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Old 05-20-2010, 10:19 AM   #21
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My rates have been going up by 10-20% annually for years. Can I blame the rate increases through 2008 on Bush and Clinton?
And now they will go up 30-50%.
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Old 05-20-2010, 10:28 AM   #22
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I think the uproar is the same.

But when the "middle men" such as GS and Insurance companies make outsized profits when they don't actually produce anything - that's a bit different than Oil and Pharma which actually do produce a tangible product, not just shuffle money around and take their cut.
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How do you define "outsized"? I find it interesting that the doctors on this forum are staying out of this discussion. Maybe the ones still working will have something to say when they get a 50% paycut, courtesy of the govt setting maximum rates on what doctors can charge........
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Old 05-20-2010, 11:11 AM   #23
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How do you define "outsized"? I find it interesting that the doctors on this forum are staying out of this discussion. Maybe the ones still working will have something to say when they get a 50% paycut, courtesy of the govt setting maximum rates on what doctors can charge........
Not sure what you are going on about, but I was talking about the increasingly outsized profits of the middlemen - i.e. health insurance companies - not about doctors.

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Old 05-20-2010, 11:16 AM   #24
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Not sure what you are going on about, but I was talking about the increasingly outsized profits of the middlemen - i.e. health insurance companies - not about doctors.

Audrey
Health insurers post losses, blame state rate caps - Daily Business Update - The Boston Globe
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Old 05-20-2010, 11:25 AM   #25
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How do you define "outsized"? I find it interesting that the doctors on this forum are staying out of this discussion. Maybe the ones still working will have something to say when they get a 50% paycut, courtesy of the govt setting maximum rates on what doctors can charge........

Yes... this is the place that people don't want to discuss... no other place pays doctors as much as we do...

This is going back 30 years... when I used to do tax returns... there was a doctor that worked for a famous heart surgeon... and he finally made it... he was doing the surgeries himself... and his salary increased by $1 million... not that he was getting $1 mill, but his INCREASE was $1 mill.. I wonder what this kind of person makes today...


And we have a new memember... who is going to be a doc and his wife a doc (sorry, not trying to jump on you... just using you as an example)... and he said they will start at about $250K to $300K each (on average)... I am not trying to get into a debate on how long it took to get his education etc. etc.... but just pointing out that docs in other countries when we want to 'be like' pay less than half... and probably less than 25%...

Hmmm... any link someone can find to show what different docs make in different countries
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Old 05-20-2010, 11:32 AM   #26
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And we have a new memember... who is going to be a doc and his wife a doc (sorry, not trying to jump on you... just using you as an example)... and he said they will start at about $250K to $300K each (on average)... I am not trying to get into a debate on how long it took to get his education etc. etc.... but just pointing out that docs in other countries when we want to 'be like' pay less than half... and probably less than 25%...
It would also be instructive to see what docs in other countries pay for malpractice insurance and student loans. And the incomes of the docs should be compared with the median income of their own country, not to U.S. doctors in U.S. dollars.
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Old 05-20-2010, 11:38 AM   #27
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Hmmm... here is a link for the UK...

PayScale - Doctors' Salaries in UK, Average Salaries

A general practice make on average 38,293 pounds (* 1.43 right now is $54,759)

Vs ours at $204,000

Salary Information for Physician Jobs

Not sure if I got it right... but Canada looks like a range of 83K to 150K Canadian.. so say the middle is 115K



Now... here is an article that says... it will not make much of a difference anyhow... but that docs will probably be paid less anyhow...

Do American doctors get paid too much? - By Christopher Beam - Slate Magazine
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Old 05-20-2010, 11:46 AM   #28
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Hmmm... here is a link for the UK...

PayScale - Doctors' Salaries in UK, Average Salaries

A general practice make on average 38,293 pounds (* 1.43 right now is $54,759)
Medical school tuition in the UK is also capped at 3,250 UKP ($4,648) per year. So presumably part of the reason NHS can pay a lot less is because they have highly subsidized the UK doctor's education. Granted, that alone doesn't close the wide gap completely, but it likely is a factor.
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Old 05-20-2010, 11:48 AM   #29
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Vs ours at $204,000 ...

Now... here is an article that says... it will not make much of a difference anyhow... but that docs will probably be paid less anyhow...

Do American doctors get paid too much? - By Christopher Beam - Slate Magazine
This one says the median income of a physician in family practice is $137,000, not $204,000.
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Old 05-20-2010, 11:52 AM   #30
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Medical school tuition in the UK is also capped at 3,250 UKP ($4,648) per year. So presumably part of the reason NHS can pay a lot less is because they have highly subsidized the UK doctor's education. Granted, that alone doesn't close the wide gap completely, but it likely is a factor.

Yes... but if we want to be like 'them'... should we not be more like them in more than just having a single payor system

This is my problem with the call to just go single payor... because it does not address the real costs..

And if the gvmt says this is the max we will pay for X... and then your local hospital goes under because they can not survive no that amount... and now you have to drive 100 to 200 miles to get healthcare... who do you blame

I for one do not know the answer... but I know that some of the simple responses do not forsee what changes will take place if their suggestion is implemented...
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Old 05-20-2010, 11:54 AM   #31
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This one says the median income of a physician in family practice is $137,000, not $204,000.
I just grabbed one of the first sites I got when I looked them up... I have no idea how accurate they are... and what is included in the number... that is why I think it would be interesting to see someone who actually did the research...
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Old 05-20-2010, 12:04 PM   #32
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The cost of medical school and starting a practice, etc., are all irrelevant in regard to what doc's "should" be paid. They should be paid what a competitive, transparent market will bear. Unfortunately, price competition is not a significant factor in the US today for medical services. A real problem.........

I'd gladly see my taxes raised to provide full schlorships to medical school for all medical students who meet stringent standards. Couple this with low interest govt loans to help new docs (especially family practice types) start/join practices post graduation and I bet you'll see physician compensation levels decrease while supply is increasing.

I feel the same way about nursing and medical technician vocations as well. Send 'em to school on taxpayers' dimes and make entry into the field easy from a financial perspective. Keep academic requirements tough, of course.
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Old 05-20-2010, 01:48 PM   #33
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It's clear that this promise cannot be kept. Insurers and physicians are already reshaping their businesses
This has been going on for a long time. A number of doctors in my area have stopped taking Medicare patients over the past 15 years or so. (Maybe earlier, but I first noticed the little 'No new Medicare patients' signs around 1995.) Most Medicare care here goes through HMOs that are in other federal programs, and so must take Medicare patients.

This dropping of certain providers is not limited to Medicare. Several years ago, United Healthcare cut reimbursements significantly (while paying out some 1.5 BILLION to a departing CEO!), leading to about half the doctors here dropping UHC as accepted insurance, and the only lab service in the region, Quest Diagnostics, dropping UHC and demanding cash in advance. So, you could keep your UHC insurance if you liked it, and just pay out of pocket for doctors and lab work. Of course, you might not like your UHC coverage so much after paying enough in 'out of network' expenses...
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Old 05-20-2010, 03:28 PM   #34
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I'd gladly see my taxes raised to provide full schlorships to medical school for all medical students who meet stringent standards. Couple this with low interest govt loans to help new docs (especially family practice types) start/join practices post graduation and I bet you'll see physician compensation levels decrease while supply is increasing.

I feel the same way about nursing and medical technician vocations as well. Send 'em to school on taxpayers' dimes and make entry into the field easy from a financial perspective. Keep academic requirements tough, of course.
Except that, as we've seen, when government makes cheap money available for school, it drives tuition prices through the roof. I don't know if we need flocks of "Jimmy's Doctor School" storefronts opening up to take advantage of a flood of federal money. Federal involvement to date is one of the primary reasons we don't have more doctors--there's an interesting story/scandal of how the AMA has worked with Congress to cap the number of medical residencies available. This serves as an effective cap on the supplies of new doctors, which keeps their wages high (the AMA's intent all along).

With government help of the appropriate kind (e.g. to promote price transparency and an efficient marketplace in medical services and insurance) the market will do a fine job of producing good doctors, and the right kind of doctors, far better than any governemnt program--just like the market does it for every other occupation/profession/calling.
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Old 05-20-2010, 06:50 PM   #35
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I think the uproar is the same.

But when the "middle men" such as GS and Insurance companies make outsized profits when they don't actually produce anything - that's a bit different than Oil and Pharma which actually do produce a tangible product, not just shuffle money around and take their cut.

Audrey
And then, our gummint is also another middleman who takes a cut in everything.

And there's more. Our American megacorps are full of middlemen who push papers, regulate, monitor, or supervise, rather than actually produce the goods or services. We are surrounded by middlemen, who make more money than people who actually produce.

We are doomed, I tell you, we are doomed!
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Old 05-20-2010, 09:22 PM   #36
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Except that, as we've seen, when government makes cheap money available for school, it drives tuition prices through the roof. I don't know if we need flocks of "Jimmy's Doctor School" storefronts opening up to take advantage of a flood of federal money. Federal involvement to date is one of the primary reasons we don't have more doctors--there's an interesting story/scandal of how the AMA has worked with Congress to cap the number of medical residencies available. This serves as an effective cap on the supplies of new doctors, which keeps their wages high (the AMA's intent all along).

With government help of the appropriate kind (e.g. to promote price transparency and an efficient marketplace in medical services and insurance) the market will do a fine job of producing good doctors, and the right kind of doctors, far better than any governemnt program--just like the market does it for every other occupation/profession/calling.
Many good points samclem. But, my point in mentioning "stringent standards" was to focus on a program that would allow topnotch medical students to attend existing, expensive programs that they might not have been able to justify financially otherwise....... not to create a abundance of new "storefront" medical schools in every strip mall from here to Omaha catering to the not-so-qualified. I think there are already bountiful numbers of offshore institutions taking care of that.........

I understand that gov't programs struggle to accomplish intended goals and avoid unintended consequences. Still, it's frustrating to envision a shortage of medical personnel when the cost of training seems cheap in light of the benefits gained.
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Old 05-20-2010, 09:37 PM   #37
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Here's another piece on the disappearance of employer-sponsored health plans.

From the article (emphasis added):
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. . . employers are quickly discovering that it may be cheaper to pay fines to the government than to insure workers.


AT&T, Caterpillar, John Deere and Verizon have all made internal calculations, according the House Energy and Commerce Committee, to determine how much could be saved by a) dropping their employer-provided insurance, b) paying a fine of $2,000 per employee, and c) leaving their employees with the option of buying highly-subsidized insurance in the newly created health-insurance exchange.

. . .But considering that [workers] will be required by federal law to buy their own insurance in an exchange, will they be net winners or losers? That depends on their incomes.A Congressional Budget Office (CBO) analysis of the House version of ObamaCare, which is close to what actually passed in March, assumed a $15,000 premium for family coverage in 2016. Yet the only subsidy available for employer-provided coverage is the same one as under current law: the ability to pay with pretax dollars. For a $30,000-a-year worker paying no federal income tax, the only tax subsidy is the payroll tax avoided on the employer's premiums. That subsidy is only worth about $2,811 a year.
If this same worker goes to the health-insurance exchange, however, the federal government will pay almost all the premiums, plus reimburse the employee for most out-of-pocket costs. All told, the CBO estimates the total subsidy would be about $19,400—almost $17,000 more than the subsidy for employer-provided insurance.


.
But will the insurance in the exchange be as good? In Massachusetts, people who get subsidized insurance from an exchange are in health plans that pay providers Medicaid rates plus 10%. That's less than what Medicare pays, and a lot less than the rates paid by private plans. Since the state did nothing to expand the number of doctors as it cut its uninsured rate in half, people in plans with low reimbursement rates are being pushed to the rear of the waiting lines.
The Massachusetts experience will only be amplified in other parts of the country. The CBO estimates there will be 32 million newly insured under ObamaCare. Studies by think tanks like Rand and the Urban Institute show that insured people consume twice as much health care as the uninsured. So all other things being equal, 32 million people will suddenly be doubling their use of health-care resources. In a state such as Texas, where one out of every four working age adults is currently uninsured, the rationing problem will be monumental.


Even if health plans in the exchange are identical to health plans at work, the subsidies available can only be described as bizarre. In general, the more you make, the greater the subsidy at work and the lower the subsidy in the exchange. People earning more than $100,000 get no subsidy in the exchange. . . . That implies that the best way to maximize employee subsidies is to completely reorganize the economic structure of firms.
Take a hotel with maids, waitresses, busboys and custodians all earning $10 or $15 an hour. These employees can qualify for completely free Medicaid coverage or highly subsidized insurance in the exchange.
So the ideal arrangement is for the hotel to fire the lower-paid employees—simply cutting their plans is not an option since federal law requires nondiscrimination in offering health benefits—and contract for their labor from firms that employ them but pay fines instead of providing health insurance. The hotel could then provide health insurance for all the remaining, higher-paid employees.
Ultimately, we could see a complete restructuring of American industry, with firms dissolving and emerging based on government subsidies.
I sure hope the CBO already accounted for the magnitude of all these extra subsidy costs in their estimates.
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Old 05-20-2010, 10:09 PM   #38
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How do you define "outsized"? I find it interesting that the doctors on this forum are staying out of this discussion. Maybe the ones still working will have something to say when they get a 50% paycut, courtesy of the govt setting maximum rates on what doctors can charge........
FD they already do set reimbursement rates for medicare/medicaid and many insurance companies factor those numbers in when determining their reimbursement rates. We are set for a further 21.2% drop in Medicare reimbursement June 1st unless they once again delay implementation. To add insult to injury that will be applied to a rate that is already less then what we were paid in 1998 Powered by Google Docs. Ever wondered why you only get to see your doctor for 5 minutes or less for a visit? That's why. Given the current climate I would expect the private insurance companies will leap on the Medicare reduction to cut their reimbursement rates as well. This all predates the health care reform bill.

The entire system is broken - including physician compensation. Some of us are paid more than necessary for doing things that may not be of maximal benefit to society and others are paid too little thus forcing us to recruit foreign medical graduates to fill more than half of our primary care residency slots AMA-IMG Section Position Paper Discusses Role of IMGs in Primary Care -- AAFP News Now -- American Academy of Family Physicians.

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Old 05-20-2010, 10:47 PM   #39
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I realise that the picture is so large I can't see the forest for the trees when it comes to the health care issue.
With that said, when I look at recent bills from using my insurance. If I could get the contractual prices negotiated by big blue and cut out my premium I wouldn't need insurance at all. Just pay the bill and move on. But of course there's the fear of the huge life saving hospital stay that keeps us glued to our coverage. All based on fear I tell you, fear !!!
That's how they got us by the short hairs.
Its a no win situation,
Steve

PS. Can't blame a guy for dreaming of pie in the sky though
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Old 05-21-2010, 11:37 AM   #40
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I realise that the picture is so large I can't see the forest for the trees when it comes to the health care issue.
With that said, when I look at recent bills from using my insurance. If I could get the contractual prices negotiated by big blue and cut out my premium I wouldn't need insurance at all. Just pay the bill and move on. But of course there's the fear of the huge life saving hospital stay that keeps us glued to our coverage. All based on fear I tell you, fear !!!
That's how they got us by the short hairs.
Its a no win situation,
Steve

PS. Can't blame a guy for dreaming of pie in the sky though
Or the chronic disease that costs an arm and a leg. I just wrote a HIPAA policy on a guy whose wife has MS and her prescription is about $3,500 a month that she will be taking for the rest of her life. That'll change your ER plans a bit if you pay out of pocket...
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