An article of concern

[Barcu]

This isn't really a rebuttal to their point. The 70% they quote is for the salaries of all health care workers. Presumably this includes the phlebotomists, the lab techs, and all the other people who need to do their jobs in order for those daily labs to happen and the results to come back. Depending on how loose of a definition of "health care worker" they use, they might include other hospital support staff (janitors, accountants, etc), equipment/disposable manufacturing workers, and/or bench scientists who design and optimize the labs in the first place. It'd be nice to see a more specific definition of whose salaries exactly they are including in that figure.

You're right. And I'm sure their definition was quite loose.

But posters were confused because this article is about rising physician salaries. Using that 70% number is quite misleading, and I'm sure intentionally so.

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[willen101383]

This isn't really a rebuttal to their point. The 70% they quote is for the salaries of all health care workers. Presumably this includes the phlebotomists, the lab techs, and all the other people who need to do their jobs in order for those daily labs to happen and the results to come back. Depending on how loose of a definition of "health care worker" they use, they might include other hospital support staff (janitors, accountants, etc), equipment/disposable manufacturing workers, and/or bench scientists who design and optimize the labs in the first place. It'd be nice to see a more specific definition of whose salaries exactly they are including in that figure.

Before I went to med school I worked for 5 years in clinical lab medicine (so I was one of those dudes running tests). A CBC costs less than 5 cents a pop to run. CBCs are optically done and essentially all you need is a diluent to run the blood through, a hgb lyse and a wbc lyse. It is so insanely cheap....yet they are routinely charged out anywhere from 50-100 dollars a pop. Most routine lab studies are incredibly cheap to run depending on the methodology used. CMPs PTs/PTTs all less than a dollar to run. Yeah certain tests cost far more (type and screens/basically all the blood bank stuff...which was my specialty area and where i worked for most of my time). Of course insurance companies only pay a percentage of this grossly inflated cost but still.

But labs are a good way to recoup some reimbursement cash because the rest of the reimbursement scheme is so broken. Its just such a hilarious game to me. Bill 20X to insurance...get 5% back.

 

[typicalindian]

I would gladly accept the idea of a pay cut if they significantly cut tuition cost, raised residency pay, and reduced malpractice insurance or made it harder to sue doctors.

 

[Gut Shot]

Before I went to med school I worked for 5 years in clinical lab medicine (so I was one of those dudes running tests). A CBC costs less than 5 cents a pop to run. CBCs are optically done and essentially all you need is a diluent to run the blood through, a hgb lyse and a wbc lyse. It is so insanely cheap....

Is that the unit cost or the incremental cost?

 

[HumbleMD]

Is that the unit cost or the incremental cost?

clearly incremental. he's not counting the cost of the machine, the building it's standing in, or himself, among many other contributers to the cost.

but you can't hold it against him. there are plenty of attendings who don't grasp these concepts.

 

[willen101383]

clearly incremental. he's not counting the cost of the machine, the building it's standing in, or himself, among many other contributers to the cost.

but you can't hold it against him. there are plenty of attendings who don't grasp these concepts.

Yeah, all I am saying is that the cost of actually performing tests is far far far cheaper than what they are being billed out for. Most of the machinery used in labs is leased out by X manufacturer. So beckman coulter/abbott/IL/ whoever will lease the machine out, and as part of that you get a maintainance package, free training, etc. As that machine ages and the lease term comes to an end you get another analyzer.

I understand your point Humble, I didnt factor the overhead costs into my argument, I was just stating that the costs to run X test is far less substantial than they are being billed at. Furthermore I am not an attending, I am an MS2 so my experience in healthcare administration etc is limited to my knowledge of what goes on in the lab. In many cases I know that the lab is one of the largest revenue generating centers for a practice (should they have their own lab in house).

 

[HumbleMD]

Yeah, all I am saying is that the cost of actually performing tests is far far far cheaper than what they are being billed out for. Most of the machinery used in labs is leased out by X manufacturer. So beckman coulter/abbott/IL/ whoever will lease the machine out, and as part of that you get a maintainance package, free training, etc. As that machine ages and the lease term comes to an end you get another analyzer.

I understand your point Humble, I didnt factor the overhead costs into my argument, I was just stating that the costs to run X test is far less substantial than they are being billed at. Furthermore I am not an attending, I am an MS2 so my experience in healthcare administration etc is limited to my knowledge of what goes on in the lab. In many cases I know that the lab is one of the largest revenue generating centers for a practice (should they have their own lab in house).

Don't sweat it. I knew you were a med student and that was my point - few attendings even get these concepts. I certainly didn't grasp these concepts until taking a health econ course in my Masters of Epidemiology program. You seem to already be partway there (and advanced) by knowing about the ridiculous game of the charges system (vs. costs) where a hospital has to charge extra for a colonoscopy (or maybe even a CBC) to regain a loss from a complicated obstetric delivery.

 

[James105]

Let me get this staight: Doctors have the longest training (as far as I know) with the greatest amount of responsbility, they pay tons for tuition, work for at least three years for at least 80 hours for next to nothing, then upon completion of this process they are responsible for keeping a population heatlhy and after that they make less than an NFL teams backup kicker who never even plays.

Education+debt+responsiblity+importance to society= high income to match

 

[willen101383]

Don't sweat it. I knew you were a med student and that was my point - few attendings even get these concepts. I certainly didn't grasp these concepts until taking a health econ course in my Masters of Epidemiology program. You seem to already be partway there (and advanced) by knowing about the ridiculous game of the charges system (vs. costs) where a hospital has to charge extra for a colonoscopy (or maybe even a CBC) to regain a loss from a complicated obstetric delivery.

I am definitely interested in the economics of healthcare...sadly I already wasted enough money getting a forensics (useless) masters. We dont get any coursework on this subject either which sucks. But I guess we dont need one as physicians are supposed to be selfless healers and work for free.

 

[willen101383]

Let me get this staight: Doctors have the longest training (as far as I know) with the greatest amount of responsbility, they pay tons for tuition, work for at least three years for at least 80 hours for next to nothing, then upon completion of this process they are responsible for keeping a population heatlhy and after that they make less than an NFL teams backup kicker who never even plays.

Education+debt+responsiblity+importance to society= high income to match

Yeah but people just dont see things this way unfortunately. Just reading those comments will give you a pretty good understanding of what most people think. Most people arent intelligent/driven/good hearted/whatever enough to make it through medical school, let alone understand the sacrifices docs make. And if they dont possess the ability to have a high paying career they dont think anyone should....yet they have no problem supporting the NFL/NBA/MLB/NHL...because ya know those salaries are totally justified. People in this country have an entitled attitude toward their healthcare and frankly it makes me sick. Laws like EMTALA have helped to develop opinions like this in America. Think what you want, but medicine is a business like any other. Nobody expects to get anything else for free, why should healthcare be any different. Eat and smoke and drink away America...afterall you are entitled to free healthcare. One of the labs I worked in after undergrad was in a large general practice office. I cannot tell you how many times ive seen patients throw a HUGE hissy fit out at the front desk because they didnt pay their bill and are now demanding to get seen. Its a lose lose for everyone involved, either you are a bad doc for refusing someone care, or a sucker for seeing a patient for free.

 

[vadeem]

*sigh* Such misconception in these articles. You obviously have to look at the bigger picture and see that insurance companies are the real culprits of expensive healthcare. Physician salaries have to be high to compensate for tuition, malpractice insurance, and various other costs that doctors have to deal with. Not only that, but it's not fair to quote other countries' physician salaries considering that we, in the U.S., have totally different healthcare systems.

The New York times article states that orthopedic and primary care are payed extremely well, they even claim that the AVERAGE ortho earns over 400K$ and primary cares are about 180K$. I HIGHLY doubt that's the average, they probably took a sample of a few hundred doctors or so. These articles should do lots of justice to physician stigmas. -_-

 

[NickNaylor]

*sigh* Such misconception in these articles. You obviously have to look at the bigger picture and see that insurance companies are the real culprits of expensive healthcare. Physician salaries have to be high to compensate for tuition, malpractice insurance, and various other costs that doctors have to deal with. Not only that, but it's not fair to quote other countries' physician salaries considering that we, in the U.S., have totally different healthcare systems.

The New York times article states that orthopedic and primary care are payed extremely well, they even claim that the AVERAGE ortho earns over 400K$ and primary cares are about 180K$. I HIGHLY doubt that's the average, they probably took a sample of a few hundred doctors or so. These articles should do lots of justice to physician stigmas. -_-

Those figures are actually slightly low according to the 2010 MGMA salary survey, which is generally seen as reliable. See this thread to check it out for yourself: http://forums.studentdoctor.net/showthread.php?t=817247

For FP without OB, the mean is $201,512, the median $183,999, 25th percentile $151,207, and 75th percentile $233,948.

For general orthopedics, the mean is $524,529, median $473,770, 25th percentile $345,065, 75th percentile $653,841.

 

[vadeem]

Those figures are actually slightly low according to the 2010 MGMA salary survey, which is generally seen as reliable. See this thread to check it out for yourself: http://forums.studentdoctor.net/showthread.php?t=817247

For FP without OB, the mean is $201,512, the median $183,999, 25th percentile $151,207, and 75th percentile $233,948.

For general orthopedics, the mean is $524,529, median $473,770, 25th percentile $345,065, 75th percentile $653,841.

I just looked at the PDF file and haha I guess I was a lil' misinformed. I didn't realize the salary potential for some of these specialties. Apparently the mean salary for orthopedic surgeons that specialize in spinal care is $750,000. Kinda blows my mind.

 

[NickNaylor]

I just looked at the PDF file and haha I guess I was a lil' misinformed. I didn't realize the salary potential for some of these specialties. Apparently the mean salary for orthopedic surgeons that specialize in spinal care is $750,000. Kinda blows my mind.

Well, don't be too allured. Spine probably has ridiculous malpractice premiums that cut pretty significantly into that salary.

 

[bucks2010]

I just looked at the PDF file and haha I guess I was a lil' misinformed. I didn't realize the salary potential for some of these specialties. Apparently the mean salary for orthopedic surgeons that specialize in spinal care is $750,000. Kinda blows my mind.

To be fair that figure is likely significantly outdated by now because reimbursements for spinal fusions (the big moneymakers) were slashed bigtime last yr.

 

[gettheleadout]

Those figures are actually slightly low according to the 2010 MGMA salary survey, which is generally seen as reliable. See this thread to check it out for yourself: http://forums.studentdoctor.net/showthread.php?t=817247

For FP without OB, the mean is $201,512, the median $183,999, 25th percentile $151,207, and 75th percentile $233,948.

For general orthopedics, the mean is $524,529, median $473,770, 25th percentile $345,065, 75th percentile $653,841.

Isn't the MGMA data for total compensation though and not income? As in the numbers reflect earnings + insurance benefits + retirement contribution matches + etc...

 

[NickNaylor]

Isn't the MGMA data for total compensation though and not income? As in the numbers reflect earnings + insurance benefits + retirement contribution matches + etc...

I don't remember. There's a thread somewhere discussing the particulars of the survey (it may even be the one I linked to), but I don't know what they are.

 

[Cornu Ammonis]

Mmmmeeeeeeh.

At some point the laws of freshman economics kick in.

Demand: Continually increasing, likely to increase more quickly as baby-boomer demographic wave crashes.

Supply: Rigidly controlled by medical schools, massive barriers to entry (new school is expensive), existing supply protects its scarcity.

For these reasons, I don't think that anybody has to worry about physician salaries dropping considerably in the near future. For these reasons I also think medical care should be treated more like a utility than a commodity, but that's just me.

I know this is from the last page, but I can't contain myself. I'd like to have a word with your freshman economics professor, becuase this is a bunch of crap! Demand is nothing but a number with a dollar sign in front of it, and that number is likely shrinking, not growing. We just saw many people's retirement funds burst into smoke and air a few years ago, and as has been mentioned before, medicare reimbursement is going to drop and is a likely target for further cuts. Unless you are willing to take your pay in chickens and apples from uninsured patients like my great-grandfather did during the depression, and unless you can pay the bank and your staff in bartered goods, you're going to run into the same problem farmers did during the depression: demand dropped even as actual hunger increased, forcing price deflation until they couldn't pay back loans and their property was foreclosed.

Just like farming, there is a wall of profitability set by student loans, property and equipment costs, administration, insurance profiteering, and staff pay. Since these costs outstrip physician compensation by a wide margin, they ought to be the first to be cut. The point has already been reached in some places where treating some patients on medicare is unprofitable, and no amount of de-regulation will fix this.

 

[45408]

Well, don't be too allured. Spine probably has ridiculous malpractice premiums that cut pretty significantly into that salary.

Doubt it. Most salaries are quoted after malpractice is taken out. Spine surgeons make absurd amounts of money (for himself and the hospital), which is evidenced by the fact that the one here gets two operating rooms at the same time. Let's just say that the general surgeons never get that (or anyone other than the orthopedic surgeons who do joint replacements).

I refuse to answer on the grounds that I wanted that avatar and you stole it.

I had it first.

 

[wholeheartedly]

Before I went to med school I worked for 5 years in clinical lab medicine (so I was one of those dudes running tests). A CBC costs less than 5 cents a pop to run. CBCs are optically done and essentially all you need is a diluent to run the blood through, a hgb lyse and a wbc lyse. It is so insanely cheap....yet they are routinely charged out anywhere from 50-100 dollars a pop. Most routine lab studies are incredibly cheap to run depending on the methodology used. CMPs PTs/PTTs all less than a dollar to run. Yeah certain tests cost far more (type and screens/basically all the blood bank stuff...which was my specialty area and where i worked for most of my time). Of course insurance companies only pay a percentage of this grossly inflated cost but still.

But labs are a good way to recoup some reimbursement cash because the rest of the reimbursement scheme is so broken. Its just such a hilarious game to me. Bill 20X to insurance...get 5% back.

I also work as a clinical lab scientist and those hidden costs you aren't factoring in really add up.

Some lab tests are money makers but a large majority actually lose money for the lab. The price of the test is calculated to be a certain fraction of numerous other expenses. In addition to the costs of the reagents you also have to factor in the cost of the analyzer itself hundreds of thousands of dollars for some of them (even leasing them is ridiculously expensive), replacement parts like 500 dollar probes & photometer bulbs, the cost of the salary of the techs responsible for running, maintaining, and troubleshooting it, verifying results, validating the instruments, the cost of the service/repair plan, the information system/software linking it to the charting system, water filtration systems, temperature control systems, licenses for the data servers (very expsensive) the electrical bill for the lab and other overhead costs required for running and upkeep on the equipment. Some reagents are cheap, some like immunoassay reagents, coag reagents, etc, are hundreds of dollars for a small bottle with 5 mls or less. It's just not accurate to even say a CBC costs 5 cents a pop.


You're right, it is a really ridiculous game. Our institution did a study on what it costs our facility to collect and process a unit of blood through transfusion compared to what we get reimbursed for it and discovered we lose several million dollars a year on that alone.

While there is a lot of waste in medicine, it's this behind the scenes hidden costs, overhead, insurance wrangling nonsense that's behind people's misconceptions about healthcare and physician salaries.

 

[Morsetlis]

Doctors clearly get paid too much! Let's pay them nothing like Hungary and Italy and see what happens!

*All doctors flock to countries where people pay more for private healthcare*

 

[NickNaylor]

Doubt it. Most salaries are quoted after malpractice is taken out. Spine surgeons make absurd amounts of money (for himself and the hospital), which is evidenced by the fact that the one here gets two operating rooms at the same time. Let's just say that the general surgeons never get that (or anyone other than the orthopedic surgeons who do joint replacements).

...srs?

 

[wholeheartedly]

Here's my question, we have numerous med, pre-med, residents on SDN countering this article with their points but who is out writing the actual response to this to show the other side of the matter to the public?

It seems like most of the docs that respond to these don't necessarily respond well or in a manner thats received well by the public. I've read some that really do just sound like someone whining about sacrificing their youth in medical school and working 80 hours a week in residency.

Why don't we have somebody making a tactful well written response laying out the numbers in a way that people can see, showing the monthly debt payments, malpractice, and comparing it to other professions, the healthcare and insurance CEOs etc?

 

[BirdIsTheWord]

Even if they did cut the salary of physicians, don't they know that pay is somewhat of a major point in becoming one?

So if they cut the pay, and not the cost of med school, what will probably happen is that less people will want to become physicians and then only the wealthy ones can afford it thus leading to even fewer physicians and then a higher demand for them, which could lead in a higher cost of appointments.....which would then lead to the physician getting paid more...

Did that make sense or am I just rambling

 

[pancakesyrup]

Even if they did cut the salary of physicians, don't they know that pay is somewhat of a major point in becoming one?

So if they cut the pay, and not the cost of med school, what will probably happen is that less people will want to become physicians and then only the wealthy ones can afford it thus leading to even fewer physicians and then a higher demand for them, which could lead in a higher cost of appointments.....which would then lead to the physician getting paid more...

Did that make sense or am I just rambling

Or more doctors from other countries can immigrate to the US.

 

[miui]

Or more doctors from other countries can immigrate to the US.

Oh great, first we outsource all the minimum-paying jobs and now we will start in-sourcing all the high-paying jobs.

 

[bucks2010]

Here's my question, we have numerous med, pre-med, residents on SDN countering this article with their points but who is out writing the actual response to this to show the other side of the matter to the public?

It seems like most of the docs that respond to these don't necessarily respond well or in a manner thats received well by the public. I've read some that really do just sound like someone whining about sacrificing their youth in medical school and working 80 hours a week in residency.

Why don't we have somebody making a tactful well written response laying out the numbers in a way that people can see, showing the monthly debt payments, malpractice, and comparing it to other professions, the healthcare and insurance CEOs etc?

The political clout of doctors is pathetic. Until that improves significantly, don't count on any optimism from me.

You probably don't see a response because one isn't really necessary. Studies come out all the time saying all sorts of things without having any sort of political merit. Same deal here. Some researchers did a study that a couple columnists picked up and sensationalized... happens all the time without any actual change being affected. Writing out some sort of formal response to the issue would likely not garner any sympathy from the public (most of whom earn far less than most physicians anyway) and would just draw more unnecessary attention to the issue.

These columnists have had their 5 minutes in the limelight to make their 2 cents known. Tomorrow, and the day after, and the day after will bring new issues that journalists will pick up to get attention, with each successive issue eventually fading into journalistic history with no actual change being brought about.

I do agree that physicians need a stronger voice in healthcare reform and Washington in general, but that influence is probably mainly achieved through more lobbying, not responding to poor journalism.

 

[deleted393595]

The political clout of doctors is pathetic. Until that improves significantly, don't count on any optimism from me.

I thought that there were numerous healthcare industry lobbies on Capitol Hill.

 

[NickNaylor]

I thought that there were numerous healthcare industry lobbies on Capitol Hill.

Not for physicians. Unless you count the AMA; whether or not they represent the views of most physicians is somewhat contentious.

 

[NickNaylor]

Well, they certainly think they do, don't they? I love how, no matter how many times I tell them I don't want to be a member, I keep getting a card.

98% of physicians are AMA members? Of course they are...involuntarily.

Lol. I know med students get pulled in by the "free" crap you receive simply by paying dues.

 

[45408]

...srs?

yah.

 

[Wolfman89]

You probably don't see a response because one isn't really necessary. Studies come out all the time saying all sorts of things without having any sort of political merit. Same deal here. Some researchers did a study that a couple columnists picked up and sensationalized... happens all the time without any actual change being affected. Writing out some sort of formal response to the issue would likely not garner any sympathy from the public (most of whom earn far less than most physicians anyway) and would just draw more unnecessary attention to the issue.

These columnists have had their 5 minutes in the limelight to make their 2 cents known. Tomorrow, and the day after, and the day after will bring new issues that journalists will pick up to get attention, with each successive issue eventually fading into journalistic history with no actual change being brought about.

I do agree that physicians need a stronger voice in healthcare reform and Washington in general, but that influence is probably mainly achieved through more lobbying, not responding to poor journalism.

Recall that when it comes to news, most Americans have short memories. This article and its companion articles will be forgotten by the majority of Americans by Monday if not earlier.

 

[gettheleadout]

Recall that when it comes to news, most Americans have short memories. This article and its companion articles will be forgotten by the majority of Americans by Monday if not earlier.

And thank god for that...

 

[bambam02]

Supply and Demand:

We are about to have a massive increase in patients that need service (Baby boomers, and obama). If anything, we are in short supply. When demand increases, and supply is low.... your price increases...if anything we should increase doctors salaries.

 

[Morsetlis]

Supply and Demand:

We are about to have a massive increase in patients that need service (Baby boomers, and obama). If anything, we are in short supply. When demand increases, and supply is low.... your price increases...if anything we should increase doctors salaries.

Except that your Medicare patients aren't paying you, but Medicare is......

 

[gettheleadout]

Supply and Demand:

We are about to have a massive increase in patients that need service (Baby boomers, and obama). If anything, we are in short supply. When demand increases, and supply is low.... your price increases...if anything we should increase doctors salaries.

Yeah, this would work if medicine operated like a free market.

 

[neurodoc]

"Easily," eh? Data, please.

Just check out the education requirements and pay scales for local and State public service employees (police, correctional officers, firefighters, transit drivers in places like SF, NYC, LA, etc.. Most have base salaries in the $60-75K range, which increases with promotions and seniority, so that after 5-10 years on the job your base salary goes up another $30K+/-. And then there is overtime... And don't forget the great healthcare and retirement benefits.

Not bad for a job you can start after high-school (unlike medicine).

 

[gettheleadout]

Just check out the education requirements and pay scales for local and State public service employees (police, correctional officers, firefighters, transit drivers in places like SF, NYC, LA, etc.. Most have base salaries in the $60-75K range, which increases with promotions and seniority, so that after 5-10 years on the job your base salary goes up another $30K+/-. And then there is overtime... And don't forget the great healthcare and retirement benefits.

Not bad for a job you can start after high-school (unlike medicine).

But in those particular areas the COL is higher than average, so that $100k doesn't really hold the same lifestyle power as $100k in the midwest.

 

[Wolfman89]

But in those particular areas the COL is higher than average, so that $100k doesn't really hold the same lifestyle power as $100k in the midwest.

You mean you can't compare apples and oranges? /sarcasm

 

[NH14]

Yes, I'm sure doctor's salaries will be on a downward trajectory. However, to state that doc's salaries are the main driving force of sky rocketing health care costs is totally misplaced. New medical technologies are by far the largest contributing factor to increases in health care costs. Numerous studies support this. Remember, just because 70% of health care costs are due to physician compensation, you have to remember what physicians are being compensated for, and that the driving increase in these costs are directly correlated with new tech, not because doctors are being "paid too much".

 

[NickNaylor]

Yes, I'm sure doctor's salaries will be on a downward trajectory. However, to state that doc's salaries are the main driving force of sky rocketing health care costs is totally misplaced. New medical technologies are by far the largest contributing factor to increases in health care costs. Numerous studies support this. Remember, just because 70% of health care costs are due to physician compensation, you have to remember what physicians are being compensated for, and that the driving increase in these costs are directly correlated with new tech, not because doctors are being "paid too much".

That's not even true.

 

[CorneliaSt]

Yeah, this would work if medicine operated like a free market.

Medicine should work like the free market. Has anyone read Consumer Driven Health Care or Who Killed Health Care by Regina Herzlinger? If health care worked more like a free market, costs would go down significantly. Right now there is no transparency and lack of choice when it comes to health care insurance.

 

[NickNaylor]

Medicine should work like the free market. Has anyone read Consumer Driven Health Care or Who Killed Health Care by Regina Herzlinger? If health care worked more like a free market, costs would go down significantly. Right now there is no transparency and lack of choice when it comes to health care insurance.

This should be good.

I agree with you, by the way.

 

[HumbleMD]

Medicine should work like the free market. Has anyone read Consumer Driven Health Care or Who Killed Health Care by Regina Herzlinger? If health care worked more like a free market, costs would go down significantly. Right now there is no transparency and lack of choice when it comes to health care insurance.

It depends on how altruistic you are. If you want to minimize cost, then yes, a free market would be wonderful. If you want to achieve maximal cost-effectiveness it won't cut the bill.

I got into medicine and epidemiology to try to assure the maximal number of healthy, working, tax-paying citizens. A free-market system does not try to achieve that. You're certainly free to believe that a basic amount of healthcare is a human right or not (I do, and EMTALA makes us agree to some extent), but please realize the repercussions of a completely free-market system on healthcare.

 

[NickNaylor]

It depends on how altruistic you are. If you want to minimize cost, then yes, a free market would be wonderful. If you want to achieve maximal cost-effectiveness it won't cut the bill.

I got into medicine and epidemiology to try to assure the maximal number of healthy, working, tax-paying citizens. A free-market system does not try to achieve that. You're certainly free to believe that a basic amount of healthcare is a human right or not (I do, and EMTALA makes us agree to some extent), but please realize the repercussions of a completely free-market system on healthcare.

I don't think most people argue for a free market in the sense that there should be no regulation. Minimum coverage standards, for example, could be easily implemented by mandating that all private companies offer the same basic plan at roughly the same price. If people want to pay more for plans with greater amounts of coverage, then they should be free to do so.

Obviously this is a gross oversimplification that doesn't address a lot of key issues, but I fail to buy into the argument that something intrinsic characteristic of private companies makes them unsuitable to provide affordable and readily available coverage. Government can easily implement regulations that allow for universal and, at a basic level, equitable coverage while keeping intact the benefits of "free" markets (competition, incentive to innovate, choice, etc.).

 

[HumbleMD]

I don't think most people argue for a free market in the sense that there should be no regulation. Minimum coverage standards, for example, could be easily implemented by mandating that all private companies offer the same basic plan at roughly the same price. If people want to pay more for plans with greater amounts of coverage, then they should be free to do so.

Obviously this is a gross oversimplification that doesn't address a lot of key issues, but I fail to buy into the argument that something intrinsic characteristic of private companies makes them unsuitable to provide affordable and readily available coverage. Government can easily implement regulations that allow for universal and, at a basic level, equitable coverage while keeping intact the benefits of "free" markets (competition, incentive to innovate, choice, etc.).

You're practicing in Chicago, correct? With a pulse on urban healthcare, I assume you are witness to the fact that poverty correlates with lower health and poorer outcomes. I fail to see how a free-market system would resolve this.

 

[NickNaylor]

You're practicing in Chicago, correct? With a pulse on urban healthcare, I assume you are witness to the fact that poverty correlates with lower health and poorer outcomes. I fail to see how a free-market system would resolve this.

I'm not opposed to a social safety net for people that are truly impoverished that would be unable to afford private plans. However I think we can reasonably agree that this isn't true of most of the population, and those that would be unable to afford more expensive plans would, in theory, be able to purchase the minimum plan the government would mandate that all insurance companies offer.

I'll also say that, in the case of the south side of Chicago, access and ability to get care is just as great problem (if not more so) as having coverage.

Another key problem is how you get people to buy coverage in the first place. I don't think the mandate in the ACA is constitutional, and I'm opposed to the idea that the federal government can mandate that you purchase health insurance without a constitutional amendment. States certainly have that right, but then you have the problem of portability across state lines.

As I said, it's an immensely difficult and complex issue that I don't know how to solve. However I think it's a bit ridiculous to dismiss private insurance as a solution prima facia.

 

[Eric01]

It depends on how altruistic you are. If you want to minimize cost, then yes, a free market would be wonderful. If you want to achieve maximal cost-effectiveness it won't cut the bill.

I got into medicine and epidemiology to try to assure the maximal number of healthy, working, tax-paying citizens. A free-market system does not try to achieve that. You're certainly free to believe that a basic amount of healthcare is a human right or not (I do, and EMTALA makes us agree to some extent), but please realize the repercussions of a completely free-market system on healthcare.

What do you mean by "cost-effectiveness?" I know right now NHS over in Britain spends about $40,000 per approved cancer patient to fly them over to the United States to receive proton therapy, because Britain's one and only particle accelerator is a low powered one feasible only for a few operations compared to America's 9 fully powered centers (soon to be 16).

That's just one example that doesn't seem cost effective to me.

However, when we look at government entities like the FDA, and we see the enormous rise in cost of approving and researching drugs, we see that our government has created monopolies, that the cost to entry in the drug market lies somewhere in the hundreds of millions to billions of dollars. Effectively pricing out any company that isn't a major international pharmaceutical entity, and heavily discouraging the development of drugs for which only small patient populations exist (high cost/low revenue). Not to mention that everytime you see a drug come out that saves "thousands of lives per year" you have to factor in, that that means that thousands of lives were killed by the FDA in the many year (sometimes near decade long) approval process. So that for the drugs that the FDA prevents from harming patients, it prevents many more drugs from potentially helping patients.

When one looks to the past for data on the topic, we see that as our country has grown increasingly Keynesian and increasingly corporatist, (governments directly/indirectly assisting the private sector) the cost of health care has dramatically increased. Now of course there are other factors that contribute to this trend, not the least of which is litigation and malpractice issues which have effectively prevented lowered tier care (increased supply) and discouraged charitable health care.

Above all else, I think a very brilliant man by the name of Milton Friedman, who was a nobel laurete in economics explains the issue of free market health care better than I ever could.

[YOUTUBE]-6t-R3pWrRw[/YOUTUBE]

 

[HumbleMD]

What do you mean by "cost-effectiveness?" I know right now NHS over in Britain spends about $40,000 per approved cancer patient to fly them over to the United States to receive proton therapy, because Britain's one and only particle accelerator is a low powered one feasible only for a few operations compared to America's 9 fully powered centers (soon to be 16).

That's just one example that doesn't seem cost effective to me.

However, when we look at government entities like the FDA, and we see the enormous rise in cost of approving and researching drugs, we see that our government has created monopolies, that the cost to entry in the drug market lies somewhere in the hundreds of millions to billions of dollars. Effectively pricing out any company that isn't a major international pharmaceutical entity, and heavily discouraging the development of drugs for which only small patient populations exist (high cost/low revenue). Not to mention that everytime you see a drug come out that saves "thousands of lives per year" you have to factor in, that that means that thousands of lives were killed by the FDA in the many year (sometimes near decade long) approval process. So that for the drugs that the FDA prevents from harming patients, it prevents many more drugs from potentially helping patients.

When one looks to the future and the past for data on the topic, we see that as our country has grown increasingly Keynesian and increasingly corporatist, (governments directly/indirectly assisting the private sector) the cost of health care has dramatically increased. Now of course there are other factors that contribute to this trend, not the least of which is litigation and malpractice issues which have effectively prevented lowered tier care (increased supply) and discouraged charitable health care.

Above all else, I think a very brilliant man by the name of Milton Friedman, who was a nobel laurete in economics explains the issue of free market health care better than I ever could.

I mean cost-effective by agreed-upon criteria (I'm assuming you know the meaning of the term).

Even the almighty NHS approves (especially recently) things that aren't cost-effective at the $50,000 or $100,000/QALY mark, usually due to lobbying efforts from companies or large patient groups. The effectiveness data is barely there for proton therapies, let-alone cost-effectiveness data.

There's really no point arguing this over an internet thread, as we've arrived at the point where we get down to differences over our core values (and beyond discussions of Keynesian and Classical econ), which aren't going to budge on either side, so I'll duck out after this post.

I do still assert, however, that a free market system, and a equal and cost-effective healthcare system are nearly mutually exclusive. Additionally, despite the fact that I always argue for tort reform, the effects of malpractice are indeed some of the "least of which" in healthcare costs (just like physician salaries - the impetus for this whole thread).

 

[phltz]

Another key problem is how you get people to buy coverage in the first place. I don't think the mandate in the ACA is constitutional, and I'm opposed to the idea that the federal government can mandate that you purchase health insurance without a constitutional amendment. States certainly have that right, but then you have the problem of portability across state lines.

According to the ACA, if you don't have coverage, you pay more money in taxes to the government than if you do have coverage. The exact same thing is (and has long been) true about mortgages. If you don't have a mortgage, you pay more money to the government in taxes than if you do have one. In your mind, what is the legal difference between these two situations? Or do you also thing mortgage deductions are also unconstitutional?