patrick.net

d3, >>I think the problem is over regulation A tetanus shot ended up costing you $2000, and you think the problem is OVER-regulation? I just don't get the logic behind this type of thinking.

The problem is that over regulation as scared of family practitioners. If you want to get a shot you are forced to go to an emerancy room which costs both them and you more money.

d3, still not getting it. Exactly what kind of regulation is it that "scares off" family practitioners, and how? Why are they seemingly less scared of becoming highly-paid specialists?

I also beleive over regulation would make regular doctor visits cheaper because doctors are currently forced to give a people with insurance huge discounts in there rates. It also costs doctors an arm and a leg for all of the personal and software required to deal with medical billing of insurance providoers. In order to make up the costs docters are forced to raise prices on every one else. If doctors had more power vs the goverment there would be compitition again. Doctors would only be able to charge based on there expenses and what people would be willing to pay them. Also being a good doctor is no longer rewarding because there is no monitary benifit any more. Keeping the goverment out and letting free market in could fix this. If the goverment wants to be involved; I think it should be limited only to subsidizing the costs for low income and for expensive emergancy proceedures.

Some Guy says

Does it not mean that the government controls the means of production?

No, it means that *EVERYBODY* owns the means of production. Socialism is when the government owns the means of production.

Some Guy says

d3 says

The problem is that over regulation as scared of family practitioners. If you want to get a shot you are forced to go to an emerancy room which costs both them and you more money.

Huh? What does government regulation have to do with a doctor being too busy to see you?

The relationship is fairly indirect, but it does exist. From my understanding, for Medicare and a lot of specific treatments ie vaccines, there is price setting that is in effect which prevent a doctor from refusing certain treatments and charging more than a set amount for that treatment. Doctors will often have to take loses to provide certain treatments. Also depending upon the area the doctor serves he may have even greater limits to what he is allowed to charge for certain treatments. This is what has been scaring doctors away.

Some Guy says

You are paying

It is true a doctor maybe charge what he wants, however the insurance and medicare are only obligated to pay a certain amount. For many treatment that amount is set below what makes it profitable for many practitioners to make any money off the treatments. Sometimes they are even forced to take a loss. Why would one spend 8 years in school to be a primary care doctor when you can make more money in most fields with a 4 year education. I just feel that over regulation from medicare and the insurance companies have taken away the profitability of family practice. It is a fact family doctors are leaving the field. I just think that socializing medicine is the current root cause of the problem and adding more regulation will only make things worse

Regarding the $2000 Tetanus shot (even $200 seems high) A good usually quicker and cheaper alternative to emergency rooms for such medical problems are the so called "prompt" and "urgent" care facilities. One of the absurdities of the current system as referenced indirectly in the comments about "billed" costs verses what insurance companies actually pay is that uninsured people are typically charged more by hospitals and other providers and end up paying a higher amount then insured people (either private or Medicare etc.) for the same service. A small step that could help a lot of people without insurance would be a regulation that they be charged on a fee for service basis at a rate no higher then either the Medicare rates or perhaps an average of all the private insurance companies that the provider accepts. The political debate on this proposal would be interesting to observe as I am sure it would be opposed by the entire medical establishment as well as insurance companies but how can this practice be defended?

rdm says

Regarding the $2000 Tetanus shot (even $200 seems high) A good usually quicker and cheaper alternative to emergency rooms for such medical problems are the so called “prompt” and “urgent” care facilities. One of the absurdities of the current system as referenced indirectly in the comments about “billed” costs verses what insurance companies actually pay is that uninsured people are typically charged more by hospitals and other providers and end up paying a higher amount then insured people (either private or Medicare etc.) for the same service. A small step that could help a lot of people without insurance would be a regulation that they be charged on a fee for service basis at a rate no higher then either the Medicare rates or perhaps an average of all the private insurance companies that the provider accepts. The political debate on this proposal would be interesting to observe as I am sure it would be opposed by the entire medical establishment as well as insurance companies but how can this practice be defended?

Sad to say but the urgant care near me was closed about a year ago.. I agree that people without insurance should not be forced to pay more than those with insurance, but I do not think medicare or any other entity should have the excusive right to determine what those fees should be. I do not think the goverment has the ability to fairly regulate prices. A doctor in NYC should not be forced to charge the same as a doctor in Idaho, also if all doctors had to accept the same payment what would be the point of one doctor working harder trying to be better then another. One of the great things about a free market is that you have a choice and if you work harder and make more money you are rewarded by being able to get better things. One of the problems over regulating medicine or any other company is that you end up with rules that may appear fair on paper but are not fair in reality

Where are all the doctors http://www.cnn.com/2008/HEALTH/11/17/primary.care.doctors.study/ http://www.law.duke.edu/shell/cite.pl?69+Law+&+Contemp.+Probs.+195+(autumn+2006)+pdf http://bulletin.aarp.org/yourhealth/caregiving/articles/where_have_all_the_doctors_gone_.html

d3, Your argument is essentially that "if doctors could charge everyone whatever they wanted, then prices would go down" mixed in with a bit of "the cost of billing software and services is what makes care expensive now". I'm not buying this argument. Not at all. It defies logic.

TOB, right on. Let us ban rubber bands and electric scooters from medicare. These are the types of items that *would* be cheaper if we had an open an free market.

Where are all the doctors? They have become specialists because they can then charge more. It is as simple as that. It's got nothing to do with medicare, government regulations or anything like that.

Some Guy says

d3 says

Some Guy says

d3 says

The problem is that over regulation as scared of family practitioners. If you want to get a shot you are forced to go to an emerancy room which costs both them and you more money.

Huh? What does government regulation have to do with a doctor being too busy to see you?

The relationship is fairly indirect, but it does exist. From my understanding, for Medicare a lot of specific treatments ie vaccines, there is price setting that is in effect which prevent a doctor from refusing certain treatments and charging more than a set amount for that treatment. Doctors will often have to take loses to provide certain treatments. Also depending upon the area the doctor serves he may have even greater limits to what he is allowed to charge for certain treatments.

I don’t believe that’s true. It may be true that Medicare will only reimburse the doctor for a certain amount, but that doesn’t mean he can’t charge whatever he wants. Unless you are on Medicare, the limiting factor is usually going to be your PRIVATE insurance company. The insurance company decides how much a given procedure is “worth”, and will not pay the doctor more than that amount. Sorry, but you can’t blame the evil government for that. And even then, you still haven’t explained what any of this has to do with a doctor being too busy to see you.

There are a ton of regulations on what a doctor can charge for medicare. The federal government has a cap of 15% over standard allowable rate for a doctor that does not accept assignment (although most do). In addition most states have even tighter regulations on how much a doctor can charge over assignment for medicare. The issue here is around the fact that a doctor couldn't be seen immediately. I know that the local family practice clinic I go to I can always be seen the same day, but they charge me $150 / yr for the privilege of seeing doctors at their practice. Without government interference you can start to see more models like this one. Where the government really needs to step in, is in creating transparency in pricing for medical procedures and visits.

I think Sarah was being facetious with that VP comment. Everyone knows that the veep is second banana but that job doesn't exactly have a bunch of appeal. Some swingers around here seem to consider her the gorilla their dreams and I'm sure they wouldn't mind monkeying with her tail if the time was ripe. Well, at least this Chiquita isn't on the Dole and doesn't act like a fruit.

Cheaper than a lapdance!

It's not just down south: "Northern California home sales highest in three years as prices rise 3 percent" http://www.mercurynews.com/ci_12851341?source=rss For all of the talk about it being impossible to get a mortgage, there seem to be a lot of people buying. Where do they get their money?

camping: "For all of the talk about it being impossible to get a mortgage, there seem to be a lot of people buying. Where do they get their money?" I was told by my investment manager that its hedge funds and REITs buying properties that they intend to resell later for profit. Kind of like "institutional flipping".... Individuals and couples - yes them too. They are buyers who are going for State and Federal incentives ($8k, $20k in Cali if you buy a new home from a builder. Not sure if that program is still going on though). Buyers are using the incentive in lieu of a traditional down that they've saved, so we're heading straight back into the same situation as before where a buyer gets seller assisted financing or some other funny-money arrangement that allows them to bypass time-tested avenues of market entry. Sorry for my simplistic response regarding individual buyers/couple and the "incentive" monies - I read up on this several months ago and seeing the absurdity of it all I've just set it all aside in my mind as junk financing to uncredit-worthy borrowers. However, these are the folk that vote for the politicians that provide this sort of thing. Gov't wouldn't do this unless it worked. Just look at the numbers in Congress who got re-elected. Tells you something, No???

The REITs and hedge funds part makes sense. I'm curious what percentage of the market is them though. As for individuals/couples, assuming we're only talking about non-new homes, only the $8k applies. I believe that also has an income cap of $150k (for couples). In the Bay Area, many of the homes I'm seeing go sale pending are $500k+, so $8k doesn't go very far towards your down and also if they technically can afford a $500k+ house, they should probably be over the income limit anyway. Something doesn't make sense.

"I’m curious what percentage of the market is them though." That I do not know, but what he has told me is that the hedgies and REITs are buying huge blocks of foreclosures directly from lenders, say 1000 residences at a time such as in PHX for example. Prices vary but generally are below 20 cents on the dollar. Some individual investors are doing this too: buying a property at auction for $10k and turning around and selling it for $60k. Sorry, I don't know how many of these form the percentage of RE sales. "also if they technically can afford a $500k+ house, they should probably be over the income limit anyway. Something doesn’t make sense." Yep, another problem to deconstruct.