcare attorneys, and pharmaceutical companies,etc. are all sucking from the same income pool. Your monthly premium.

Most medical care in the U.S. is paid by government: Medicare, Medicaid, and other programs. Your monthly premium, though large and growing, is largely wasted, and in any event pays only a fraction of total spending.

Rin says

despite the fact that there are intelligent and hard-working scientists and engineers who can score well on both the MCAT and USMLEs.

You use the fact that people can score well on MCATs as an argument against high salaries? This is absurd.
The MCATs are just the first step into getting into medical school, let alone completing residency, and then actually working as a doctor. Would you base PhD salaries based on how well most people could score on the GRE's? Or lawyer salaries based on how well others can score on LSATs?

Rin says

Next, if so many doctors are fed up with 60+ hour work weeks, have they ever heard about 'moonlighting'? There's enough demand for MD services that doctors can work 3 days per week and still earn a $100K.

DO you even know what moonlighting means? When most doctors moonlight, they are working a second job after their primary job, hence the reason it is called moonlighting. Thus moonlighting is not a solution to avoiding a 60+ hour work week as you suggest, since if you are moonlighting you are working a second job. Even if a doctor works 3 days a week "moonlighting" as you suggest, its most likely about a 40 hours/week, since most doctors work 10-12 hours a day. Hence 100k is hardly much money considering a full 40hr work week. Do you really think 100k is that much money? I can list a page of different profession who can make 100k, most of them without the amount of education, hours worked, level of responsibility as a doctor.

Rin says

If you're an ordinary engineer [ chemical, mechanical, biomedical, electronics ], chances are that you'll be a full time W-2 or contract 1099 full time employee with little leeway, during weekdays, to do your own thing. And for that regimentation, all you get is a salary from $65K to $110K, and as soon as you're in the $100K category, MBAs will look for ways to lay you off and send your work to a cheaper cost center. Only in some sectors of IT, can one consult for half-time for half-pay. But the price for that is earning less than $50K, not good if you're building an egg's nest.

Sounds like you are bitter about your profession, hence why you are trying to minimize another profession.

Rin says

First of all, I never said it was easy. Any science and engineering person knows that knowledge-based work takes effort and determination.

You are right, its not easy.. and you would actually never know how hard it is unless you go through it. In addition, I find it funny how you always refer back to engineering in your threads. You clearly have a chip on your shoulder...

Rin says

Thus, losing 10 years of income means nothing if one's unemployed anyways.

If you are complaining about high doctor salaries, shouldnt you consider the 10 years of lost earning potential in addition to 200k in debt in becoming a doctor?

Rin says

But as a former engineer, that's a lame way to spend one's retirement years. I'd rather be actively seeing patients (even if it's moonlighting twice per week) and doing my own research, since I won't be needing to carry a grant to do so.

Yes, why dont you just go to medical school and do that and stop complaining and whining about other people's salaries. Do it... if you can. Somehow I doubt you will not have the patience, determination to pull it through however... you will find that engineering is not medicine, contrary to the multiple comparisons you tried to make in your previous threads.

Meccos says

If you are complaining about high doctor salaries, shouldnt you consider the 10 years of lost earning potential in addition to 200k in debt in becoming a doctor?

Again the defensive use of self-inflicted past suffering to justify current compensation from others, even though the past suffering is not the patient's fault and confers no benefit upon the patient. "We chose to suffer, so now we own you and have a right to overcharge you, and you are required to pay us whatever we say, and you're not allowed to take care of your own health." Plus now a counter-attack on engineers, of all people.

BTW, there is a significant mismatch between the amount some doctors collect, and the amount the public are required to pay. A lot gets lost in the mandatory insurance system and the administrative levels, as others have pointed out. So, some of this disagreement results from perspective: patients are paying a lot, but many doctors aren't getting a lot. The disparity is particularly wide in emergency care, where hospital charges are enormous and the amount actually passed through to doctors is often small. But emergency care is less than 10% of total spending, so when people talk about how much is paid, more than 90% is in non-emergency settings.

Personally, I would rather see real healthcare reform based on engineering, expert systems, and at-home devices, instead of the mandatory entrenchment of the existing allopathy and its gatekeepers. Every pharmacy sells at-home devices so you can check your bp, pulse, temperature, weight, and height as often as you like and buying them costs less than a single doctor visit. It isn't necessary to pay a physician for tests you can do at home; the technology has advanced like the digital camera, and yet we're mandated to pay for the equivalent of film and old-fashioned processing. Computerized stethoscopes have been shown to outperform human doctors at detecting certain conditions. If we didn't have the mandatory insurance-driven system, costs could be reduced substantially with probably better results.

But that's just it. Allowing free choice in a free market, where new technology can compete with the existing models, would result in the existing MDs possibly not extracting the same rents in compensation for their past suffering. MDs say they sacrificed to get where they are, and I say (1) I didn't ask them to do that, and (2) I'd rather take control of my own health instead of being treated like a passenger in their revenue-maximizing system. Yet, they do not understand such "convoluted" reasoning - because, as Upton Sinclair said, "It is difficult to get a man to understand something, when his salary depends upon his not understanding it."

Mecco and others, you keep insisting that alternate science/engineering persons can't do medicine. Why did the Univ of Miami then offer this 2 yr MD program for PhDs in sciences/engineering in the 70s and 80s?

http://www.ncbi.nlm.nih.gov/pubmed/20354390

So it did exist. Next, you ask if I'm bitter, etc? Yes, I am. And here's why ... today, I work for a hedge fund and I earn a ton of money. Yes, I should be thumbing my noses at you and others, however, I'm clearly aware of the fact that this is 'Money For Nothing', which I why I never bought into Romney's spiel about the well off, being jobs creators, as a default condition w/o question.

I'm well aware of my experience of being a chemical engineer/applied chemist, working 12 hr days for a fraction of my current pay, but yet, society thinks of me today as an immaculate winner because I bring home the bacon. Back then, I was simply a cog in the MBAs' cost centers, always expendable. Who wouldn't look back and feel a sense of angst towards that.

For me, it's those who contribute, regardless of his/her compensation, that are *the winners* which is why I reject MBAs so vehemently. And yes, scientists and engineers have been contributing extensively, to the success of the practitioners of medicine. Just look around you, all the equipment including scanners, life support systems, drug delivery mechanisms, stents, pharms, etc, were once invented by scientists and engineers. Would you really be able to do your work without them?

But enough of this, as it's clear that we're at an impasse. I'd brought up this subject to get people talking about medicine and the fact that it's a waste to have 4000+ NASA engineers (and others) unemployed or underemployed, working for Home Depots, vs re-training them for careers as MDs, PAs, Nurses, Pharmacists, or whatever. Personally, it doesn't affect me at all, as I'm already well off and soon, will have no problems paying tuition for any overpriced schools but I'm thinking about others, who aren't so fortunate.

Facebooksux says

First off, physicians are not overpaid. In fact, GP's are grossly UNDERPAID for the amount of work they have to do.

To be fair, just about everyone in every field declares them self underpaid.

The truth is that just about everyone in America is overpaid when you consider we live in a global economy. Perhaps relative to your neighbor or another state you are underpaid and overworked, but leave America and you'll see just how good we have it here.

curious2 says

Again the defensive use of self-inflicted past suffering to justify current compensation from others, even though the past suffering is not the patient's fault and confers no benefit upon the patient. "We chose to suffer, so now we own you and have a right to overcharge you, and you are required to pay us whatever we say, and you're not allowed to take care of your own health." Plus now a counter-attack on engineers, of all people.

Wow talk about putting words into people's mouths. Did anyone really say any of this? No doctor blames the patient for their past suffering...I find it funny how you can twist words.
This is not a defensive use of self-inflicted past suffering. However whenever you consider pricing anything, including a salary, you have to take into consideration the cost to produce something, including a profession. Clearly if something or someone could be produced cheaply and quickly, it would be hard to justify a high cost. However if something was expensive and took long to produce, then a higher cost can be justified. Why can a buggati veyron sell for 2 million while a toyota camry sell for 20k? Similar principle. Isnt the whole purpose of this thread to see how a salaries can be justified? If so, why cant the argument that many years of training and thousands of dollars are required to train a doctor be used to justify the pricing for their service? We all know the salaries for the most part correlate to level of education.

BTW doctors dont set pricing, medicare sets pricing which is used by all insurances companies when deciding how much to pay doctors. may want to get your facts straight.

curious2 says

BTW, there is a significant mismatch between the amount some doctors collect, and the amount the public are required to pay. A lot gets lost in the mandatory insurance system and the administrative levels, as others have pointed out. So, some of this disagreement results from perspective: patients are paying a lot, but many doctors aren't getting a lot. The disparity is particularly wide in emergency care, where hospital charges are enormous and the amount actually passed through to doctors is often small. But emergency care is less than 10% of total spending, so when people talk about how much is paid, more than 90% is in non-emergency settings.

YOu are right. doctors make up about 8.5% of all healthcare costs in this country. Much disdain for doctor salaries come from the fact that people pay a lot of money for services rendered. Unfortunately doctors see only a fraction of that money.

curious2 says

Personally, I would rather see real healthcare reform based on engineering, expert systems, and at-home devices, instead of the mandatory entrenchment of the existing allopathy and its gatekeepers. Every pharmacy sells at-home devices so you can check your bp, pulse, temperature, weight, and height as often as you like and buying them costs less than a single doctor visit. It isn't necessary to pay a physician for tests you can do at home; the technology has advanced like the digital camera, and yet we're mandated to pay for the equivalent of film and old-fashioned processing. Computerized stethoscopes have been shown to outperform human doctors at detecting certain conditions. If we didn't have the mandatory insurance-driven system, costs could be reduced substantially with probably better results.

No one is forced to go to the doctors. If more people were like you, demand for doctors would decrease and perhaps the law of supply and demand may drive down doctor salaries. HOwever as I mentioned before doctors are 8.5% of healthcare costs and probably wouldnt make much of a dent in terms of costs. IN addition, being in the profession myself, I can guarantee you results would not be better. If you truly think so, i would urge you to try it. Next time your wife or mother has a lump in her breast, lets see you do your own history,exam,testing, diagnosis and treatment. Your clear lack of knowledge of medicine makes your statement here quite absurd...

curious2 says

Allowing free choice in a free market

YOu have free choice in a free market. No one forces you to go the doctors, no one forces you to go to a specific doctor and no one forces you to go to a doctor that you feel may charge you too much. Well.. you had the choice, not so much with obamacare...

Meccos says

HOwever as I mentioned before doctors are 8.5% of healthcare costs and probably wouldnt make much of a dent in terms of costs.

http://www.washingtonpost.com/blogs/ezra-klein/post/how-1-in-health-insurance-gets-spent/2012/01/04/gIQAuzDmaP_blog.html

says 28%

>Well.. you had the choice, not so much with obamacare

as the law stands now, if you don't like health insurance, just take the penalty/tax, and make sure the IRS never owes you money, since that's the only way -- now, at least -- that the IRS can beat the penalty/tax out of you.

Rin says

Mecco and others, you keep insisting that alternate science/engineering persons can't do medicine

I never said other people cant. Plenty of people I know had other profession before going into medicine. HOwever you insinuate that many if not most people can, which is not true. Having a basic science background means really nothing. Becoming a doctor does not require a lot of intelligence. Rather the difficulty lies in the decade long process of sacrifice, persistence, dedication and delayed gratification, which is the part that most people cannot do.

In addition, the study that you quote took students that already had PhD or some other degree. Medical school is divided into 2 years of basic science and two years of clinical rotation. Since these students already had their basic sciences, they were able to graduate in two years because all they were required to do was the clinical rotations. The results of this study basically showed that students with basic science degrees can graduate quicker. Unfortunately this is pointless since you have to spend years to get a phd anyways. BTW many medical schools have a combined 6 year MD-PhD degree already. IN addition, this studies does not discuss residency, which is where you really learn EVERYTHING. ask any doctor and they will tell you that residency is what is important. Medical school just prepares you for residency, just like high school prepares you for college.

Rin says

Next, you ask if I'm bitter, etc? Yes, I am. And here's why ... today, I work for a hedge fund and I earn a ton of money. Yes, I should be thumbing my noses at you and others,

Clearly you are bitter, we all knew that. Perhaps we should be asking whether you are overpaid. But in all honesty I dont care.

Rin says

Back then, I was simply a cog in the MBAs' cost centers, always expendable. Who wouldn't look back and feel a sense of angst towards that.

You chose to go into the profession... no one to blame but yourself. Trying to minimize someone else's profession without any merit doesnt make anything better. HOWEVER if you did want to talk about big pay checks, why didnt you focus on california highway patrol officers making 300K with AWESOME benefits?

http://www.sacbee.com/statepay/

Rin says

For me, it's those who contribute, regardless of his/her compensation, that are *the winners* which is why I reject MBAs so vehemently. And yes, scientists and engineers have been contributing extensively, to the success of the practitioners of medicine. Just look around you, all the equipment including scanners, life support systems, drug delivery mechanisms, stents, pharms, etc, were once invented by scientists and engineers. Would you really be able to do your work without them?

I appreciate everyone who contributes. I appreciate everyone at the hospital down to the custodians and the cafeteria workers. However, this thread was never about appreciating who contributes was it? Rather it was an attack on doctor's salaries.

Rin says

But enough of this, as it's clear that we're at an impasse. I'd brought up this subject to get people talking about medicine and the fact that it's a waste to have 4000+ NASA engineers (and others) unemployed or underemployed, working for Home Depots, vs re-training them for careers as MDs, PAs, Nurses, Pharmacists, or whatever. Personally, it doesn't affect me at all, as I'm already well off and soon, will have no problems paying tuition for any overpriced schools but I'm thinking about others, who aren't so fortunate.

You are right. I agree that is sucks to have these scientists unemployed. However if that was your point, you clearly did not express it well... at least not until this very last paragraph.

Rin says

Personally, it doesn't affect me at all, as I'm already well off and soon, will have no problems paying tuition for any overpriced schools but I'm thinking about others, who aren't so fortunate.

Well I wouldnt say tuition is overpriced. Its not cheap to train a physician. BTW, I wasnt fortunate to have money to pay for medical school, but most doctors are not so fortunate. 200k loans are not unusual. it sucks but we all do it...

Bellingham Bill says

Meccos says

HOwever as I mentioned before doctors are 8.5% of healthcare costs and probably wouldnt make much of a dent in terms of costs.

http://www.washingtonpost.com/blogs/ezra-klein/post/how-1-in-health-insurance-gets-spent/2012/01/04/gIQAuzDmaP_blog.html

says 28%

>Well.. you had the choice, not so much with obamacare

as the law stands now, if you don't like health insurance, just take the penalty/tax, and make sure the IRS never owes you money, since that's the only way -- now, at least -- that the IRS can beat the penalty/tax out of you.

YOu got your stats from one insurance company, which is hardly credible especially when their argument is that majority of their money is spent on actual care. These links below totaled the entire cost of healthcare costs for the country. I would say these are more accurate.

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

http://www.healthcarefinancenews.com/news/physician-compensation-among-lowest-western-nations

chanakya4773 says

The supply of doctors has been artificially constricted by the Doctors lobby. its one of the most powerful lobby. Its very difficult for doctors from other countries to come to US for practice.

Chanakya,

I am not sure where you got your information from but this is not completely true. Although you are correct in that the number of doctors has not risen significantly, they certainly have not been artificially constricted by the "powerful doctor lobby", which I assume is a reference to the AMA. In fact there have much several studies funded by the AMA to investigate barriers to increases in medical school class sizes. In addition, due to physician shortages, there have been efforts made since the 1970 to increase the number of physicians. In the 70-80's many foreign physicians were recruited, which is why you currently see so many physicians of foreign origin in their 60's. In addition there have been much efforts to actually increase medical school sizes.

http://www.medicalnewstoday.com/releases/30270.php

http://www.remappingdebate.org/article/recruitment-foreign-physicians-zero-sum-equation?page=0,2

Believe it or not, the nursing unions are much more powerful than any doctor lobby, hence the reason why doctors are losing much ground in terms of patient care. You now have nurses who practice independently of doctors. They are able to see and treat patients without doctor supervision, prescribe medications and even perform anesthesia on patients solo. Surely if the doctor lobby was so strong, you would not see any of this.

chanakya4773 says

Its quite surprising that the whole discussion is US is not on the topic of rootcausing the issue as shown in the graph above but its on how we redistribute the high cost.

That surprised me too until I figured out that the policy discussion is dominated by lobbyists and politicians who get a cut of the $ and commercial newscasters who depend on advertising revenue from the same industry. Watch any national newscast (ABC, CBS, NBC), count the commercials, and see whom they're for. I find a clear majority are from PhRMA, and half of those are for drugs that legally require a prescripton ("Ask your doctor!"). Again it goes back to the difference between book smarts and street smarts.

Meccos says

YOu have free choice in a free market. No one forces you to go the doctors, no one forces you to go to a specific doctor and no one forces you to go to a doctor that you feel may charge you too much. Well.. you had the choice, not so much with obamacare.

You are right that Obamacare reduces choice, but you are mistaken in saying there was a free market before Obamacare. The 1951 prescription mandate made prescriptions mandatory for most drugs. People can't even buy contact lenses without a recent prescription, though they are free to buy firearms and fire blindly. (See comment above about gatekeepers.)

Meccos says

BTW doctors dont set pricing, medicare sets pricing which is used by all insurances companies when deciding how much to pay doctors.

Thank you for pointing out the importance of Medicare in setting prices. To be sure that we have our facts, can you please elucidate, exactly who sets Medicare prices, and who owns the insurance billing codes that will be used in ObamaCare? To guide your research, I'll offer you a hint: they are an Association that endorsed ObamaCare, and their members tend to share a specific degree, though admittedly they do not represent the majority of doctors (only around 10%).

curious2 says

Meccos says

BTW doctors dont set pricing, medicare sets pricing which is used by all insurances companies when deciding how much to pay doctors.

Thank you for pointing out the importance of Medicare in setting prices. To be sure that we have our facts, can you please elucidate, exactly who sets Medicare prices, and who owns the insurance billing codes that will be used in ObamaCare? To guide your research, I'll offer you a hint: they are an Association that endorsed ObamaCare, and their members tend to share a specific degree, though admittedly they do not represent the majority of doctors (only around 10%).

Once again, why not try being an adult and put the facts out along with your analysis and have an actual discussion.

Not that facts matter to you but I'll try. There are two sets of codes, cpt which defines service levels and icd9 which defines diagnoses. Both are an integral part of medical billing. You have to have both and get both right to get paid. Since the icd9 (soon to be 10) are owned and copyrighted by the world health organization I'm going to assume you are talking about the cpt codes.

Cpt codes are copyrighted by the AMA and developed by a committee. Cpt codes are service codes, not billing amounts. There is also the Resource-Based Relative Value Scale codes which are a scale to give differentials for different levels of expense. Physicians get more in NYC than in Moses Lake.

I think what you are groping for is the medicare fee schedule. That's set by CMS (Centers for Medicare and Medicaid Services) which is the federal body responsible for administering Medicare and Medicaid programs. The base schedule is run through the cpt codes for the service level and then rbrvs to get an actual payment amount. http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/FeeScheduleGenInfo/index.html

The AMA defines the service and the CMS sets the Medicare and Medicaid rates for that service. Hope that clears things up for you. It's not some giant conspiracy.

chanakya4773 says

The only person i think who sees through this B.S is ron paul.

I think the "insiders" all know the numbers, too.

http://nation.foxnews.com/bill-clinton/2011/05/25/bill-clintons-private-words-paul-ryan-caught-tape

But the reality is just pretty scary and is not something that can be honestly talked about.

Who wants to hear that their taxes are going to have to DOUBLE?

Who can PAY double the tax burden?

Theoretically, it's possible, but geting there from here is not something the politicians want to tackle.

bob2356 says

It's not some giant conspiracy.

http://en.wikipedia.org/wiki/Cartel however . . .

bob2356 says

try being an adult... Not that facts matter to you.... It's not some giant conspiracy.

Although your sarcasm doesn't help your point, I appreciate your detailed and informative post including an actual link. As for whether it is a conspiracy, you might consider the opinion of non-AMA doctors who contend it is illegal. Some people conflate "AMA" and "doctors," for example when the AMA endorsed Obamacare, but in reality 90% of doctors are not in the AMA. In any event, it certainly isn't market pricing, because there isn't a free market.

Meccos says

if something was expensive and took long to produce, then a higher cost can be justified. Why can a buggati veyron sell for 2 million while a toyota camry sell for 20k? Similar principle.

I understand the principle but respectfully you are applying it backwards, i.e. you are putting the cart before the horse. In a free market, price is based on value, i.e. how much customers are willing to pay, not cost of production. This is why you see the same item sell for different prices at different times and in different markets. The causal relationship between value and cost of production is, people invest in producing things that they expect to be able to sell profitably. Sometimes they are right, other times they are wrong. If nobody wants to pay $ 2 million for a Bugatti, then Bugatti will have to accept a lower price or go out of business. Bugatti employees cannot stand athwart the road and say, "You shall not pass until you buy our car at our price." No matter how much time and money Bugatti put into building their Veyron, it is worth only what customers are willing to pay, and those customers are free to buy something cheaper, or walk.

It is interesting that in medicine, Medicare pricing (outsourced to the AMA cartel) seems to have spawned a culture where otherwise intelligent people (Bob, Meccos) get basic causation completely backwards. Bob seemed sincerely to believe that increasing supply increases prices, even though the causation is precisely opposite: higher prices attract more supply.

chanakya4773 says

our health care system is like saying only cars which meet the standards/luxiury of buggati veryron can sell.

...and the standards/luxury of Bugatti Veyron are not even better for most people, even if they were available at the same price. If the Veyron were discounted to the same price as the Toyota Prius and Sienna, and setting aside resale value, many people would still choose the Sienna because it has more space and many would still choose the Prius because it uses less fuel. The Veyron is a more expensive car, but that does not make it an intrinsically better car, at least not for everyone. As noted above, Americans pay more than people in any other country, but our outcomes are not better, in fact they are worse than dozens of other countries where people pay less.

curious2 says

It is interesting that in medicine, Medicare pricing (outsourced to the AMA cartel) seems to have spawned a culture where otherwise intelligent people (Bob, Meccos) get basic causation completely backwards. Bob seemed sincerely to believe that increasing supply increases prices, even though the causation is precisely opposite: higher prices attract more supply.

That's interesting. I have no idea where you got that. I've been arguing time after time that area's the most doctors have the highest health care costs but the lowest doctors pay.

http://www.doctor411network.com/?option=com_content&view=article&id=55
http://www-958.ibm.com/software/data/cognos/manyeyes/visualizations/doctors-per-capita-by-state
http://www.statehealthfacts.org/comparemaptable.jsp?yr=92&typ=4&ind=596&cat=5&sub=143

5 states with most doctors (not in order)
expenditures per year pay for Gp Surgeon

NY 7600-10,300 137 185
MD 7600-10,300 155 166
NJ 7600-10,300 160 164
CA 5000-6400 164 222
MA 7600-10300 187 222

5 states with least doctors

ID 5000-6400 180 234
NV 5000-6400 180 233
OK 6400-6700 165 210
OH 6400-7600 163 222
IA 6800-7600 185 230

States with the most number of doctors per capita have much lower doctors pay than the states with the least number of doctors. Except MA which has Romneycare and surgeons in CA for some reason.

So doctors aren't "flocking", to use your word from a previous post, to the most expensive healthcare areas to make more money. They make less money in those areas. That also makes it hard to defend your assertion that a lack of doctors, because AMA constrains supply as per you, drives up health care costs. The area's with the least doctors have the lowest expenditures.

More desirable places to live attracts more doctors, not some giant macroeconomic conspiracy. Hard to believe but it's really just that simple.

bob2356 says

So doctors aren't "flocking", to use your word from a previous post, to the most expensive healthcare areas to make more money.

When did I ever use the word "flocking"? Sometimes I think the reason you dislike me so much is because your memory drifts so badly, you're shadowboxing a phantom that exists only in your own mind.

Nevertheless, it is true that people (including doctors) do tend to move to areas where they can make more money, rather than less. For example, highly qualified doctors from India want to immigrate to America, because they can make more money here, but very few American doctors want to emigrate to India, largely because they would make less. Supply goes to where the demand is.

chanakya4773 says

As a doctor you cannot just move from one state to another at your will. there are different "regulations" for different areas to practice medicine.

Of course you can move state to state at your will, who told you that you couldn't? Getting state licensing after the first time isn't difficult. I've done it for my wife 4 times. It takes a few hours of filling out forms is all. Practice isn't really different from state to state.

chanakya4773 says

now can somebody give me a no -nonsense big picture answer to why the following is happening?

I find it hard to believe this is actually a serious question. Can you think of anything being done today in medicine today that wasn't being done in 1947?

bob2356 says

Can you think of anything being done today in medicine today that wasn't being done in 1947?

For one thing, healthy people weren't being sold "preventive" C-T scans in 1947:

"What's new is that CT is being marketed as a preventive or proactive health care measure to healthy individuals who have no symptoms of disease. [There are] No Proven Benefits for Healthy People."

Meanwhile, in nearly all private sector fields, advancing technology has led to higher productivity and lower costs. Computers today can do all sorts of things they couldn't in 1947, yet in real terms they cost less.

curious2 says

When did I ever use the word "flocking"? Sometimes I think the reason you dislike me so much is because your memory drifts so badly, you're shadowboxing a phantom that exists only in your own mind.

I don't dislike you, I just dislike your tendency to make grand paranoid rhetorical statements that you can't back up. I agree with you the system sucks, one of the biggest reasons I'm an expat. I just find your perceptions of why the system sucks, where the costs really lie, and who is driving them is so out in left field that I can't believe it. I do notice that your holy trinity of evil (government/medicare, doctors/ama, pharma) is almost never joined by insurance companies and is absolutely never joined by lawyers. I suspect I know what you do and for who.

curious2 says

Nevertheless, it is true that people (including doctors) do tend to move to areas where they can make more money, rather than less. For example, highly qualified doctors from India want to immigrate to America, because they can make more money here, but very few American doctors want to emigrate to India, largely because they would make less. Supply goes to where the demand is.

I can't believe you have the nerve to say I never admit to being wrong, (which I actually do pretty frequently) then post this. That is so lame I can't believe it. You can't be serious. So you are saying that for all your posts about supply and demand you were actually talking about foreign docs coming to America not American docs working in America? That's the causation I'm getting backwards? I'm the one "fishing for ad hominem targets"? I don't think so.

Give it up. I've given you charts, links, tables, everything you hold dear. Most doctors prefer to live in desirable areas even if they make less. Where there are more doctors than needed they drive up the cost of health care. There's lots of scratch my back, I'll scratch yours. It's especially bad in area's where docs are allowed to refer to facilities they own. A practice that is such a conflict of interest I can't believe any state allows it. Go back and read the Atlantic article again, that's just what it says. Supply and demand doesn't overcome human nature. My mind hasn't drifted, I've said this from the beginning.

I'm fine with phasing down average Doctor's salaries... BUT, then you also have to lower the bar for entry to Med School, lower the cost of med school, lower the length of Med School.

Maybe have a Jr. Doctor... Sr. Doctor.. maybe a Jr. Doctor only needs an additional 2 years.. like a masters degree. And they can work as General Family doctors for lower pay.

The on the job training.. .REsidency for Doctor's is the most important part of training. If you want an average doctor.. you pay less... If you want a GREAT Doctor... you pay more.

curious2 says

Can you think of anything being done today in medicine today that wasn't being done in 1947?

For one thing, healthy people weren't being sold "preventive" C-T scans in 1947:

I've agreed with you time and again that medical care shouldn't be marketed. People don't need preventive c-t scans for anything. People that are sick or very sick need medical care. If it exists today but didn't exist in 1947 then it's more expensive. What's your point?

curious2 says

Meanwhile, in nearly all private sector fields, advancing technology has led to higher productivity and lower costs. Computers today can do all sorts of things they couldn't in 1947, yet in real terms they cost less.

No businesses were using computers in 1947 so no matter what the cost of a computer is today it's higher than 1947. What did a pc cost in 1947? laser printer, fax machine, cell phone, digital phone system, pda, server for the office network? They didn't exist, no one bought them. Now they are de rigour in very large numbers for all offices. Are they more expensive today than when they didn't exist or not?

Be interesting to see what an average office spent on equipment in 1947 vs today. Some typewriters, analog phones, and adding machines vs a full on office of today. You might find the chart above isn't so far off.

Doctors ARE overpaid including the hospital, medical centers & pharmacuetical companies they work for.

You dumb degenerate cockroach peasants need to stop denying the truth.

My grandfather John D. Rockefeller got together with his very close business pal and later his in-law... Andrew Carnegie to shutdown natural cures and remedies while only pushing expensive pharmacuetical treatments.

To produce pharmacuetical drugs, you need oil.

My grandfather did this by hiring the best lobbyists money could buy at the time. They established the AMA and required medical licenses to practice medicine which can only be obtained through unneccesary long schooling with brainwashing misinformation and propganda that will teach a doctor to only know how to prescribe pharmacuetical drugs... Not cure.

There is no profit in cure. There is also not much profit in direct mass murder.

But there is MUCH MUCH profit in indirect gradual mass murder in the form of "medical treatment".

You sap idiots slaves need to stop thinking of the mass majority of doctors (pretty much 99.99%) as so highly, as if they deserve so much god damn respect because they care so dearly to cure your illnesses and they know so much.

They know nothing except how to make us white collar old money financial scumfuck crooks more fucking insanely WEALTHY!

Anyone that denies US doctors make a undeserved inflated salary is just a dumb degenerate cockroach peasant and a donkey-fucking bastard serf...

They many not make as much as their masters but they sure as hell aren't mother-teresa. We bribe these dirty new money yuppies with expensive dinners and fancy vacations.

They know full well that they are just as miserable like you peons and they only reason they got in this profession is so the wall street criminal scumfucks will flip them a few more nickels than the rest of the worthless pieces of shit.

Once doctors and other medical professionals mass murder the population through poisions veneering as "medicine"...

We will also dispose of these self-deluded worthless piece of shit pawns...

Doctors are just new money pawns to be equally tortured to death once they prove to no longer be of any use...

It makes me chuckle when people respect the majority of them (only a few should be worthy of your respect)... Many doctors also believe themselves to be in the good old boys club with us white collar financial scumfuck robber barons... hahahaha

ALL OF YOU FUCKING DIE ALREADY INCLUDING DOCTORS ALONG WITH THEIR WORSHIPPING FANBOY COCK-SUCKERS!

bob2356 says

your holy trinity of evil (government/medicare, doctors/ama, pharma) is almost never joined by insurance companies and is absolutely never joined by lawyers.

Bob, your comment illustrates yet again that your distorting memory does a sad disservice to you and the discussion. I say it's sad because with links you ought to be able to overcome your defect, just as glasses and contact lenses enable nearsighted people to see clearly. You sound like someone who needs glasses (links) but refuses for reasons of vanity or pride or whatever to admit it. In this thread and elsewhere, I have repeatedly cited insurance (including especially mandatory insurance) as part of "the problem," and likened insurance companies to organized crime syndicates. And, I have yet again rebutted your false Republican talking point about lawyers and "tort reform". Nevertheless, you and Homeboy seem to view PatNet as an opportunity to vent your "warrior gene" fighting instincts, apparently too weak to step into a ring at your local gym so you fish for ad hominem fallacies as a way to attack rather than discuss. It is a real pity that the illuminating points of light in your comments are hidden under a bushel of strawman arguments and misplaced ad hominem attacks.

P.S. Two more links on what I've actually written about insurance, in addition to the links I fit into the text above:

curious2 says

Most medical care in the U.S. is paid by government: Medicare, Medicaid, and other programs. Your monthly premium, though large and growing, is largely wasted, and in any event pays only a fraction of total spending.

curious2 says

A lot gets lost in the mandatory insurance system and the administrative levels....

curious2 says

You are right that Obamacare reduces choice, but you are mistaken in saying there was a free market before Obamacare.

I never said there was a free market before Obamacare. The market pre-Obama care however was MUCH more free than post-Obamacare however.

chanakya4773 says

you can only reduce the price by increasing the number of doctors. there is no other solution.

I find it funny how people still focus on the cost of the physicians when considering cost of health care. Physicians make up about 8% of healthcare costs. Reducing this cost by 50% will not make much of a dent in costs...

curious2 says

hank you for pointing out the importance of Medicare in setting prices. To be sure that we have our facts, can you please elucidate, exactly who sets Medicare prices, and who owns the insurance billing codes that will be used in ObamaCare? To guide your research, I'll offer you a hint: they are an Association that endorsed ObamaCare, and their members tend to share a specific degree, though admittedly they do not represent the majority of doctors (only around 10%).

Yes Curious. THere is a conspiracy by the AMA and the doctors to set high payment plans. This must be the reason why physician payment schedules have been being reduced year after year after year. Perhaps you can find solid evidence to support your conspiracy theories instead of following the rest of the sheeps in thinking that doctors are the sole reason health care costs are high...

Meccos says

Physicians make up about 8% of healthcare costs.

Do you have a source for that? I keep finding numbers around 20% for "physician services:"

http://www.kevinmd.com/blog/2012/04/wasted-health-dollars.html

An issue is how much goes directly to doctors, and how much goes to other services that the doctors refer to (sometimes in exchange for kickbacks) or own. The biggest waste is in the insurance system though, including both actual insurance overhead and the billing coordinators that medical practices need to hire.

Issues with this thread include (1) there are bigger problems driving overspending and (2) it's probably more accurate to say physicians are inefficiently paid, with perverse incentives and little or no correlation between price and value.

chanakya4773 says

now can somebody give me a no -nonsense big picture answer to why the following is happening?

this thing is impossible to happen in free market.

THe graph you showed was an increase in medical care vs the price of goods. How does that relate to doctor salaries, unless you are assuming that the increase in cost of medical care is based solely on the increase in doctor salaries. Have you considered that the increased health care costs are a result of other increased cost structures?

curious2 says

but very few American doctors want to emigrate to India, largely because they would make less.

no one wants to move to India... did you think that people just dont want to live in India? would you want to live there?

Meccos says

did you think that people just dont want to live in India? would you want to live there?

I love the food :) Also medical care seems inexpensive, partly because they don't seem to require an Rx to buy drugs.

curious2 says

I have repeatedly cited insurance (including especially mandatory insurance) as part of "the problem," and likened insurance companies to organized crime syndicates. And, I have yet again rebutted your false Republican talking point about lawyers and "tort reform".

Obamacare is "mandatory insurance"....
insurance companies are not doctors...
so whats your point again?

curious2 says

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

http://www.healthcarefinancenews.com/news/physician-compensation-among-lowest-western-nations

Here are two links i posted earlier

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

http://www.healthcarefinancenews.com/news/physician-compensation-among-lowest-western-nations

the article you quote says 20% goes to doctors and other clinicians. Im guessing the other clinicians take up a lot of this as there are typically a lot more mid-level (non-doctor) providers than actual doctors themselves.

In addition, you should also take note of amount of money spent in overtreatment. This is classic defensive medicine, which many doctors are forced into due to the numerous frivolous lawsuits. I only mention this because you dismissed tort reform in earlier posts.