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Old 04-11-2011, 12:21 PM   #61
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Oh come on.... arguing can be fun



As to a universal system.... I just do not trust our government to get it right.. and if they do not, then I have no choice after it happens... I have to live with it....

Right now, in our expensive and flawed system, I still have choices... if I do not like the docs I go to, or the group they are in.... I can choose another doc or another group of docs...

.
And this is true of the entire rest of the world's systems, (including cost leader UK) regardless of demagoguery to the contrary.

This illustrates why one should not argue these topics on the internet. The minumum requirement for a discussion, as opposed to an argument, is that all participants be familiar with the known facts.

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UK doctors do not get paid anywhere near as much as ours.....

And that is true for pretty much the entire world. But what conclusion do you draw from that? The "..." doesn't really tell me.


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Old 04-11-2011, 01:20 PM   #62
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As to question of choice in the UK you can still choose your primary doctor I believe. You always could when I was living here, and I believe it is still the same now. Our friends where we are currently staying have already told us witch which Doctor they usually choose when they have to go to the health center. I know the same has been true for our families as they have had a lot of medical problems this last few years.

Where I have seen a lot more choice in the USA is with specialists. When I had foot problems in my 20's I was referred to a consultant at the local hospital, and seen by one of his Registrars who decided on surgery. I met the consultant himself on the day of the surgery and he explained what was going to be done.

In the USA I have had surgery 3 times and each time I had a choice, which I made on initial recommendation of my primary doctor followed up by myself prior to making an appointment. When I needed a specialist for my shoulder my Doc asked me who did my knee surgery (my primary Doc had retired since then). When I told her, she said that he was great for knees but she would recommend Doc "X", who had many LSU baseball players as patients and was highly regarded as an expert on elbows and shoulders.
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Old 04-11-2011, 02:26 PM   #63
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And this is true of the entire rest of the world's systems, (including cost leader UK) regardless of demagoguery to the contrary.

This illustrates why one should not argue these topics on the internet. The minumum requirement for a discussion, as opposed to an argument, is that all participants be familiar with the known facts.

And that is true for pretty much the entire world. But what conclusion do you draw from that? The "..." doesn't really tell me.


Ha

It tells me that as long as our costs are higher than the other countries everybody compares us to, we will always be paying more per person than any other country... no matter what system we are under...

some doctors here make more than $1 million a year.... I doubt you could find that level of compensation in any other country (but then again, I could be wrong)....
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Old 04-11-2011, 03:01 PM   #64
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It tells me that as long as our costs are higher than the other countries everybody compares us to, we will always be paying more per person than any other country... no matter what system we are under...

some doctors here make more than $1 million a year.... I doubt you could find that level of compensation in any other country (but then again, I could be wrong)....
There is a comparison here: How Much Do Doctors in Other Countries Make? - NYTimes.com

Issues that are not mentioned are duration of training - in many countries you can earn the equivalent of an MD degree in fewer years than possible in the US. That will be reflected somewhat in the student debt but also means you have fewer years to earn. Also there are large regional variations for compensation - desirable locations usually pay significantly less (simple supply and demand). It would be interesting to see a comparison of physician satisfaction across these countries as well. Having to deal with all the dysfunctional elements of our current system is burning out a lot of docs.

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Old 04-11-2011, 03:05 PM   #65
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Not quite true. Waits in the US can be long if you need to see a specialist, need a non-emergency appointment with your primary care doctor or are sitting in an emergency room. I do not have the info at hand, but a number of other countries outshine us on wait times and have good care and are less expensive than us.
Certainly NOT Canada and England...........
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Old 04-11-2011, 03:07 PM   #66
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It tells me that as long as our costs are higher than the other countries everybody compares us to, we will always be paying more per person than any other country... no matter what system we are under...

some doctors here make more than $1 million a year.... I doubt you could find that level of compensation in any other country (but then again, I could be wrong)....
One of my dad's newest neighbors is from Egypt. He was a top surgeon there but never made more than $42,000 US dollars in Cairo.
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Old 04-11-2011, 03:24 PM   #67
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Certainly NOT Canada and England...........
When I lived in the UK I had private insurance provided by my company, which is very common, and the purpose of that is exactly to have little or no wait to see specialists. When I had my foot surgery in '84 I was able to choose a date to suit my commitments to the big project I was working on.

Even without insurance you have the option of paying privately to jump the queue, otherwise you have to wait. I've known a couple of people who have paid for an initial consultation so they can find out how serious their knee or hip problem is and what options they have for treatment.
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Old 04-11-2011, 03:25 PM   #68
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One of my dad's newest neighbors is from Egypt. He was a top surgeon there but never made more than $42,000 US dollars in Cairo.
And the average per capita income in Egypt is? I bet you could live very well in Egypt on that much money.

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Old 04-11-2011, 04:28 PM   #69
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And the average per capita income in Egypt is? I bet you could live very well in Egypt on that much money.

DD
THE average per capita income in third world countries is not very helpful in addressing what you seem to be addressing, which is how well can this doc live on that salary amount.

One could not do in third world countries what some people on this board do, which is to have upper middle class jobs and live in lesser surroundings to save money.

Other than servants, which are cheap, an upper middle class or upper class (safe) lifetyle in most third world countries can be a fairly expensive proposition.

For the most part, US Docs make much more when measured by a necessary basket of goods and services than other doctors around the world.

I am not interested in debating the merits or otherwise of this. But, it clearly is not making our healthcare any cheaper.

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Old 04-11-2011, 04:47 PM   #70
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Other than servants, which are cheap, an upper middle class or upper class (safe) lifetyle in most third world countries can be a fairly expensive proposition.
That qualification "other than servants" is important. I'm sort of upper middle class, here in the US, but I am miles away from being able to afford servants. In another thread, I suggested that the essential qualification here for being rich was being able to afford servants.
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Old 04-11-2011, 07:49 PM   #71
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While food, I'm sure, is more expensive than in the USA it is not overly so. Quality cheeses and "artisan" breads that we love and eat in USA are actually much cheaper here. e.g. a large whole grain extremely tasty fresh baked, still warm loaf from our local supermarkets costs £1 ($1.60) and we pay well over $3 for that in the USA.
We have been to the UK only once, and in that short trip did not get out of London. I remember telling myself that "Gosh, food is really expensive here!". In other European countries, we spent some time out in the countryside, and hope to do so in our next trip to England. I can use some more affordable meals. By the way, my experience was that food cost was lowest in Spain.

Anyway, statistics do show that Americans are heavier than Europeans. According to CDC, in 2000, the mean BMI for US males was 27.9 for men, and 28.2 for women. Compared that to Europe, where the male BMI ranged from 24.6 for France (mademoiselles at 23.5 ) to 27.6 for Greek males. The Brit males weighted in at 26.4. Note that the European survey was for people 15 and older, while the US data was for the age group of 20-74.

How much of that extra weight influences different national healthcare costs? I now begin to think that the weight effect may not be that much, and in the case of the US, is masked out by other factors. I will follow up later.

References: http://www.cdc.gov/nchs/data/ad/ad347.pdf, and Health Stats UK File.
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Old 04-11-2011, 08:35 PM   #72
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THE average per capita income in third world countries is not very helpful in addressing what you seem to be addressing, which is how well can this doc live on that salary amount.

One could not do in third world countries what some people on this board do, which is to have upper middle class jobs and live in lesser surroundings to save money.

Other than servants, which are cheap, an upper middle class or upper class (safe) lifetyle in most third world countries can be a fairly expensive proposition.

For the most part, US Docs make much more when measured by a necessary basket of goods and services than other doctors around the world.

I am not interested in debating the merits or otherwise of this. But, it clearly is not making our healthcare any cheaper.

Ha
If you follow the link I posted above there is a comparison in purchasing power parity, not per capita, for the reasons you stated. Interestingly GP's came out highest in the US but US specialists did not. My point was that throwing out a single number ($42K) is meaningless as it is an apples to oranges comparison. As I have an obviously biased opinion I'm not going to vigorously defend US physician pay - although I would note that in my specialty I could make the same or more in Canada. In Australia or NZ I would make about a third less.

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Old 04-11-2011, 09:12 PM   #73
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I'm not so sure about this skin-in-the-game argument. Maybe with elective surgery - cosmetic, hip replacement and the like. And maybe if the copay is substantial enough to make you really think twice about it. But do we really want to encourage people to hobble around all their life rather than get a knee replaced? ...
The copay for a regular doctor's visit is not a good example of how to have the patients getting more involved. Most of the health care cost is in hospitalization, I believe.

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Doctors decide on how to treat patients, but here is a national panel that decides on whether the NHS will pay for a treatment. Recently there have been some cases where an experimental cancer drug was not available on the NHS and this gets headlines. That's the deal you make for overall care for everyone. The UK populace likes that deal and the NHS is UK's political "third rail". I don't think such as system would be appropriate for the US because of it's emphasis on individualism rather than the collective good.
Yes! There are people who argue that human lives are so precious that no expenses should be spared, no experimental treatments should be denied. We can bankrupt any country that way.

On the other hand, if people want to pay out of their own pocket for any nebulous treatment, I hope that they are allowed to.

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From Tadpole:
"Anyone who has not read this article from the New Yorker really should because too little of the conversation goes down to the health care delivery area:McAllen, Texas and the high cost of health care : The New Yorker"

I've been a registered nurse working in health care for over 35 years. This article reminds me of something a colleague said many, many years ago...which was "The most expensive thing in health care is the ball point pen in a physicians hand."

I can't even begin to describe the thousands of useless tests, procedures, consults and therapies I have seen prescribed. But....health care is a product, and if you go to where they sell it....they will try and force you to buy top-of-the-line, even when there is no clear advantage to your health.
Thank you, thank you for sharing this article!

It shows how the lack of top-down coordination and a nationwide policy result in such disparity in hospitalization costs between different parts of the country, and how more money spent does not result in better health care.

About "having own skin in the game", I can relate to this with my own experience. As I worked part-time at my leisure during the last year of my late father's life, I was able to spend a bit of time with him in the hospital, although not as much as my mother who was there everyday. I saw various tests done on my father, some repeatedly with ambiguous results. When I pressed the staff about what would be done if the test results were positive, they replied that nothing would be done anyway. My father's poor health would mean he would not come out of the operating room alive. And as his body was falling apart, there were some conditions that had no treatments.

My mother, being an assertive woman, wanted to be sure that no available tests or procedures would be spared, no matter how nebulous some of these were. I could tell that doctors had given up on my father, but he wanted to live, and my mother could care less about how much something cost or what little result that would bring. If the cost came out of my mother's pocket rather than Medicare, perhaps she would get a bit more involved in understanding what the tests were for.

Did the hospital do all those tests because they wanted more money, similarly to the story told by the article referenced by Tadpole? Or were they afraid of getting sued for not pursuing all avenues? I do not know the answer, but the one thing I was sure of was that many things were done to no avail.

As I loved my father, I was torn to see him put through these fruitless procedures that gave him even more discomfort. But how could someone tell a patient, particularly your loved one, that it was hopeless? People do not live forever, no matter how much money is available. I have been trying to tell my family members that beyond a certain point, money does not buy longevity. Billionaires die too, and do not necessarily live longer than us peasants.
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Old 04-11-2011, 09:25 PM   #74
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As I have an obviously biased opinion I'm not going to vigorously defend US physician pay - although I would note that in my specialty I could make the same or more in Canada. In Australia or NZ I would make about a third less.

DD
Look at any study you can find and you will see that physicians in the U.S. make on average, by far, more than anywhere esle in the western world, including Canada. Anecdotes about one or another's specialities being able to command more outside the U.S. are not useful, relevent or substantial. When you run a private "for profit" healthcare system with virtually no controls on what doctors charge, you will wind up spending a lot of money and some people will die because they cannot afford any of it. That is the American healthcare system.
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Old 04-11-2011, 10:44 PM   #75
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Look at any study you can find and you will see that physicians in the U.S. make on average, by far, more than anywhere esle in the western world, including Canada. Anecdotes about one or another's specialities being able to command more outside the U.S. are not useful, relevent or substantial. When you run a private "for profit" healthcare system with virtually no controls on what doctors charge, you will wind up spending a lot of money and some people will die because they cannot afford any of it. That is the American healthcare system.
Your comment reveals an incredible lack of understanding of the issues involved and how physicians are reimbursed. Did you even read the link I posted above? It is excerpted from this report to congress (http://assets.opencrs.com/rpts/RL34175_20070917.pdf). I suggest you read it before posting any more inflammatory comments.

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Old 04-11-2011, 10:49 PM   #76
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If you follow the link I posted above there is a comparison in purchasing power parity, not per capita, for the reasons you stated. Interestingly GP's came out highest in the US but US specialists did not. My point was that throwing out a single number ($42K) is meaningless as it is an apples to oranges comparison. As I have an obviously biased opinion I'm not going to vigorously defend US physician pay - although I would note that in my specialty I could make the same or more in Canada. In Australia or NZ I would make about a third less.

DD
What I see is that according to this data, Dutch and Australian specialists earn marginally more than US specialists and US specialists earn quite a lot more than all the rest. And as you said, US GPs are at the very top.

IMO this data without knowing specialist's efficiency is slightly to not at all helpful. Utilization is a very big factor. If an opthalmologists does 950 cataracts/year, his pay should not be compared to someone doing 150. A heavily hierarchical system that achieves efficient utilization could bring in more revenues to the practice, while at the same time costing the patients and 3rd party payors less. It's the concept of capacity utilization. When througput goes down, costs per unit go up, sometimes a lot.

It is obvious to me that the modern world has outgrown the model that our system (if it can be called that) is based on. Now that clearly does not mean that our system will change, it has successfully resisted change for a very long time and every year that goes by powerful interests are further entrenched.

I don't know if this kind of thing (utilization rates) is recorded cross-country; journalist tend to be satisfied with any story, not necessarily a meaningful one

Group Health, an HMO here in Seattle tends to have surgeons who become specialized in some procedure or small group of procedures-eg. arthroscopic shoulder surgery. And they do a whole lot of this set of operations. Well, you know this, as you live and practice in or near Seattle yourself I believe.

Clearly US doctors are very well paid compared to those from other countries. I do not know how much effect this has on US medical costs which is a more complicated question. But like I said before, I doubt it lowers them.

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Old 04-11-2011, 11:39 PM   #77
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This is far more complicated than even these 4 pages of posts have touched upon as "health care" is not ONE thing. It is preventive care and cardiac care and cancer care and orthopedic and health maintenance and diabetes management, and radiology and pathology and etc etc...some of these we do worse than countries with national systems and some we do far better. And even that is complex as doing better might mean curing more, or living longer but costing more. So it becomes a question of cost per gain and what is it worth to live 3 or 6 months longer with incurable cancer, for example?
Bottom line is that all is so fragmented that nobody knows what things should or do cost-not the patients who "demand' the care, not the doctors who order it, not the payers who pay for it...and in this country the more you "do" the more $$ you make- pretty much independent of how well the care is delivered.
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Where does the report contradict me?
Old 04-12-2011, 06:03 AM   #78
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Where does the report contradict me?

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Your comment reveals an incredible lack of understanding of the issues involved and how physicians are reimbursed. Did you even read the link I posted above? It is excerpted from this report to congress (http://assets.opencrs.com/rpts/RL34175_20070917.pdf). I suggest you read it before posting any more inflammatory comments.

DD
I have read the report in it's entirety. It clearly disputes your claim that specialists will make more in Canada. It is a report chock full of interesting data that essentially says that while outcomes on average, are no better than other OECD countries, the cost is hugely higher. It acknowledges repeatedly that by nearly any measure, America physicians are paid "substantially" more than their OECD counterparts.

With regards to my "inflammatory" comments on uninsured patient mortality, I would like to draw your attention to the following excerpt from the report "(Americans) were also most likely to delay or forgo treatment because of cost." While this report does not dwell on the fact that the 45 million Americans that have little or no insurance experience shorter life expectancies and poorer health, there are many studies that do. Anyway, this is intuitively obvious and as a physician, I assume that you would acknowledge this.

Finally the report makes the observation that of the OECD nations "only the United States, Mexico, and Turkey have not established
“universal or near-universal coverage.” Not great company to keep. At least it could be said that Mexico and Turkey are economically backward countries and so cannot afford to care for their citizens. There are 45 million Americans that would be better off almost anywhere else.
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Old 04-12-2011, 07:13 AM   #79
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This is far more complicated than even these 4 pages of posts have touched upon as "health care" is not ONE thing. It is preventive care and cardiac care and cancer care and orthopedic and health maintenance and diabetes management, and radiology and pathology and etc etc...some of these we do worse than countries with national systems and some we do far better. And even that is complex as doing better might mean curing more, or living longer but costing more. So it becomes a question of cost per gain and what is it worth to live 3 or 6 months longer with incurable cancer, for example?
Bottom line is that all is so fragmented that nobody knows what things should or do cost-not the patients who "demand' the care, not the doctors who order it, not the payers who pay for it...and in this country the more you "do" the more $$ you make- pretty much independent of how well the care is delivered.
It is not so complicated that it cannot be fixed. Powerful lobbies spend billions making it seem complicated and obfuscating the real facts because they support the status quo.

Basic fact is, some things should be left to free enterprise. Car makers, refrigerator companies and airlines need to be free to set prices based on costs and demand. Medical care providers should not. Can you imagine a society that allowed fire protection to be free enterprise based? How much would you have to pay firefighters to put out your burning house when you need them?
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Old 04-12-2011, 07:54 AM   #80
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About "having own skin in the game", I can relate to this with my own experience. ...I saw various tests done on my father, some repeatedly with ambiguous results. When I pressed the staff about what would be done if the test results were positive, they replied that nothing would be done anyway...

My mother, being an assertive woman, wanted to be sure that no available tests or procedures would be spared, no matter how nebulous some of these were.... If the cost came out of my mother's pocket rather than Medicare, perhaps she would get a bit more involved in understanding what the tests were for.
I agree that this is a situation where costs should be shifted to the patient but I don't really see it as a "skin-in-the-game" situation. The only way this would work would be if the hospital and doctors (or someone else) could rule these tests as unnecessary without excessive fear of litigation. Then you mother would have to decide if she wanted to pay for them out of pocket or not. There is currently no incentive for doctors to get real about this stuff. I don't see some more generic - copay type skin in the game sharing affecting this.
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