Hillary: 'Going After Peoples Wages'

Off Topic Politics & World Issues
21

[quote]Headhunter wrote:
Professor X wrote:
pat wrote:
Actually, something that is in fact coming down the pipe, is the ability to price shop for procedures.

I think if people think of health care like a local fast food place, they should accept that quality will fall right along with it. Doctors didn’t go to school for 10-15 years to be broke.

As an oral surgeon, Dr. ‘Professor’ X, your input here is of great value: If someone regulated how much you could earn and told you who your patients were going to be, would you be as likely to choose medicine as a career? Would such policies leave the field open to those who don’t mind taking orders and being regulated?

[/quote]

Of course not. I would be doing something else right now. School was hard enough even when the prospect of above average earnings were in the future. Few will put themselves through hell for absolutely no reward…and that is coming from someone who actually loves what he does.

22

[quote]Headhunter wrote:
Professor X wrote:
pat wrote:
Actually, something that is in fact coming down the pipe, is the ability to price shop for procedures.

I think if people think of health care like a local fast food place, they should accept that quality will fall right along with it. Doctors didn’t go to school for 10-15 years to be broke.

As an oral surgeon, Dr. ‘Professor’ X, your input here is of great value: If someone regulated how much you could earn and told you who your patients were going to be, would you be as likely to choose medicine as a career? Would such policies leave the field open to those who don’t mind taking orders and being regulated?
[/quote]

Is anybody talking about salary caps? I am talking about getting flat fucking ripped. When I broke my hand, I went to the ER. I got two x-rays, a splint, a percocet, and a sore ass from sitting there writhing in agony for 4 hours.

My insurance company got charged $800 bucks and lost $100…You cannot possibly tell me, that’s right. Because it’s obviously completely absurd.

I am all for doctors making a ton of money.I got no issues with that, but I very much object to raping the living, unadulterated fuck out of the patients.

The problem with medical care is that we all need it. It is just flat wrong to take advantage of people…

In my opinion, the doctors are the least culpable in this problem. It’s hard to choose the biggest villin. The pharmaceutical companies, the insurance companies, the frivolous laws suits, illegal alians, people who refuse to pay when they actually can, etc.

Make no mistake, there is a health care crisis when talking about pricing and affordablity. If the people running this shit acted right and didn’t take advantage then there wouldn’t be a problem.

People need health care, it’s not a want. It cannot not continue as is. If we don’t get a gentler solution with minimal government involvement, then the government will take it over and we all lose…I’ll see you in line.

23

[quote]Professor X wrote:
Headhunter wrote:
Professor X wrote:
pat wrote:
Actually, something that is in fact coming down the pipe, is the ability to price shop for procedures.

I think if people think of health care like a local fast food place, they should accept that quality will fall right along with it. Doctors didn’t go to school for 10-15 years to be broke.

As an oral surgeon, Dr. ‘Professor’ X, your input here is of great value: If someone regulated how much you could earn and told you who your patients were going to be, would you be as likely to choose medicine as a career? Would such policies leave the field open to those who don’t mind taking orders and being regulated?

Of course not. I would be doing something else right now. School was hard enough even when the prospect of above average earnings were in the future. Few will put themselves through hell for absolutely no reward…and that is coming from someone who actually loves what he does.[/quote]

And I believe you and other doctors deserve to make a good living. I’d rather doctors make the big bucks rather than the likes of A-Rod. After all doctors help people and ease suffering. That’s worth a hell of a lot more then hitting a home run.

Hell, I’d be for doubling the doctor’s take over giving it to pharmaceutical co.s that jack up the price of something 50000% when, for instance, the veterinary equivalent is far far less. That is just fucking bullshit.

24

[quote]pat wrote:
Headhunter wrote:
Professor X wrote:
pat wrote:
Actually, something that is in fact coming down the pipe, is the ability to price shop for procedures.

I think if people think of health care like a local fast food place, they should accept that quality will fall right along with it. Doctors didn’t go to school for 10-15 years to be broke.

As an oral surgeon, Dr. ‘Professor’ X, your input here is of great value: If someone regulated how much you could earn and told you who your patients were going to be, would you be as likely to choose medicine as a career? Would such policies leave the field open to those who don’t mind taking orders and being regulated?

Is anybody talking about salary caps? I am talking about getting flat fucking ripped. When I broke my hand, I went to the ER. I got two x-rays, a splint, a percocet, and a sore ass from sitting there writhing in agony for 4 hours.

My insurance company got charged $800 bucks and lost $100…You cannot possibly tell me, that’s right. Because it’s obviously completely absurd.

I am all for doctors making a ton of money.I got no issues with that, but I very much object to raping the living, unadulterated fuck out of the patients.

The problem with medical care is that we all need it. It is just flat wrong to take advantage of people…

In my opinion, the doctors are the least culpable in this problem. It’s hard to choose the biggest villin. The pharmaceutical companies, the insurance companies, the frivolous laws suits, illegal alians, people who refuse to pay when they actually can, etc.

Make no mistake, there is a health care crisis when talking about pricing and affordablity. If the people running this shit acted right and didn’t take advantage then there wouldn’t be a problem.

People need health care, it’s not a want. It cannot not continue as is. If we don’t get a gentler solution with minimal government involvement, then the government will take it over and we all lose…I’ll see you in line.

[/quote]

I think you may be overestimating how much the average doctor is actually making. Most are in debt to begin with considering 100grand in student loans is the average, not to mention the cost of starting a practice.

I had a patient complain that she had to wait 3-4 hours before she was seen. Mind you, this is a WALK IN CLINIC and we were packed that day. In all honesty, if you want “cadillac treatment” then you should expect to pay much more for it. If you expect to walk in and be seen immediately, then that doctor must have a patient flow that allows that…which generally means he charges more…which means he has patients in a higher income bracket.

If you want cheap service, then expect to walk into a crowded clinic and also expect that doctor not to kill himself trying to see every patient at the exact same time.

I get what you are saying, but it isn’t like docs are coming out on top in every situation. Many are actually leaving the medical field because of exactly what we are discussing here.

This is where I add in some cliche about not being able to have cake and eat it at the same time.

It may have cost you 800 bucks, but if it were that easy to solve without professional medical treatment, then why did you need to see a doctor?

25

[quote]pat wrote:

And I believe you and other doctors deserve to make a good living. I’d rather doctors make the big bucks rather than the likes of A-Rod. After all doctors help people and ease suffering. That’s worth a hell of a lot more then hitting a home run.

Hell, I’d be for doubling the doctor’s take over giving it to pharmaceutical co.s that jack up the price of something 50000% when, for instance, the veterinary equivalent is far far less. That is just fucking bullshit.
[/quote]

We don’t disagree.

26

[quote]Sloth wrote:
…
But seriously. I can refuse medical treatment at a hospital, yet not opt out of her ‘free’ health care? [/quote]

Yes. And here’s why.

Medical insurance works when the risk pool is large and most members are at low risks for an event. Of course, few would voluntarily buy insurance when they are young and healthy; most would wait until they be old and sick. Unfortunately, the costs would then rise “unacceptably” for the “at risk” population. (The historical example is Reagan’s catastrophic health care measure, which was repealed.)

But, contrary to Clintonism, there is no reason to have a single payer system. The country could not bear the costs if medical care (14% of GDP) were transferred to Bethesda, MD. Instead, people choosing a patchwork of plans might work; but they would be forced to choose a benefit or pay for one–somehow.

You may choose not to have health care, but when an unavoidable medical event occurs to you, who will bear the costs? Trust me; you will not be able afford my efficient and economic services. Whose risk pool will pay for your lack of foresight? A community hospital? The state? The Feds?

(Boston Barrister, in another thread, points out–correctly I believe–that there are not 47 million static uninsured; the number probably is “only” 15 million. But events happen to the transiently uninsured as well. No sane person–clearly Hillary in 1994 is excluded–would dismantle all medical care insurance to correct the problem.)

Get ready for for the inevitable word: compulsory.

If people want medical care as a right, like sewers, participation will be compulsory. And the final product, I hope, would be different.

27

[quote]Headhunter wrote:
I do find it interesting that in all the discussion about national healthcare, no one bothers to ask the doctors if that is what they want. It is assumed that they will simply go right on working as before and that they have no rights in regard to this.
…
[/quote]

The unraveling has already begun.

MediCare cutbacks now make it marginally unprofitable to see one more patient. In my neighborhood, not only have generalists stopped seeing MediCare patients, they have actually converted to “concierge” practices. Patients have come to me, asking (begging, sometimes) me to take care of them because no one else will.

In June, there may be a further 10% cut in MediCare payments to MDs. It may not happen–Congress couldn’t stand the heat in an election year–but if it happens in 2009, I will not be surprised. But there will be fallout. Most insurance companies gear their payments to MediCare rates. If practices are not satisfactory, many doctors in their 50s and 60s will simply take early retirement.

So who fills their shoes if service collapses? Well, witness the British National Health: half the physicians in the Health Service, I am told, is South Asian or Middle Eastern immigrants. (This is not a racist remark; their training and objective are somewhat different, shall we say, than British and North American physicians.)

I think highly of my acumen; I would like to think that I do something of value, and that society agrees. If not, than maybe I should stop, and we would see what level of quality society is willing to pay for.

28

[quote]Professor X wrote:

I think you may be overestimating how much the average doctor is actually making. Most are in debt to begin with considering 100grand in student loans is the average, not to mention the cost of starting a practice.

I had a patient complain that she had to wait 3-4 hours before she was seen. Mind you, this is a WALK IN CLINIC and we were packed that day. In all honesty, if you want “cadillac treatment” then you should expect to pay much more for it. If you expect to walk in and be seen immediately, then that doctor must have a patient flow that allows that…which generally means he charges more…which means he has patients in a higher income bracket.

If you want cheap service, then expect to walk into a crowded clinic and also expect that doctor not to kill himself trying to see every patient at the exact same time.

I get what you are saying, but it isn’t like docs are coming out on top in every situation. Many are actually leaving the medical field because of exactly what we are discussing here.

This is where I add in some cliche about not being able to have cake and eat it at the same time.

[/quote]

I don’t think all doctors are making a killing, my contention is that if they are, I don’t have problem with that. I also know that ER docs deal with 90% bullshit colds and people jacking off the system. Hell, I saw the doc long enough for her to tell my I broke my hand and I will have to see an orthopedist…duh. Trust me, that night, I didn’t put her out.

That night, that ER was empty. Can’t prove it, you’d have to take my word for it.

That’s my point, I had to see a doctor; it didn’t really matter how much it cost. That give no one the right to rip me off. I am all for paying a fair price. I understand that an ER will be more because of it’s availability and staffing. But holy fucking shit, I mean come the fuck on…

29

[quote]pat wrote:
Beowolf wrote:
Does anyone have any ideas on health care that wouldn’t kill us economically?

I say we expand Medicare to cover everyone. …

I can think a few ways to improve the health care situation improve in this country.

While I typically disagree with any government involvement in practically anything…I want them to put in some form of price controls.

Secondly, putting some control over the epidemic of frivolous law suites.

My opinion, is that foreign competition is one of the best ways to control prescription prices. Foreign drugs are far cheaper and hence would cause competition.

Actually, something that is in fact coming down the pipe, is the ability to price shop for procedures.

What I want you to think about is to come up with solutions to problems with involving the government. … It’s often the problem.

[/quote]
Beowolf and Pat
With respect,

Medicare…see my post above. It could work, but not as the MediCare I know. The Devil is in the details.

Price controls? They already exist. Most costs conferred onto insurance and government are controlled and contracted. This leads to gamesmanship, the multiplication of the unnecessary and the ill-conceived procedure, unnecesary testing, shifting of the choice of treatment, etc. We agree the doctors’ wages–which are arguably “too high” --are a very minor component of the cost of medical care. Technology is the culprit. And the most expensive piece of medical technology is…the doctor’s pen.

Drugs? Long story there. 2 points. The international price differential will disappear if a sizable segment bought their drugs across the border. Would Canadian provinces want to subsidize our expense in this fashion? And the cost of limiting profitability will be a loss of technical progress. Witness: very few unique drugs of value have been developed in the last 30 years in Britain, Germany, Switzerland and France, the erstwhile engines of pharmaceutical invention.

Price shopping? There is no free market in medical care. Information is held closely by few, and the buyer is not aware that all services are not the same. The ultimate buyer is not the patient; and it is the patient who often insists, “Spare no expense.” In any case, all prices in medical care are fictions, designed to capture a few extra pennies from insurance schemes. No one should buy retail!

The government can help: it can provide the green. But it is impossible to deal with: how can a office worker in Bethesda, tell me what is right for the person in my office? And they do, nevertheless.

30

[quote]DrSkeptix wrote:
pat wrote:
Beowolf wrote:
Does anyone have any ideas on health care that wouldn’t kill us economically?

I say we expand Medicare to cover everyone. …

I can think a few ways to improve the health care situation improve in this country.

While I typically disagree with any government involvement in practically anything…I want them to put in some form of price controls.

Secondly, putting some control over the epidemic of frivolous law suites.

My opinion, is that foreign competition is one of the best ways to control prescription prices. Foreign drugs are far cheaper and hence would cause competition.

Actually, something that is in fact coming down the pipe, is the ability to price shop for procedures.

What I want you to think about is to come up with solutions to problems with involving the government. … It’s often the problem.

Beowolf and Pat
With respect,

Medicare…see my post above. It could work, but not as the MediCare I know. The Devil is in the details.

Price controls? They already exist. Most costs conferred onto insurance and government are controlled and contracted. This leads to gamesmanship, the multiplication of the unnecessary and the ill-conceived procedure, unnecesary testing, shifting of the choice of treatment, etc. We agree the doctors’ wages–which are arguably “too high” --are a very minor component of the cost of medical care. Technology is the culprit. And the most expensive piece of medical technology is…the doctor’s pen.

Drugs? Long story there. 2 points. The international price differential will disappear if a sizable segment bought their drugs across the border. Would Canadian provinces want to subsidize our expense in this fashion? And the cost of limiting profitability will be a loss of technical progress. Witness: very few unique drugs of value have been developed in the last 30 years in Britain, Germany, Switzerland and France, the erstwhile engines of pharmaceutical invention.

Price shopping? There is no free market in medical care. Information is held closely by few, and the buyer is not aware that all services are not the same. The ultimate buyer is not the patient; and it is the patient who often insists, “Spare no expense.” In any case, all prices in medical care are fictions, designed to capture a few extra pennies from insurance schemes. No one should buy retail!

The government can help: it can provide the green. But it is impossible to deal with: how can a office worker in Bethesda, tell me what is right for the person in my office? And they do, nevertheless.[/quote]

I am not sure what your solution is. Change and expand medicare? If that’s what your saying, I disagree, but I rather be clear on your solution is before I argue pro and cons. Can expain it a little more?

31

[quote]pat wrote:
DrSkeptix wrote:
pat wrote:
Beowolf wrote:

I am not sure what your solution is. Change and expand medicare? If that’s what your saying, I disagree, but I rather be clear on your solution is before I argue pro and cons. Can expain it a little more?[/quote]

I don’t have a solution. Let’s see if we can agree on goals: universality, open access, choice, economy, quality.
I would argue you cannot have all 5; and usually it is quality that is sacrificed.

MediCare would not do; but it offers a clue. An outline:
Establish regional risk pools (states or multistate region). Establish minimum acceptable insurance programs. Invite insurers to bid on contracts to provide payment for services, and insurers cannot deny any willing applicant. Let’s say 3 low-bidders offer conforming programs. Participation by employers and workers and individuals is compulsory; the poorist can redeem vouchers but must “purchase” some program. Some individuals may choose to buy only catastrophic insurance; some may choose first dollar coverage. But everyone except the poorest has some out-of-pocket expenses (to limit, to a degree, pointless consumption.) Packages differ, but everyone’s risks are limited. People who move take their insurance with them; with residence comes application to new insurance.
Doctors and facitlities are free to contract or not; few could afford to opt out.
Notice: minimum government interference once standards are established.

None of this is new. Alain Einthoven calls this “managed competition,” but aspects of his plans are somewhat contrived and punitive. The similar Dutch program is worth careful review. I have been looking at schemes since Congress in 1972 came up with a dozen bills, all failures.

A note on pluralist politics, 1972 and since. The best thinking on these matters–Mark Pauly, Martin Feldstein, Uwe Reinhardt–was ignored because a good plan needs an interested sponsoring group for its success.

32

One really good way to keep costs down would be to make medicine kind of like public school teaching — fix the salaries very low and have all sorts of administrators to regulate everything. Have doctors collectively paid by the taxpayers, so they could vote on how much the doctors make.

Like education programs at universities, dumb down the curriculum for prospective doctors, so that about anyone could graduate. Then we’ll have plenty of doctors and can keep salaries low.

Medicine would then be much cheaper and would match the sterling success we see in public school teaching.

33

[quote]DrSkeptix wrote:
pat wrote:
DrSkeptix wrote:
pat wrote:
Beowolf wrote:

I am not sure what your solution is. Change and expand medicare? If that’s what your saying, I disagree, but I rather be clear on your solution is before I argue pro and cons. Can expain it a little more?

I don’t have a solution. Let’s see if we can agree on goals: universality, open access, choice, economy, quality.
I would argue you cannot have all 5; and usually it is quality that is sacrificed.
[/quote]
I would universality and open access are the same thing. We already have choice if we got money. On the economy, I am not talking about discount health care, I am simply talking about not being ripped off. No more $5 tylenols and $20 penicillin when it cost pennies to make and distribute. I don’t want cheap health care, I want health care that costs what it takes to provide it. Not have 50 different organizations adding an extra chuck so that a .5 liter of saline solution does not cost over $200. After mark up and all the middle men the cost of a bag of saline would already be excessive a $5. The slat water is very cheap, steralizing it is cheap, the bag it comes in is cheap, the tube it runs out of is cheap and the needle is cheap. Where’s the $200?

You have some good points but it addresses only on part of the problem which is insurance. This just moves the problem around. So everybody is insured, what does that mean? Hopefully they won’t let you die on the operating table, but having insurance is not a guarantee to affordable health care to all. Universal health care would be minimal health care coverage. Which mean the person pays the maximal. I have top shelf health insurance, if I get a tonsillectomy I still pay a grand. Imagine, lesser insurance.
Insurance is only part of the problem, try to fix it will just create an issue somewhere else. All of it has to be addressed simultaneously. You can’t deny people necessary health care, but you can’t put doctors and hospitals out of business. Pharmaceutical costs need to be reeled in, but the companies need to make money still. Frivolous law suites need to be dealt with, but people still need a way to recoup when there was woeful negligence or misconduct.

34

[quote]pat wrote:
DrSkeptix wrote:
pat wrote:
DrSkeptix wrote:
pat wrote:
Beowolf wrote:

…
Insurance is only part of the problem, try to fix it will just create an issue somewhere else. All of it has to be addressed simultaneously. You can’t deny people necessary health care, but you can’t put doctors and hospitals out of business. Pharmaceutical costs need to be reeled in, but the companies need to make money still. Frivolous law suites need to be dealt with, but people still need a way to recoup when there was woeful negligence or misconduct.
[/quote]

Agreed. Like I said, something’s got to give.

Goods and services follow the money; insurance turns on the tap and co-pays and out-of-pocket expenses curb the flow, a bit.

Now, about that $200 bag of salt water. It costs me, in my office, $1.50. But MediCare and some insurance doesn’t pay anyhthing for it, or for the $10 needle I sometimes use, or the $15.00 vinyl tube that must match certain medicines, or…
It is “bundled” into the already inadequate payments for some drugs and services.

Now consider the hospital ER you visited. I certainly do not defend hospitals–they are not my friends. But: The nominal charge of $200 is a fiction. Everyone knows that you and insurance don’t pay it. It is a fiction–unlesss you pay cash!!! The ficitional charge is a way to recoup some part of the unbillable costs of operation: nursing care, administration, legal issues, lawyers, depreciation of assets, interest on bonds, capital expenses, committees which enforce endless regulations, underpaid physical therapists, translators, transcribers, records personnel… It just doesn’t get covered in room rates and chargeable services.

I agree, Pat: It is ridiculous. And it will not get better. It is an axiom, if you will, of health policy, that when health care is “nationalized,” the fundamental system and arrangements are not changed. This was true in 1917 Soviet Union, 1946 Britain, Scandinavia, etc.