The role of physicians at the centre of health care is under pressure

[Acoustic]

You are aware that MD salaries are a drop in the bucket when it comes to the sticker price of modern medicine, yes?

The real reason for exorbitant healthcare costs is that there's (understandably) a demand for bleeding edge healthcare, which means ridiculously expensive medical equipment, facilities, and drugs. Hospitals get this stuff for obvious reasons but since most hospitals are, surprise, businesses they need to somehow turn a profit on their multi-million dollar machines which also require multi-million dollar annual upkeep costs. Normally they would just shift the cost onto the health insurance companies, except that said companies will often flat out refuse to pay for what they view as unnecessarily expensive procedures until they've been "proven". In addition to this, you've got legions of uninsured patients who only show up in the system when their conditions have progressed to their most severe (and expensive) stages, and of course there's no way in hell a hospital is going to get a guy who makes $15k a year to pay $1.5 million in medical bills.

The result of all of this is that hospitals have to spread around the cost burden wherever they can. This is why getting a band-aid in the ER costs $500. You're not actually paying $500 for the physician or nurse's time, nor are you paying for the privilege of being in the ER, and you sure as hell aren't paying $500 for that band-aid. Rather, the hospital has decided that they're going to have EVERYONE chip in for their new surgical robot whether they use it or not.

Also, even if salaries were the main culprit (they're not), doctors make nothing compared to hospital administrators. To paraphrase Chris Rock:

"To get an idea of the difference between 'wealthy' and 'rich' look at Kobe. Kobe Bryant is not wealthy. Kobe Bryant is rich. The guy PAYING Kobe...HE'S wealthy".

This is one of the better explanations I've seen of the doctor's perspective of healthcare and what's wrong with it. Unfortunately that doesn't really reach and sink into the rest of the population.

---

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[Instatewaiter]

That said, the monopoly on engineering is much less tightly held than the medical monopoly.

Actually this is completely wrong. No one except an engineer can legally do engineering. However, it seems NPs and PAs are legally allowed to diagnose and treat despite markedly less training. Often, NPs are allowed to be completely independent.

So, actually, the engineering monopoly is markedly more stringent. The difference is that after 2 years of college, other people aren't allowed to do an engineer's job while in medicine they are allowed to do a most of what a doctor does.

****ty medical care is better than no medical care. You know that Spanish speaking pregnant mother of two, the one with gestational diabetes whose third came out stillborn? Go tell her that at least she was "protected" by the guaranteed quality provided by the medical monopoly, even though she couldn't afford to see a doctor.

Yeah, no. ****ty medical care kills you actively.

And I'm not saying this is the case for all doctors and med students, many understand the problems associated with monopolization. Its the one s that post here and are militant that make everyone look bad. For their own profit willing to risk public safety to try to preserve the monopoly. Stupid argument all in all.

It is not so much a monopoly. Anyone can be a doctor. They just need doctor training and pass the doctor exams. Hell, even people from India, pakistan etc can be doctors in this country and don't have to go to school in this country. They just need medical school.

A truck driver can be a doctor. He just needs be trained to be a doctor.

Look at law, you actually have to go ot specific aba accredited law schools to practice in every state except NY. How about being an electrician. You have to be a licenesed electrician to work. Are these monopolies? No.

They just require that to do something that would be dangerous or could have large reprocussions on someone's life needs to have the requisite training.

 

[Instatewaiter]

And I'm not saying this is the case for all doctors and med students, many understand the problems associated with monopolization. Its the one s that post here and are militant that make everyone look bad. For their own profit willing to risk public safety to try to preserve the monopoly. Stupid argument all in all.

The irony of your statement...

It is actually the people who want a piece of the health care pie who arewilling to risk public safety. It is those people who don't have the knowledge or training to practice independently who are pushing to enter medicine without the needed training.

Years ago we had system that did not have the stringent requirements to practice medicine. At that time, medicine was full of quacks, swindlers and dangerous practices. The regulations in place, have done a tremendous amount of good in protecting the public from unsafe practicioners.

I'm no free market worshiper. But it's hardly controversial to say that the free market provides a nicely graded menu of options, and that monopolies result in the stagnation/deterioration of quality. Any left wing economics professor will acknowledge these basic facts.

Opening up the market will possibly lead to higher quality medical care at the top, and will certainly lead to cheaper medical care at the bottom.

The difference is that in these free markets, there is minimal required knowledge. For instance, in steel smelting, you need 1 engineer to set up the factory and the workers need breif training and basically no formal education to do their job. It is easy for another person to create a factory provided they have the capitol to open up a factory.

Actually medicine is a lot like this. The diffference is the training the workers in medicine need is long and extensive. This is what it seems you have issue with. You just don't want people to have to have such extensive training.

If you want to go to an NP next time you have a serious medical problem, be my guest. I'll just laugh when you show up in my ICU.

 

[SpecterGT260]

Wow, that is insane, 6.5%. I knew it wasn't the majority of the costs but I never would have thought it would be that low.

I took the last estimate for # physicians working in the USA, rounded that up to the nearest 100k (added about 30k-ish)
Then took the last estimate for average (mean, so skewed appropriately for those beverly hills boob docs making millions) physician salary and did the same. Took it from 170k to 200k.

Multiplied, and calculated the % of total healthcare costs. 6.5% Mother of God.......
Unless this is more of Rothy's homeopath stuff.... Such a small % really being responsible for the effect

 

[SpecterGT260]

Yeah, no. ****ty medical care kills you actively.
.

Yeah but a ****-ily designed building kills LOTS of people actively! ........................


OH GOD OH GOD! Saying that hurt my brain!

Thank you for making this point. People taking the position of the poster you quoted often flipflop on what poor quality care actually means to the consumer. They also mix and match definitions of what "poor quality" actually means. It's all just self-satisfying bullsh*t as they tell themselves what they want/need to hear in order to justify a skewed and inaccurate point of view.


Id also just like to point out - concerning the free market business: people are free to choose the healthcare they wish to have. There is confusion here that a free market means that everybody has the ability to sell everything. That isnt really the case. The consumer is free to choose. This system WILL improve outcomes because 1) the alternatives are ineffective and are becoming increasingly dangerous and 2)the standard (medicine) is effective and becoming increasingly safe. The freedom of the market will skew use towards the more valid treatment.

Rothbards argument is a direct parallel to bitching at Michael Bluth because only people working at the Bluth Banana Stand are allowed to sell Bluth Bananas. Look at it "bitching at doctors because only people working as doctors in real clinics are allowed to sell medicine (the practice of)".
and ANYONE can become a doctor assuming they show themselves to be qualified. Every job has such restrictions. Not many paraplegics in construction. Is that an unfair monopoly? It is subjective opinion alone that demonizes these qualities in medicine when it is the same for every other profession. Even if we want to focus on the fact that this is governed by law..... well, the government is most often the payer (the employer in a sense) via medicare and other government sponsored insurances/programs and the government has set its policy for who it wishes to "hire" in the very same way based on qualifications that a fast food manager would. And before anyone protests I invite you to re-read my statement concerning how the markets are actually open and you cannot scream "monopoly" just because someone else has a restriction on their own individual product. That is like claiming Dell has a monopoly on slightly crooked and square letter "E"s - that misses the point entirely.

 

[SpecterGT260]

The irony of your statement...

It is actually the people who want a piece of the health care pie who arewilling to risk public safety. It is those people who don't have the knowledge or training to practice independently who are pushing to enter medicine without the needed training.

Years ago we had system that did not have the stringent requirements to practice medicine. At that time, medicine was full of quacks, swindlers and dangerous practices. The regulations in place, have done a tremendous amount of good in protecting the public from unsafe practicioners.




The difference is that in these free markets, there is minimal required knowledge. For instance, in steel smelting, you need 1 engineer to set up the factory and the workers need breif training and basically no formal education to do their job. It is easy for another person to create a factory provided they have the capitol to open up a factory.

Actually medicine is a lot like this. The diffference is the training the workers in medicine need is long and extensive. This is what it seems you have issue with. You just don't want people to have to have such extensive training.

If you want to go to an NP next time you have a serious medical problem, be my guest. I'll just laugh when you show up in my ICU.

I think if we wanted to refine your example.... (oh puns!)
In your steel example the engineer is the one required to have all the training. This guy is similar to the physician. The one in the team who "designs" the "product". In construction, there are a plethora of people who administer the product. There is minimal risk in administration of the product. This isnt true in medicine. You are asking the "engineer" to be not only the designer but also the interface between the product and the end user. Medicine also has assistants, nurses, and techs (listed in a very specific order according to ability and this is true in all cases ). In many cases these people fulfil the same roles that their counterparts - contractors, foremen, and laborers - in the [construction] engineering world. However, if you wanted engineers to build a house from start to finish expect it to cost a whole hell of a lot more and take a whole hell of a lot longer . Per this example, the argument made to "free up the market" is not at all parallel to engineering. You (not you, waiter, rhetorical you) are talking about allowing laborers to do the job of engineers or to flip it over: talking about allowing lower level medical personel to be the designers of the therapy rather than to assist in the administration and management. This is VERY different.

I dont have a problem with an argument that says we expand mid-level numbers and administration privileges - construct a system that still uses physicians to diagnose and create treatment plans and an army of minions to carry out the orders quickly, efficiently, and even with the touchy-feely crap the patients like . I DO have a problem putting the bottle neck at diagnosis and saying that people with arguably NO training as compared to an MD (lets face it, even new PGY-1's (read: new med school graduates) dont know squat compared to what they will need to know by the time they are licensed and certified) should be allowed to pick up that slack or open that bottle neck or whatever the hell the analogy i need to use here is....

 

[likeaboss]

OP: funny I was always taught that the patient is the center of health care, not the doctor

 

[SpecterGT260]

OP: funny I was always taught that the patient is the center of health care, not the doctor

your argument makes it sound as if you would consider proper child care to be unlimited ice cream, no bed times, and no veggies..... ever.

 

[dr zaius]

OP: funny I was always taught that the patient is the center of health care, not the doctor

Did you even read the article? Or did you just get out of a patient care class lecture? If you read it you would realize the title is talking about the situation from only the side of the provider.

 

[likeaboss]

your argument makes it sound as if you would consider proper child care to be unlimited ice cream, no bed times, and no veggies..... ever.

so in this analogy you the physician are dad and the patient is your child... nice..

 

[likeaboss]

Did you even read the article? Or did you just get out of a patient care class lecture? If you read it you would realize the title is talking about the situation from only the side of the provider.

yes I read it. the last line says that patients will win which is a good thing, especially in this terrible health care system where patients suffer due to health care providers (not just doctors but everyone) who simply dont give a ****.

900+ posts and you haven't even started your third year of med school. why don't you spend less time as an armchair quarterback and update me after you see your first patient

 

[SpecterGT260]

nice..

Yes I thought so too it was a reflection on relative understanding and knowledge and the ability to make a good decision. Glad you agree, son

 

[dr zaius]

yes I read it. the last line says that patients will win which is a good thing, especially in this terrible health care system where patients suffer due to health care providers (not just doctors but everyone) who simply dont give a ****.

900+ posts and you haven't even started your third year of med school. why don't you spend less time as an armchair quarterback and update me after you see your first patient

I can read an article as well as any 3rd or 4th year. It doesn't take clinical experience to understand the article is about encroachment of mid-level providers.

 

[likeaboss]

I can read an article as well as any 3rd or 4th year. It doesn't take clinical experience to understand the article is about encroachment of mid-level providers.

these arguments over mid level providers are mostly an online sdn phenomenon. I have never heard a resident or attending complain about nurse practitioners or crna's in the hospital.

when you start clinical work you will see that every person plays a role in health care, from the dr to the pa to the np, etc. there is plenty of work to go around and the role of the physician will continue to be the gold standard as long as they continue to be the smartest and best trained providers.

no nurse will ever be able to take that away from you, period...

 

[dr zaius]

Right, and I never said any of that would occur. I was pointing out what the article was about and why the thread was titled so.

 

[IDBasco]

these arguments over mid level providers are mostly an online sdn phenomenon. I have never heard a resident or attending complain about nurse practitioners or crna's in the hospital.

You haven't spent much time in hospitals, then. That or people can tell you aren't one to discuss it with for some reason. Certainly not every doc talks about it, but quite a few do. The ones that do don't typically broadcast their opinions for everyone to hear.

 

[likeaboss]

You haven't spent much time in hospitals, then. That or people can tell you aren't one to discuss it with for some reason. Certainly not every doc talks about it, but quite a few do. The ones that do don't typically broadcast their opinions for everyone to hear.

every anesthesiologist I have talked to about CRNAs wasn't all that concerned about it because they know they add something intangible that a CRNA does not. they know a CT surgeon will never allow someone with a nursing eduction do cardiopulmonary bypass for his cabg..

 

[SpecterGT260]

every anesthesiologist I have talked to about CRNAs wasn't all that concerned about it because they know they add something intangible that a CRNA does not. they know a CT surgeon will never allow someone with a nursing eduction do cardiopulmonary bypass for his cabg..

I can make this same statement and have it be 100% accurate while also never having talked to one.... numbers please.

 

[Acoustic]

every anesthesiologist I have talked to about CRNAs wasn't all that concerned about it because they know they add something intangible that a CRNA does not. they know a CT surgeon will never allow someone with a nursing eduction do cardiopulmonary bypass for his cabg..

That may be true, but this sounds an awful lot like what created the current situation to begin with: doctors not lobbying for their own interests because they think the public will agree / understand their point of view naturally.

Current situation being a trend of wanting to reduce physician autonomy and pay in popular opinion. Obviously I have no numbers for this though.

 

[IDBasco]

every anesthesiologist I have talked to about CRNAs wasn't all that concerned about it because they know they add something intangible that a CRNA does not. they know a CT surgeon will never allow someone with a nursing eduction do cardiopulmonary bypass for his cabg..

Try again. Hearts are done by CRNAs in some places.

Look, your last couple of comments prove you don't really know what you're talking about. The fact that you can't get someone to admit they don't like midlevel scope creep doesn't mean they aren't thinking it. Its all in how you approach the topic with them.

 

[IDBasco]

Try again. Hearts are done by CRNAs in some places.

And just in case you don't think its true- from this link:

http://www.midwestern.edu/Programs_and_Admission/AZ_Nurse_Anesthesia.html

CRNAs practice in every setting where anesthesia is available. They administer every type of anesthetic, and provide care for every type of surgery (from open heart to cataract) or procedure, including pain management.

There are even CRNAs doing kids hearts:

http://www.childrenshospital.vanderbilt.org/interior.php?mid=6445

 

[likeaboss]

And just in case you don't think its true- from this link:

http://www.midwestern.edu/Programs_and_Admission/AZ_Nurse_Anesthesia.html

CRNAs practice in every setting where anesthesia is available. They administer every type of anesthetic, and provide care for every type of surgery (from open heart to cataract) or procedure, including pain management.

There are even CRNAs doing kids hearts:

http://www.childrenshospital.vanderbilt.org/interior.php?mid=6445

correction, i see CRNAs doing hearts all the time, but not without the anesthesiologist's supervision. they do not do that unsupervised thats just crazy.

has anyone here seen a valve repair or cabg done by an unsupervised CRNA? i'm sure its technically legal in some states but simply doesnt happen because CT surgeons know how complicated they can be

 

[Rothbard]

nm

 

[likeaboss]

It's not just MD's who benefit from the monopoly. It's an entire industry of ****ty service.



I agree with what you say here. The problem is ****ty government subsidized/mandated research, ****ty government subsidized/mandated treatment, and a manipulated consumer base.





So because there are three degrees that allow one to deliver medical care, and only one that allows for working in engineering, there's more of monopoly in engineering? Is "number of degrees" how we determine which fields have monopolies and which don't?

Every day I spend on these forums makes me feel more and more hopeless for the future of medicine and the future of this country.



AFAIK two year post-secondary programs that allow you to function at (or near) the level of an MD are rare or non-existent.



No, ****ty medical care is care that is substandard. Most of that does not actively kill you.




No, they need medical school and then residency. The number of residency spots is artificially limited.

This is like saying "anyone can be a congressman". The number of doctors in the US is tightly regulated.





It is a monopoly, though to a much lesser extent than in medicine. It's much easier to become an electrician than a doctor. I'm not sure why I need to point out the obvious.




This is precisely what we have today. Most published research findings are false (http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.0020124).

ok can you please look up the definition of the word monopoly? this is getting ridiculous...

 

[Rothbard]

nm

 

[SpecterGT260]

So because there are three degrees that allow one to deliver medical care, and only one that allows for working in engineering, there's more of monopoly in engineering? Is "number of degrees" how we determine which fields have monopolies and which don't?

do you realize that your argument has now become "because I said so, nana-nana boo-boo!"?

yes, your entire argument earlier focused on obtaining a degree as the bottle-neck for practice.

I get the feeling you want to discuss the job market being artificially capped by residency. Well.... residencies ARE jobs. It is employment with further training. From a specific point of view, the match serves to increase efficiency. Engineers are capped at the job market too, but they do not have a service that makes sure everyone finds a job, they all just compete against each other which means that many graduates dont find placement and many jobs go unfilled. The match actually serves to minimize this bottleneck into entry into the job market, not limit it. you act as if because engineering jobs don't have government and program-set numbers (even though many due) like medicine that the job market is infinite. Both # of residency spots and # of engineering jobs (and also # burger king jobs) are capped by available resources.

This is just a poor argument in general..... But that is kinda par for the course here isnt it?

 

[FutrPharm]

Look guys, it's obvious Rothbard is just some mid-level provider who wanted to be a doctor but couldn't make the cut. So now he's all butthurt about it. His whole argument is "It's not fair! Medicine is too hard to get into!" but then in the same breath takes little cheap shots at doctors by saying we make tons of medical errors. Nice logic. So lets llower the standards to practice medicine when the best and brightest can't even practice it properly, according to you.

Your agenda is clear. Now GTFO and find some other imaginary "sick monopoly" to bring down so you can feel better about yourself.

 

[Rothbard]

nm

 

[FutrPharm]

No, I'm a third year med student. Ask Specter, he'll tell you.

-well I'm actually a new fourth year.

Well if that's the case, then congrats: you've just made the transition from jealous to idiotic in my book. Since you're in med school, you're obviously aware of the fact that even some of your peers aren't smart enough/don't have the work ethic to be good doctors. And your logic is to give mid-level providers, many of whom either a) consciously chose not to pursue medicine because it was too much work or b) wanted to do medicine but couldn't make the cut, the same privileges and responsibilities as doctors? Do you not see the obvious flaw in this logic? Has it ever occurred to you that maybe, just maybe, medicine is a hard job and everyone isn't cut out for it? No of course not, that couldn't be it. It's just a sick monopoly. Its sad, bleeding-hearts like you are eating away at our profession because you've been brainwashed into believing some of the most ridiculous, counterintuitive bullsh*t imaginable, all fueled by other people's self interest. Please drop out of medical school now so you can stop being a pawn for certain greedy midlevel providers who want to make more money.

 

[Rothbard]

nm

 

[Socrates25]

Rothbard's fundamental premise that more doctors = lower healthcare costs is wrong. Its wrong because healthcare never was and never will be a free market, regardless of how doctors are licensed.

Consider the fact that NYC and Boston have the highest number of doctors per capita in the world. Now, if rothbard's premise was correct, that means that Boston and NYC should also have very low healthcare costs per capita when adjusted for cost of living. After all, since there are thousands of primary care docs in Manhattan they should be competing against each other, driving down costs.

But thats NOT what occurs. In fact, Boston and NYC have some of the HIGHEST healthcare costs per capita, even when cost of living is adjusted for. Thats because more doctors = more diagnoses, more tests, more treatments.

The USA has too many doctors, not too few. The Dartmouth group has shown over and over again how many overdiagnoses we have in this country. Overdiagnosis happens when a market is saturated with physicians. If there are only 2 cardiologists in a large metro area, they are so busy that they dont have time to mess with the 40% blockages and have to focus on their energies on the really sick patients. When you have 2000 cardiologists in the same area, all of a sudden those people with 40% blockages who would have been left alone start getting cathed.

 

[Lokhtar]

hey according to fox news today: an entomologist is a doctor

http://www.foxnews.com/us/2012/06/0...-barnes-and-noble-for-being-alone-in-children
Arizona doctor booted from Barnes & Noble for being alone in kid's section may sue

An Arizona doctor thrown out of a Barnes & Noble bookstore because he was alone in the children’s section said he will sue the company if he does not get a public apology from the employee who ousted him. Dr. Omar Amin, 73, of Scottsdale, said he was shopping for books for his grandchildren at his neighborhood bookstore May 4 when he was bounced simply because he was not accompanied by a child. After initially defending its handling of the matter, the company issued a statement apologizing to Amin. But it wasn't good enough for Amin.....

http://www.cancercontrolsociety.com/bio2007/Amin.htm
OMAR AMIN, Ph.D. was born in Egypt and received his M.Sc. Degree in Zoology and M.S. in Medical Entomology from Cairo University. He later received his Ph.D. Degree in Parasitology and Infectious Diseases from Arizona State University

Um, he's got a PhD in parasitology and infectious diseases. The appropriate term for him would be 'Dr.', unless he has a professorship, in which case that supersedes the Dr. title and would be referred to as that. Doctor has until very recently referred to the academic title. The word you're looking for a 'physician', which is different. Its funny sometimes to see people whine about 'other professions' co-opting the 'Dr' because physicians did the same thing. In most countries, the degree you get after medical school is an MBBS (a bachelors level degree, not a doctorate).

 

[SpecterGT260]

Um, he's got a PhD in parasitology and infectious diseases. The appropriate term for him would be 'Dr.', unless he has a professorship, in which case that supersedes the Dr. title and would be referred to as that. Doctor has until very recently referred to the academic title. The word you're looking for a 'physician', which is different. Its funny sometimes to see people whine about 'other professions' co-opting the 'Dr' because physicians did the same thing. In most countries, the degree you get after medical school is an MBBS (a bachelors level degree, not a doctorate).

Define "recently" because academics were originally only called "professor" (never heard of Dr. Dumbledore amirite?) As far back as colonization of the US at least physicians have been known as doctor.

 

[Instatewaiter]

No, they need medical school and then residency. The number of residency spots is artificially limited.

Actually it is not artificially limited. Anyone can open a residency, they just have to pony up the dough (roughly 100,000 dollars per person per year). There are a few osteopathic programs that have opened up recently. The problem is that no one wants to pony up the money.

This is like saying "anyone can be a congressman". The number of doctors in the US is tightly regulated.

Anyone can be a congressman... they just have to be elected. Similarly, anyone can be a doctor. They just have to get in and go to school.

If there are only 2 cardiologists in a large metro area, they are so busy that they dont have time to mess with the 40% blockages and have to focus on their energies on the really sick patients. When you have 2000 cardiologists in the same area, all of a sudden those people with 40% blockages who would have been left alone start getting cathed.

well technically you have to FFR the lesion to prove it is hemodynamically significant.

 

[deleted103644]

Similarly, anyone can be a doctor. They just have to get in and go to school.

Anyone can be a doctor, but not everyone. The number of US graduates is pretty tightly regulated, and the number of Medicare funded residency spots is as well (and very few hospitals have the resources for additional unfunded residency spots).

 

[SpecterGT260]

Anyone can be a doctor, but not everyone. The number of US graduates is pretty tightly regulated, and the number of Medicare funded residency spots is as well (and very few hospitals have the resources for additional unfunded residency spots).

This does nothing to counter his point. You are acting as if the gov'ment is the only source of funding for becoming a doctor. Anyone is welcome to put down the cash and meet the requirements for accreditation. It's not like it's illegal. This "artificial limit" is the same limit that governs everything else. # of Twinkies made is artificially limited by cash flow too. Either way since everyone has the opportunity (but not necessarily the ability) it is a moot point

 

[deleted103644]

This does nothing to counter his point. You are acting as if the gov'ment is the only source of funding for becoming a doctor. Anyone is welcome to put down the cash and meet the requirements for accreditation. It's not like it's illegal. This "artificial limit" is the same limit that governs everything else. # of Twinkies made is artificially limited by cash flow too. Either way since everyone has the opportunity (but not necessarily the ability) it is a moot point

Sure it does. There is zero demand for paid residents. We are heavily subsidized and without those subsidies there would be almost no residency training programs (and the few remaining would pay nothing or even charge for the right to work there).

Everything about medicine is tightly regulated, either by professional organizations or by the government.

Saying the government doesn't regulate the number of residency spots is like saying the government doesn't mandate a drinking age of 21. You're technically right, but practically wrong.

 

[SpecterGT260]

Sure it does. There is zero demand for paid residents. We are heavily subsidized and without those subsidies there would be almost no residency training programs (and the few remaining would pay nothing or even charge for the right to work there).

Everything about medicine is tightly regulated, either by professional organizations or by the government.

Saying the government doesn't regulate the number of residency spots is like saying the government doesn't mandate a drinking age of 21. You're technically right, but practically wrong.

So you're saying there is a supply and demand effect and that the gov'ment is reluctant to shell out more money than it already is...... what a novel concept

You are only "practically right" in the sense that it is through the gov, and as such it has a policy or "regulation" which mandates it. That doesnt mean it is done artificially. It is no different than money flowing to meet demands as best as possible. You seem to suggest that the government should throw infinity-hundred dollars at residencies in order to quelch this notion of "artificial limits". But hey, thanks for supporting the notion that defense spending is artificially limited by the government. Take THAT, hippies!

 

[mydodger]

You are only "practically right" in the sense that it is through the gov, and as such it has a policy or "regulation" which mandates it. That doesnt mean it is done artificially. It is no different than money flowing to meet demands as best as possible.

Judging by his pseudonym and likely Austrian economic ideals, I think by "artificially limited" Rothbard is saying that the supply of doctors in limited by regulations in a way that could be described as rent-seeking instead of pure competition. If anyone could practice medicine without the government's stamp of approval then doctors would be forced to compete for patients with other less or differently trained "practitioners" who had the same ability to perform surgeries and prescribe medicine without limit. The only limit would be voluntary - does the patient agree or not agree to have the practitioner perform a procedure on them. There would be no $100,000 buy-in to start a residency as that is an artificial barrier to entry into a market. I assume that this would be Rothbard's anarcho-capitalist ideal.

I'm personally not willing to go that libertarian with my ideas. I think the evils of the greedy free market can be balanced by the evils of the parasitic government. Right now we appear to be in the position that these two powers have aligned themselves to create our current system of "crony capitalism" or "corporatocracy" which appears to have eliminated any benefits of a 'free' market and any benefits of regulation.

Before the 'artificial limiting' of physician supply we had a whole lot of people being swindled by persons billing themselves as physicians and harming people. A large part of that ended when the AMA started and closed a bunch of 'medical schools.' This is not to say anything of what the AMA is currently, which is a different conversation entirely. But I have come to believe that ultimately this was a good thing since for the most part a person going to an MD can safely assume that they will receive care by a person with a standard amount of training who will treat them correctly. There are of course exceptions to this and bad physicians, but it would be hard to argue that it is worse now than before.


Anyway Rothbard can either confirm or deny my assumptions about what he meant. I don't pretend to speak for him I just wanted to point out how I read his comment differently.

 

[SpecterGT260]

Judging by his pseudonym and likely Austrian economic ideals, I think by "artificially limited" Rothbard is saying that the supply of doctors in limited by regulations in a way that could be described as rent-seeking instead of pure competition. If anyone could practice medicine without the government's stamp of approval then doctors would be forced to compete for patients with other less or differently trained "practitioners" who had the same ability to perform surgeries and prescribe medicine without limit. The only limit would be voluntary - does the patient agree or not agree to have the practitioner perform a procedure on them. There would be no $100,000 buy-in to start a residency as that is an artificial barrier to entry into a market. I assume that this would be Rothbard's anarcho-capitalist ideal.

I'm personally not willing to go that libertarian with my ideas. I think the evils of the greedy free market can be balanced by the evils of the parasitic government. Right now we appear to be in the position that these two powers have aligned themselves to create our current system of "crony capitalism" or "corporatocracy" which appears to have eliminated any benefits of a 'free' market and any benefits of regulation.

Before the 'artificial limiting' of physician supply we had a whole lot of people being swindled by persons billing themselves as physicians and harming people. A large part of that ended when the AMA started and closed a bunch of 'medical schools.' This is not to say anything of what the AMA is currently, which is a different conversation entirely. But I have come to believe that ultimately this was a good thing since for the most part a person going to an MD can safely assume that they will receive care by a person with a standard amount of training who will treat them correctly. There are of course exceptions to this and bad physicians, but it would be hard to argue that it is worse now than before.


Anyway Rothbard can either confirm or deny my assumptions about what he meant. I don't pretend to speak for him I just wanted to point out how I read his comment differently.

As long as you are aware that such a system works only when there is constant input validating the decisions of those in the free market toward one product over another. In this case, patient deaths

 

[Lokhtar]

Wow, that is insane, 6.5%. I knew it wasn't the majority of the costs but I never would have thought it would be that low.

6.5% roughly by the last calculation I did. The pie charts have a bad habit of labeling a big cut as "doctor salaried and clinic costs" which includes admin and other crap and implying that the whole cut is doctors. Ya that's right, if we were all charity workers Joe America would see a nickel back on the dollar for his health costs. Whoopty freakin doo

But as far as the cost to the guy paying the bills, it's a lot more than 6.5%. If I go get a sandwich, my cost might be $6, even if the owner is making only $0.50 on it. The owner can say he's only making $0.50, but in reality I'm still paying $6 and I have to budget according to the $6. The person who is pulling down $200,000 has to bill a lot more than that, which would be the actual cost to the insurance company/government/whoever.

 

[SpecterGT260]

But as far as the cost to the guy paying the bills, it's a lot more than 6.5%. If I go get a sandwich, my cost might be $6, even if the owner is making only $0.50 on it. The owner can say he's only making $0.50, but in reality I'm still paying $6 and I have to budget according to the $6. The person who is pulling down $200,000 has to bill a lot more than that, which would be the actual cost to the insurance company/government/whoever.

Im not sure if you understand your own argument here......

"health care is too high! blame the rich doctors!"
This argument implies that if we cut doctor salary the costs will come down.

And according to this number, they will come down 6% if ALL doctors work ENTIRELY FO FREE!

So that guy with the $200,000 healthcare bill will now shell out 187,000 but now he has to deal with doctors who are not motivated by for-fee services, doctors who refuse to work longer hours (so a lower availability or higher wait time before being seen) and the list goes on........

The only point being made here is not to blame doctor salaries for high costs.
Blame canada
[YOUTUBE]http://www.youtube.com/watch?v=vxPRHXgYVlk[/YOUTUBE]

 

[mydodger]

As long as you are aware that such a system works only when there is constant input validating the decisions of those in the free market toward one product over another. In this case, patient deaths

Exactly. Patient deaths and poor outcomes. That would be the driving factor for informed decision making in a truly free healthcare market, and that's what makes me unwilling to be wholeheartedly libertarian about it.

This argument implies that if we cut doctor salary the costs will come down.

And according to this number, they will come down 6% if ALL doctors work ENTIRELY FO FREE!

I've seen this quote before with similar amounts around 5% but I have never found a link that shows how the number was obtained. Do you have a good source for that information? I'd like to have a good source to pull out of my hat if I quote that number. Maybe such a source has been posted already and I missed it, if so my bad.

 

[SpecterGT260]

Exactly. Patient deaths and poor outcomes. That would be the driving factor for informed decision making in a truly free healthcare market, and that's what makes me unwilling to be wholeheartedly libertarian about it.



I've seen this quote before with similar amounts around 5% but I have never found a link that shows how the number was obtained. Do you have a good source for that information? I'd like to have a good source to pull out of my hat if I quote that number. Maybe such a source has been posted already and I missed it, if so my bad.

I had to dig and calculate myself as every pie chart ive ever seen doesnt actually separate doctor pay from other clinical and administrative costs.

1. Find a few reliable sourcesfor # practicing physicians and average
2. Find a few reliable sources for mean doctor salary and average (seemingly redundant but it's not)
3. Multiply these numbers together and divide by total HC costs
4.??????????
5. profit

 

[deleted103644]

So you're saying there is a supply and demand effect and that the gov'ment is reluctant to shell out more money than it already is...... what a novel concept

You are only "practically right" in the sense that it is through the gov, and as such it has a policy or "regulation" which mandates it. That doesnt mean it is done artificially. It is no different than money flowing to meet demands as best as possible. You seem to suggest that the government should throw infinity-hundred dollars at residencies in order to quelch this notion of "artificial limits". But hey, thanks for supporting the notion that defense spending is artificially limited by the government. Take THAT, hippies!

You're completely missing the point. There are no artificial LIMITS on the number of residency slots - they're artificially inflated.

Residents are only cost effective for hospitals with heavy subsidies - without them most residency spots would disappear.

You could draw a parallel with the defense industry - it exists pretty much only due to government subsidies too.

I don't think you made much of a point and appear to have completely misunderstood what I said.

 

[deleted103644]

I had to dig and calculate myself as every pie chart ive ever seen doesnt actually separate doctor pay from other clinical and administrative costs.

1. Find a few reliable sourcesfor # practicing physicians and average
2. Find a few reliable sources for mean doctor salary and average (seemingly redundant but it's not)
3. Multiply these numbers together and divide by total HC costs
4.??????????
5. profit

No, these are redundant. Maybe you meant median?

 

[SpecterGT260]

No, these are redundant. Maybe you meant median?

no. and it wouldnt make any difference which form of average they use.

if different sources give different numbers for their reported "average", then it is appropriate to average them together so.... seemingly redundant but not.

also, median is a measure which partially corrects for the data being skewed in one direction by gross ouliers. But for what we want to do here we want to know the actual dollar value spent which means "mean", since regardless of skewing or outlying data if you perform the multiplication as described you get the actual dollar value spent. Median would reduce this number as it will exclude the beverly hills millionaire doctors.

 

[SpecterGT260]

You're completely missing the point. There are no artificial LIMITS on the number of residency slots - they're artificially inflated.

Residents are only cost effective for hospitals with heavy subsidies - without them most residency spots would disappear.

You could draw a parallel with the defense industry - it exists pretty much only due to government subsidies too.

I don't think you made much of a point and appear to have completely misunderstood what I said.

oh, well when you put it that way your point was irrelevant so im not at a loss for misunderstanding it

 

[Lokhtar]

Im not sure if you understand your own argument here......

"health care is too high! blame the rich doctors!"

Not what I said. I just said the total payments to physicians total more than 6%.

For what it's worth, I don't believe the average physician is overpaid at all.


But let's deal in facts - as a percentage of healthcare budget, payments to physicians total more than 6%. 6% is the amount that physicians have left over after administrative expenses (though still pre tax of course).

 

[SpecterGT260]

Not what I said. I just said the total payments to physicians total more than 6%.

For what it's worth, I don't believe the average physician is overpaid at all.


But let's deal in facts - as a percentage of healthcare budget, payments to physicians total more than 6%. 6% is the amount that physicians have left over after administrative expenses (though still pre tax of course).

You are assuming that physicians are the "store owners". This is not the majority of cases.
Payments to the clinic will be more, yes.