No Politics, HC big issue for FIRE

[Senator]

However the services they provide are just as good.

If healthcare salaries are lower, and the care is just as good, why isn't that the first piece of the puzzle? It is the easiest to solve.

What percentage of healthcare dollars go to Salaries, rather than insurance companies (which include many salaries), or pharma?

 

[Meadbh]

If healthcare salaries are lower, and the care is just as good, why isn't that the first piece of the puzzle? It is the easiest to solve.

What percentage of healthcare dollars go to Salaries, rather than insurance companies (which include many salaries), or pharma?

In Canada, 15.4% of public healthcare costs go to physician salaries. Salaries of other healthcare professionals are included in “hospitals” and tend to run about 70% of that category, so perhaps 20%.
https://www.cihi.ca/en/where-is-most-of-the-money-being-spent-in-health-care-in-2017

In the US, physician salaries accounted for 8% of total healthcare spending in a 2012 report.
https://www.jacksonhealthcare.com/media-room/news/md-salaries-as-percent-of-costs/

Here is another perspective.
https://economix.blogs.nytimes.com/2008/11/14/do-doctors-salaries-drive-up-health-care-costs/

All this information can be Googled very easily.

The bottom line is that, while US physicians earn more than Canadian physicians, their earnings account for only a small proportion of the costs of healthcare. Cutting physician earnings would not, in itself, solve the cost issue in the US. I have worked as a physician in both countries, and I believe that other contributory factors include

1. A litigious culture that encourages excessive testing, i.e. waste
2. Patient expectations that every deviation from normal will be treated, and ASAP
3. Private healthcare organizations whose goal is to make as much profit for shareholders as possible, using #1 and 2
4. A free market in healthcare that is based on charging whatever the market will bear
5. A huge administrative burden of insurers, assessors and managers. Example: in the 1980s when I trained in the US, in my division, there were 10 specialist physicians and 12 billing clerks. The division made over $1 million profit in 1986. I received a bonus and didn’t know what to do with it because I had never received a bonus before (or since). Later, I worked in a large department in Canada with over 100 specialist physicians and four billing clerks. No profit, no bonuses.
6. Patients without healthcare insurance ration their own healthcare. They wait until they can afford it, or until their chronic conditions cause complications requiring emergency care. (Ask any rural family doctor in an under serviced area). Emergency care is much more expensive than preventive care.

Please note, I am not expressing any political opinions. These are just facts that I have learnt from many years in the medical profession.

 

[Rianne]

Thank you for that! So, is our VA, medicare, medicaid system more similar to Canada? How do we mesh these systems? Canada is one system for all and we have this messy mixed up system. The complexity is unreal.

 

[Mr._Graybeard]

I'm not so sure that excessive testing is so much a malpractice CYA for the doctor as a revenue source for the medical group. The average patient, IMO, wants to be poked and prodded as little as possible.

 

[Senator]

So is the reason other countries healthcare is relatively cheaper, is that someone else is paying for it?

Or is everyone paying for it, but somewhat indirectly through a VAT or sales tax?

It would obviously be cheaper for me, if you paid for my healthcare. And it actually is, as I get my care through the VA. My DGF's care is also free, even though we have a household income well over $150K. Someone else is paying for that too.

The problem seems to come in when we have fewer payers for the many services. Similar to SS, something will get done, but it may not be pretty.

 

[explanade]

Here's a pie chart (scroll to second page) of where all the health care money goes:

https://www.cms.gov/Research-Statis...ata/Downloads/PieChartSourcesExpenditures.pdf

Insurance and administration is 8%.

Biggest piece of the pie is hospital care at about 1/3 of total Heath care spending of $3.2 trillion.

 

[MRG]

In Canada, 15.4% of public healthcare costs go to physician salaries. Salaries of other healthcare professionals are included in “hospitals” and tend to run about 70% of that category, so perhaps 20%.
https://www.cihi.ca/en/where-is-most-of-the-money-being-spent-in-health-care-in-2017

In the US, physician salaries accounted for 8% of total healthcare spending in a 2012 report.
https://www.jacksonhealthcare.com/media-room/news/md-salaries-as-percent-of-costs/

Here is another perspective.
https://economix.blogs.nytimes.com/2008/11/14/do-doctors-salaries-drive-up-health-care-costs/

All this information can be Googled very easily.

The bottom line is that, while US physicians earn more than Canadian physicians, their earnings account for only a small proportion of the costs of healthcare. Cutting physician earnings would not, in itself, solve the cost issue in the US. I have worked as a physician in both countries, and I believe that other contributory factors include

1. A litigious culture that encourages excessive testing, i.e. waste
2. Patient expectations that every deviation from normal will be treated, and ASAP
3. Private healthcare organizations whose goal is to make as much profit for shareholders as possible, using #1 and 2
4. A free market in healthcare that is based on charging whatever the market will bear
5. A huge administrative burden of insurers, assessors and managers. Example: in the 1980s when I trained in the US, in my division, there were 10 specialist physicians and 12 billing clerks. The division made over $1 million profit in 1986. I received a bonus and didn’t know what to do with it because I had never received a bonus before (or since). Later, I worked in a large department in Canada with over 100 specialist physicians and four billing clerks. No profit, no bonuses.
6. Patients without healthcare insurance ration their own healthcare. They wait until they can afford it, or until their chronic conditions cause complications requiring emergency care. (Ask any rural family doctor in an under serviced area). Emergency care is much more expensive than preventive care.

Please note, I am not expressing any political opinions. These are just facts that I have learnt from many years in the medical profession.

Well said. #5 IMHO is huge. The cost of administration is enormous. The clinic I go to probably has 2 administrative people for every medical professional.

Part of Megacorp did healthcare claims for payers. Let's get real, the payers paid Megacorp hundreds of millions every year to collect their money.

If I have so much coming in, that I can't be bothered to count and collect it, there is a problem. Megacorp profits were outrageous for this segment.

Our whole system feeds on itself. Year's ago I was rear ended and didn't understand how insurance worked. Ha, I thought I'd submit bills to the person's insurance company. Who knew I was supposed to collect up mega bills, some for things I didn't need, and hire an attorney to sue for many times what my costs were! Who knew? Why it sounds like someone could game and profit from that system?

 

[Mdlerth]

Re: Tort reform

This often comes up, and I think it's an issue that has largely been dealt with on the state level. Thirty-three states have imposed caps on damage awards for medical malpractice, including most of the biggest ones.

In my state, the "pain and suffering" cap was $750,000. That limit was recently set aside in the case of a woman who lost all four of her limbs because doctors let a strep infection go untreated. The jury awarded her $25 million. Was that excessive? She's going to need round-the-clock care for the rest of her life, and as we know, that kind of care is expensive.

Not commenting on the merits of the case, but it doesn't sound like a cap if a jury can ignore it.

 

[ShokWaveRider]

So is the reason other countries healthcare is relatively cheaper, is that someone else is paying for it?

Or is everyone paying for it, but somewhat indirectly through a VAT or sales tax?

It would obviously be cheaper for me, if you paid for my healthcare. And it actually is, as I get my care through the VA. My DGF's care is also free, even though we have a household income well over $150K. Someone else is paying for that too.

The problem seems to come in when we have fewer payers for the many services. Similar to SS, something will get done, but it may not be pretty.

Everyone pays. There are part of Taxes that go towards it (I think) and provinces have a monthly premium based on Income.

These are the BC tiers.

https://www2.gov.bc.ca/gov/content/...-plan-administrators/msp-premium-changes-2017

 

[ncbill]

Giving up the salary for 8 years is the major sacrifice, not the 8 years. Paying people while they are in medical school would solve that. A salary of $30K while in school and a guaranteed $75K once you got out would still bring in many people to be a doctor.

Yep, this is what my oldest is pursuing.

Studying for MCAT to be taken this spring, and if accepted, hopefully Uncle Sam will pay (he's already paying for their undergrad)

 

[Senator]

Everyone pays. There are part of Taxes that go towards it (I think) and provinces have a monthly premium based on Income.

These are the BC tiers.

https://www2.gov.bc.ca/gov/content/...-plan-administrators/msp-premium-changes-2017

Yes, in Canada everyone pays for healthcare. In the USA, not so much...

 

[scrabbler1]

Not sure how long you have been RE, but the past 15 years (2 companies) that I have worked for is exactly opposite of what you are talking about.

Also, a LOT of companies are self insured, and pay for administration of the HC program. I love how some lambast that employees have company sponsored HC, but work as hard as possible to game the ACA system.

My ladyfriend's company does not use income as a factor in determining her group HI premium, only the type of plan and family status like I encountered in my working years. What you and others have mentioned about using one's income to determine one's HI premium is totally new and foreign to me.

 

[wmc1000]

I see the BC rates for MSP starting 1-1-18 was reduced by 50% - won't see that happen in US.

https://www2.gov.bc.ca/gov/content/...-plan-administrators/msp-premium-changes-2018

 

[Meadbh]

Everyone pays. There are part of Taxes that go towards it (I think) and provinces have a monthly premium based on Income.

These are the BC tiers.

https://www2.gov.bc.ca/gov/content/...-plan-administrators/msp-premium-changes-2017

Here are the BC Medical Services Plan premiums for 2018. The provincial government is going to phase out the premiums and just take use regular income taxes, which will increase slightly. 2018 MSP premiums are down by 50%.

https://www2.gov.bc.ca/gov/content/...-plan-administrators/msp-premium-changes-2018

 

[Mr._Graybeard]

Not commenting on the merits of the case, but it doesn't sound like a cap if a jury can ignore it.

The cap was declared unconstitutional in state appeals court. Not sure if the case will go before the state supreme court; as of July, an appeal was anticipated.

Edit: I just checked state court records. The state Supreme Court has agreed to hear the appeal.

 

[kgtest]

This often comes up, and I think it's an issue that has largely been dealt with on the state level. Thirty-three states have imposed caps on damage awards for medical malpractice, including most of the biggest ones.

In my state, the "pain and suffering" cap was $750,000. That limit was recently set aside in the case of a woman who lost all four of her limbs because doctors let a strep infection go untreated. The jury awarded her $25 million. Was that excessive? She's going to need round-the-clock care for the rest of her life, and as we know, that kind of care is expensive.

Would be interesting to see a list of those states, lined up vs care quality and other states and also their state taxes.

On Maui, you fly to Oahu for a specialist IN most situations. Yet, Hawaii has one of the highest life expectancy rates of any state...is it because people stay ship shape knowing it might be a helicopter ride across the great ocean blue that puts them over the edge.

We had to wait for the coroner to fly in when traffic fatalities occurred often shutting one main road down for hours. Rural island life bra.

Personally I think Hawaii has the highest expectancy because its sunny the most.

 

[DEC-1982]

I just wish we could have the option of paying a premium to join Medicare prior to 65. I would at least like to know what such a premium might cost.

I love this idea.

 

[LARS]

I feel fortunate my ACA offered plans that were POS (point of service) so if we go out of state or to out of network doctors they cover 50%.

I, too, have POS and am covered out of network (and state). However, the coverage out of state is only at BCBS stipulated rates. And out of state provider is not contractually obligated to accept those rates.

So if push ever came to shove and we needed expensive care out of state the cost to us could still be very expensive. Clearly you would try to negotiate upfront (if possible) for out of state provider to accept my BCBS reimbursement rates. Whether that would work, who knows...

 

[explanade]

I just wish we could have the option of paying a premium to join Medicare prior to 65. I would at least like to know what such a premium might cost. I mean we are all (or nearly all) going to end up on medicare so why not let those that would like to, pay the cost prior to reaching 65? How many people here would do that if the cost was much better? This is also know as the public option in the political arena and is looked on just about as favorably by some parties as single payer, which as stated, is what Medicare basically is. I'm sure the private insurance industry lobby is one of the main obstacles preventing a public option.

Way things are going, we may have to worry more about just keeping the Medicare benefits as they are than expanding Medicare.

 

[ncbill]

I, too, have POS and am covered out of network (and state). However, the coverage out of state is only at BCBS stipulated rates. And out of state provider is not contractually obligated to accept those rates.

So if push ever came to shove and we needed expensive care out of state the cost to us could still be very expensive. Clearly, you would try to negotiate upfront (if possible) for out of state provider to accept my BCBS reimbursement rates. Whether that would work, who knows...

Yep, the above is why we'll be purchasing the school-provided (in-network) insurance for our youngest when the go off to out-of-state undergrad this fall, as well as maintaining them on our family plan here at home.

Fortunately, that option will cost only a few hundred bucks/semester.