Author Topic: What comes after the ACA?  (Read 806094 times)

the_gastropod

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Re: What comes after the ACA?
« Reply #4900 on: November 08, 2018, 01:09:06 PM »
BTW, I have a few higher income earner friends whose spouses do not work because of taxes.  Add in the need for purchasing childcare when both parents work and the spouse working could actually become a net loss.]

You get the most favorable tax treatment (relative to what you'd pay as two single people) if you are married filing jointly but only one of you has any income at all. <-- which is just taking the point you made above to its logical extreme.

If partner A is already making 600k/year, if partner B starts a job, they'll be paying full social security tax (which A has maxed out) plus they are paying the highest marginal income tax rate starting from the first dollar they earn. So the more money your spouse makes, the harder it is for you to earn enough money (after taxes) to cover the cost of the childcare your household will need to pay for if both parents work.

Ah, touche! Thank you for explainin'!

Quote from: EnjoyIt
Not sure why you bring up conservative vs. liberal or who invented the ACA.  it makes no difference to me since I am a mixture of the two.  ACA is the law of the land and people make decisions based on that law.  Some have decreased their income by working less to get the subsidy.  I don't blame them, but it does show examples of how laws and taxes can stifle productivity and actually decrease the income coming into the government.

I was responding to this piece, specifically:

Quote from: EnjoyIt
...Move evidence of how our progressive laws stifle productivity.

Seemed like a slight against "progressives". Maybe I misunderstood.

DavidAnnArbor

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Re: What comes after the ACA?
« Reply #4901 on: November 08, 2018, 01:15:43 PM »
BTW, I have a few higher income earner friends whose spouses do not work because of taxes.  Add in the need for purchasing childcare when both parents work and the spouse working could actually become a net loss.]

You get the most favorable tax treatment (relative to what you'd pay as two single people) if you are married filing jointly but only one of you has any income at all. <-- which is just taking the point you made above to its logical extreme.

If partner A is already making 600k/year, if partner B starts a job, they'll be paying full social security tax (which A has maxed out) plus they are paying the highest marginal income tax rate starting from the first dollar they earn. So the more money your spouse makes, the harder it is for you to earn enough money (after taxes) to cover the cost of the childcare your household will need to pay for if both parents work.

Ah, touche! Thank you for explainin'!

Quote from: EnjoyIt
Not sure why you bring up conservative vs. liberal or who invented the ACA.  it makes no difference to me since I am a mixture of the two.  ACA is the law of the land and people make decisions based on that law.  Some have decreased their income by working less to get the subsidy.  I don't blame them, but it does show examples of how laws and taxes can stifle productivity and actually decrease the income coming into the government.

I was responding to this piece, specifically:

Quote from: EnjoyIt
...Move evidence of how our progressive laws stifle productivity.

Seemed like a slight against "progressives". Maybe I misunderstood.


More evidence that health care workers are paid too much and why health costs are ridiculous.

PiobStache

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Re: What comes after the ACA?
« Reply #4902 on: November 08, 2018, 01:46:50 PM »
More evidence that health care workers are paid too much and why health costs are ridiculous.

Far too broad of a brush stroke there.  The person that cleans dirty bottoms does not get over paid as just one example.

Mr. Green

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Re: What comes after the ACA?
« Reply #4903 on: November 08, 2018, 03:22:15 PM »
BTW, I have a few higher income earner friends whose spouses do not work because of taxes.  Add in the need for purchasing childcare when both parents work and the spouse working could actually become a net loss.]

You get the most favorable tax treatment (relative to what you'd pay as two single people) if you are married filing jointly but only one of you has any income at all. <-- which is just taking the point you made above to its logical extreme.

If partner A is already making 600k/year, if partner B starts a job, they'll be paying full social security tax (which A has maxed out) plus they are paying the highest marginal income tax rate starting from the first dollar they earn. So the more money your spouse makes, the harder it is for you to earn enough money (after taxes) to cover the cost of the childcare your household will need to pay for if both parents work.

Ah, touche! Thank you for explainin'!

Quote from: EnjoyIt
Not sure why you bring up conservative vs. liberal or who invented the ACA.  it makes no difference to me since I am a mixture of the two.  ACA is the law of the land and people make decisions based on that law.  Some have decreased their income by working less to get the subsidy.  I don't blame them, but it does show examples of how laws and taxes can stifle productivity and actually decrease the income coming into the government.

I was responding to this piece, specifically:

Quote from: EnjoyIt
...Move evidence of how our progressive laws stifle productivity.

Seemed like a slight against "progressives". Maybe I misunderstood.


More evidence that health care workers are paid too much and why health costs are ridiculous.
I think if you dig deep enough you'll find that worker costs are but a small part of the price problem. A much larger issue is all these "non-profit" hospitals with 25% profit margins. The profits are so obscene they are basically forced to build cancer wings, etc. to help make them look only reasonably profitable.

pecunia

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Re: What comes after the ACA?
« Reply #4904 on: November 08, 2018, 07:22:04 PM »
Mr Green:

"I think if you dig deep enough you'll find that worker costs are but a small part of the price problem. A much larger issue is all these "non-profit" hospitals with 25% profit margins. The profits are so obscene they are basically forced to build cancer wings, etc. to help make them look only reasonably profitable."

Explain - I've read Blue Cross Blue Shield is nonprofit.  Yet I see that they somehow own Anthem which makes a profit.  How does this make sense?  If they are non profit, wouldn't they be a bit like a single payer health plan?

Mr. Green

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Re: What comes after the ACA?
« Reply #4905 on: November 08, 2018, 09:24:58 PM »
Mr Green:

"I think if you dig deep enough you'll find that worker costs are but a small part of the price problem. A much larger issue is all these "non-profit" hospitals with 25% profit margins. The profits are so obscene they are basically forced to build cancer wings, etc. to help make them look only reasonably profitable."

Explain - I've read Blue Cross Blue Shield is nonprofit.  Yet I see that they somehow own Anthem which makes a profit.  How does this make sense?  If they are non profit, wouldn't they be a bit like a single payer health plan?
Insurers are just middlemen; they help pay costs and take a profit for their service. The real problem is the cotton swab in the ER that costs $10.

seattlecyclone

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Re: What comes after the ACA?
« Reply #4906 on: November 08, 2018, 10:51:01 PM »
The problem with the Laffer Curve argument is "there are lies, damn lies, and statistics".  I don't think I've ever seen an objective argument from either side on this.  It gets manipulated to prove a point.

The only argument I can event remotely produce is me. For a few years now I have chosen to work less because I did not feel my time is worth the extra income when such a huge chunk of it is taken by taxes.  The higher taxes made a big difference where I would have chosen to work a little more and get to 25x sooner, but at the high tax rate I just did not think it was worth it.  I could just put in an extra 1.5-2 years part time at much lower tax brackets and get to the same goal with less stress.


This is basically my situation as well. I switched to a 60% schedule a couple years ago. Due to the progressive tax code my take-home pay is more than 60% of what it used to be. I would have more money coming in if I switched back to a full-time schedule, but my effective hourly rate for those extra two days a week is less than what I'm getting for the first three, and because I'm living well below my means I don't find it worthwhile to take on that extra responsibility to get the comparatively lower hourly wage.

However I think it's important to realize that most people don't live below their means to the same extent as the members of this forum tend to. The Laffer Curve predicts that a tax cut will lead to a literal increase in government revenue, when considering all the taxpayers in the whole country. Most workers are not in the same position as we are, where we can chop off 40% of our gross salary without really missing much. We're outliers in that regard. And even in my case, lowering the tax rate by a couple percentage points would not convince me to work more, so there's no revenue increase to be had from me. Maybe if the tax rates were around 90%, sure you could lower it to 80% and cause enough additional income to be reported on the books that overall revenue might increase a bit. Our current tax rates are way below that range though.

PiobStache

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Re: What comes after the ACA?
« Reply #4907 on: November 09, 2018, 12:30:59 PM »


Explain - I've read Blue Cross Blue Shield is nonprofit.  Yet I see that they somehow own Anthem which makes a profit.  How does this make sense?  If they are non profit, wouldn't they be a bit like a single payer health plan?

Non-profits are allowed to own for profit subsidiaries, and of course, those subsidiaries pay taxes on any profit.  And no, being non-profit does not equate to a single payer health plan.

Exflyboy

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Re: What comes after the ACA?
« Reply #4908 on: November 09, 2018, 06:17:10 PM »
Side note.. The local Walmart charges $260 for my Wife's asthma inhalers.

I just ordered online from the Medix pharmacy in the UK and got the same thing for less than $27 each.. with a Veteren's day discount coupon for $20 off three of them.

You know that $27 is a marked up price to make it worth their while..

Thank God the Government isn't protecting the welfare of these American consumers!.. what a joke.

Mr. Green

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Re: What comes after the ACA?
« Reply #4909 on: November 09, 2018, 10:23:44 PM »
Another good example is a prescription I filled recently. The pharmacy didn't have my insurance on file so when I went to pick it up the bill was $290. I gave them my insurance card and the new price was $29. The simple fact of having insurance lowered the price 90%.

The overwhelming majority of Americans have insurance, so they pay the low price. There's no way the few people without insurance paying $290 has much affect on the manufacturer's bottom line (common drug, widely prescribed) because a) it's a tiny percentage of their sales, and b) many people would balk at the full price and go without. Also consider that the people stuck paying full boat are also likely the poorest because they can't afford insurance.

That's the bullshit that makes me angry. We charge our poorest the most money, by a factor of ten in this case, when the net result to the company's profit marginal is probably not even worth the tax break they'd get if they gave it to those people at the same price as those with insurance. It's a totally nonsensical system that is overtly cruel, simply because we can.

EnjoyIt

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Re: What comes after the ACA?
« Reply #4910 on: November 09, 2018, 11:45:12 PM »
Another good example is a prescription I filled recently. The pharmacy didn't have my insurance on file so when I went to pick it up the bill was $290. I gave them my insurance card and the new price was $29. The simple fact of having insurance lowered the price 90%.

The overwhelming majority of Americans have insurance, so they pay the low price. There's no way the few people without insurance paying $290 has much affect on the manufacturer's bottom line (common drug, widely prescribed) because a) it's a tiny percentage of their sales, and b) many people would balk at the full price and go without. Also consider that the people stuck paying full boat are also likely the poorest because they can't afford insurance.

That's the bullshit that makes me angry. We charge our poorest the most money, by a factor of ten in this case, when the net result to the company's profit marginal is probably not even worth the tax break they'd get if they gave it to those people at the same price as those with insurance. It's a totally nonsensical system that is overtly cruel, simply because we can.

Sometimes it is the other way around. You go to pick a medication with insurance but ask for the no insurance price and find it significantly cheaper. The whole system is totally opaque and fucked up.

Bucksandreds

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Re: What comes after the ACA?
« Reply #4911 on: November 10, 2018, 05:52:44 AM »
Another good example is a prescription I filled recently. The pharmacy didn't have my insurance on file so when I went to pick it up the bill was $290. I gave them my insurance card and the new price was $29. The simple fact of having insurance lowered the price 90%.

The overwhelming majority of Americans have insurance, so they pay the low price. There's no way the few people without insurance paying $290 has much affect on the manufacturer's bottom line (common drug, widely prescribed) because a) it's a tiny percentage of their sales, and b) many people would balk at the full price and go without. Also consider that the people stuck paying full boat are also likely the poorest because they can't afford insurance.

That's the bullshit that makes me angry. We charge our poorest the most money, by a factor of ten in this case, when the net result to the company's profit marginal is probably not even worth the tax break they'd get if they gave it to those people at the same price as those with insurance. It's a totally nonsensical system that is overtly cruel, simply because we can.

Sometimes it is the other way around. You go to pick a medication with insurance but ask for the no insurance price and find it significantly cheaper. The whole system is totally opaque and fucked up.

I have a eczema hand cream that runs about $160 through anthem insurance and $60 when I donít run it through insurance and give them a goodrx.com printout. Absurd. Reason 1856 that I believe parts of Western Europe, Canada, Australia and New Zealand have surpassed the US in overall quality of life/governance.

EnjoyIt

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Re: What comes after the ACA?
« Reply #4912 on: November 10, 2018, 10:29:05 AM »
BTW, I have a few higher income earner friends whose spouses do not work because of taxes.  Add in the need for purchasing childcare when both parents work and the spouse working could actually become a net loss.]

You get the most favorable tax treatment (relative to what you'd pay as two single people) if you are married filing jointly but only one of you has any income at all. <-- which is just taking the point you made above to its logical extreme.

If partner A is already making 600k/year, if partner B starts a job, they'll be paying full social security tax (which A has maxed out) plus they are paying the highest marginal income tax rate starting from the first dollar they earn. So the more money your spouse makes, the harder it is for you to earn enough money (after taxes) to cover the cost of the childcare your household will need to pay for if both parents work.

Ah, touche! Thank you for explainin'!

Quote from: EnjoyIt
Not sure why you bring up conservative vs. liberal or who invented the ACA.  it makes no difference to me since I am a mixture of the two.  ACA is the law of the land and people make decisions based on that law.  Some have decreased their income by working less to get the subsidy.  I don't blame them, but it does show examples of how laws and taxes can stifle productivity and actually decrease the income coming into the government.

I was responding to this piece, specifically:

Quote from: EnjoyIt
...Move evidence of how our progressive laws stifle productivity.

Seemed like a slight against "progressives". Maybe I misunderstood.


More evidence that health care workers are paid too much and why health costs are ridiculous.

So you are telling me my neuro-surgeon friend that is super specialized and does procedures that only a handful of other surgeons do does not deserve to make $1 million a year.  People fly in from all over the world to see him and every day he saves and improves the quality of life for so many people.  How much do you think he should make?  What would be fair in your eyes?

What about a radiologist.  How much should a radiologist make for every image they look at?  Now remember they are expected to be perfect.  100%, no misses.  How much should they make to read a single CT? Again, remember they want to do their best and miss nothing because a patient's life is at stake plus if they miss something big they get sued for $1 million plus dollars and if they miss too much, they get kicked off the medical staff and or lose their license.

What about an ER doctor.  How much do you think they should get reimbursed for fixing a broken ankle by providing anesthesia, managing the airway, reducing the fracture and then setting it in a splint so that now they don't need surgery?  What about diagnosing a heart attack and getting them the right therapy so that they sustain only minimal damage and live with a normal quality of life?  What about catching and treating a stroke quickly so that the patient isn't paralyzed and bed ridden for the rest of their lives?  What do you think?

How much do you think a surgeon deserves to remove someone's gallbladder at 2am because if they don't the patient will go sceptic and die?  What about a simple outpatient gallbladder procedure which also includes office visits and managing any potential complications?  What about removing colon cancer and making sure the cancer is fully resected including any potential lymph nodes?

I know, I know I am giving straw men examples and I will admit that my wages as a physician are very good compared to the rest of the world.  It is so easy to throw blame at the front line doctors as they are the visible side of healthcare. The reality is that they are only a tiny fraction of the cost of healthcare even at these higher wages. I get to keep significantly less than 5% of what a patient pays to see me and that excludes the patients that choose not to pay anything at all. The rest of the cash goes to the hospital, suppliers, support staff, etc.

With physicians coming out of medical school owning $300k or more with many coming out with $400k or even $500k in debt, I work with two docs who were just hired that each have over $500k in school debt. They must make a reasonable salary to even think about paying that debt off. The average wage for a doctor is about $250k/yr (varies where you look for statistics)  After taxes and school loan payoff and the cost of keeping a medical license there isn't really that much left for the average physician.

The problem is that doctors are a bunch of pussies who are unwilling to stand up and fight for what is right.  They are so entrenched into the system and idiotically dependent on their high wages to sustain their idiot doctor lifestyle that they can't afford to fight and are willing to accept all the bullshit thrown our way.

But sure, doctors make too much because that is all you see.

seattlecyclone

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Re: What comes after the ACA?
« Reply #4913 on: November 10, 2018, 11:07:27 AM »
I know, I know I am giving straw men examples and I will admit that my wages as a physician are very good compared to the rest of the world.  It is so easy to throw blame at the front line doctors as they are the visible side of healthcare. The reality is that they are only a tiny fraction of the cost of healthcare even at these higher wages. I get to keep significantly less than 5% of what a patient pays to see me and that excludes the patients that choose not to pay anything at all. The rest of the cash goes to the hospital, suppliers, support staff, etc.

Can you give a better breakdown of where the money actually goes? Like, I go in with my son for a well-child visit and some vaccines, and our insurance pays something like $600 for a short visit. We see the doctor for about 15 minutes and the nurse for about the same amount of time. I know the actual vaccines and needles aren't free, and you need to pay rent for the building, and some people spend some time when we're not there to take care of billing and scheduling and cleanup and stuff, but how big of a piece of the pie is all this?

Quote
With physicians coming out of medical school owning $300k or more with many coming out with $400k or even $500k in debt, I work with two docs who were just hired that each have over $500k in school debt. They must make a reasonable salary to even think about paying that debt off. The average wage for a doctor is about $250k/yr (varies where you look for statistics)  After taxes and school loan payoff and the cost of keeping a medical license there isn't really that much left for the average physician.

Agreed that this is a problem. Is there anything we can do to fix it? So many of our medical schools are run through state-owned universities, collecting millions of dollars from these students. At the same time, those same state governments are spending millions of dollars on Medicaid and other health programs, needing to pay halfway-competitive rates in our broken healthcare system. Couldn't these two parts of the state government come together to offer free medical school and free nursing school to students who commit to serving Medicaid patients at a lower salary for a decade after they graduate? Seems like that could be a win-win, compared to the current system where a big fraction of a doctor's gross pay goes directly to the bank that holds their student loans.
« Last Edit: November 10, 2018, 11:09:23 AM by seattlecyclone »

Bucksandreds

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Re: What comes after the ACA?
« Reply #4914 on: November 10, 2018, 11:20:56 AM »
Iím a dentist making very average dentist income (less than medical doctors) and I am probably overpaid. Yeah Iíve found cancer on multiple people and maybe helped save their life, Iíve restored function to hundreds of mouths to help people be able to eat and saved hundreds from potentially deadly abcesses. I also graduated with $220,000 in student loans. I live in a new house in one of the best suburbs in my state, drive a new vehicle, travel frequently and I still can save $4,000 cash per month. The assistants who do more labor than me make 1/5 what I make.  The guy who keeps my electricity on or built my house makes 1/4 what I make. Medical doctors are overpaid. It doesnít matter if itís just a small part of the overall cost. Dozens of small changes need to happen to make health care affordable. Quit with the whining.

DavidAnnArbor

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Re: What comes after the ACA?
« Reply #4915 on: November 10, 2018, 01:41:19 PM »
So Enjoy It you're making hundreds of thousands of dollars a year and yet you're complaining about an important program like Obamacare that enables working class people to have an affordable way to get access to healthcare. As imperfect as it is, it's vital to millions of people. And the program could be vastly improved but for the scorched earth politics of the Republicans that are putting our whole democracy at risk. But all you see is how much tax you're paying and feel you're the one being cheated. You bring up these Mother Theresa like stories of selfless doctors saving lives, while I agree they are important, it's not the whole story - just the one you paint - to elicit some kind of odd sympathy to these ungodly salaries.  -You  want to pay as little as possible despite the multiple hundreds of thousands of dollars earned, as a physician, with little regard of others in less income generous professions.

DreamFIRE

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Re: What comes after the ACA?
« Reply #4916 on: November 10, 2018, 01:42:35 PM »
BTW, I have a few higher income earner friends whose spouses do not work because of taxes.  Add in the need for purchasing childcare when both parents work and the spouse working could actually become a net loss.]

You get the most favorable tax treatment (relative to what you'd pay as two single people) if you are married filing jointly but only one of you has any income at all. <-- which is just taking the point you made above to its logical extreme.

If partner A is already making 600k/year, if partner B starts a job, they'll be paying full social security tax (which A has maxed out) plus they are paying the highest marginal income tax rate starting from the first dollar they earn. So the more money your spouse makes, the harder it is for you to earn enough money (after taxes) to cover the cost of the childcare your household will need to pay for if both parents work.

Ah, touche! Thank you for explainin'!

Quote from: EnjoyIt
Not sure why you bring up conservative vs. liberal or who invented the ACA.  it makes no difference to me since I am a mixture of the two.  ACA is the law of the land and people make decisions based on that law.  Some have decreased their income by working less to get the subsidy.  I don't blame them, but it does show examples of how laws and taxes can stifle productivity and actually decrease the income coming into the government.

I was responding to this piece, specifically:

Quote from: EnjoyIt
...Move evidence of how our progressive laws stifle productivity.

Seemed like a slight against "progressives". Maybe I misunderstood.


More evidence that health care workers are paid too much and why health costs are ridiculous.
I think if you dig deep enough you'll find that worker costs are but a small part of the price problem. A much larger issue is all these "non-profit" hospitals with 25% profit margins. The profits are so obscene they are basically forced to build cancer wings, etc. to help make them look only reasonably profitable.

Many hospitals are closing down due to lack of reimbursement, etc.

http://docdelta.com/hospitals-continue-closing-down-in-places-where-they-are-needed-the-most/

DreamFIRE

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Re: What comes after the ACA?
« Reply #4917 on: November 10, 2018, 01:50:38 PM »
Well it looks like the Dems are taking the House. Hopefully that means two more years of the status quo re: the ACA. I think in that time we'll see more insurers return to the marketplace and a stronger marketplace overall, making it that much harder for a repeal measure to happen in the future.

There's still that pesky lawsuit to deal with.  And I suppose it is technically possible that the Republicans could ram through a repeal bill before the new Congress starts in January.  I think the latter is unlikely, but who knows how the lawsuit will turn out.

It's expected by those who followed the questions asked and statements made during oral arguments that the republican appointed judge will rule to invalidate key provisions or the entire ACA and that he has atypically delayed his ruling because he knew it would hurt the republicans in the midterms to rule in advance of that.  So, it shouldn't be much longer at this point.

https://www.nytimes.com/2018/11/06/opinion/republican-lawsuit-pre-existing-coverage.html

EnjoyIt

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Re: What comes after the ACA?
« Reply #4918 on: November 10, 2018, 02:15:38 PM »
Iím a dentist making very average dentist income (less than medical doctors) and I am probably overpaid. Yeah Iíve found cancer on multiple people and maybe helped save their life, Iíve restored function to hundreds of mouths to help people be able to eat and saved hundreds from potentially deadly abcesses. I also graduated with $220,000 in student loans. I live in a new house in one of the best suburbs in my state, drive a new vehicle, travel frequently and I still can save $4,000 cash per month. The assistants who do more labor than me make 1/5 what I make.  The guy who keeps my electricity on or built my house makes 1/4 what I make. Medical doctors are overpaid. It doesnít matter if itís just a small part of the overall cost. Dozens of small changes need to happen to make health care affordable. Quit with the whining.

Actually by hour your electrician probably makes more than you do.  And who is whinging? Someone said docs get paid too much and I provided information regarding that comment.  There is no complaining on my end.  Just stated information.  And if you feel you are overpaid, feel free to pay your hygienist more if you thin you are overpaid and they are underpaid.  Also, I don't  know about your practice, but one of the nice things about being an established dentist is that you don't have to deal with insurance companies or medicaid which can save a bundle on overhead costs.

I know, I know I am giving straw men examples and I will admit that my wages as a physician are very good compared to the rest of the world.  It is so easy to throw blame at the front line doctors as they are the visible side of healthcare. The reality is that they are only a tiny fraction of the cost of healthcare even at these higher wages. I get to keep significantly less than 5% of what a patient pays to see me and that excludes the patients that choose not to pay anything at all. The rest of the cash goes to the hospital, suppliers, support staff, etc.

Can you give a better breakdown of where the money actually goes? Like, I go in with my son for a well-child visit and some vaccines, and our insurance pays something like $600 for a short visit. We see the doctor for about 15 minutes and the nurse for about the same amount of time. I know the actual vaccines and needles aren't free, and you need to pay rent for the building, and some people spend some time when we're not there to take care of billing and scheduling and cleanup and stuff, but how big of a piece of the pie is all this?

Quote
With physicians coming out of medical school owning $300k or more with many coming out with $400k or even $500k in debt, I work with two docs who were just hired that each have over $500k in school debt. They must make a reasonable salary to even think about paying that debt off. The average wage for a doctor is about $250k/yr (varies where you look for statistics)  After taxes and school loan payoff and the cost of keeping a medical license there isn't really that much left for the average physician.

Agreed that this is a problem. Is there anything we can do to fix it? So many of our medical schools are run through state-owned universities, collecting millions of dollars from these students. At the same time, those same state governments are spending millions of dollars on Medicaid and other health programs, needing to pay halfway-competitive rates in our broken healthcare system. Couldn't these two parts of the state government come together to offer free medical school and free nursing school to students who commit to serving Medicaid patients at a lower salary for a decade after they graduate? Seems like that could be a win-win, compared to the current system where a big fraction of a doctor's gross pay goes directly to the bank that holds their student loans.

Anyways, to answer your questions.  A lot of the cash you spend goes to compliance and overhead.  Computer software and IT people to manage it.  Billing people, coding people, compliance people as well as the wages for the secretaries and nurses. Plus, the rent and utilities on the large building. The needle and plastic syringe are under a buck but the vaccines are pretty pricey and it seams like most of the $600 you spent went to the drug manufacturers.  Here is a link to the cost of these vaccines from the CDC.  https://www.cdc.gov/vaccines/programs/vfc/awardees/vaccine-management/price-list/
So, a 12 month vaccine list including Hib (~$20), pneumococcal (~$95), MMR (~$70), Varicella (~$120), Hepatits A (~$30) and maybe meningococcal ($165) = that comes out to ~$500.  Don't forget the owner of the company/business will charge a markup on reselling those drugs to you.  I would bet your pediatrician made something like $20-$30 for seeing your child which I honestly don't think is too much.  Generally, pediatricians are on the lower spectrum of of physician wages in the US.

You ask for a simple solution to a very complex and broken system.  It is akin to asking how to end poverty with one little fix which is impossible and needs to be a multi-prong approach.  Personally I think the first step in the process is to have complete 100% mandated transparency in the cost.  Patients need to know how their money is being spent.  I'm sure you had no idea that out of the $600 you paid, your doctor got maybe 5% of of it at best.  Next, we need to stop making medicaid provide the same experience as paid insurance.  There is no reason someone getting charity (so to speak) government funded healthcare (I am not talking about medicare) get the same services as someone who is spending money.  No reason to have private rooms, cutting edge expensive robotic procedures, or the latest expensive overpriced drug. Those patients should receive evidence based low cost medical care and nothing more.  Next we need to have CMS be able to negotiate pricing with pharmaceutical and hardware companies. We need to cut back on the regulatory compliance that is currently mandated which provides no patient value but is very expensive to implement. Through the above measures the cost of healthcare would decrease substantially and we can then implement a no frills public option health insurance for everyone. Basically low cost and affordable healthcare to be implemented at designated public option locations such as university hospitals while allowing those with money to be able to pay for private insurance which will cover improved amenities and still give incentive for innovation.  I'm not saying the above is the complete package answer, but something similar would be a huge step in the right direction. 

EnjoyIt

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Re: What comes after the ACA?
« Reply #4919 on: November 10, 2018, 02:33:30 PM »
So Enjoy It you're making hundreds of thousands of dollars a year and yet you're complaining about an important program like Obamacare that enables working class people to have an affordable way to get access to healthcare. As imperfect as it is, it's vital to millions of people. And the program could be vastly improved but for the scorched earth politics of the Republicans that are putting our whole democracy at risk. But all you see is how much tax you're paying and feel you're the one being cheated. You bring up these Mother Theresa like stories of selfless doctors saving lives, while I agree they are important, it's not the whole story - just the one you paint - to elicit some kind of odd sympathy to these ungodly salaries.  -You  want to pay as little as possible despite the multiple hundreds of thousands of dollars earned, as a physician, with little regard of others in less income generous professions.

Yes, I get paid very well for my profession.  I chose to go into that profession, worked my ass off to get there and get compensated well to perform it.  Each and every person has or had the same potential as me.  In the game of life we are given rules and those who understand them and able to play the game can win in the financial part of the game.  There are plenty other ways to win other than finances. With regards to wages I did very well.  You chose your profession and get paid accordingly, so stop complain you don't get paid enough and put it off on someone who maybe chose wiser.  Honestly I think you are the one who is whining.

Don't expect me for one minute to apologize because I get paid well for my profession.

Next, no, I am not a fan of the ACA.  Yes, it has created some great provisions that I am very much and whole heartedly support, but it also confuses health insurance with healthcare and shifts the high cost of healthcare unto the middle class. The rich can afford an increase but the middle/upper middle class gets screwed as they don't get subsidies. We have talked about this ad nauseam before and no need to regurgitate the past 100+ posts about it.  I am all for either a significant adjustment of the ACA or a replacement to something that actually does something about the cost of implementing care. I am not for a simple repeal back to the way it was.

Lastly, I clearly pointed out how I gave straw men examples above.  I ask you again how much do you think a doctor should get paid for a specific task.  What is correct in your eyes? What do you think is fair?  You just say it is too much and I ask, how much is right per task to take on the liability? 

pecunia

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Re: What comes after the ACA?
« Reply #4920 on: November 10, 2018, 03:45:12 PM »
More crazy thoughts:

Enjoy It:

What about a school bus driver?  How much should a bus driver make for every trip they make?  Now remember they are expected to be perfect.  100%, no misses.  How much should they make to make every turn, have no accidents and no tickets? Again, remember they want to do their best and miss nothing because a child's life is at stake plus if they miss something big they get fired and or lose their license.

"I chose to go into that profession, worked my ass off to get there and get compensated well to perform it.  Each and every person has or had the same potential as me."

Oh, if it were only true, what a better world we would have.

Come the revolution, we will all have health care.

Bucksandreds

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Re: What comes after the ACA?
« Reply #4921 on: November 10, 2018, 04:49:47 PM »
Iím a dentist making very average dentist income (less than medical doctors) and I am probably overpaid. Yeah Iíve found cancer on multiple people and maybe helped save their life, Iíve restored function to hundreds of mouths to help people be able to eat and saved hundreds from potentially deadly abcesses. I also graduated with $220,000 in student loans. I live in a new house in one of the best suburbs in my state, drive a new vehicle, travel frequently and I still can save $4,000 cash per month. The assistants who do more labor than me make 1/5 what I make.  The guy who keeps my electricity on or built my house makes 1/4 what I make. Medical doctors are overpaid. It doesnít matter if itís just a small part of the overall cost. Dozens of small changes need to happen to make health care affordable. Quit with the whining.

Actually by hour your electrician probably makes more than you do.  And who is whinging? Someone said docs get paid too much and I provided information regarding that comment.  There is no complaining on my end.  Just stated information.  And if you feel you are overpaid, feel free to pay your hygienist more if you thin you are overpaid and they are underpaid.  Also, I don't  know about your practice, but one of the nice things about being an established dentist is that you don't have to deal with insurance companies or medicaid which can save a bundle on overhead costs.

I know, I know I am giving straw men examples and I will admit that my wages as a physician are very good compared to the rest of the world.  It is so easy to throw blame at the front line doctors as they are the visible side of healthcare. The reality is that they are only a tiny fraction of the cost of healthcare even at these higher wages. I get to keep significantly less than 5% of what a patient pays to see me and that excludes the patients that choose not to pay anything at all. The rest of the cash goes to the hospital, suppliers, support staff, etc.

Can you give a better breakdown of where the money actually goes? Like, I go in with my son for a well-child visit and some vaccines, and our insurance pays something like $600 for a short visit. We see the doctor for about 15 minutes and the nurse for about the same amount of time. I know the actual vaccines and needles aren't free, and you need to pay rent for the building, and some people spend some time when we're not there to take care of billing and scheduling and cleanup and stuff, but how big of a piece of the pie is all this?

Quote
With physicians coming out of medical school owning $300k or more with many coming out with $400k or even $500k in debt, I work with two docs who were just hired that each have over $500k in school debt. They must make a reasonable salary to even think about paying that debt off. The average wage for a doctor is about $250k/yr (varies where you look for statistics)  After taxes and school loan payoff and the cost of keeping a medical license there isn't really that much left for the average physician.

Agreed that this is a problem. Is there anything we can do to fix it? So many of our medical schools are run through state-owned universities, collecting millions of dollars from these students. At the same time, those same state governments are spending millions of dollars on Medicaid and other health programs, needing to pay halfway-competitive rates in our broken healthcare system. Couldn't these two parts of the state government come together to offer free medical school and free nursing school to students who commit to serving Medicaid patients at a lower salary for a decade after they graduate? Seems like that could be a win-win, compared to the current system where a big fraction of a doctor's gross pay goes directly to the bank that holds their student loans.

Anyways, to answer your questions.  A lot of the cash you spend goes to compliance and overhead.  Computer software and IT people to manage it.  Billing people, coding people, compliance people as well as the wages for the secretaries and nurses. Plus, the rent and utilities on the large building. The needle and plastic syringe are under a buck but the vaccines are pretty pricey and it seams like most of the $600 you spent went to the drug manufacturers.  Here is a link to the cost of these vaccines from the CDC.  https://www.cdc.gov/vaccines/programs/vfc/awardees/vaccine-management/price-list/
So, a 12 month vaccine list including Hib (~$20), pneumococcal (~$95), MMR (~$70), Varicella (~$120), Hepatits A (~$30) and maybe meningococcal ($165) = that comes out to ~$500.  Don't forget the owner of the company/business will charge a markup on reselling those drugs to you.  I would bet your pediatrician made something like $20-$30 for seeing your child which I honestly don't think is too much.  Generally, pediatricians are on the lower spectrum of of physician wages in the US.

You ask for a simple solution to a very complex and broken system.  It is akin to asking how to end poverty with one little fix which is impossible and needs to be a multi-prong approach.  Personally I think the first step in the process is to have complete 100% mandated transparency in the cost.  Patients need to know how their money is being spent.  I'm sure you had no idea that out of the $600 you paid, your doctor got maybe 5% of of it at best.  Next, we need to stop making medicaid provide the same experience as paid insurance.  There is no reason someone getting charity (so to speak) government funded healthcare (I am not talking about medicare) get the same services as someone who is spending money.  No reason to have private rooms, cutting edge expensive robotic procedures, or the latest expensive overpriced drug. Those patients should receive evidence based low cost medical care and nothing more.  Next we need to have CMS be able to negotiate pricing with pharmaceutical and hardware companies. We need to cut back on the regulatory compliance that is currently mandated which provides no patient value but is very expensive to implement. Through the above measures the cost of healthcare would decrease substantially and we can then implement a no frills public option health insurance for everyone. Basically low cost and affordable healthcare to be implemented at designated public option locations such as university hospitals while allowing those with money to be able to pay for private insurance which will cover improved amenities and still give incentive for innovation.  I'm not saying the above is the complete package answer, but something similar would be a huge step in the right direction.

Not sure what imaginary world you live in but not one word you said makes much sense. Electrician median salary is about $50,000 per year so unles they work like 10-12 hours per week theyíre not making more per hour worked than a median dentist. Secondly, what type of Ďestablishedí dentist you speak of doesnít deal with insurance? Thirdly, if you donít know the difference between a dental assistant and hygienist then I doubt you actually work in health care. Also I am an employee and donít pay anyoneís salary. You are greedy. Accept it an move on. You care about getting yours and not much else.

Teachstache

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Re: What comes after the ACA?
« Reply #4922 on: November 10, 2018, 04:55:04 PM »
More crazy thoughts:

Enjoy It:

What about a school bus driver?  How much should a bus driver make for every trip they make?  Now remember they are expected to be perfect.  100%, no misses.  How much should they make to make every turn, have no accidents and no tickets? Again, remember they want to do their best and miss nothing because a child's life is at stake plus if they miss something big they get fired and or lose their license.

"I chose to go into that profession, worked my ass off to get there and get compensated well to perform it.  Each and every person has or had the same potential as me."

Oh, if it were only true, what a better world we would have.

Come the revolution, we will all have health care.

Thanks for this, pecunia. Signed, a public school teacher.

Bucksandreds

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Re: What comes after the ACA?
« Reply #4923 on: November 10, 2018, 05:01:11 PM »
More crazy thoughts:

Enjoy It:

What about a school bus driver?  How much should a bus driver make for every trip they make?  Now remember they are expected to be perfect.  100%, no misses.  How much should they make to make every turn, have no accidents and no tickets? Again, remember they want to do their best and miss nothing because a child's life is at stake plus if they miss something big they get fired and or lose their license.

"I chose to go into that profession, worked my ass off to get there and get compensated well to perform it.  Each and every person has or had the same potential as me."

Oh, if it were only true, what a better world we would have.

Come the revolution, we will all have health care.

Thanks for this, pecunia. Signed, a public school teacher.

Sadly, most of us who started on third base think we hit the home run.

Threshkin

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Re: What comes after the ACA?
« Reply #4924 on: November 10, 2018, 09:17:06 PM »
...big snip...
You ask for a simple solution to a very complex and broken system.  It is akin to asking how to end poverty with one little fix which is impossible and needs to be a multi-prong approach.  Personally I think the first step in the process is to have complete 100% mandated transparency in the cost.  Patients need to know how their money is being spent.  I'm sure you had no idea that out of the $600 you paid, your doctor got maybe 5% of of it at best.  Next, we need to stop making medicaid provide the same experience as paid insurance.  There is no reason someone getting charity (so to speak) government funded healthcare (I am not talking about medicare) get the same services as someone who is spending money.  No reason to have private rooms, cutting edge expensive robotic procedures, or the latest expensive overpriced drug. Those patients should receive evidence based low cost medical care and nothing more.  Next we need to have CMS be able to negotiate pricing with pharmaceutical and hardware companies. We need to cut back on the regulatory compliance that is currently mandated which provides no patient value but is very expensive to implement. Through the above measures the cost of healthcare would decrease substantially and we can then implement a no frills public option health insurance for everyone. Basically low cost and affordable healthcare to be implemented at designated public option locations such as university hospitals while allowing those with money to be able to pay for private insurance which will cover improved amenities and still give incentive for innovation.  I'm not saying the above is the complete package answer, but something similar would be a huge step in the right direction.

....and as soon as someone dies because they only received "basic" healthcare there will be massive outcry because it isn't FAIR that poor people don't receive the same quality of health care rich people receive.  Any program that does not provide exactly the same level of care, regardless of ability to pay must be racist, sexist, ageist, or some other "...ist".

maizeman

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Re: What comes after the ACA?
« Reply #4925 on: November 10, 2018, 09:44:34 PM »
...big snip...
You ask for a simple solution to a very complex and broken system.  It is akin to asking how to end poverty with one little fix which is impossible and needs to be a multi-prong approach.  Personally I think the first step in the process is to have complete 100% mandated transparency in the cost.  Patients need to know how their money is being spent.  I'm sure you had no idea that out of the $600 you paid, your doctor got maybe 5% of of it at best.  Next, we need to stop making medicaid provide the same experience as paid insurance.  There is no reason someone getting charity (so to speak) government funded healthcare (I am not talking about medicare) get the same services as someone who is spending money.  No reason to have private rooms, cutting edge expensive robotic procedures, or the latest expensive overpriced drug. Those patients should receive evidence based low cost medical care and nothing more.  Next we need to have CMS be able to negotiate pricing with pharmaceutical and hardware companies. We need to cut back on the regulatory compliance that is currently mandated which provides no patient value but is very expensive to implement. Through the above measures the cost of healthcare would decrease substantially and we can then implement a no frills public option health insurance for everyone. Basically low cost and affordable healthcare to be implemented at designated public option locations such as university hospitals while allowing those with money to be able to pay for private insurance which will cover improved amenities and still give incentive for innovation.  I'm not saying the above is the complete package answer, but something similar would be a huge step in the right direction.

....and as soon as someone dies because they only received "basic" healthcare there will be massive outcry because it isn't FAIR that poor people don't receive the same quality of health care rich people receive.  Any program that does not provide exactly the same level of care, regardless of ability to pay must be racist, sexist, ageist, or some other "...ist".

I don't disagree with you at all in your prediction about the outcry that would result.

What's interesting to me is that having MDs order more tests/drugs/procedures may be associated with higher patient satisfaction but worse patient outcomes (source). This, along with the observation that the best time to have a heart attack (in terms of not dying during the experience) is when a lot of the senior cardiologists are away at a conferences (just confirmed in a second study, here's the original) makes me think that the patients who received "evidence based" medical treatment might have significantly better health outcomes than the rich folks paying out of pocket and receiving treatment aimed at optimizing patient customer satisfaction.

But in either case, lots of people who check into hospitals do die (as of course do those who don't), so sooner or later (probably sooner), you'd get that death of a person receiving unequal care, and the protests and outcry and all that. I don't have a good solutions.

Last tidbit to contribute to this discussion: a lot of hospitals already have programs set up to treat the rich differently from average patients. If you search google for "red blanket patients" you can get an op-ed from a couple of years ago about this (not linking directly because google search can get you around the paywall).

maizeman

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Re: What comes after the ACA?
« Reply #4926 on: November 10, 2018, 09:51:21 PM »
What about a school bus driver?  How much should a bus driver make for every trip they make?  Now remember they are expected to be perfect.  100%, no misses.  How much should they make to make every turn, have no accidents and no tickets? Again, remember they want to do their best and miss nothing because a child's life is at stake plus if they miss something big they get fired and or lose their license.

Something felt off about the logic of the argument but I couldn't put my finger on it. This example makes it quite clear. Well said, pecunia.

EnjoyIt

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Re: What comes after the ACA?
« Reply #4927 on: November 11, 2018, 09:48:26 AM »
I'm somehow greedy because I make a good income?  Seriously?  This all started because I said I chose to work less hours because at our progressive tax code and laws it is not worth my time to put in that extra days work and everyone jumps down my throat.  Does that make me greedy?

An electrician can show up at your house to fix a problem and charge $150 taking up only 30 minutes of work. Per hour that is way more money than I make. My father in law was an electrician.  By the hour they do pretty damn well.  They final income is lower because they don't have consistent hourly emergency work available.

Yes a bus driver should make less than a airline pilot, web designer or dentist.  In what idiotic world should they make the same income?  Every single person on this forum has had the option to go into IT, law, medicine and each person for whatever reason has made their choice. Those who chose to be teachers knew they were going to make less that a dentist but chose it because they have a passion in what they do and enjoy their Holidays off.  They won the game on quality of work/life balance. Those who chose to not get an education may be a school bus driver and will make a whole lot less than a teacher.  What is awesome about the country is that everyone has that choice to succeed financially if they so desire.  Sure having parents that push education makes it more possible and it is harder for those without that supportive backbone, but it is still possible. It is the American dream and why so many immigrants come to America. I chose medicine and succeeded financially, but somehow I am a villain because I chose well and make a good income.

My dentist does not take insurance.  He has a sole proprietorship very established practice and does much better without having to deal with the insurance bullshit.  My parents dentist in another state also does not take insurance, again an established practice with plenty of clientele. Everyone is better off when we don't have to deal with the insurance middle man in elective procedures.

Lastly, evidence based medicine is exactly how we should practice but government mandated patient satisfaction has skewed how we practice medicine. We do expensive robotics surgeries when a simple laparoscopic procedure has equal if not better outcomes.  We use the latest medication when the cheap generics work just as good.  We are forced to update hospital rooms to large single bed rooms when the size of the room and how many people in it does not affect patient outcome.  We are mandated to spend countless hours documenting information taking precious time away from direct patient care forcing us to hire more people to do the same job.  Medicine is expensive because we allow it to be and there is nothing wrong with cutting back on how we deliver care as long as the care is appropriate evidence based care.  If we want to provide good healthcare to everyone (not just insurance subsidies) we need to make it more affordable 1st.

The funny part about all this is I agree with so much of the liberal arguments discussed here. Including the benefits of a good safety net for our population, good affordable healthcare for all, but unless I agree with the full socialist agenda 100% you all portray me as some sort of greedy monster. And, what is worse is that the socialists here won't even consider or discuss any other option because for them full on socialism somehow is the only way to go.  It is rather sad and narrow minded.



maizeman

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Re: What comes after the ACA?
« Reply #4928 on: November 11, 2018, 09:55:26 AM »
Lastly, evidence based medicine is exactly how we should practice but government mandated patient satisfaction has skewed how we practice medicine. We do expensive robotics surgeries when a simple laparoscopic procedure has equal if not better outcomes. We use the latest medication when the cheap generics work just as good.  We are forced to update hospital rooms to large single bed rooms when the size of the room and how many people in it does not affect patient outcome.

So for the rest of these I understand the economics, but I'm curious about the bolded bit. Do you happen to know why surgery by a robot is more expensive than surgery by a human? If anything I would have guessed moving to more automation would bring costs down rather than up because we'd need fewer of those $1M/year surgeons.

Paul der Krake

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Re: What comes after the ACA?
« Reply #4929 on: November 11, 2018, 10:00:15 AM »
My dentist does not take insurance.  He has a sole proprietorship very established practice and does much better without having to deal with the insurance bullshit.  My parents dentist in another state also does not take insurance, again an established practice with plenty of clientele. Everyone is better off when we don't have to deal with the insurance middle man in elective procedures.
Unlike general health, dental insurance is very limited in scope, which makes it a good deal in only two situations:
1) someone else (usually the employer) pays for it
2) you have really poor cash flow management skills

When I leave the comforts of employment, I would love to find a dentist like yours. My understanding is that most dentists who take both cash and insurance have to inflate their cash prices because a good chunk of the uninsured patient pool is a pain to collect from. I don't mind paying at time of service so they don't have to worry about collecting their fee, and enjoy lower prices.

former player

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Re: What comes after the ACA?
« Reply #4930 on: November 11, 2018, 10:09:06 AM »
I'm somehow greedy because I make a good income?

Before I was FIREd I thought I made "a good income".  It was never even 6 figures, so I'm guessing it was way below what you think of as "a good income".  It was still what I suspect many here would think of as a good income.  Everything's relative, right?   I did study and train for 6 years for my professional qualification, if that helps you make comparisons.

Also as a point of comparison, doctors in many countries do the same work as doctors in the USA, to the same standard, for far less income.  And lets be honest, albeit probably because of the different and more equal systems within which they work, to much better effect in the general population.

This all started because I said I chose to work less hours because at our progressive tax code and laws it is not worth my time to put in that extra days work and everyone jumps down my throat.  Does that make me greedy?

Once I was FIREd I did some consultancy work.  The problem was that my baseline FIREd income used up all the tax space below the 40% level, so all of the consultancy income was taxed at 40%.  At which point I decided the hassle wasn't worth it - I was living way below my baseline income as it was. So from that point of view I'm in the same situation as you.   Those tax free and lower tax rated amounts make a big psychological difference.

pecunia

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Re: What comes after the ACA?
« Reply #4931 on: November 11, 2018, 10:21:16 AM »
"The funny part about all this is I agree with so much of the liberal arguments discussed here. Including the benefits of a good safety net for our population, good affordable healthcare for all, but unless I agree with the full socialist agenda 100% you all portray me as some sort of greedy monster. And, what is worse is that the socialists here won't even consider or discuss any other option because for them full on socialism somehow is the only way to go.  It is rather sad and narrow minded."

No,.....doctors are people too,......I guess.

I see a lot of frustration from everybody about the current medical system, yourself included. 

These discussions did help me when I recently voted.

Is there a link to a description of where another option has been used and has succeeded as well as those Socialist ideas?  I only hear about the Socialist ones.  There is a place where free enterprise should reign and there is a place where the government has to do the job,

EnjoyIt

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Re: What comes after the ACA?
« Reply #4932 on: November 11, 2018, 10:51:14 AM »
Lastly, evidence based medicine is exactly how we should practice but government mandated patient satisfaction has skewed how we practice medicine. We do expensive robotics surgeries when a simple laparoscopic procedure has equal if not better outcomes. We use the latest medication when the cheap generics work just as good.  We are forced to update hospital rooms to large single bed rooms when the size of the room and how many people in it does not affect patient outcome.

So for the rest of these I understand the economics, but I'm curious about the bolded bit. Do you happen to know why surgery by a robot is more expensive than surgery by a human? If anything I would have guessed moving to more automation would bring costs down rather than up because we'd need fewer of those $1M/year surgeons.

Robotic surgeries are just a cool name, and not a procedure done solely by a robot.  These are expensive tools that are able to work in a small space and run by a surgeon.  They are very expensive to purchase and more time consuming to set up and do.  Hospitals buy and sue them because it is a hot fad and people want robotic surgeries.  Studies show that outcomes on most robotic cases are the same and at time inferior compared to open or a laparoscopic approach.

@pecunia,
Most of the so called socialist healthcare we point at in other countries are not actually 100% socialist but a hybrid.  Just about every example has a private insurance component to it or is managed by private insurance firms while the government pays the bills.  What makes the US so different is that the government component is smaller and the bills are multifold higher and in my opinion the biggest setback to affordable healthcare for all.

And yes, doctors are people too....lol.

Also as a point of comparison, doctors in many countries do the same work as doctors in the USA, to the same standard, for far less income.  And lets be honest, albeit probably because of the different and more equal systems within which they work, to much better effect in the general population.

Also, doctors in those countries do not come out with $300k-$500k in debt. In addition the average standard of living in those countries is far less consumerist driven as compared to the US. Americans drive bigger and more expensive cars.  We live in much bigger and more expensive homes, and frankly spend a lot more money. The middle class in the US is far more "comfortable" as compared to the middle class in European.  I dare to say our poor live more affluently compared to the lower middle class of much of Europe.  Everything is more opulent in the US including the physician wages. Taking all that into consideration and adjusting for debt and societal norms are US physicians better paid than those in Europe.  I would venture to say, probably. But then again, there is no reason why everyone can't work and become a doctor in the US if they have the time, fortitude, and intelligence to do so. I guess that is why so many foreign doctors try to come to the US.  Free education at home and then a higher income abroad.

fuzzy math

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Re: What comes after the ACA?
« Reply #4933 on: November 11, 2018, 11:35:52 AM »
More crazy thoughts:

Enjoy It:

What about a school bus driver?  How much should a bus driver make for every trip they make?  Now remember they are expected to be perfect.  100%, no misses.  How much should they make to make every turn, have no accidents and no tickets? Again, remember they want to do their best and miss nothing because a child's life is at stake plus if they miss something big they get fired and or lose their license.

"I chose to go into that profession, worked my ass off to get there and get compensated well to perform it.  Each and every person has or had the same potential as me."

Oh, if it were only true, what a better world we would have.

Come the revolution, we will all have health care.

The difference is in skill level. 99% of us on this board drive and could conceivably learn to drive a school bus. It's a skill simple enough that we allow people aged 15.5 to learn to do.

99% of us you would not want making the types of clinical decisions a physician makes multiple times a day. 99% of us lack the dexterity and precision to perform many of the procedures a Dr performs. We do not allow 15.5 yr olds to begin searching for the internal jugular vein and differentiate it from the internal carotid artery so that a Swan Ganz catheter can safely be inserted to measure right heart pressures.

An ENT surgeon is going to perform my DD's 4th ear surgery this month to verify a non cancerous tumor has not returned and insert a hearing implant. You bet your ass I want this man well paid. I want the most well trained and knowledgeable person that busted their ass for 10+ years to perform this surgery. I questioned the shit out of this Dr and his outcomes, overall risks vs benefits before allowing these surgeries to proceed.

In comparison, I do not know the name or college attended (if applicable) of the people who drive my children's school buses. The company who provides this service has likely done a background check and that's good enough for me. I have never held up the bus in the morning to ask the driver what scholarly publications they have written on subjects in their field.

Anyone who has ridiculed EnjoyIt, feel free to post your salaries so that we can judge whether the market rate is reasonable or whether your education justifies it. I've seen tech managers making $250k on this forum arguing that Dr's are overpaid. Why is it we value high salaries by private companies who produce very little of value to the public good, yet the very people who keep us alive should be subject to such scrutiny?

maizeman

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Re: What comes after the ACA?
« Reply #4934 on: November 11, 2018, 12:35:33 PM »
What about a radiologist.  How much should a radiologist make for every image they look at?  Now remember they are expected to be perfect.  100%, no misses.  How much should they make to read a single CT? Again, remember they want to do their best and miss nothing because a patient's life is at stake plus if they miss something big they get sued for $1 million plus dollars and if they miss too much, they get kicked off the medical staff and or lose their license.

More crazy thoughts:

Enjoy It:

What about a school bus driver?  How much should a bus driver make for every trip they make?  Now remember they are expected to be perfect.  100%, no misses.  How much should they make to make every turn, have no accidents and no tickets? Again, remember they want to do their best and miss nothing because a child's life is at stake plus if they miss something big they get fired and or lose their license.

The difference is in skill level. 99% of us on this board drive and could conceivably learn to drive a school bus. It's a skill simple enough that we allow people aged 15.5 to learn to do.

99% of us you would not want making the types of clinical decisions a physician makes multiple times a day. 99% of us lack the dexterity and precision to perform many of the procedures a Dr performs. We do not allow 15.5 yr olds to begin searching for the internal jugular vein and differentiate it from the internal carotid artery so that a Swan Ganz catheter can safely be inserted to measure right heart pressures.

This is a very distinct argument from the one EnjoyIt made with regards to Radiologists (quoted above) which was that lives are on the line and no mistakes are permissible. pecunia followed that reasoning to one of its logical endpoints, which is that there are a lot of jobs where lives are on the line and no mistakes are permissible, yet we don't pay salaries which are nearly as high. Hence, it is unlikely that the reason we pay radiologists so much is because there are lives on the line and no mistakes are permissible.

The argument that there aren't enough people with the right skillsets, therefore we need to pay the folks with the right skills a lot of money so that enough of them will want to go into medicine doesn't have that same fundamental flaw. However, while I agree with you that the majority of americans lack the mental abilities or physical dexterity necessary to be a physician or surgeon, I would put forward that, at the moment, the main constraint on the number of MDs is the total number of training slots at american med schools,* and, even more so, the total number of residency positions available for newly minted MDs and folks trained outside the USA who would like to immigrate to the USA and practice here.

Now, if I am correct in that assertion, it would mean that the reason a physician can claim such high a salary in the USA today relative to other developed countries around the world isn't because there aren't enough people with the right native abilities, or that not enough people with the right native abilities want to go into the field, but because we are artificially and dramatically limiting the supply of MDs who are legally allowed to practice medicine in the USA.

*This was more of a problem a decade ago. MD granting schools have finally started to grow enrollment, and DO granting schools are doing even more, but residency positions remain a big and increasingly constricting bottleneck on the supply of physicians who are legally allowed to practice medicine. The fact that med schools have been able to expand total enrollment by 10,000 a year (from ~20,000 a year in 2002 to ~30,000 year in 2017) also supports the assertion that the problem is not a shortage of qualified applicants. If med school admissions had only kept up with population expansion we'd only have added ~2,750 med school slots per year over the same time frame.

fuzzy math

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Re: What comes after the ACA?
« Reply #4935 on: November 11, 2018, 12:57:01 PM »

The argument that there aren't enough people with the right skillsets, therefore we need to pay the folks with the right skills a lot of money so that enough of them will want to go into medicine doesn't have that same fundamental flaw. However, while I agree with you that the majority of americans lack the mental abilities or physical dexterity necessary to be a physician or surgeon, I would put forward that, at the moment, the main constraint on the number of MDs is the total number of training slots at american med schools,* and, even more so, the total number of residency positions available for newly minted MDs and folks trained outside the USA who would like to immigrate to the USA and practice here.

Now, if I am correct in that assertion, it would mean that the reason a physician can claim such high a salary in the USA today relative to other developed countries around the world isn't because there aren't enough people with the right native abilities, or that not enough people with the right native abilities want to go into the field, but because we are artificially and dramatically limiting the supply of MDs who are legally allowed to practice medicine in the USA.

*This was more of a problem a decade ago. MD granting schools have finally started to grow enrollment, and DO granting schools are doing even more, but residency positions remain a big and increasingly constricting bottleneck on the supply of physicians who are legally allowed to practice medicine. The fact that med schools have been able to expand total enrollment by 10,000 a year (from ~20,000 a year in 2002 to ~30,000 year in 2017) also supports the assertion that the problem is not a shortage of qualified applicants. If med school admissions had only kept up with population expansion we'd only have added ~2,750 med school slots per year over the same time frame.

I am not saying that there aren't enough docs, and that's the reason that salaries are high. I'm saying that Doctor skill sets are specialized enough, their training long enough and we only allow the best of the best to become physicians so that's why salaries are high.

This is what happens when people without skills are allowed to practice. https://www.propublica.org/article/dr-death-christopher-duntsch-a-surgeon-so-bad-it-was-criminal


You also can't look at physician salaries in the US vs abroad in a vacuum. The nations that people look to in these conversations have lower pay amongst a broad variety of employment sectors. They have higher taxation too, less wealth inequality etc. it is duly unfair to suggest that physician salaries should be the only ones targeted as part of a scheme to lower the costs of healthcare in an unaltered capitalistic society like the US.

sol

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Re: What comes after the ACA?
« Reply #4936 on: November 11, 2018, 01:20:20 PM »
The difference is in skill level.

Oh bullshit.  Professional violinists train from birth to compete for a few thousand jobs in the entire world, and their average salary rarely crosses the six figure mark.  "Skill" has nothing to do with it. 

If doctors think they should be paid more because they are saving lives, they should remember that bus drivers and airline pilots are solely responsible for hundreds of lives every day, and they rarely crack six figures either.

The only difference between violinists and pilots and doctors, and the reason why doctors make more money, is just artificial scarcity.  Doctors have deliberately made it as hard as possible to become a doctor, thus artificially depleting the labor supply and thus increasing their own wages.  Many other trades have followed similar pathways.  Pretty much any job that requires a "certification" or "apprenticeship" or "license" of some sort is doing the same thing.  They're keeping out lower-cost competition.

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99% of us lack the dexterity and precision to perform many of the procedures a Dr performs.

99% of doctors lack the dexterity and precision to perform many of the procedures that a surgeon performs.  Most doctors are not surgeons.

99% of surgeons also lake the dexterity and precision to perform as a concert pianist, too, yet we don't pay them a half mil per year no matter how good they are.

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An ENT surgeon is going to perform my DD's 4th ear surgery this month to verify a non cancerous tumor has not returned and insert a hearing implant. You bet your ass I want this man well paid.

You are free to pay any price to anyone of your choosing, that has nothing to do with the artificial requirements that everyone ELSE should also pay so much.  You are interfering in the free market if you believe that your decisions should be forced on all other patients.

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feel free to post your salaries so that we can judge whether the market rate is reasonable or whether your education justifies it.

I have 11 years of post-secondary education, plus required on-the-job training akin to a residency.  I graduated from the number one and number two programs in the country in my specialty, and went to work for the premier employer for people with my PhD.  I completed my career and then retired without every making more than six figures.  I thought I was overpaid for my work, because there were guys in my office who worked twice as hard as me for half the money.  My education and background "justified" my salary only in the eyes of the people writing my checks, but they did not accurately reflect the amount of work that I did compared to other people in my office.

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I've seen tech managers making $250k on this forum arguing that Dr's are overpaid. Why is it we value high salaries by private companies

We don't.  They are also overpaid.  You cannot justify one overpaid profession (doctors) by pointing to another (tech managers) as if murder is okay because other people are also being murdered.  At least tech managers can justify their salaries by the incredible profits they generate for their employers, unlike doctors.  If tech companies weren't so flush with cash,they wouldn't pay such high salaries.

Every med student I've ever met has delusions of grandeur, as if their medical degree confers some sort of special social status and makes them better than the rest of us.  My doctor is not smarter than me.  He does not work harder than me.  He is not responsible for more profits than me, or helping more people than me.  Why does he make so much more than me?
« Last Edit: November 11, 2018, 01:25:09 PM by sol »

maizeman

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Re: What comes after the ACA?
« Reply #4937 on: November 11, 2018, 02:00:31 PM »
I am not saying that there aren't enough docs, and that's the reason that salaries are high. I'm saying that Doctor skill sets are specialized enough, their training long enough and we only allow the best of the best to become physicians so that's why salaries are high.

Okay, then I guess I don't understand your argument after all. I thought you were arguing that that because only a small number of people could pass the training that was why we had to pay them so much. If your argument is simply that people who train for many many years in specialized fields should be paid more, just because they have more training, we're back to the disconnect that there are many other fields which require as many years, if not more, of specialized training, yet are paid far less (as sol pointed out).

Also, I disagree with your bolded assertion. Most MDs do need to be in the top 5-10% of the population academically/intellectually, but the biggest problem for med school admissions offices isn't shifting through lots of unqualified to find the qualified ones, it's trying to come up with tie breakers among way too many qualified applicants. That's why the most effective advice for getting admitted to med school isn't to work on continuing to goose you GPA/MCAT scores -- once you've got those high enough to show you are qualified -- but to have something unusual about you to make your application stand out.

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You also can't look at physician salaries in the US vs abroad in a vacuum. The nations that people look to in these conversations have lower pay amongst a broad variety of employment sectors. They have higher taxation too, less wealth inequality etc. it is duly unfair to suggest that physician salaries should be the only ones targeted as part of a scheme to lower the costs of healthcare in an unaltered capitalistic society like the US.

Releasing a current constraint on the supply of physicians who are legally allowed to practice medicine in the USA would move us closer to a capitalistic free market for determining MD pay, not away from a free market.

And no, this is not singling out MDs. In both many subfields of programming and in many of the hard sciences there are no caps on the number of trainees and, in addition to domestic trainees, we bring in huge numbers of the most talented people from all over the world. As a result, salaries in those fields are a lot lower than they otherwise would be, but it's also a lot easier to hire skilled geologists, and statisticians, and AI experts than it would be if we constrained the supply of trainees the same way we do for MDs/DOs, which in turn benefits society as a whole.

Cranky

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Re: What comes after the ACA?
« Reply #4938 on: November 11, 2018, 02:26:53 PM »
My dh has a PhD and postdoced for 6 years. He teaches medical students. He is paid much less than MDs. I think itís interesting that many of the people who teach MDs those skills earn so much less...

pecunia

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Re: What comes after the ACA?
« Reply #4939 on: November 11, 2018, 04:40:36 PM »
Reading through some of these past posts greatly reminds me of the arguments I was fed on FOX news a few years back when I still had cable TV.  They were justifying the excessively high pay of CEOS saying that there were limited people with such talent and their skillset was rare.

I could smell BS on that one too.

I went to school with a lot of folks who were in pre-med.  Most were not accepted, could not obtain financing or did not go to medical school for some other reason.  These were smart kids.  Perhaps they only scored a 95 rather than a 100.  Maybe, they would have had to work just a bit harder to get their medical degree.  Maybe, they just had an off day when they took some of their tests.  However, I don't think the small statistical difference would have made any difference to me had I been their potential patient.  (I was not in pre-med.)  I've also noted that a lot of doctors had doctors as parents.  Don't you think that was a significant advantage having grown up with a mentor who could show you the ropes?  We do not all have the same opportunity to become doctors or anything else for that matter.  It's just common sense.

It is a respected profession and good doctors deserve decent pay just like other people who had to work hard to get where they are.

fuzzy math

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Re: What comes after the ACA?
« Reply #4940 on: November 11, 2018, 09:32:38 PM »
If doctors think they should be paid more because they are saving lives, they should remember that bus drivers and airline pilots are solely responsible for hundreds of lives every day, and they rarely crack six figures either.

The only difference between violinists and pilots and doctors, and the reason why doctors make more money, is just artificial scarcity.  Doctors have deliberately made it as hard as possible to become a doctor, thus artificially depleting the labor supply.

Again the skill level required of someone to drive a bus, or pilot a plane (similar to my profession actually) is much different than that of a physician. Your referencing of pilots brings up a really important point, that most do not actually save lives in a true emergency. I can name only 2 pilots who have successfully landed planes in dire emergencies in the past few years, the vast majority go on to perish with their plane full of passengers. As far as bus drivers, again we are talking about a skill set that in essence is learned by teenagers. It is not a valid comparison.

Talk to any physician in a teaching facility and they will tell you not about the lack of spaces for qualified applicants, but the lack of fellowships being filled by qualified applicants. I work with residents and frequently baby sit them. It does not fill me with hope that I as a non physician get to teach them a ton of things they should have learned way earlier in their medical career. Lowering the bar is not the answer.

Experienced pilots make ~150k a year. 

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99% of surgeons also lake the dexterity and precision to perform as a concert pianist, too, yet we don't pay them a half mil per year no matter how good they are.

A bad concert performance in and of itself never killed anyone. You're trying to equate the value of human life with entertainment. By the way, popular entertainers make many times more than physicians.


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You are free to pay any price to anyone of your choosing, that has nothing to do with the artificial requirements that everyone ELSE should also pay so much.  You are interfering in the free market if you believe that your decisions should be forced on all other patients.

Are you really stating that little old me, anonymous internet poster, is actually actively interfering with the free market? That's hyperbole if I ever heard it.

When my DD's surgeon comes out of the OR and tells me that he spent 3 hours (of what he predicted would take 90 minutes or less) staring through a microscope scraping shit off a tiny fucking membrane (the only thing keeping my DD from having her inner ear punctured and suffering life long vertigo), I'm thankful that there are people out there who are talented and hard working to keep at it. Because I can tell you, I've seen the stamina of these people first hand and I don't have it. I doubt anyone who hasn't been there witnessing what doctors do could have even a basic idea of the difference in drive and work ethic that a skilled physician has and the absolute shit show of someone who lacks either the knowledge, skill seat, or drive. People die over this sort of thing, every goddamn day. You want the dr who sees this stuff and performs the test or procedure 200x a year, not 15x a year. The person who forgoes a personal life because they are married to medicine.

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I have 11 years of post-secondary education, plus required on-the-job training akin to a residency.  I graduated from the number one and number two programs in the country in my specialty, and went to work for the premier employer for people with my PhD.  I completed my career and then retired without every making more than six figures. I thought I was overpaid for my work, because there were guys in my office who worked twice as hard as me for half the money.  My education and background "justified" my salary only in the eyes of the people writing my checks, but they did not accurately reflect the amount of work that I did compared to other people in my office.

You are sorely mistaken if you think most Drs are making 7 figures. Family practice medicine makes ~200k, anesthesia ~300k, ER medicine 300-400k, cardiology and other skilled specialties like neurosurgery ~600k. Some is high. I don't disagree with that. Based off your previous statements however, you agree to some extent as you stated that most physicians don't require dexterity to perform complex procedures. Just because a specialty doesn't state surgeon in their name does not mean they never perform procedures.

Perhaps you should have worked harder.


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We don't.  They are also overpaid. You cannot justify one overpaid profession (doctors) by pointing to another (tech managers) as if murder is okay because other people are also being murdered.  At least tech managers can justify their salaries by the incredible profits they generate for their employers, unlike doctors.  If tech companies weren't so flush with cash,they wouldn't pay such high salaries.

You just did what you said you don't do.

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Every med student I've ever met has delusions of grandeur, as if their medical degree confers some sort of special social status and makes them better than the rest of us.  My doctor is not smarter than me.  He does not work harder than me.  He is not responsible for more profits than me, or helping more people than me.  Why does he make so much more than me?

Because your dr doesn't sit around on this forum during his work hours, complaining about how stupid his job is and how he's reached the top of the pay scale and how there's just no incentive for him to work harder so he's going to slack off until his retirement. Sound familiar? Do you expect others to work super hard without appropriate compensation when you spent months on this forum bitching about the federal govt not allowing you advancement opportunities? Now pretend you were caring for 40 patients a day, juggling their medical histories, writing prescriptions and referrals, performing in office procedures. Then you get to go home, be on call, maybe log into your EMR at home and review images, order some urgent tests, and wow get paged into the hospital for a consult at 3 am. You're there til 6 am, you change clothes in your office, then you have another full day of doing the same shit. Maybe you're on call again, maybe you're not. Maybe the only call you get that night is that Mr Jones can't poop and he ran out of his shit medicine and can you please call him in a script because his wife (or the unit nurse) is going to nag you to death on the phone if you don't. Repeat, repeat, repeat. Now it's the weekend. You're not on call for new patients, but the on call guy does a shit job of seeing your inpatients, so you go in on Saturday and Sunday to round on them, but hell its only 3 hours each day.

So yeah, whatever you did in your office with your 11 years of training (comparable to many physician specialities btw) probably does not compare at all to the shit that a lot of docs put up with day in and day out. The lack of sleep and a predictable schedule in and of itself is a huge factor in pay. While lower paid hourly people are paid each and every time they go back to work, most physicians are salaried and their 60 hour weeks do not earn them any call pay (20- 50% pay for hourly workers), overtime or call back pay (1.5 - 2x pay), night, holiday or weekend differential (again often 1.5 - 2x pay).
« Last Edit: November 11, 2018, 09:45:07 PM by fuzzy math »

fuzzy math

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Re: What comes after the ACA?
« Reply #4941 on: November 11, 2018, 09:51:35 PM »
I'm somehow greedy because I make a good income?  Seriously?  This all started because I said I chose to work less hours because at our progressive tax code and laws it is not worth my time to put in that extra days work and everyone jumps down my throat.  Does that make me greedy?


These are the same people who do the same thing in their private industry professions, then take advantage of the ACA insurance subsidies after becoming millionaires, but believe since you had a MD after your name you should be benevolent, and not do as they do. Don't let them get you down.

Classical_Liberal

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Re: What comes after the ACA?
« Reply #4942 on: November 12, 2018, 03:41:18 AM »
Wow, this has gone downhill... As has this forum in general.

Doctors and bus drivers have the same type of job? What are nurses then?   

There is a serious disconnect between the reality of what healthcare worker's endure, the amazing talent/dedication it takes to meet daily demands and what most of you think. 

Edit:  I took the rest out.  Rather leave on a good note.
« Last Edit: November 12, 2018, 03:43:38 AM by Classical_Liberal »

Bucksandreds

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Re: What comes after the ACA?
« Reply #4943 on: November 12, 2018, 06:40:28 AM »
I'm somehow greedy because I make a good income?  Seriously?  This all started because I said I chose to work less hours because at our progressive tax code and laws it is not worth my time to put in that extra days work and everyone jumps down my throat.  Does that make me greedy?


These are the same people who do the same thing in their private industry professions, then take advantage of the ACA insurance subsidies after becoming millionaires, but believe since you had a MD after your name you should be benevolent, and not do as they do. Don't let them get you down.

Iím not that person you describe. Iím a full time dentist making typical dentist money, receiving no ACA subsidies, while claiming that Iím overpaid. The quote that youíre responding to was a response to my post. If youíre going to generalize everyone in this thread than at least get your facts straight. There are dozens of factors that contribute to our absurd healthcare costs. Overpaid medical professionals is one of them. If ones goal is to make 10 times the median pay in the US then many of us, including many medical professionals, believe that it should not be at least partially on the backs of bankrupting tens of thousands of Americans in a market where those people have no other options. You can make your rationalizations all day and I can have my beliefs. There is no definitive proof either way. Logically, when there is an income bubble in one country in one field in comparison to virtually every other country in the world, there is an artificial distortion that is driving it.

freya

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Re: What comes after the ACA?
« Reply #4944 on: November 12, 2018, 06:44:27 AM »
This discussion is actually not so different from stuff I hear every day.  People see high medical bills and somehow think that it's primarily driven by doctor's salaries because yes, they're high and I do agree that it's sometimes beyond what's easily justifiable.  I'm a physician-scientist (~20% clinical, 80% research/administration), so my pay is on the low end of the scale.  I'm fine with this since I think my quality of life is way better than the poor sod in private practice who is on call every 4th night and weekend, and works 12 hour days in between.   Perhaps if doctors' lifestyles were better, they'd be OK with salaries that are more in line with, say, what a lawyer or PhD engineer makes.  The $200-300K range sounds about right to me for equivalent levels of work.  (Please don't compare doctors to bus drivers....)

Here's how things actually work.  From your typical office visit, this is where the money goes:

- Billing:  Outsourced, which is usual practice.  They take 30% right off the top.  Insurance denials and price limits cut off another 30%, roughly.
- Overhead:  This includes the Dean's tax, office space, administrative overhead, ancillary staff, and let's not forget the EHR - one of the major flubs of Obamacare.  The expense it adds for virtually no benefit is hard to fathom, not to mention that it has driven most small practices out of business.  My institution has so far spent almost $200 million on the purchase costs alone.

So yes, EnjoyIt is right - there's basically nothing left over, and in fact office visits are generally a money losing enterprise.  The only financial reason to even run an office is to get patients in for procedures - and THAT, my friends, is where the real money comes in, and where a major bit of corruption has been taking place under the radar.  Procedure codes pay WAY better than "evaluation and management" codes.   This state of affairs, btw, is a big reason why I refuse to join the AMA.  They're the primary force behind keeping this disparity alive.  There is increasing pressure on physicians to order more studies.  It comes from the patients, who equate more studies with more attentive doctors and higher quality healthcare (which is the opposite of reality), and from management above, who apply corporate logic and have the goal of maximizing income.

example:  our dept recently decided to mandate that all new patients in my division automatically get a short procedure along with their visit, whether they need it or not.  Most physicians dutifully went along with this, having absorbed the lessons of the corporate atmosphere.  Refusing is not an option.

Another example:  A specific surgical procedure I'm involved with (I'm not the surgeon but I'm part of the decision making team that sends people for this procedure) shifted from an open approach that had pretty good outcomes to an approach touted as "minimally invasive" that does have slightly less morbidity, but outcomes are not as good.  The new procedure is done with a robot (purchased at a cost of $800K).  It is no faster than the old, open procedure.  However, the surgeon gets to advertise "minimally invasive" and "robot" to patients, and of course it's a major draw.  And, instead of one hospitalization with two trips to the OR, the patient now has to undergo two hospitalizations with 3 trips to the OR.  That increases the surgeon's & hospital's profit per patient - and it's still more because the patient sometimes has to undergo more procedures when the new "minimally invasive" one fails.

You might be thinking now, but what about evidence based medicine?  Well, that's little more than a mirage.  There is almost nothing about medicine that is actually based on it.  This is another major money sink of Obamacare that had the best of intentions:  PCORI, a completely useless institution soaking up a ton of federal dollars.  And anyway most questions facing doctors every day won't ever be studied because it would be either too expensive or unethical to do so.

So there you have it.  The high costs are being driven by a medical culture gone bad, plus an increasingly top-heavy administrative/corporate governance that was unfortunately made worse by Obamacare.  The only hope I see for fixing it is to go single payer, e.g. Medicare for all.



maizeman

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Re: What comes after the ACA?
« Reply #4945 on: November 12, 2018, 06:48:46 AM »
Doctors and bus drivers have the same type of job? What are nurses then?   

EnjoyIt posited a reason radiologists might have to be payed a lot of money. Pecunia pointed out that factor isn't unique to radiologists but it also shared by other professions which are not paid a lot of money. This demonstrated that this particular factor is likely not the reason that radiologists are paid a lot of money.

Nowhere in that are people saying that doctors and bus drivers have the same job.

It is the same as if I was wondering why giraffes has necks that are much longer than most animals, someone else said "oh it's because they have spots, if you have spots you need to have a long neck" and then a third person pointed out "but cheetahs have spots and they don't have long necks." That doesn't mean a cheetah and a giraffe as the same animal, just that, despite the fact that giraffes have spots, it having spots probably isn't the reason they have unusually long necks.

radram

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Re: What comes after the ACA?
« Reply #4946 on: November 12, 2018, 07:13:09 AM »
That doesn't mean a cheetah and a giraffe as the same animal, just that, despite the fact that giraffes have spots, it having spots probably isn't the reason they have unusually long necks.
Are you sure? I have never seen a cheetah and a giraffe in the same room at the same time.

Have you?

Metta

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Re: What comes after the ACA?
« Reply #4947 on: November 12, 2018, 07:42:10 AM »
My biggest concern for people working in health care is not that how much doctors are paid but that the low-level staff have health care. It seems profoundly unfair to me for doctors to say that we should get rid of the ACA while physical therapy assistants, home health aides, and others have a hard time getting insurance without either Medicaid or ACA. These are not lazy people and they are doing important work. Letís support a system that ensures health care for everyone. I think the ACA (with all its problems) is better than what we had before. Iíd also support single-payer. Iíd support any system that provided health care to everyone.

maizeman

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Re: What comes after the ACA?
« Reply #4948 on: November 12, 2018, 07:55:33 AM »
That doesn't mean a cheetah and a giraffe as the same animal, just that, despite the fact that giraffes have spots, it having spots probably isn't the reason they have unusually long necks.
Are you sure? I have never seen a cheetah and a giraffe in the same room at the same time.

Have you?

You are right. It doesnít PROVE that a giraffe and a cheetah are the same animal. But technically it doesnít DISPROVE it either. ;-)

radram

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Re: What comes after the ACA?
« Reply #4949 on: November 12, 2018, 08:38:39 AM »
That doesn't mean a cheetah and a giraffe as the same animal, just that, despite the fact that giraffes have spots, it having spots probably isn't the reason they have unusually long necks.
Are you sure? I have never seen a cheetah and a giraffe in the same room at the same time.

Have you?

You are right. It doesnít PROVE that a giraffe and a cheetah are the same animal. But technically it doesnít DISPROVE it either. ;-)

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