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Old 06-02-2007, 08:26 AM   #201
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Health care technology keeps advancing, which should normally reduce costs in any other industry, but it doesn't seem to apply here - why?
That's an excellent question. I can think of some reasons:

1. The competitive open market works very poorly when the vendor is ethically and legally bound to deliver the requested service even if the buyer is unable or unwilling to pay for it. Such is the case in medical practice.

2. When virtually every purchase is carried out under onerous third party agency, the negotiation between buyer and seller is perpetually disrupted.

3. Indirectly, the vendor operates under price fixing - medicare sets reimbursement rates; carriers often follow though at a somewhat higher rate much of the time; a byzantine and unpredictable "percent of charges" method coerces the vendor to set artifically high prices in order to receive a fraction of them, then the same prices prevails when dealing with a customer who is NOT under that kind of system

4. Compliance with regulations and malpractice protection superimposed on the above ad further distorted pressures to the market.

5. Medicine itself has failed to embrace proven standards of care, guidelines, performance incentives, and other industrial practices which apply to the profession, if not perfectly. This is changing rapidly but often at the hand of carriers who overweight cost compared to quality.

So it is not a system that is controlled by free-market sources. Best I can tell, the majority of patients, physicians and economists are distressed by the system.
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Old 06-02-2007, 08:55 AM   #202
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That's an excellent question. I can think of some reasons:
So it is not a system that is controlled by free-market sources. Best I can tell, the majority of patients, physicians and economists are distressed by the system.
Well who the h*ll is in control and why don't the doctors, who the entire system depends on, do something? Seems like they hold the key, without the doctors, no insurance companies would be in business.
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Old 06-02-2007, 09:08 AM   #203
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Basically you need the doctors and the patients. Anyone else is overhead.

If you want a true free market that should eventually produce an efficient cost system, let doctors set their rates, patients pay them, and patients get reimbursed by the insurer.

Eventually, a stratified set of doctor and insurer choices will be produced, from cheap and somewhat sucky to expensive and full quality service.

By putting the patient in the middle, insurers with excessive horsepuckey or insufficient payments will get tossed in favor of the cheaper, better payers with fewer forms.

Hell, i'm already thoroughly in the middle, with no value added. My doctor bills blue cross for $100, blue cross initially refuses to pay the bill, citing improper coding by the doctors office, which on resubmission of the paperwork turns out to be the proper codes after all. Then BC negotiates a $56 payment, but the doctor decides the process was worth $62 and bills me for six bucks. I fill out the payment form and send a check or credit card number, either of which has to be processed by yet another middleman - the bank.

In the meanwhile, pressed with ridiculous overhead, onerous paperwork, resubmissions, and the need for the personnel to deal with this, it seems to me that doctors are hiring more inexpensive workers to cope with the hoo-hah, resulting in a lousier patient experience from said inexpensive (read: less effective) personnel screwing up my appointments, not following through with stuff, and not returning phone calls.

Is anyone seeing the worthless cost components yet and the reduced benefit side effects they induce?
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Old 06-02-2007, 09:41 AM   #204
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Health care technology keeps advancing, which should normally reduce costs in any other industry, but it doesn't seem to apply here - why?
There certainly seems to be room for price cutting. Yesterday I was chatting with a nurse while I waited on a gurney for my colonoscopy. I asked her how many they did daily. (This is an 8 MD gastroenterology practice). She said, well, we do about 36 to 40 a day. Each nurse has room, which does one an hour. each Doc rotates between 2 rooms, doing one every 30 minutes. It all takes place in their own suite within their offices.

I haven't seen the bill yet, but I think that suite will easily pull $50,000 or so daily in gross billings. Pluss lots of other treatments, 2 surgeons working, etc.

BTW, I am happy to report that I checked out OK, and don't have to report for that particular ordeal for another 10 years.

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Old 06-02-2007, 09:52 AM   #205
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Well who the h*ll is in control and why don't the doctors, who the entire system depends on, do something? Seems like they hold the key, without the doctors, no insurance companies would be in business.
Doctors can't "collude" as an organized group without being employees under most circumstances. There is great diversity of beliefs within the profession. Most state and county medical societies and other advocacy groups seem obsessed with sustaining physician income and freedom from outside interference; they seem to evade the larger issues at stake.

While it is growing noticeably, there is still only a minority of doctors who, like myself, feel that the ultimate solution has to include universal coverage, some degree of federal oversight and enforcement, unlinking from employment and underwriting, and inclusion of all socioeconomic subsets (implying means testing and some tax-supported subsidies for the disabled and poor).

I think the profession inadvertently contributed to the current mess through greed, shortsightedness, and arrogance. The stage was set by about 1980. But nowadays doctors are really not a major agent of the problem -- in fact they are one of its many victims.

Fortunately, the actual practice of the profession remains one of the most rewarding and satisfying pursuits I can think of. If not for that, it's hard to see why anyone would choose it until things settle out.
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Old 06-02-2007, 10:07 AM   #206
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Fortunately, the actual practice of the profession remains one of the most rewarding and satisfying pursuits I can think of. If not for that, it's hard to see why anyone would choose it until things settle out.
See my post above for a taste of the tangible rewards.

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Old 06-02-2007, 10:17 AM   #207
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See my post above for a taste of the tangible rewards.
Who do you think opposes national or managed health care within the profession?

Hint: it's not the internists, pediatricians, and family docs.
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Old 06-02-2007, 12:04 PM   #208
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Who do you think opposes national or managed health care within the profession?

Hint: it's not the internists, pediatricians, and family docs.
It's going to be the specialists that will oppose national health care, because salary caps will place income levels below the true value of their services as well as discourage people from choosing those kind of professions. (which will ultimately have a negative impact on the quality of high tech care in our country).

But the way things are right now with more and more of the baby boomer generatoin approaching Medicare (socialized medicine) eligibility, primary care docs (especially geriatrics) are beginning to become inundated with customers (unlimited demand), so we're starting to see longer wait times already with primary care. Being inundated with customers isn't necessarily a bad thing when it comes to trying to start a career (and that, I am sure is one of the reasons why primary care docs don't necessarily oppose socialized medicine), but when the reimbursement levels from Medicare and Medicaid barely cover operating costs, it's got to be discouraging for the docs.
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Old 06-02-2007, 12:38 PM   #209
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It's going to be the specialists that will oppose national health care, because salary caps will place income levels below the true value of their services as well as discourage people from choosing those kind of professions. (which will ultimately have a negative impact on the quality of high tech care in our country)
Right.

It's goiing to be tough for them to get by on $500K a year instead of $900K. We all have to sacrifice I guess .
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Old 06-02-2007, 04:15 PM   #210
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Right.

It's goiing to be tough for them to get by on $500K a year instead of $900K. We all have to sacrifice I guess .
The question is...how many will even bother to go through the lengthy educational process for half the income, when they could make just as much money being a fashion designer or a small business owner...or a real estate investor AND not have to pay back huge student loans and buy expensive liability insurance?

I don't have a problem with doctors making half the income and making sacrifices...to tell you the truth, that would be the noble thing to do, but the real question is, will they even bother...or will we lose many of them altogether and wind up with huge shortages of specialists 10 or 20 years down the road?
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Old 06-02-2007, 05:55 PM   #211
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The question is...how many will even bother to go through the lengthy educational process for half the income, when they could make just as much money being a fashion designer or a small business owner...or a real estate investor AND not have to pay back huge student loans and buy expensive liability insurance?
So, for example:

Choice 1: be a thoracic surgeon at $500k starting out at age 32 with a $200K debt. Kind of a rough start, but debts could be paid off in 2 years with ease, rest of life = rewarding work, wealth, prestige, and ER.

Choice 2: be a fashion designer.

While you might not exactly be fishing in the same pond for such candidates you might find a few willing to take choice 1. Just my guess .

But seriously, as long as the reimbursement reasonably reflects the time, effort, brains, and cost the calling will be there. Of course there is some number below which it just doesn't make sense but I think its probably well below the $700k - $1mm per year that the highest paying MDs make.

If money is their main driver, they can always become Wall Street investment bankers or insurance company executives.
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Old 06-02-2007, 07:00 PM   #212
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I wonder though....if the true market value of a brain surgeon or heart surgeon should really only be in the 500K range, then why isn't that the price they settle for now? I'm sure that some people would be willing to go through 10 or more years of schooling for 1/2 the salary simply because of the rewarding career, but if doctors were only in it for the heart warming rewards, then why don't they just settle for half right now?
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Old 06-02-2007, 08:25 PM   #213
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I wonder though....if the true market value of a brain surgeon or heart surgeon should really only be in the 500K range, then why isn't that the price they settle for now? I'm sure that some people would be willing to go through 10 or more years of schooling for 1/2 the salary simply because of the rewarding career, but if doctors were only in it for the heart warming rewards, then why don't they just settle for half right now?
I hate to bring this up but you know there are a lot of doctors that enjoy their work because they are helping people. There are many who put their patients health above the almighty dollar. But for a pure capitalist who would sell his mother to make a buck this is hard to understand.

Money is not everything to a lot of doctors!
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Old 06-02-2007, 08:35 PM   #214
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Any good web sites on how to become a 500k a year fashion designer?

Apparently I missed my one true calling...
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Old 06-02-2007, 08:41 PM   #215
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I hate to bring this up but you know there are a lot of doctors that enjoy their work because they are helping people. There are many who put their patients health above the almighty dollar. But for a pure capitalist who would sell his mother to make a buck this is hard to understand.

Money is not everything to a lot of doctors!
Then why don't they graciously cut their salaries in half and save America 1 Trillion dollars? Look, I realize that many docs are in it for the rewards. My concern is that we will lose precious talent down the road if we cap salaries, which is what we will eventually be forced to do in a nationalized system with no out of pocket responsibility.

....And just because you believe in capitalism does not make you an evil person. I really take offense to that. The rewards I get from helping people in my career are a huge part of why I do it. I left my job as as a technical service rep making very good money to work with my DH and have a more flexible schedule so I could work at home and spend more time with my kids.

In the meantime, I discovered that I could help people save thousands of dollars on their healthcare budgets and provide them with better coverage than they had before by taking the time to do work that they found to be incrediby complicated and confusing on their behalf.
As a team, DH and I have helped hundreds of small businesses provide affordable benefits to their employees, and helped save them from having to drop their benefit plans or make drastic business changes, because they didn't know how to tweek their benefit plans on their own.

While I do believe our system has it's problems, I truly believe that nationalizing coverage will eventually hurt more people than it helps (particularly 20 or 30 years down the road), and that's why I am so against it - my passion really has nothing to do with my salary, as I could make more money doing other careers that I am well trained for. We can't afford to make quick decisions about our healthcare system, nor can we afford to elect the first yahoo who promises to make it better without putting out a solid plan of action to the people of America before election day.

There are too many uneducated people out there who will vote based on empty promises and no insight as to the long-term consequences of their decisions, and I resent that!
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Old 06-02-2007, 08:51 PM   #216
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Any good web sites on how to become a 500k a year fashion designer?

Apparently I missed my one true calling...
Very funny. Hey - I bet Calvin Klien and Ann Taylor do OK!
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Old 06-02-2007, 08:56 PM   #217
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I'm thinking my chances are better at succeeding at brain surgery than becoming ann taylor.
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Old 06-02-2007, 08:58 PM   #218
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Getting rid of the middleman is a very capitalist concept.

Universal healthcare systems have been well tested in other countries (since the 1930s in western Canada), and in most cases they deliver better healthcare at a lower cost. Fear not

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Old 06-02-2007, 09:04 PM   #219
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I'm thinking my chances are better at succeeding at brain surgery than becoming ann taylor.
To each his own!
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Old 06-02-2007, 09:06 PM   #220
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Given I pick out an air compressor and some tools, any interest in becoming a test patient? I'll only charge half my expected usual full rate since you're "in the business"...
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