Congress puts off cuts to doctor Medicare payments

[IvyHopeful20]

you just described Medicare/Medicaid

i'd like to see what people think of running health insurance similar to the way utilities are run now: privately capitalized, but heavily regulated. this model keeps the lights on, why not your local ER?

My utility bill shot through the roof as soon as it was privatized even though the government program was breaking even.

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[WorldChanger36]

This is not actually not technically true. A lot of countries with universal coverage (such as Japan or Germany) have a private health care system. I actually like this system quite a bit.

Keep in mind there is a difference between single payer systems and single provider systems. Single payer systems have healthcare funded from a single source usually tax payers and often still have privately owned hospitals and clinics that can still make a profit. While single provider systems have healthcare funds come from a number of sources but the hospitals and clinics are owned by the government and run at a loss. I believe Japan and Germany are both single payer, while the Brits are the only ones I can think of that have single payer and single provider systems. People often think the two are the same.

 

[Lokhtar]

Switzerland is universal coverage via private insurance but heavily regulated by the government.

Healthcare in Switzerland

 

[avatarftw]

Not all debt is bad, especially if you are making more money with the borrowed money that what you owe.

To all these incredibly idealistic and naive posters, why not be paid what your skills and hard work warrant and THEN decide what you want to do with the money. There is nothing wrong with getting compensated appropriately for your talents. Also, "greed" is in the eyes of a beholder. Some people may think that a new, 17,000 Honda Civic is a luxury. Others would consider the BMW 3 series costing 35,000 to be luxurious, etc. Unless you are somebody living in a cave on only the bare essentials, somebody can call you greedy based on their standards.

yeah, sounds drastic i know. not to mention the fact that it's a sure financial loser (provided the reimbursement model remains the same for the next thirty years, that's a laugh)

debt blows. even a moderate amount will make you second-guess yourself so much more than you deserve.

EDIT: forgot to mention that the tax regime will have to become more progressive in the next thirty years, so i would never see a lot of that money anyway

 

[Suncrusher]

In Germany and Japan, the government forced all the private insurance companies to turn non-profit. That eliminated the huge money-suck that we have in the U.S.A. where out of every dollar paid to private insurance companies, only $0.83 goes towards actual healthcare reimbursements, with the other 17% going towards administrative costs for the complex billing operations, paying the salaries of people who figure out ways to drop someone's coverage the minute they get in a car accident, et cetera (just compare to the 3% administrative cost of Medicare. A completely unnecessary amount of money is wasted on private insurance company shareholders in the status quo). Germany and Japan finally realized that it is inefficient for everyone else in the country to have insurance companies which view every single payment made to a healthcare provider as something that cuts into their company's profits. Everyone must have insurance, and the government has the purchasing power to negotiate the basic insurance package that each of the private insurance companies must offer, which greatly drove down costs even further. The private but non-profit insurance companies still compete for customers by offering better services, pricing, and perks, but any profit goes towards decreasing their customers' insurance premiums for the next year. The insurance companies did not go out of business when these changes were made; in fact, they flourished. And consumers in those countries now have more choice of which insurance procedures they are able to get and which doctors they are able to visit, because there is actually more competition in their system now than before. I'm not suggesting that doing exactly what those countries did would work just as well for the U.S., but observing what worked well in other countries with expensive, tech-heavy healthcare is a much better alternative for the U.S.A. than a lot of ignorant, red-faced blustering about how government is bad.

Eta: to clarify for above and below: Germany and Japan are single payer only for the basic health insurance package. Their systems use thousands (i.e. many more than here in the U.S.) of private (yet nonprofit) insurance companies which compete for customers in every area except the basic package.

 

[ModerateMouse]

Keep in mind there is a difference between single payer systems and single provider systems. Single payer systems have healthcare funded from a single source usually tax payers and often still have privately owned hospitals and clinics that can still make a profit. While single provider systems have healthcare funds come from a number of sources but the hospitals and clinics are owned by the government and run at a loss. I believe Japan and Germany are both single payer, while the Brits are the only ones I can think of that have single payer and single provider systems. People often think the two are the same.

In other words:

"single provider"=publicly funded and publicly run systems
"single payer"=publicly funded but privately run

In the first system, physicians are actually also civil servants, and there is a fairly large set of controls/rules. For example, the NHS in the UK pays specific bonuses to doctors based on delivering specific outcome measures (e.g., controlling blood pressure for X percent of their roster). Also, there is a strict hierarchy of pay scales in the NHS. The pay is tied to experience (among other things, I think).

In the second system, there is essentially a "free for all" amongst physicians. This means that even though the government is footing all the bills, individual physicians are private businessmen. This is the system in Canada (of course, individual physicians can still choose not to use the fee-for-service system and become salaried or government employees).

 

[ModerateMouse]

In Germany and Japan, the government forced all the private insurance companies to turn non-profit.

...

The insurance companies did not go out of business when these changes were made; in fact, they flourished.

I never knew about this.

There is something that bothers me about this model: if all the insurance companies are "non-profits", then what incentive does anyone have to start up or to keep these running?

Clearly, charities will always exist, but are enough people interested in running all these insurance companies? What's the drive for all these CEOs?

It seems like this model would eventually lose many of the insurance companies? That's just my gut feeling. Do you know more about this?

 

[MDub1]

Keep in mind there is a difference between single payer systems and single provider systems. Single payer systems have healthcare funded from a single source usually tax payers and often still have privately owned hospitals and clinics that can still make a profit. While single provider systems have healthcare funds come from a number of sources but the hospitals and clinics are owned by the government and run at a loss. I believe Japan and Germany are both single payer, while the Brits are the only ones I can think of that have single payer and single provider systems. People often think the two are the same.

Sorry, that's what I meant. The taxpayers pay the cost of health care but doctors and hospitals and still left to compete amongst themselves in a (somewhat) Laissez-Faire style. I don't think this is all that bad of an idea.

 

[avatarftw]

The general consensus amongst many doctors is that people already see health care as a right in the USA. Sadly, many people are unwilling to pay for their healthcare but will gladly fork over hundreds of dollars for sports tickets, cable tv, and other nonessential pleasures. Much of our health is dependent on our lifestyle, making health care a right won't keep people from eating unhealthy foods and it won't make them exercise.

If health care is a right, is driving a car and having tv rights as well? I read on the bbc a few years ago about a European country making the internet a right. This is madness; if everything is a right then all that we will end up with is a spoiled, entitled populace that will not work for their happiness.

But, please continue being an idealistic person espousing your extreme views.

Keep in mind there is a difference between single payer systems and single provider systems. Single payer systems have healthcare funded from a single source usually tax payers and often still have privately owned hospitals and clinics that can still make a profit. While single provider systems have healthcare funds come from a number of sources but the hospitals and clinics are owned by the government and run at a loss. I believe Japan and Germany are both single payer, while the Brits are the only ones I can think of that have single payer and single provider systems. People often think the two are the same.

 

[Suncrusher]

I never knew about this.

There is something that bothers me about this model: if all the insurance companies are "non-profits", then what incentive does anyone have to start up or to keep these running?

Clearly, charities will always exist, but are enough people interested in running all these insurance companies? What's the drive for all these CEOs?

It seems like this model would eventually lose many of the insurance companies? That's just my gut feeling. Do you know more about this?

They didn't go out of business because suddenly having a larger pool of customers (due to universal mandate) and suddenly having costs driven down by the government-negotiated basic package mandate actually worked. It differed from the U.S.'s failed public option because the government single-payer system was not "unfairly" competing with the private system, but instead an integrated part of the private system where the private insurance companies offer the newly-low-cost basic package.

As for CEO incentive, I presume they can set their own salaries fairly high. And I think the companies also compete for government bonus subsidies based on the amount of people they lure to their company by offering more choices and perks and lower costs. Really where all the money is being saved is the lack of shareholders. The CEOs run their businesses and make enough money to pay themselves and their employees, and that's enough. There is no incentive for them to have a business model that turns a gigantic profit margin each quarter by employing expensive teams of people who deny coverage to customers who have been paying their premiums but suddenly have a healthcare emergency (e.g. the U.S. man who never missed a payment but the second he got hit by a semi truck and needed $40,000 in procedures, he was dropped from his insurance policy because he had gained 40 pounds since originally being approved for the policy and was now deemed ineligible for it...by someone whom the insurance company is employing in order to minimize the amount of healthcare they resignedly pay for). There is no incentive to make extra profit at the expense of consumers in order to satisfy shareholders and it ended up making a huge difference in administrative costs. The savings to both countries were dramatic when combined with the savings of the basic-package single-payer system driving down costs. And the amazing part is that consumers now have more choices in those systems. Really, you'd think the strongly capitalistic U.S. would be jumping all over the German and Japanese healthcare model, except that the insurance lobby+shareholders are simply making too much money in the status quo to go down without a fight and are putting out tons of propaganda.

And as a bonus, a small amount of additional government regulation which forbids insurers from ever dropping a customer who keeps current on their monthly premiums and allows people to keep their same insurance company despite job switches or job loss (the government steps in and pays the premiums while the person is unemployed) has resulted in insurance companies realizing that they are stuck with their customers for life, unless the customer decides to switch. This caused them to start covering preventive healthcare, and both they and the country as a whole saved tons of money because of it. Contrast that with the U.S., where insurers have no incentive to invest in preventive healthcare because they know that the healthy 30-year-old male who is currently paying them monthly premiums will probably lose or switch his job (and therefore lose or change his health insurance company) by the time he is 60 and would realize the benefits of that preventive care. Preventive care is exactly what the U.S. needs to help decrease the future costs of the obesity epidemic.

Germany and Japan have expensive, technology-heavy healthcare, just like the U.S.A. And Japan has an aging population similar to the one the United States will soon be dealing with. I think it is probably a good idea to look at what worked for those countries and learn from it. But first we have to get past the lies of the people who are making a killing in the status quo, as well as the unreasonable, knee-jerk "BLASPHEMY" response many Americans have for any government regulation, no matter how unintrusive and sensible it has proven to be.

 

[Lokhtar]

The general consensus amongst many doctors is that people already see health care as a right in the USA. Sadly, many people are unwilling to pay for their healthcare but will gladly fork over hundreds of dollars for sports tickets, cable tv, and other nonessential pleasures. Much of our health is dependent on our lifestyle, making health care a right won't keep people from eating unhealthy foods and it won't make them exercise.

If health care is a right, is driving a car and having tv rights as well? I read on the bbc a few years ago about a European country making the internet a right. This is madness; if everything is a right then all that we will end up with is a spoiled, entitled populace that will not work for their happiness.

But, please continue being an idealistic person espousing your extreme views.

Getting chemotherapy is on a slightly different plane than tv nights in terms of essential services that a person needs.

 

[avatarftw]

How did they get cancer? It could have been their fault or not. There are always exceptions, but the vast percentage of individuals don't have 20 health problems from birth.

Getting chemotherapy is on a slightly different plane than tv nights in terms of essential services that a person needs.

 

[PostHaste]

I like your idea because making medicine a charity should weed out all the students who mainly want to become doctors for the money.

It's another argument whether a physician's motivation affects his or her competence, but I think that it might.

It'll also serve to weed out the intelligence. Look at the state of public education in the US. Teachers are practically expected to provide charity work; entry-level teachers are paid crap, work long hours, and have next to zero job security. It's no wonder that the smart kids are running away from teaching and into stable and/or high-income fields... like medicine. Let's see... rewarding career + money or rewarding career + no money... hmm...

Quote:
Originally Posted by toastedcheese
I was just about to write this exact same thing. Have fun paying your mortgage or saving for your kids' college tuition when your pay drops from 150,000 to 75,000 pre-tax overnight.

Funny, I manage to pay my mortgage, save for college, pay down my student debt, pay daycare for 2 kids, buy reasonable cars, go on vacations, and improve my home on my $(less-than-75k) salary. The problem that's run into by so many here is the expectation that "Because I sacrificed 7 extra years of my life and $xxx,xxx extra in student loans, I should get to live in a $500,000 house and drive a $50,000 car and go to Fiji for holiday and my wife will never work." Um, no. It'd be nice, but that's not the real world. You have to be realistic about what a physician salary buys you, and I'm willing to bet that in most cases it's not those things, at least not to start.

Physicians should be paid for their skills, training, and expertise, yes. I don't think $75k/yr is a fair compensation. And I totally agree that the current system is a mockery of the free market; insurance and the government tell you what they'll pay you, and if you don't like it, tough titties. There's a lot that can be done to improve on that front. However, the general assertion on this board about $75k not being enough to live on smacks of ignorance or irresponsibility or entitlement and frankly just pisses me off.

 

[avatarftw]

With my med school loans (relatively low because of frugality) I would be making 48,000 gross per year for the 20 years of loan repayment.

That does not take into account the opportunity cost of medicine. I do understand your point about feeling entitled to having a bigger house or car, however. Plenty of people survive on 50,000 gross/year or less.

Would you want to have the same net worth as a person that has a relatively easy bachelor's degree? That changes the equation...

It'll also serve to weed out the intelligence. Look at the state of public education in the US. Teachers are practically expected to provide charity work; entry-level teachers are paid crap, work long hours, and have next to zero job security. It's no wonder that the smart kids are running away from teaching and into stable and/or high-income fields... like medicine. Let's see... rewarding career + money or rewarding career + no money... hmm...



Funny, I manage to pay my mortgage, save for college, pay down my student debt, pay daycare for 2 kids, buy reasonable cars, go on vacations, and improve my home on my $(less-than-75k) salary. The problem that's run into by so many here is the expectation that "Because I sacrificed 7 extra years of my life and $xxx,xxx extra in student loans, I should get to live in a $500,000 house and drive a $50,000 car and go to Fiji for holiday and my wife will never work." Um, no. It'd be nice, but that's not the real world. You have to be realistic about what a physician salary buys you, and I'm willing to bet that in most cases it's not those things, at least not to start.

Physicians should be paid for their skills, training, and expertise, yes. I don't think $75k/yr is a fair compensation. And I totally agree that the current system is a mockery of the free market; insurance and the government tell you what they'll pay you, and if you don't like it, tough titties. There's a lot that can be done to improve on that front. However, the general assertion on this board about $75k not being enough to live on smacks of ignorance or irresponsibility or entitlement and frankly just pisses me off.

 

[Suncrusher]

congress should be focusing on controlling the costs of insurance companies and not the much smaller costs associated with physician compensation. I really think physicians need to stand up for themselves more and have their opinions on how to fix healthcare heard in a more organized way than they currently have.

The entire time that Obamacare was being debated in congress, the only peep I heard from the AMA was a very poorly-worded statement that physician compensation should not be the target of cost-control measures. And of course the consensus by the general population is that doctors are paid way too much (even though they don't understand about med school loans, operating costs, malpractice insurance, etc. and have no idea how many healthcare providers are in the red or barely scraping by each month), so you can imagine that that didn't go over very well. They basically got shouted down by a lot of people saying that they weren't altruistic and needed to shut up and do their part to fix healthcare

 

[Dr Oops]

In Germany and Japan, the government forced all the private insurance companies to turn non-profit. That eliminated the huge money-suck that we have in the U.S.A. where out of every dollar paid to private insurance companies, only $0.83 goes towards actual healthcare reimbursements, with the other 17% going towards administrative costs for the complex billing operations, paying the salaries of people who figure out ways to drop someone's coverage the minute they get in a car accident, et cetera (just compare to the 3% administrative cost of Medicare. A completely unnecessary amount of money is wasted on private insurance company shareholders in the status quo). Germany and Japan finally realized that it is inefficient for everyone else in the country to have insurance companies which view every single payment made to a healthcare provider as something that cuts into their company's profits. Everyone must have insurance, and the government has the purchasing power to negotiate the basic insurance package that each of the private insurance companies must offer, which greatly drove down costs even further. The private but non-profit insurance companies still compete for customers by offering better services, pricing, and perks, but any profit goes towards decreasing their customers' insurance premiums for the next year. The insurance companies did not go out of business when these changes were made; in fact, they flourished. And consumers in those countries now have more choice of which insurance procedures they are able to get and which doctors they are able to visit, because there is actually more competition in their system now than before. I'm not suggesting that doing exactly what those countries did would work just as well for the U.S., but observing what worked well in other countries with expensive, tech-heavy healthcare is a much better alternative for the U.S.A. than a lot of ignorant, red-faced blustering about how government is bad.

Eta: to clarify for above and below: Germany and Japan are single payer only for the basic health insurance package. Their systems use thousands (i.e. many more than here in the U.S.) of private (yet nonprofit) insurance companies which compete for customers in every area except the basic package.

doctors in germany were going on strike quite often, and the wait times were getting ridiculous so much so that people just werent getting seen in japan.

Governments waste ridiculous amounts of money. Medicare wastes billions in fraud.

Is this better than insurance companies? I dont know, but neither doctor nor patient wins in either system. I think the best would be private insurance with gov regulation.

Problem is politicians run the government and I consider slimier than any insurance company CEO

 

[Suncrusher]

doctors in germany were going on strike quite often, and the wait times were getting ridiculous so much so that people just werent getting seen in japan.

Governments waste ridiculous amounts of money. Medicare wastes billions in fraud.

Is this better than insurance companies? I dont know, but neither doctor nor patient wins in either system. I think the best would be private insurance with gov regulation.

Problem is politicians run the government and I consider slimier than any insurance company CEO

German doctors go on strike because of pay issues (an additional cost-cutting measure that doesn't have to go hand-in-hand with their insurance system). It's just that the government wanted to spend an even lower % of GDP on healthcare even after all they saved due to the insurance reform, so they also pay doctors less.

I've never heard of wait times in Japan. I've only ever heard about those in Canada's single-provider system, which isn't anything like what Japan has in terms of providers...if there are indeed wait times in Japan, are you suggesting it is because of a lack of providers because their insurance/healthcare reimbursement doesn't give enough money/incentive to providers...? I'm not sure there are data to support that..

P.S. the German and Japanese systems are private insurance with government regulation. It's just that the private insurance is also non-profit and offers essentially a single-payer basic package

 

[KTownGT]

Yes quite a conundrum from the outside view point. One of those things I looked at, scratch my head and said this is going to confuse somebody....crap....

I feel medicine should be for charity. Of course that is not super popular in this country. Practising medicine for profit feels unethical to me. So you can see why I personally am not bothered by pay cuts as long as my needs are met. Medicare needs to be free of the up and down shift of government, which is why I feel it should be run by private community charities.
Hope that clears some of the corn-fuse-in'...

I'll just... Leave this here.

http://star.txstate.edu/content/greed-good

 

[NickNaylor]

Getting chemotherapy is on a slightly different plane than tv nights in terms of essential services that a person needs.

How do you mandate that people receive something that is in inherently limited supply? There's no limited amount of "life," "liberty," or "happiness," to quote the Declaration of Independence. There's no limited amount of "free speech" or "bearing arms" or any other right. By making healthcare a right, you are indirectly requiring some people to work for the government. What if there aren't enough physicians to guarantee this right? Are we going to draft physicians?

I understand the sentiment, but you're walking a very dangerous line IMO.

 

[NickNaylor]

I'll just... Leave this here.

http://star.txstate.edu/content/greed-good

That is one of the worst pieces of journalism I've ever read.

 

[mtbtx]

Worldchanger... go into primary care. Problem solved.

 

[Cleavername]

How do you mandate that people receive something that is in inherently limited supply? There's no limited amount of "life," "liberty," or "happiness," to quote the Declaration of Independence. There's no limited amount of "free speech" or "bearing arms" or any other right. By making healthcare a right, you are indirectly requiring some people to work for the government. What if there aren't enough physicians to guarantee this right? Are we going to draft physicians?

I understand the sentiment, but you're walking a very dangerous line IMO.

i Luv you.

 

[IvyHopeful20]

How do you mandate that people receive something that is in inherently limited supply?

Every other industrialized country does it. None of them want to go back.

 

[Cleavername]

Every other industrialized country does it. None of them want to go back.

their doctors do. and hm, remind me why we are on this forum again?

 

[IvyHopeful20]

their doctors do. and hm, remind me why we are on this forum again?

They do? To a non universal healthcare system? Give me polls to back that up.

I have no idea why you're on the forums. I'm here to get help with my app.

 

[goldandapager]

obamacare!!!

 

[IvyHopeful20]

Nah.

Single payor!!!

 

[MDub1]

Every other industrialized country does it. None of them want to go back.

All due respect, but the "all the cool kids are doing it" argument was never a sound one. A single payer system may be the way to go, but not because other countries are doing it. After all, Europe's not doing so hot right now and I don't we think we should be copying their policies just because they're doing it.

Having said that, I know you're opinion isn't based on that and I appreciate your passion on the topic. Good healthy debate is just what this issue needs .

 

[NickNaylor]

They do? To a non universal healthcare system? Give me polls to back that up.

I have no idea why you're on the forums. I'm here to get help with my app.

Because, like Americans, the general citizen is ignorant. I posted in a similar thread several sources indicating that socialized healthcare is unsustainable. The NHS has to make a substantial reduction in its budget to remain solvent. Similar measures are being taken in other countries with socialized medicine.

Of course if you poll the people they're not going to want to give away their medical care. That doesn't mean the system is viable. Of course this is a different approach than my last post. But I object to socialized medicine both philosophically and practically.

 

[IvyHopeful20]

Because, like Americans, the general citizen is ignorant. I posted in a similar thread several sources indicating that socialized healthcare is unsustainable.

So a more viable system is where we spend twice as much?

The fact of the matter is that they spend much less per person than we do...

Their out of control costs is our dreamland of how much we spend....

 

[NickNaylor]

Every other industrialized country does it. None of them want to go back.

And you still avoided the question I originally posed. And its a serious one. What do we do when we don't have enough healthcare providers but guarantee healthcare for all? How do we ensure that that right is actually realized? There's no good answer. By giving everyone this right you're going to have to infringe on the more fundamental rights of others. And I have a problem with that.

 

[IvyHopeful20]

And you still avoided the question I originally posed. And its a serious one. What do we do when we don't have enough healthcare providers but guarantee healthcare for all?

Why wouldn't we? I don't see Canadian medical schools begging for applicants. Or UK Medical schools....

How do we ensure that that right is actually realized? There's no good answer. By giving everyone this right you're going to have to infringe on the more fundamental rights of others. And I have a problem with that.

Some cities have problems filling their police quotas too. That doesn't mean we say that we should give up and move to a pay for private security force system.

 

[NickNaylor]

Some cities have problems filling their police quotas too. That doesn't mean we say that we should give up and move to a pay for private security force system.

That's not at all what I'm advocating, though I do think I highly regulated private system is feasible. Please note that safety and peace of mind aren't rights guaranteed to individuals. If they were, we would have to force people to become police officers. Are you cool with that? Because I'm not. More fundamental than a right to healthcare (or safety for that matter), IMO, is a right to choose what you want to spend your time doing.

 

[IvyHopeful20]

That's not at all what I'm advocating, though I do think I highly regulated private system is feasible. Please note that safety and peace of mind aren't rights guaranteed to individuals. If they were, we would have to force people to become police officers. Are you cool with that? Because I'm not. More fundamental than a right to healthcare (or safety for that matter), IMO, is a right to choose what you want to spend your time doing.

I recognize that police protection is not a right, however, as a society we realize that such a service is necessary in a civil society and that it should be provided by the government. I believe that healthcare is just as important and should be the same way.

 

[Dr Oops]

So a more viable system is where we spend twice as much?

The fact of the matter is that they spend much less per person than we do...

Their out of control costs is our dreamland of how much we spend....

Start telling people what they can & cant have in healthcare like they do in Europe & we wont Spend so much

Surprise: Older Americans Sicker than Brits, but Live Longer

http://news.yahoo.com/s/livescience...iseolderamericanssickerthanbritsbutlivelonger

 

[NickNaylor]

So a more viable system is where we spend twice as much?

The fact of the matter is that they spend much less per person than we do...

Their out of control costs is our dreamland of how much we spend....

I totally agree. However you're suggesting switching to a system that we see right now is failing. Why would we do that? Why not try something new?

Believe it or not, there are other solutions beyond socialized medicine and the patchy private system we have now that are better than both options.

 

[IvyHopeful20]

I totally agree. However you're suggesting switching to a system that we see right now is failing. Why would we do that?

Why is it failing?

 

[NickNaylor]

Why is it failing?

Because it's financially unsustainable. It's better than the U.S. system, but it's destined for the same fate, only farther away. It's not a permanent or viable solution.

 

[KTownGT]

That is one of the worst pieces of journalism I've ever read.

Texas State's newspaper....

 

[CaptainSSO]

Believe it or not, there are other solutions beyond socialized medicine and the patchy private system we have now that are better than both options.

??

 

[saveourpens]

I know a doc who makes $150,000...sounds fine until you find out that he works like crazy and his hourly compensation is slightly above that of an experienced plumber.

Lets stop talking about doctor compensation in terms of salary.