Another health care thread.

[WTF]

Originally Posted by Rudyard K

Don't let WTF bait you DFW. He can't have a discussion about any kind of spending without running to defense spending. This thread was on health care.

Hell, I hear he gets "defensive" even when talking about his own limited arsenal.

Come on now RK....I'm trying to get these boys to think!

I was merely offering up an idea of letting the military ferret out medical care! We go'n do it, let's do it right.

[Texas Contrarian]

Originally Posted by Marcus Aurelius

Will my taxes go up and service go down?

Probably yes, on both counts (eventually).

The current bill does little for cost containment -- it's all about coverage expansion. It simply provides massive subsidy of a very bad, very inefficient system in which no one has any real incentive to rein in costs. Earlier in the debate, there was much discussion about "bending the cost curve downward." The bill's proponents seem to have forgotten all about that. Now they have to use Enron-style accounting to keep the 10-year cost projections under a trillion bucks!

Virtually everyone agrees that our present system is too expensive to be sustainable over the long term, and that some sort of real reform is needed, but this bill will make the problem worse -- not better.

In one way, it reminds me of the American Recovery and Reinvestment Act of 2009: The more this rotten lemon marinates in the sun, the more people see how bad it is. That's why its cheerleaders are obsessed with rushing it to a vote before (already shaky) support collapses.

I believe most Americans would strongly prefer that political "leaders" offer proposals based on realistic projections and honest numbers. Were they to do so, perhaps polls would even indicate majority support for some sort of health care reform plan.

But as it now stands, supporters of health care "reform" are losing the debate, and will probably have to distribute even more pork to a number of congressional districts to get it past the finish line.

[npita]

Originally Posted by atlcomedy

The doc's I know tell me they are already cut to the bone.

Really? A friend of mine is an othopaedic surgeon. When he was a resident (at Cook County Hospital in Chicago) back in the late 80's, he was making $50k/year plus an additional 1 or 2k on weekends by moonlighting in the ER at private hospitals around Chicago. When he finished his residency, his offers were around $250k/year and he told me the average starting salary for a thoracic surgeon was about 500k/year.

You can look up the average physician's salary on google and I'll bet it's around $200k/year. That doesn't really sound like cutting things to the bone (unless your doc friends are doing volunteer work or are not very good at what they do and make well below the average.)

[Marcus Aurelius]

I hope thoracic surgeons continue to make that kind of money or more.

[atlcomedy]

Originally Posted by npita

Really? A friend of mine is an othopaedic surgeon. When he was a resident (at Cook County Hospital in Chicago) back in the late 80's, he was making $50k/year plus an additional 1 or 2k on weekends by moonlighting in the ER at private hospitals around Chicago. When he finished his residency, his offers were around $250k/year and he told me the average starting salary for a thoracic surgeon was about 500k/year.

You can look up the average physician's salary on google and I'll bet it's around $200k/year. That doesn't really sound like cutting things to the bone (unless your doc friends are doing volunteer work or are not very good at what they do and make well below the average.)

I was referring specifically to Medicare reimbursements being cut & my point being that those cuts simply get pushed on to other patients.

You seem to be talking about Dr. compensation in general. Since you wanna go there, I will. I really don't have a problem with Dr's making good money. I don't wanna go down the path of talking about all the education etc. they have or trying to justify what they make vs. other professions; sometimes life just isn't fair. I will simply say:

1) The answer to our HC situation isn't cutting Dr. pay.

2) I have trouble with anybody criticizing what someone else makes, particularly without understanding some of the work, risk, sacrifice, talent (and yeah, luck) that goes into someone's success. Most of the guys on this board ("Tuxedos") make pretty good coin. We might even have a few Doc's among us. Do we really want to go around the circle and debate the merits of what any of us make?

[Rudyard K]

Originally Posted by npita

You can look up the average physician's salary on google and I'll bet it's around $200k/year. That doesn't really sound like cutting things to the bone (unless your doc friends are doing volunteer work or are not very good at what they do and make well below the average.)

Wow! And there you have it folks. Undergraduate school. Medical School. Residency. And then you're living on "Easy Street" at $200K per year.

Wasn't it Churchill who said?..."The best argument against democracy is a five minute conversation with the average voter."

[pjorourke]

Originally Posted by jdean208

I employ about 74 people. We spend about $39,000 per month on health care. We just received a notice from our current carrier that they want to take our premiums up by $10,920 per month, a 28% increase. We are negotiating. I do not know that we can afford it without passing some of it along to the employees. We will try our damndest.

I'm afraid that you are going to look back on that 28% increase as being the good old days. Under this POS Obamacare, we are expanding the people with coverage without any increase in docs or facilities, increasing the benefit levels that people must have* (i.e., read that as isolating them further from the financial effect of their decisions), taxing the industry by $9 trillion dollars (i.e, more than their aggregate profits) just from the excise tax (the Cadillac tax is plan specific and is in addition) and you wonder how much premiums will explode? Do the math -- 28% will look cheap.

Oh, and btw, all of the really good doctors are going to flee the reimbursement system and just take cash. Get used to saying Dr Jose or Dr. Rajah -- the ones left will all be trained in third world countries where they are used to working for government reimbursement rates or less.

The problem is with the rising COST of healthcare. We had 4 pregnancies, 2 heart attacks, several diabetics and the usual raft of medical issues in the mix.

One of the pregnancies was for premature twins. They are fabulous now and we all adore them. Total cost to the plan was about $920,000 for this one medical event.

Well that works out to over $1,000 per employee per month --about twice your annual premium. You got a pretty good deal there. But the real issue no one is dealing with is how can we as a society afford to pay $1 million for a set of premature twins. That is a lot of money. And even more when the people who have the direct impact on the decisions have no financial stake in the game. I'm sure they are fabulous and a medical miracle. But where do we stop the spending.

* About 50% of current employer provided heal insurance plans do not meet the minimum standards the high priests in DC now say are necessary.

[Texas Contrarian]

I find it astonishing that someone would consider $200K an excessive (or even adequate) income for a physician.

Medical schools don't accept the world's B students. Establishing a career as an M.D. physician takes time, dedication, and quite a healthy work ethic. Doctors earn their money -- the old-fashioned way!

If we create an atmosphere in which our highest-achieving kids do not wish to consider a career in medicine, we'll all be the worse off for it.

[charlestudor2005]

Originally Posted by nevergaveitathought

this line struck me...i think its one of the defining differences between people who vote liberal/dem and those who vote conservative....

i was listening to a radio talk show thing once..and this guy calls in..he said..look..i dont care abt the deficit or anything..i will die one day and i want mine now..i want to have everything and i dont care who its bothers or who has to pay....you conservatives dont get it...

i hear conservatives talk about leaving a debt to our grandchildren and ruining future generations freedom and handing off less liberty to the next generation...which we do when we add to the debt..we limit future generations liberty and choices and layer up either crushing taxes or a ruinous economy on them...i think that argument falls on deaf ears to most people who vote dem...they dont care, they want theirs...

i know that republican politicians have gone along with this debt thing for decades...and they are co-dependents...
im not talking abt those idiots...they have voted for idiotic things for political reasons or to not look like kooks to the liberal media....i'm talking about the great unwashed..the common man (and woman) who just think about right and wrong ..or about i want mine...as the case may be..and vote.

I really hate broad, sweeping statements like this. Not only can you not support broad, sweeping statements, historically it is untrue. The U.S. operated in deficit spending for generations until Bill Clinton left office and left the government in the black. George Bush put us in the red again.

[Marcus Aurelius]

I thought he was assuming much.

[charlestudor2005]

Originally Posted by CaptainMidnight

I find it astonishing that someone would consider $200K an excessive (or even adequate) income for a physician.

Seems to me that the general public would object to doctors making more than the President of the U.S. I know I do.

I think the whole system should change: (1) we pay for dr. education; (2) we do tort reform; (3) we limit outrageous Midas-type profits. A reasonable and even really good income by the standards of most people. But not outrageous profits as they now exist.

[charlestudor2005]

Originally Posted by pjorourke

Oh, and btw, all of the really good doctors are going to flee the reimbursement system and just take cash. Get used to saying Dr Jose or Dr. Rajah -- the ones left will all be trained in third world countries where they are used to working for government reimbursement rates or less.

PJ--I knew you were an elitist, but I didn't know you were such a bigot. I live in S. Texas. Lots of Docs there who have been trained in India and Mexico. Before they can practice here, they gotta pass the boards just like every other doc. The care I have had from foreign-born docs has been very good. You should be careful. Some of the medical training overseas is some of the best in the world these days.

[nevergaveitathought]

Originally Posted by charlestudor2005

I really hate broad, sweeping statements like this. Not only can you not support broad, sweeping statements, historically it is untrue. The U.S. operated in deficit spending for generations until Bill Clinton left office and left the government in the black. George Bush put us in the red again.

read the thing before you make a broad sweeping stmnt

took out an expletive

[Marcus Aurelius]

Honestly. The idea of a president receiving a paycheck has been laughable for a long long time. Rich SOB's throwing money and people around for years. etc. A doctor should make MORE than ANY politician.

[atlcomedy]

Originally Posted by pjorourke

Well that works out to over $1,000 per employee per month --about twice your annual premium. You got a pretty good deal there. But the real issue no one is dealing with is how can we as a society afford to pay $1 million for a set of premature twins. That is a lot of money. And even more when the people who have the direct impact on the decisions have no financial stake in the game. I'm sure they are fabulous and a medical miracle. But where do we stop the spending.

.

Yeah that is the hard discussion that needs to take place.

At least in this case we are talking about 2 people that hopefully have long productive lives.

I recently buried a loved one after a bout with terminal cancer. The cost of his battle was staggering. It wasn't a matter of him being cured but could we buy him some time (measured in months).

Now here's the rub: his family had no financial skin in the game.

Now imagine a scenario where the Dr. or Hospital or whoever had a conversation with his adult children and said, "We understand he is worth approx. $x. His monthly cost of care is about $y. You do the math. Depending on how long this goes on may be difference between you inheriting a nice sum or actually being stuck with some hefty bills when he's gone. And the only thing we are certain of is he isn't getting better."

What if someone had that conversation with the patient himself?