patrick.net

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.

curious2 says

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.

I agree food is great... but really? You really think people dont move there cuz the lower salaries? I doubt that is hardly in anyones mind when deciding NOT to move there...

Meccos says

but really? You really think people dont move there cuz the lower salaries?

Around the world people in every line of work tend to move to places where they can earn higher salaries. Why would doctors be somehow different from all other people in all lines of work?

Meccos says

I only mention this because you dismissed tort reform in earlier posts.

Not only dismissed, disproved. Bob and I have had this debate.

curious2 says

Around the world people in every line of work tend to move to places where they can earn higher salaries. Why would doctors be somehow different from all other people in all lines of work?

Unfortunately your argument was not that doctors would move somewhere for higher salaries. Of course people would move to another country if they got paid more. Instead, your argument was that doctors dont move to India cuz salaries are lower there, which is an entirely different argument. My argument was that there are PLENTY of other reasons why ANYONE would not move to India.

curious2 says

Not only dismissed, disproved. Bob and I have had this debate.

Funny how you take the quote of a couple people and think that it is disproved. The fact of the matter is that, there are tons and tons of frivolous lawsuits. Just look on daytime TV and you will see lawyers paying millions for TV ads to recruit clients. This is a cost to healthcare since eventually the cost of lawsuits are eventually passed to patients.

Meccos, if you are going to spout a myth from Faux News, you should at least give equal time to opposing views and some factual numbers. Decades of studies have shown that American hospitals injure 20% patients, but most malpractice does not result in litigation, and the share that does result in litigation amounts to only 2% of total spending:

The Medical Malpractice Myth

http://www.justice.org/cps/rde/justice/hs.xsl/8686.htm

How American Healthcare Killed My Father

http://www.medscape.com/viewarticle/503853

Malpractice Lawsuits Are ‘Red Herring’

Your myth is slightly irritating because certain people keep repeating it even though it's a red herring.

curious2 says

Meccos, if you are going to spout a myth from Faux News, you should at least give equal time to opposing views and some factual numbers. Decades of studies have shown that American hospitals injure 20% patients, but most malpractice does not result in litigation, and the share that does result in litigation amounts to only 2% of total spending:

I find it amusing that a liberals first instinct is to accuse someone of watching Fox news if they have an opposing view.
I also find it funny how you can make such a strong argument about doctor salaries being too high when it makes up 8% of health care costs, but dismiss cost of malpractice suits at 2-3% of health care costs. The fact is frivolous lawsuits add cost to healthcare. Even based on the articles you linked, if it comes to 2-3% of healthcare costs, that would equate to 40-80 billions dollars depending on what figures you read. Can you tell me 40-80 billion dollars is nothing?

BTW most malpractice suits do not go to litigation because they are either thrown out because they are outrageous or because it is more cost effective to settle. These costs are unknown and not calculated. In addition, most would argue that the true cost of defensive medicine is unknown and other costs such as the cost of malpractice insurance carried by all medical professionals, administrative costs, lawyer costs, lost work time are also additional costs not calculated into these figures. Regardless even at 2-3%, based on your figures, the cost are into the billions and billions of dollars.

btw, do you think your articles written by trial lawyers or quoting trial lawyers are really credible in making an argument on this subject matter??? linking articles do not really mean much, especially if they were produced by people with a clear bias

curious2 says

Your myth is slightly irritating because certain people keep repeating it even though it's a red herring.

So what exactly is "my myth" that you accuse me of? All i said are the quotes belowMeccos says

Funny how you take the quote of a couple people and think that it is disproved. The fact of the matter is that, there are tons and tons of frivolous lawsuits. Just look on daytime TV and you will see lawyers paying millions for TV ads to recruit clients. This is a cost to healthcare since eventually the cost of lawsuits are eventually passed to patients.

Meccos says

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.

So these things Ive said got your panties in a bunch?

Wow....this is old. Am an MD/PhD, worked in foreign countries and respect non-MD jobs: people work hard and compensation does not scale with "hard work" - this is nonsense. YES, we are handsomely paid as MDs in the USA, which is not true in Germany and other countries with better healthcare systems. It's the way the system is set up, it has NOTHING (I repeat, NOTHING) to do with how hard MDs work, how smart and dedicated they are, and the cost of education. The supply of MDs is low, the market is carefully controlled and the honoraries are extraordinarily high compared to other developed countries, except Netherlands and Australia that also pay high MD honoraries. Most of the world does FINE paying MDs normal wages, equivalent to that of professionals such as lawyers and engineers: that's the upper middle class in most of the world.

It's pure economics. If hard work and sacrifice paid well, Bangladeshi sweatshops would be full of 6-figure pay checks.

As for why the technology sector pays comparatively worse: US-based tech companies employ and reward handsomely engineers and scientists abroad. They can also easily bring foreign labor into the US, which can explain part of the decay in the salaries of most technology and manufacture sectors. So, the oddity in America is that engineers and other professions that are "equivalent to medicine" are severely undervalued. Plus, an MD is never out of a job, other careers are hit harder by unemployment. For the MD crusaders out there, who brag about their 1 billion hours per week and so on, try 6+ months of unemployment and see what it does to your mental health.

But keep in mind: MDs are not the crème of american society, just a niche of high-paid professionals that generated a "super upper middle class". Those salaries do not place MDs in positions of power and influence...

edit. To the MDs who give the "we deal with people's lives" argument, have you thought of becoming kidnappers? That argument violates basic ethical standard to be a physician: you cannot monetise a human life, that's what criminals do.

Rin says

can earn over $200K, as a doctor, in places like Des Moines Iowa, nevermind the big coastal cities.

More like 500-700k even for primary care