Physician Salaries - below 100K

[thomasko]

Meister, how do you have time as a med student to constantly patrol and hijack all threads on SDN?

[tjaze]

"Medicare has the highest patient satisfaction level of any health insurance in the country. Social security is probably one of the most successful government programs in the US, again with extremely high levels of satisfaction. How is that nonsensical unless you are a nihilist who just hates all taxes and feels that living in a first-world nation where people don't die in the streets due in large part to compulsory taxation is THEFT?"

WOW. Are you sure you're a medical student? Of course the patients that get money from others are highly satisfied. Patients would be satisfied if we skipped rectal and pelvic exams, but that doesn't make it the right thing to do. Multiple sources, including the TREASURY OF THE UNITED STATES, have stated that medicare and social security are UNSUSTAINABLE. But you know more about finance than the treasury secretary, right?

People like you who don't have any respect for themselves and their profession are what's wrong with medicine today. They seem to equate intelligence with being liberal, and balk at a student who hopes to make a living equal to their education and time sacrificed. I AM NOT A SERVANT TO MY PATIENTS, AND I WILL NEVER BE A SERVANT. I AM A PHYSICIAN WHO WENT THROUGH DECADES OF TRAINING AND I SHOULD BE RESPECTED AND COMPENSATED AS SUCH.

[atengnr]

Originally Posted by meister

I really don't know or care if they've worked, and there are certainly conservative arguments out there against a government-run option. But it's clear no one here really knows what those arguments are or can even provide me with examples.

I'm not going to do their homework for them, and I'm sure they'll continue with anti-government gut-think opinions anyway. Sad.

In my view, the economics of having a government-run option will translate into rapid demise of private insurers. Will GM or Ford or other larger company offer their employees private insurance if theres a public option? They would be fools to. Goodbye private insurance.

What does this mean? That the government will rapidly have control of the system, on the basis of being essentially the only payer. Viola, a socialized system emerges pretty quickly.

Do I want this to happen? Nope, but I think it will.

[TheProwler]

Originally Posted by tjaze

"Medicare has the highest patient satisfaction level of any health insurance in the country. Social security is probably one of the most successful government programs in the US, again with extremely high levels of satisfaction. How is that nonsensical unless you are a nihilist who just hates all taxes and feels that living in a first-world nation where people don't die in the streets due in large part to compulsory taxation is THEFT?"

WOW. Are you sure you're a medical student? Of course the patients that get money from others are highly satisfied. Patients would be satisfied if we skipped rectal and pelvic exams, but that doesn't make it the right thing to do. Multiple sources, including the TREASURY OF THE UNITED STATES, have stated that medicare and social security are UNSUSTAINABLE. But you know more about finance than the treasury secretary, right?

LOL, but BRO, people who get free money are SATISFIED! Don't you understand that? They put in $5 and get $20! They're thrilled!

[meister]

Originally Posted by tjaze

Of course the patients that get money from others are highly satisfied. Patients would be satisfied if we skipped rectal and pelvic exams, but that doesn't make it the right thing to do. Multiple sources, including the TREASURY OF THE UNITED STATES, have stated that medicare and social security are UNSUSTAINABLE. But you know more about finance than the treasury secretary, right?

I'll try and ignore the parts of your post that are childish and irrelevant and instead focus on how you are 100% wrong on these points. Social security is pay-as-you-go and is subject to changes in financing when demographics change. More old people than taxpayers? Need more contributions. Less old people than taxpayers? Need less contributions. Nothing is unsustainable about this and the system could continue forever in such a manner.

Medicare is similarly not unsustainable, but costs have gone up across the board with respect to medicine and Medicare is no different. But what is the patient make-up of Medicare? Oh yeah, that's right, old people and the disabled. Gee I wonder why it costs a lot to insure them? Gee I wonder what would happen if Medicare were expanded to cover everyone including profitable patients currently snatched up by greedy private insurers?

Your two basic premises are hilariously flawed and all of your conclusions are flawed. But don't let that stop you from gut-thinking your way into making sound policy judgments.

Originally Posted by TheProwler

LOL, but BRO, people who get free money are SATISFIED! Don't you understand that? They put in $5 and get $20! They're thrilled!

Glad you ignored every request for evidence backing up anything you ever said. Hopefully you realize now that most of your beliefs are based on gut-think "I just know this to be true" BS.

[meister]

Again, let's keep in mind that Obama isn't even proposing Medicare for all, or single-payer, or anything like that. He wants to institute an individual mandate and prop up private insurers with government subsidies for the poor.

This plan is just another corporate give-away and is just another in a long line of terrible policies enacted by Congress (brought to you by PhRMA and AETNA). Can't wait to see this fail spectacularly and the dems kicked out of office, followed by the GOP not knowing anything but tax cuts, followed by the collapse of our economy.

We are a failed state.

[Random MS]

Originally Posted by tjaze

People like you who don't have any respect for themselves and their profession are what's wrong with medicine today. They seem to equate intelligence with being liberal, and balk at a student who hopes to make a living equal to their education and time sacrificed. I AM NOT A SERVANT TO MY PATIENTS, AND I WILL NEVER BE A SERVANT. I AM A PHYSICIAN WHO WENT THROUGH DECADES OF TRAINING AND I SHOULD BE RESPECTED AND COMPENSATED AS SUCH.

You better believe I'm going to ask for my "entitled" clothing, housing, and food for free if I end up becoming a "servant" to medicine.

[Concubine]

http://www.slate.com/id/2227965/?gt1=38001

Perspective on physician pay.

[dilated]

Originally Posted by Concubine

http://www.slate.com/id/2227965/?gt1=38001

Perspective on physician pay.

Even that lacks perspective. It accepts the "doctors are overpaid" trope without comparing HOURS WORKED. US doctors work significantly more hours than EU doctors. Anybody who can't even make mention of this fact when comparing salaries is not knowledgeable enough to be talking.

[Concubine]

Originally Posted by dilated

Even that lacks perspective. It accepts the "doctors are overpaid" trope without comparing HOURS WORKED. US doctors work significantly more hours than EU doctors. Anybody who can't even make mention of this fact when comparing salaries is not knowledgeable enough to be talking.

It does fail to mention hours. However, one of the important things the article points out is that cutting physician pay will do very little to curb health care costs.

[TheProwler]

Originally Posted by meister

Glad you ignored every request for evidence backing up anything you ever said. Hopefully you realize now that most of your beliefs are based on gut-think "I just know this to be true" BS.

I ignored your requests because you were calling people ****ing idiots and accused everyone of watching Fox News, and the new fad of "gut-think." It's clear you don't want an intelligent debate, so why would I try?

Besides, you have no idea what my beliefs are.

[psychforme]

Originally Posted by TheProwler

I ignored your requests because you were calling people ****ing idiots and accused everyone of watching Fox News, and the new fad of "gut-think." It's clear you don't want an intelligent debate, so why would I try?

Besides, you have no idea what my beliefs are.

He busted you. Stop making excuses. It's embarrassing.

[Kaushik]

Originally Posted by psychforme

He busted you. Stop making excuses. It's embarrassing.

Actually, the embarassing part was where meister blew up and called everyone ****ing idiots, etc. several times. I don't see the point in arguing rationally with someone who seems to be way too emotional; it always ends up being a waste of time.

[Concubine]

Originally Posted by Kaushik

Actually, the embarassing part was where meister blew up and called everyone ****ing idiots, etc. several times. I don't see the point in arguing rationally with someone who seems to be way too emotional; it always ends up being a waste of time.

[TexasFight]

Originally Posted by psychforme

He busted you. Stop making excuses. It's embarrassing.

It's like everything you said is the complete opposite of the truth. He called meister out on what he was doing. It wasn't an excuse, it was an explanation. And it's not embarrassing for him, it's embarrassing for you. (then again it's pretty embarrassing every time you post)

Originally Posted by TheProwler

I ignored your requests because you were calling people ****ing idiots and accused everyone of watching Fox News, and the new fad of "gut-think." It's clear you don't want an intelligent debate, so why would I try?

Besides, you have no idea what my beliefs are.

Originally Posted by Concubine

It does fail to mention hours. However, one of the important things the article points out is that cutting physician pay will do very little to curb health care costs.

I just wish meister would realize that. But he/she is not one to admit that he/she is wrong.

[tjaze]

Originally Posted by meister

I'll try and ignore the parts of your post that are childish and irrelevant and instead focus on how you are 100% wrong on these points. Social security is pay-as-you-go and is subject to changes in financing when demographics change. More old people than taxpayers? Need more contributions. Less old people than taxpayers? Need less contributions. Nothing is unsustainable about this and the system could continue forever in such a manner.

Medicare is similarly not unsustainable, but costs have gone up across the board with respect to medicine and Medicare is no different. But what is the patient make-up of Medicare? Oh yeah, that's right, old people and the disabled. Gee I wonder why it costs a lot to insure them? Gee I wonder what would happen if Medicare were expanded to cover everyone including profitable patients currently snatched up by greedy private insurers?

I tend to let those with expertise in economics and mathematics do the number crunching and forecast what programs are sustainable. Even the news channels you deem worthy of watching will tell you the same as everyone else on here has.

[TheProwler]

Originally Posted by psychforme

He busted you. Stop making excuses. It's embarrassing.

Feel free to make a nice rational thread inviting me to give my thoughts on the current state of affairs, and I'll post in it. This thread is a train wreck, and I'm not going to put any time into a meaningful opinion piece now.

[meister]

Originally Posted by tjaze

I tend to let those with expertise in economics and mathematics do the number crunching and forecast what programs are sustainable. Even the news channels you deem worthy of watching will tell you the same as everyone else on here has.

Uh nobody in this thread has made a meaningful or thoughtful argument about anything. No one posted any evidence for anything they were saying except me. It's just pages and pages of inferences and assumptions based on nothing. Yes, we all know Medicare is only solvent through 2017. There are lots of reasons for this, but it does not mean that Medicare is somehow a failure or not working. That's the fundamental misunderstanding people seem to have.

Social security is doing just fine, it's just subject to demographics (just like everything else out there.) Anyone who doesn't acknowledge SSI is sustainable based on simple MONEY-IN:MONEY-OUT taxation is not being honest. The reason why the GOP loves to piss and moan about it is that they know that we'll have to raise SSI taxes at some point to "fix" it, just as we would lower taxes if there were an increase in taxpayers. Democrats don't want to "fix" it because the GOP will call them TAX AND SPEND LIBURALS when the reality is that we have to raise taxes just as we would lower them if we could. Politicians in DC are just spineless lying scare-mongering jerks.

Originally Posted by TheProwler

Feel free to make a nice rational thread inviting me to give my thoughts on the current state of affairs, and I'll post in it. This thread is a train wreck, and I'm not going to put any time into a meaningful opinion piece now.

Did your feelings get hurt or something? Everyone started playing nice in here quite some time ago. No one's going to make a special TheProwler thread just for you, so why not man up and post what your Solutions to the Healthcare Problem are rather than doing everything in your power to avoid the issue. Or just admit that you really don't have any evidence and that your opinions are based on pre-existing prejudice.

[meister]

Originally Posted by dilated

Even that lacks perspective. It accepts the "doctors are overpaid" trope without comparing HOURS WORKED. US doctors work significantly more hours than EU doctors. Anybody who can't even make mention of this fact when comparing salaries is not knowledgeable enough to be talking.

There's no question doctors make more here than anywhere else. We also work 10+ hours more per week. We also start medical school at 22+ instead of 18+. We also graduate with anywhere from 0-$300k in debt.

Is it really a mystery why doctors here feel like they have to fight every possible thing that might possibly result in lower reimbursement?

[TheProwler]

Originally Posted by meister

Did your feelings get hurt or something? Everyone started playing nice in here quite some time ago. No one's going to make a special TheProwler thread just for you, so why not man up and post what your Solutions to the Healthcare Problem are rather than doing everything in your power to avoid the issue. Or just admit that you really don't have any evidence and that your opinions are based on pre-existing prejudice.

I have plenty of evidence. I'll humor you.

[ChiDO]

Time to provide some sources for how 45 million uninsured is an overestimate:

2008 - US Census - 46.3 million uninsured: (Source: http://www.census.gov/prod/2009pubs/p60-236.pdf)
US Census OVERESTIMATES uninsured individuals as it under counts Medicaid enrollment: (Source: http://content.healthaffairs.org/cgi...ff.28.6.w991v1)
20% "uninsured" have an income over $50k+ and choose not get insurance: (Source: http://www.census.gov/prod/2008pubs/p60-235.pdf)
20% "uninsured" can afford and 25% can get public coverage but do not: (Source: http://www.healthaffairs.org/RWJ/Dubay2.pdf - another source: http://www.kff.org/uninsured/upload/7613.pdf - another source: http://www.nihcm.org/pdf/NIHCM-Uninsured-Final.pdf)
20% of "uninsured" are NOT CITIZENS: (Source: http://www.kff.org/uninsured/upload/7451-03.pdf)

Thus:
+46.3 "uninsured"
-11.5 (can get public option)
-9.26 (non-citizens)
-9.26 (make 50k+ and can afford)

16.28 million uninsured americans (this number also includes the MEDICAID OVERESTIMATE and YOUNG ADULTS who choose not to get insurance). Even this number is more accurate then the 46.3 million uninsured that Obama keeps spewing out.

[ChiDO]

Originally Posted by meister

There's no question doctors make more here than anywhere else. We also work 10+ hours more per week. We also start medical school at 22+ instead of 18+. We also graduate with anywhere from 0-$300k in debt.

Is it really a mystery why doctors here feel like they have to fight every possible thing that might possibly result in lower reimbursement?

Given this statement, I am really confused on what you are (for or against) now in regards to doctors salaries?

Spending time in school from the age of 18-27, then 4-6 years of residency and fellowship, and accumulating $300k+ debt (the "average" debt is a joke - subtract all those who had parents pay, military, or phd funding and that number will be closer to $300k then $150k) is due some sort of compensation comparable to all those years. You take away the 200-400k salaries and move them to 100k, no one is going to be willing to spend 15 years and $300k of their lives training to become a doctor.

[meister]

Originally Posted by ChiDO

Given this statement, I am really confused on what you are (for or against) now in regards to doctors salaries?

Free medical education and a good salary, $100k+. I'm saying that our system of medical education engenders the sense of hostility to any type of reform that many physicians have. To the point where significant portions of doctors are currently defending a system that most of them utterly loathe!

[atkinsje]

Originally Posted by meister

Free medical education and a good salary, $100k+. I'm saying that our system of medical education engenders the sense of hostility to any type of reform that many physicians have. To the point where significant portions of doctors are currently defending a system that most of them utterly loathe!

Most doctors aren't defending the current system. Most will agree that the system needs revamped. I think many just disagree with the direction the government is trying to reform it.

Edit: Just as an aside meister, whether you want to accept it or not your posts make you out to be belligerent and rude. Its fine to be passionate about something, but unless you can be civil while doing it no one is going to care what you have to say. Then what have you accomplished besides turning people away from a view point they may have taken into account more had you presented better?

[meister]

Originally Posted by ChiDO

Time to provide some sources for how 45 million uninsured is an overestimate:

2008 - US Census - 46.3 million uninsured: (Source: http://www.census.gov/prod/2009pubs/p60-236.pdf)
US Census OVERESTIMATES uninsured individuals as it under counts Medicaid enrollment: (Source: http://content.healthaffairs.org/cgi...ff.28.6.w991v1)
20% "uninsured" have an income over $50k+ and choose not get insurance: (Source: http://www.census.gov/prod/2008pubs/p60-235.pdf)
20% "uninsured" can afford and 25% can get public coverage but do not: (Source: http://www.healthaffairs.org/RWJ/Dubay2.pdf - another source: http://www.kff.org/uninsured/upload/7613.pdf - another source: http://www.nihcm.org/pdf/NIHCM-Uninsured-Final.pdf)
20% of "uninsured" are NOT CITIZENS: (Source: http://www.kff.org/uninsured/upload/7451-03.pdf)

Thus:
+46.3 "uninsured"
-11.5 (can get public option)
-9.26 (non-citizens)
-9.26 (make 50k+ and can afford)

16.28 million uninsured americans (this number also includes the MEDICAID OVERESTIMATE and YOUNG ADULTS who choose not to get insurance). Even this number is more accurate then the 46.3 million uninsured that Obama keeps spewing out.

Look, you posted this a couple pages ago. Unfortunately my reply was deleted because of my excessive use of profanity (lol). The bottom line is that you can't just handwave away the uninsured problem. There are at least 40m people in the US who have no insurance. Period. For various reasons. There are tens of millions more with horrible insurance that would bankrupt them. Period. These are just the facts.

Getting everyone to pay huge premiums for high deductible plans that would bankrupt them if they get diagnosed with a costly illness will only make the numbers look better and will probably result in a lot of politicians patting themselves on the back. But it does nothing to address the real problems of cost and access.

As I've previously stated, at least half of bankruptices in the US are directly related to medical bills. There are at least 25m underinsured folks who would go bankrupt if they came down with a costly illness.

In addition to all of this, if you look at median income, it fell in the past 8 years. Household income fell. Record numbers are on unemployment. Insurance premiums have outpaced inflation by at least 3x. Record numbers are losing their homes. We just had the largest increase in one month job losses since 1949.

How do we expect low- and middle-income people to pay their medical bills? It's just not going to happen and none of the BS being crapped out in DC is going to address any of these issues. The GOP utterly failed in the past decade to accomplish anything other than plunder our national treasure chest and place us in two quagmires. Oh but they did allow the richest 10% to own proportionally more wealth and have higher income than they have since 1929. And they did allow median income to fall.

In conclusion, it's time to completely ignore republicans, blue dogs, and anyone who thinks Reagan had any good economic sense at all. Oh and also Obama is not doing anything worthwhile and will likely make this problem worse and the dems are too busy congratulating themselves on winning back congress and the WH that they are caving in to corporate monied interests like the cynical politicians they all are.

[TheProwler]

Originally Posted by meister

I would ask you to provide me with some evidence that gives me any reason to think a billion private plans could reverse our spending trends. Because, you see, I have dozens of examples across the world of government run healthcare that has lower costs than the US. But you don't have any examples of free market magic powers lowering costs anywhere, ever. Although you do have examples of free housing markets bringing our country to its knees!

No country has a free market health care system, so I can't point to one.

I should emphasize that Medicare is not supposed to turn a profit, saying that it should just shows you don't understand it. The reason it's going bankrupt is due to the modern practice of medicine in the US, and because of a lack of tax revenue supporting it.

I never said it should turn a profit. However, it is going to go bankrupt in 2017, by their own calculations here - http://www.ssa.gov/OACT/TRSUM/index.html

Social Security will hang on until 2041, but it's going to be quite upside-down by then because of our population distribution:


And that's already from the 2000 Census, so add almost 10 years to that, and you can see the Baby Boomers headed towards SS beneficiary age, and the lack of wage-earners following them.

By 2050, there will be one Social Security/Medicare beneficiary for every two wage-earners. That's not sustainable, and increasing tax revenues to cover that gap is going to crush future generations.

Again, coming from SSA themselves:

Social Security’s cost rate is projected to rise rapidly from about 2012 through 2030 because the retirement of the baby-boom generation will cause the number of beneficiaries to rise much faster than the labor force. Thereaf*ter, the cost rate is estimated to rise at a slower rate for about 5 years and then to remain fairly stable for the next 25 years. Continued reductions in death rates and maintaining birth rates at levels well below those from the baby-boom era and before will cause a continued increase in the average age of the population and will raise the cost rate from 16.7 percent of taxable payroll in 2060 to 17.7 percent by 2083 under the intermediate assumptions. After 2083, the increase in the average age of the population is likely to continue and to increase the gap between OASDI cost and income rates.



The estimated number of workers per beneficiary is shown in figure II.D3. There were about 3.2 workers for every OASDI beneficiary in 2008. This ratio has been extremely stable, remaining between 3.2 and 3.4 since 1974. However, the baby-boom generation will have largely retired by 2030, and the ratio of workers to beneficiaries is projected to be only 2.2 at that time. Thereafter, the number of workers per beneficiary will slowly decline, and the OASDI cost rate will continue to increase, largely due to projected reduc*tions in mortality.

It started out pretty reasonable, but it went far astray from the original set-up:

Sorry folks history proves me right! Alright give me one example of government run healthcare gone awry outside the US. Just one. By the way quoting dead white supremacists from 200+ years ago doesn't really get you any points in my book, FYI.

Why outside the US? We're planning on applying a system to the US, so what has happened in the US is by far the most relevant. Either way, it also includes a segment on the NHS and their initial errors in projection. I found this via the Happy Hospitalist's blog:



Here's the actual source - http://jec.senate.gov/republicans/pu...ly_31_2009.pdf

And yes, I see that the report was authored by a Republican. If you see a problem with the DATA, please point that out to me.

United Kingdom’s National Health Service. In 1946, the British government estimated that the first-year cost of its proposed National Health
Service, which would provide free health care to all citizens at the point of service, would be £260 million. The actual expenditures of the NHS in its
first year of operation (1948- 49) were £359 million—38% more than predicted.ii
Britain’s official assessment of what happened is typically understated: “Architects of the NHS underestimated the immediate public demand and the consequent costs.”iii A more vivid assessment, from the British Health Minister in May 1949 to his Cabinet colleagues:

If the present [budget] estimates are not to be exceeded, services must be withheld which the community has proved it urgently needs—dental treatment and spectacles must be refused, beds must be closed, staff dismissed, and waiting lists already appallingly long must grow even longer. I do not think my colleagues will wish this to happen; I hope they will share my view that the additional money must be found to prevent its happening. But if they do not, I shall need their assistance in determining which services should be withheld and which developments cancelled.iv

Over the past 60 years, British debates about “NHS under-funding” have followed essentially this same pattern: Demand for “free” services is still exceeding available funds; therefore, the government must either increase funding or reduce patients’ access to care. This problem is not exclusive to Britain. Government health care programs in the U.S. have proven just as vulnerable to cost under-projections:



Medicare (hospital insurance). In 1965, as Congress considered legislation to establish a national Medicare program, the House Ways and Means Committee estimated that the hospital insurance portion of the program, Part A, would cost about $9 billion annually by 1990.v Actual Part A spending in 1990 was $67 billion.vi The actuary who provided the original cost estimates
acknowledged in 1994 that, even after conservatively discounting for the unexpectedly high inflation rates of the early ‘70s and other factors, “the actual [Part A] experience was 165% higher than the estimate.”vii Medicare (entire program). In 1967, the House Ways and Means Committee predicted that the new Medicare program, launched the previous year, would cost about $12 billion in 1990. viii Actual Medicare spending in 1990 was $110 billion—off by nearly a factor of 10.ix

ESRD program. In 1972, Congress enacted a universal entitlement to kidney dialysis for patients suffering from end stage renal disease. The program proved twice as expensive as the publicly predicted levels—$229 million in 1974 instead of the predicted $100 million. The bill’s authors had seriously underestimated the demand for services, especially among the over-65
population.x

Medicaid DSH program. In 1987, Congress estimated that Medicaid’s disproportionate share hospital (DSH) payments—which states use to provide relief to hospitals that serve especially large numbers of Medicaid and uninsured patients—would cost less than $1 billion in 1992xi. The actual cost that year was a staggering $17 billion. Among other things, federal lawmakers
had failed to detect loopholes in the legislation that enabled states to draw significantly more money from the federal treasury than they would otherwise have been entitled to claim under the program’s traditional 50-50 funding scheme.xii

Medicare home care benefit. When Congress debated changes to Medicare’s home care benefit in 1988, the projected 1993 cost of the benefit was $4 billion. The actual 1993 cost was more than twice that amount, $10 billion.xiii

Medicare catastrophic coverage benefit. In 1988, Congress added a catastrophic coverage benefit to Medicare, to take effect in 1990. In July 1989, the Congressional Budget Office (CBO) doubled its cost estimate for the program, for the four-year period 1990-1993, from $5.7 billion to $11.8 billion. CBO explained that it had received newer data showing it had significantly under-estimated prescription drug cost growth, and it warned Congress that even this revised estimate might be too low. This was a principal reason Congress repealed the program before it could take effect.xiv
SCHIP. In 1997, Congress established the State Children’s Health Insurance Program as a capped grant program to states, and appropriated $40 billion to be doled out to states over 10 years at a rate of roughly $5 billion per year, once implemented. In each year, some states exceeded their allotments, requiring shifts of funds from other states that had not done so. By 2006, unspent reserves from prior years were nearly exhausted. To avert mass disenrollments, Congress decided to appropriate an additional $283 million in FY 2006 and an additional $650 million in FY 2007.xv

3 Massachusetts Commonwealth Care. In 2006, the Bay State passed a historic universal-coverage plan, which combined a mandate on all residents to have health coverage with generous subsidies for lower-income uninsured families. At that time, the program was predicted to cost roughly $472
million in fiscal year 2008. It cost $628 million that year.xvi In the words of one Democratic state senator, who came to regret his vote for the plan:

The assumption was that, as more people—and, in particular, more young and relatively healthy people—joined the system, premiums would go down across the board. There was also the assumption that as more people became insured, the number of people going to the emergency room would drop dramatically, saving the Commonwealth money. Neither of those things happened—at least not enough to produce the cost savings we were told we would see. In fact, health care reform has cost the Commonwealth much more than expected.xvii

So again I ask - is OUR government known for their ability to curb spending, or to wildly underestimate the costs of its projects? Medicare costs far more than anyone ever predicted, and none of the current proposals, or anything you've said, has shown that we are going to do anything to contain costs. The Democratic senator from Massachusetts said that he thought young and healthy people being added would help, but if it did, it wasn't nearly enough.

Medicare is great for whom they apply. You admit this. All I'm arguing is that we should open up Medicare for everyone. What is your objection to that?

We can't afford it now, and we certainly can't afford it in 30 years. I don't want to start a plan that will fail right as I'm getting to the age of needing it, and I certainly don't want to bankrupt my children.

I want a sustainable plan that focuses as heavily on curbing costs as it does on providing coverage for everyone. Other countries have done it, I AGREE, but there is nothing in our past or in the current bill that suggests that we are going to do the same. We spend money like drunken sailors. I read an article last night that says that in the Netherlands, antibiotics are withheld from 23% of nursing home residents with pneumonia if they have severe dementia (Mylotte, JM 2006). I have never seen that in the US. We'd send them to the ICU and intubate them and start them on Zosyn/Vanc/Cipro and then order a swallow study as soon as they come off the vent.


Here are just a few of my suggestions to curb spending:

1. Raise the age of Medicare benefits. When Medicare was enacted in 1965, the benefits started at age 65, and the average lifespan was 70, according to the CDC - http://www.cdc.gov/nchs/data/nvsr/nvsr56/nvsr56_09.pdf - and now the average age is 77.8. We went from providing 5 years of benefits to 18 years of benefits, at the same time that our worker pool was shrinking in comparison.

2. Require everyone on Medicare to have a detailed advanced directive or refuse to give them benefits. It's sick and perverted to put a trach and PEG in an 88-year old woman who lives in a nursing home with no joy in life. We should know exactly what our patients want, and sometimes prolonging their life is not what they want. If they want it all, fine, as long as they have informed consent to what they're asking for.

3. Don't have regular health insurance cover routine office visits. My home insurance is like $200 a year. It doesn't cover my TV if it breaks, but it'll cover all my possessions if my apartment goes up in flames. If I wanted complete coverage for everything with no deductible, I'd be paying thousands a year. Between my wife's employer's contribution and our out-of-pocket premium, we spend about $8000 a year on our health insurance. If I had only a disaster-level policy and paid $100 to see my PCP once a year, I'd have a lot more money in my pocket. Unfortunately, because of the way insurance (and Medicare!) work, my doctor can't give me a "regular price" if I pay in cash. The insurance/Medicare gets "X% discount of Y cost or Z cost, whichever is less." The doctor increases Y cost so that Y-X% is a fair amount, but the cash customer doesn't get the X% discount - he gets shafted with the Y cost.

4. Do less. That'll save money. Don't give a liver transplant to an alcoholic who is still drinking (my wife has taken care of patients who came in drunk for their transplant). Use generic drugs more. Don't give everyone a drug for everything.

[TheProwler]

Originally Posted by meister

Getting everyone to pay huge premiums for high deductible plans that would bankrupt them if they get diagnosed with a costly illness will only make the numbers look better and will probably result in a lot of politicians patting themselves on the back. But it does nothing to address the real problems of cost and access.

Huge premiums for high-deductible plans? Having actually priced one out and used it personally, I can tell you that they are much cheaper.

In conclusion, it's time to completely ignore republicans, blue dogs, and anyone who thinks Reagan had any good economic sense at all. Oh and also Obama is not doing anything worthwhile and will likely make this problem worse and the dems are too busy congratulating themselves on winning back congress and the WH that they are caving in to corporate monied interests like the cynical politicians they all are.

Anyone who thinks that either Republicans or Democrats are actually trying to help the common man has not been watching either party for quite some time.

[Concubine]

Originally Posted by TheProwler

Here are just a few of my suggestions to curb spending:

1. Raise the age of Medicare benefits. When Medicare was enacted in 1965, the benefits started at age 65, and the average lifespan was 70, according to the CDC - http://www.cdc.gov/nchs/data/nvsr/nvsr56/nvsr56_09.pdf - and now the average age is 77.8. We went from providing 5 years of benefits to 18 years of benefits, at the same time that our worker pool was shrinking in comparison.

2. Require everyone on Medicare to have a detailed advanced directive or refuse to give them benefits. It's sick and perverted to put a trach and PEG in an 88-year old woman who lives in a nursing home with no joy in life. We should know exactly what our patients want, and sometimes prolonging their life is not what they want. If they want it all, fine, as long as they have informed consent to what they're asking for.

3. Don't have regular health insurance cover routine office visits. My home insurance is like $200 a year. It doesn't cover my TV if it breaks, but it'll cover all my possessions if my apartment goes up in flames. If I wanted complete coverage for everything with no deductible, I'd be paying thousands a year. Between my wife's employer's contribution and our out-of-pocket premium, we spend about $8000 a year on our health insurance. If I had only a disaster-level policy and paid $100 to see my PCP once a year, I'd have a lot more money in my pocket. Unfortunately, because of the way insurance (and Medicare!) work, my doctor can't give me a "regular price" if I pay in cash. The insurance/Medicare gets "X% discount of Y cost or Z cost, whichever is less." The doctor increases Y cost so that Y-X% is a fair amount, but the cash customer doesn't get the X% discount - he gets shafted with the Y cost.

4. Do less. That'll save money. Don't give a liver transplant to an alcoholic who is still drinking (my wife has taken care of patients who came in drunk for their transplant). Use generic drugs more. Don't give everyone a drug for everything.

Excellent ideas. I would add:

5. Tort reform to help curb defensive medicine. Not necessarily a cap on the award, but at least a rule that would make all costs incurred by a frivolous lawsuit the responsibility of the plaintiff.

It seems to me the ideas above would solve a lot of problems in our health care system in addition to injecting some common sense and responsibility.

[Concubine]

Originally Posted by meister

In conclusion, it's time to completely ignore republicans, blue dogs, and anyone who thinks Reagan had any good economic sense at all. Oh and also Obama is not doing anything worthwhile and will likely make this problem worse and the dems are too busy congratulating themselves on winning back congress and the WH that they are caving in to corporate monied interests like the cynical politicians they all are.

I actually agree with you here.

[TheProwler]

Originally Posted by Concubine

Excellent ideas. I would add:

5. Tort reform to help curb defensive medicine. Not necessarily a cap on the award, but at least a rule that would make all costs incurred by a frivolous lawsuit the responsibility of the plaintiff.

It seems to me the ideas above would solve a lot of problems in our health care system in addition to injecting some common sense and responsibility.

I'd prefer arbitration, actually. A jury is ridiculous. They're not my peers, and they're often manipulated by a skilled lawyer - either for or against the truth.

I read this comment on a malpractice blog and thought it made some good points:

A few things from a med mal guy:

How healthy are those med mal insurance companies with this great climate? Not real good. Soft market, premiums down and investments stink. Articles talk about frequency while ignoring severity. This is dishonest. See PRI in NY with a negative surplus of $40mil. Not much of a surplus in my book, but I am not an accountant !! Sounds like death benefits- never got that one either!!

I have done nothing but med mal claims since 1985, before then I was an x ray tech and litigation paralegal.

Here is the deal and the solution:
Nearly 60% of all monies paid on a case ,through the court system, does not go to the injured party. Surprised? There is plenty of fat to be saved on loss adjustment expenses and contingency fees. There is plenty of med mal and the smallest fraction gets to claim status, but that is enough to cripple many companies. I actually feel good about settling meritorious cases, but more cash needs to get to the actual patient.

Med mal is a highly specialized area and needs its own forum- Arbitration.

We could instantly drop the cost of each case by 30% while keeping the indemnity, rec’d by the patient, the same. Courts do not address the ” jury of peers” premise. Defined in Blacks dictionary as equal rank and station. Doctors do not get peers and are hurt by this disadvantage, addditionally , the hollywood courtroom scenes that amp up the non peer juries emotion and ultimately the verdicts.
What does arbitration accomplish?:
In arbitration the injured party gets the money and quickly, premiums come down, defensive medicine plummets, policies become affordable, higher limits are attainable, the cost of healthcare drops,the courts get declogged, while the attorneys involved on both sides still make a nice living. I could go on re the benefits or arbitration!! The field gets leveled. Each side picks the arbitors and they dont have to be doctors. To me, equal rank and station includes podiatrists, vets, dentists etc. The lay jury, Joe the plumber, will never get the subtleties of the accepted risks and complications of the elective retrograde cholangiopancreatatogram. Just imagine a panel of peers and trimming the tangetial costs of med mal by 30 something percent = billions. This solution may not be tolerable to those that make a fine living via the court system, but it does level the playing field. This forum gets the same of more money to the injured party. Why is it that good ideas never happen and we are always stuck shuffling the same deck of cards? regards Jim O’Hare VP med mal claims PIC

http://ravechroy.wordpress.com/2009/...ractice-myths/


I think malpractice is a good thing. I want people to have faith in their physician and trust that we are policing our own profession. I think another alternative would be a large fine against a physician, LOSING YOUR LICENSE, and then compensation for the patient from a large fund like Wisconsin has - http://oci.wi.gov/pcf.htm#geninfo - Doctors only need $1 million in coverage, because any claim larger than that is paid out by the fund. I don't think a physician should necessarily lose his license for honest mistakes even amounting to negligence, but if someone is ever selling narcotics or something, or molesting a patient, that should be a permanent ban from medicine, in addition to criminal charges.

[cgscribe]

Originally Posted by TheProwler

Anyone who thinks that either Republicans or Democrats are actually trying to help the common man has not been watching either party for quite some time.

[womp]

Originally Posted by basupran

How are you normalizing?

Just a basic division of yearly salary over 1999 levels * 100.

[RGMSU]

Physician salaries will never be below 100k. Everybody calm down. The only folks who are likely to see a dip in salary are the proceduralists and surgeons. A dip from 450k to 350k isn't going to make anybody starve to death, especially when family docs have been making 150k for a long time now.

[womp]

Originally Posted by RGMSU

The only folks who are likely to see a dip in salary are the proceduralists and surgeons. A dip from 450k to 350k isn't going to make anybody starve to death, especially when family docs have been making 150k for a long time now.

Newsflash: Most surgeons don't make 450k, not even 350k. They make around 200k and work 60-70 hours a week, after going through 5+ years of residencies/fellowships. The private practice surgeons can barely survive with the malpractice costs.

[tjaze]

Originally Posted by TheProwler

I'd prefer arbitration, actually. A jury is ridiculous. They're not my peers, and they're often manipulated by a skilled lawyer - either for or against the truth.

I read this comment on a malpractice blog and thought it made some good points:

http://ravechroy.wordpress.com/2009/...ractice-myths/


I think malpractice is a good thing. I want people to have faith in their physician and trust that we are policing our own profession. I think another alternative would be a large fine against a physician, LOSING YOUR LICENSE, and then compensation for the patient from a large fund like Wisconsin has - http://oci.wi.gov/pcf.htm#geninfo - Doctors only need $1 million in coverage, because any claim larger than that is paid out by the fund. I don't think a physician should necessarily lose his license for honest mistakes even amounting to negligence, but if someone is ever selling narcotics or something, or molesting a patient, that should be a permanent ban from medicine, in addition to criminal charges.

yes. yes. yes. i actually mentioned this somewhere, but it's good to know others agree with the idea that juries are an especially unfair way to decide cases where good understanding of the material is needed. edwards made his living on playing on juries emotions. personally, i don't think a jury is useful in any case, but especially bad in a med mal case.

[RGMSU]

I know several surgeons in private practice, and they don't look like they're barely surviving to me. And, for the record, 450 is not at all unheard of for an established orthopedist say. Your figure of 200 is indeed low. I know family physicians who make that much. Any OBGYN or general surgeon (on the low end of the surgery pay scale) who is worth a crap can make 250 down here in Texas. You'll do okay though. As someone enduring the little bit of fun that is medical school currently, let me tell you that if you think it is worth it for the money, it isn't. The only reason I stay in it at all is out of a fascination for the field of study and a belief that the life of a physician is one that contributes something meaningful. Having said that, I sleep 4 hours a night and rarely do anything that was a part of my life before med school. So, yes, I believe physicians should be compensated for their trouble.

[AlexMorph]

Originally Posted by RGMSU

I know several surgeons in private practice, and they don't look like they're barely surviving to me. And, for the record, 450 is not at all unheard of for an established orthopedist say. Your figure of 200 is indeed low. I know family physicians who make that much. Any OBGYN or general surgeon (on the low end of the surgery pay scale) who is worth a crap can make 250 down here in Texas. You'll do okay though. As someone enduring the little bit of fun that is medical school currently, let me tell you that if you think it is worth it for the money, it isn't. The only reason I stay in it at all is out of a fascination for the field of study and a belief that the life of a physician is one that contributes something meaningful. Having said that, I sleep 4 hours a night and rarely do anything that was a part of my life before med school. So, yes, I believe physicians should be compensated for their trouble.

4 hours of sleep a night? you better be an M3 on surgery rotation or you are doing it wrong...

[RGMSU]

Hah, I wish that were the case.

[Concubine]

Originally Posted by RGMSU

Hah, I wish that were the case.

Yeah, I make sure I at least get 6 or 7, and often supplement with a power nap, then catch up on weekends. Couldn't survive on 4.

[womp]

Originally Posted by RGMSU

I know several surgeons in private practice, and they don't look like they're barely surviving to me. And, for the record, 450 is not at all unheard of for an established orthopedist say. Your figure of 200 is indeed low. I know family physicians who make that much. Any OBGYN or general surgeon (on the low end of the surgery pay scale) who is worth a crap can make 250 down here in Texas. You'll do okay though.

Orthopedic surgeons aren't your typical surgeon and they were generally the very top of their class. You don't just go to medical school, barely pass on everything, and pick if you want to be a family doctor or an orthopedic surgeon, so to compare orthopods' salary (one end of the extreme of surgical salaries) with FM salary is pretty disingenuous.

Also Texas is very different from the rest of the country; it's become a very doctor friendly state. Medical malpractice premiums in Texas are very low and the state's Medicaid coverage is pretty barebones.

[AlexMorph]

Originally Posted by womp

Orthopedic surgeons aren't your typical surgeon and they were generally the very top of their class. You don't just go to medical school, barely pass on everything, and pick if you want to be a family doctor or an orthopedic surgeon, so to compare orthopods' salary (one end of the extreme of surgical salaries) with FM salary is pretty disingenuous.

Also Texas is very different from the rest of the country; it's become a very doctor friendly state. Medical malpractice premiums in Texas are very low and the state's Medicaid coverage is pretty barebones.

woohoo, TEXAS!

[RGMSU]

I am aware that Texas is a friendly state for physicians in many ways. Many states in the South are actually. I am also aware of the difficulty of getting into orthopedics. However, you missed my point. I said I personally know family physicians who make 200k or more, and I personally know general surgeons who make way over 250k. Trust me, 200k isn't something to sneeze at for most people. I actually think salaries should be flattened out more. There is no reason in my mind that an orthopedist should make 3 times what a family physician makes. And, no, I don't plan on being a family physician. Nevertheless, my points here are based on actual people, not just internet hearsay. And, my comments on medical training are based on actually being here and doing it in real time. As far as salaries and the difficulty of it, etc, if you haven't figure it out yet, medicine is a self-sacrificial career in many ways.

[Dirt]

Originally Posted by womp

The private practice surgeons can barely survive with the malpractice costs.

This statement is total and utter bull$hit.

[RGMSU]

Originally Posted by Dirt

This statement is total and utter bull$hit.

That's what I was trying to say. Much more directly put there.

[TexasFight]

Originally Posted by RGMSU

I am aware that Texas is a friendly state for physicians in many ways. Many states in the South are actually. I am also aware of the difficulty of getting into orthopedics. However, you missed my point. I said I personally know family physicians who make 200k or more, and I personally know general surgeons who make way over 250k. Trust me, 200k isn't something to sneeze at for most people. I actually think salaries should be flattened out more. There is no reason in my mind that an orthopedist should make 3 times what a family physician makes. And, no, I don't plan on being a family physician. Nevertheless, my points here are based on actual people, not just internet hearsay. And, my comments on medical training are based on actually being here and doing it in real time. As far as salaries and the difficulty of it, etc, if you haven't figure it out yet, medicine is a self-sacrificial career in many ways.

I honestly do think surgeons should make more than family physicians (and non-surgical specialties). In extremely basic terms, they are handed off the task of thinking out a solution for the patient as well as taking a huge risk by operating. I think there should be some extra compensation for just that: the risk of cutting someone open. Of course, this is in addition to the tremendous risk of planning out a patient's plan of action (prescribing conflicting meds, etc.) It's just that surgeons generally seem to deal on both sides of the fence.

With that said, I would not want a panel of doctors (much less politicians) deciding how much someone should get paid. Too bad market forces have been suppressed by managed care and the government.

[RGMSU]

There are lots of harcore medical questions that are not surgical. Some of the most difficult specialties out there are IM subspecialties - cardio, pulmo, onco, neuro. The risk is still there, not because of procedural intervention, but because of the fragility of the patient. And, the medical questions dealt with by IM subspecialists are far more complex than anything a surgeon ever prescribes or manages medically speaking. Having said that, yes there is great risk in surgical intervention. I just don't think the risk is so great that it justifies three times the salary. Take infectious disease for example. Training is just as long as surgery, and stakes are just as high. If you fail to adequately manage a septic patient in the ICU, the outcome isn't much different from that if you fail miserably in the OR. Yet an infectious disease physician makes 200k in a good year. An OBGYN might make 250 to 300k in a good practice, and that's certainly no less high risk than orthopedics, nor is it an easier lifestyle. So, some salary levels I believe are artificially inflated, while others are artificially undervalued. And, no, I wish managed care had never been allowed either. But, it's here to stay. As far as family docs, I think they get the short end of the stick. They don't just pass out cough syrup every day. If they miss the early signs of prostate cancer in a routine screening, the patient may wind up just as dead as if the urologist made a mistake later in the treatment process. All medicine is high stakes at one time or another, almost irrespective of what specialty you enter.

Honestly, at a time when we are all under assault from outside the profession, it makes more sense for us to work together toward a common goal rather than dividing ourselves down specialty interests. A surgeon has more in common with a family physician than he/she does with a malpractice lawyer or a politician. It doesn't do the surgeon any good if the family doc is knocked down, because the surgeon may well be the next target on the hit list, or vice versa.

[atkinsje]

Originally Posted by RGMSU

Honestly, at a time when we are all under assault from outside the profession, it makes more sense for us to work together toward a common goal rather than dividing ourselves down specialty interests. A surgeon has more in common with a family physician than he/she does with a malpractice lawyer or a politician. It doesn't do the surgeon any good if the family doc is knocked down, because the surgeon may well be the next target on the hit list, or vice versa.

Well said.

[meister]

Originally Posted by TheProwler

By 2050, there will be one Social Security/Medicare beneficiary for every two wage-earners. That's not sustainable, and increasing tax revenues to cover that gap is going to crush future generations.

Just to be clear, you're talking about a 2% tax increase within the next 60 projected years. That isn't an examaple of an unsustainable system, just admit it. All I've said is that MONEY IN = MONEY OUT. Raise taxes during certain times, lower it for others. That is 100% sustainable. Yes, it will cost certain people more than others because of demographics, but that's not the point. It's not going to take 50% of your paycheck, it's not going to bankrupt anyone. And it provides a vital and extremely popular government service. You can talk about Medicare being unsustainable (for myriad reasons), but SSI is just not the same. It's just used as a TAX AND SPEND LIBURAL talking point when in reality the program is quite popular and will be around for the next few decades. This is all rather irrelevant to the healthcare debate except insofar as it demonstrates a vital government service benefiting millions that is not going bankrupt within the foreseeable future. And it's run 100% by the government. Shock! You want to make things a whole lot easier for SSI funding? Erase the income cap at $100k, and eliminate benefits for rich ass oligarchs like John McCain or Ted Kennedy. The income cap is regressive as f*ck and the oligarchs receiving $500 a month while they literally sleep on a pile of gold is insulting as f*ck.

Originally Posted by TheProwler

So again I ask - is OUR government known for their ability to curb spending, or to wildly underestimate the costs of its projects? Medicare costs far more than anyone ever predicted, and none of the current proposals, or anything you've said, has shown that we are going to do anything to contain costs.

Alright, so you have evidence showing that Medicare expenditures far exceeded anyone's wildest imaginations in the 1960s. You'll find this is true for healthcare as a whole, across the wealthy first world. Do you think that is because of government involvement or in spite of it? Remember, we spend far more per capita than anyone else, and we are the only country without guaranteed access to healthcare. This is more than a random coincidence. Your argument that our government is far more incompetent than anyone else and couldn't possibly do anything right is a simple fallacy. There is nothing special about the US or its government other than its stubborn adherence to the status quo.

Originally Posted by TheProwler

We can't afford it now, and we certainly can't afford it in 30 years. I don't want to start a plan that will fail right as I'm getting to the age of needing it, and I certainly don't want to bankrupt my children.

Why are you concerned about bankrupting your children with guaranteed healthcare and not the far more imminent possibility of their bankruptcy due to extremely high and unaffordable medical bills? I've already posted evidence demonstrating that half of bankruptcies are currently directly attributable to medical bills, and that 70% of those people actually had health insurance. This is a far more immediate concern than possible taxation-to-death in 30 years. Please explain how you would address this issue. How would you prevent for-profit private entities from screwing over consumers as they have done for decades? With the result being that those who can't afford insurance or become disabled or get too old get put on the government dime.

Originally Posted by TheProwler

I want a sustainable plan that focuses as heavily on curbing costs as it does on providing coverage for everyone. Other countries have done it, I AGREE, but there is nothing in our past or in the current bill that suggests that we are going to do the same. We spend money like drunken sailors.

Other countries have done it, you say. Which countries would you like to emulate?

Originally Posted by TheProwler

1. Raise the age of Medicare benefits. When Medicare was enacted in 1965, the benefits started at age 65, and the average lifespan was 70, according to the CDC - http://www.cdc.gov/nchs/data/nvsr/nvsr56/nvsr56_09.pdf - and now the average age is 77.8. We went from providing 5 years of benefits to 18 years of benefits, at the same time that our worker pool was shrinking in comparison.

Why should seniors be entitled to government insurance and not everyone else? Wouldn't the supposed failure of Medicare to curb costs force you to cancel the entire program or privatize it completely? How do you explain this?

Originally Posted by TheProwler

3. Don't have regular health insurance cover routine office visits. My home insurance is like $200 a year.

This is often trotted out as the solution, to put consumers in control of spending. I have no doubt that what you are suggesting would lower costs tremendously, but I would challenge you to consider the consequences. For example, I literally had a lady present to clinic yesterday a week after being diagnosed with pneumonia and given antibiotics. She was presenting with a worse cough and general malaise. Ordered a PA x-ray and HELLO a gigantic aortic aneurysm taking up half the right lung field. If I were to tell the patient that I think she should get a chest x-ray and it costs $200 out of her own pocket, do you think she would have done it? Would she have had the scan done? Would we have found the aneurysm while she was alive or at autopsy?

Furthermore, besides pitting doctor vs. consumer in an epic struggle to justify prescriptions or lab tests or imaging studies, this would have huge negative repercussions on the poor. What do we do if people cannot afford the $2000 out-of-pocket expenses that are the patient's responsibility until their emergency insurance kicks in?

Originally Posted by TheProwler

4. Do less. That'll save money. Don't give a liver transplant to an alcoholic who is still drinking (my wife has taken care of patients who came in drunk for their transplant). Use generic drugs more. Don't give everyone a drug for everything.

I agree that there should be stricter guidelines for the utilization of expensive resources, but I fail to see how a hodgepodge of private insurers each seeking their own profit have any incentive at all to lower overall costs or would have any collective muscle to lower fees from hospitals or physicians. How would that work?

My answer is simple: eliminate the thousands of different plans, entrust the government with the funding and administration responsibilities, and eliminate medical education debt. What is a primary care doctor's #1 gripe? Insurance companies. Prior authorizations for prescription medication. Pre-authorization for medically warranted CT scans or MRIs. Ok, we just eliminated the six or ten or however many different companies each physician has to learn how to deal with and now we have exactly one. Sure, he's still going to bitch about the one. And it'll be the butt of jokes just as SSI or Medicare is now. But you cannot deny it'll make the practice of medicine easier, dramatically lower administrative costs, eliminate the profit motive on the part of insurance companies, eliminate the grave specter of $300k of debt for physicians who have to avoid primary care, and eliminate disgusting executive compensation. In addition, we should require electronic medical records in every physician's office and hospital. It's f*cking 2009 already, paper charts reek of the 1950s.

To be clear, I'm not even suggesting the government run all hospitals or employ all physicians. I'm purely talking about the funding mechanism. Do you deny that this would make things simpler and make it much easier to go about lowering costs? I fail to see how private insurance companies have it in their best interest to lower costs.

[Downbytheicu]

I think something we have to remember about this debate is that Physician salaries need to be sufficiently high, relative to other health care professions, to entice people into medicine. If physicians make less than $100k a year, then PAs (who can make close to that now) would have to take a hit as well. Nurses would need to take a hit also.

If only the physician salaries dropped, we would end up with a plethora of PAs, other mid level practitioners, and nurses at the expense of the medical profession.

The people in Washington know this. They can't afford to lower nurses salaries all that much, so I doubt that our salaries will fall too far. I do, however, foresee specialist pays falling significantly so that the difference between the internists and cardiologists becomes smaller.

[Dr Oops]

Originally Posted by Downbytheicu

I think something we have to remember about this debate is that Physician salaries need to be sufficiently high, relative to other health care professions, to entice people into medicine. If physicians make less than $100k a year, then PAs (who can make close to that now) would have to take a hit as well. Nurses would need to take a hit also.

If only the physician salaries dropped, we would end up with a plethora of PAs, other mid level practitioners, and nurses at the expense of the medical profession.

The people in Washington know this. They can't afford to lower nurses salaries all that much, so I doubt that our salaries will fall too far. I do, however, foresee specialist pays falling significantly so that the difference between the internists and cardiologists becomes smaller.

This is a very good point, why would I take on more debt and greater and harder time commitment to make the same as some who didnt. However i dont kno if washington cares/understands this.