I thought doctor salary was <10%?
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Doctor pay/fees/whatnot adds up to something like 20% of overall healthcare spending. But even the most draconian cut could only lower that a few percentage points.
If they wanted to lower overall per-capita healthcare spending from $9000 to $8500, that would put all of our physicians on par with their European counterparts... and would also serve to alienate the majority of the people actually working to serve those patients who you are trying to get more access to care.
4
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It is. He's making the classic ignorant mistake of assuming that payments to physicians = physician salaries. 50-60% of those payments go to physician overhead (office staff, costs of running a practice, malpractice, etc).
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Ha! Any more good jokes to share?
www.forbes.com/sites/toddhixon/2012/03/01/why-are-u-s-health-care-costs-so-high/2/
some of the comments seems interesting:
William 9 months ago
You are trying to analyze, as have others, something which is multifaceted and very much intertwined with American social and financial values. As president and managing partner of a large cardiology group in the Northeast, I find many of your comments of particular interest.
The cycle of increasing medical costs, I believe, stems from the initial policies put in place in the establishment of Medicare, along with the concomitant increase in the cost of technology. Cardiologists in 1991, the year I graduated medical school, were paid twice what we now receive in net compensation. The cycle started when CMS noted significant cost increases as technology increased. Doctors learned that they could be paid a great deal of money under a fee-for-service policy which rewarded them for doing more. CMS then reduced the fees to attempt budget neutrality. This resulted in doctors trying to make up the "gap" in their potential decrease in income. Of course, CMS then perpetuated the cycle by reducing the fees further and creating onerous rules which required doctors to hire a full staff of billing experts to even get paid.
If you ask doctors what they want, most (at least in our specialty) would say they want to practice high quality medicine without the bureaucratic nightmares, which detract from allowing them to make sound clinical decisions. Although the costs of medical care in the US are high, much of the costs which have lead to this amount are due, in my opinion, to issues which individually appear small in a quantitative analysis. However, in total, these issue add up to a large sum, which when subtracted from the gross revenue of a specialty practice , would allow doctors to reap adequate financial rewards, while providing excellent, outcomes based care.
Our practice employs over 30 people out of 150 employees, whose sole job is to pre-certify cases and procedure, file billing claims and appeals, and ensure compliance with regulations. We also pay large sums to a legal team to review various contracts with payors and contracting organizations.
Your comment about the AMA is a blind one. While the AMA is recognized by the general public as the "voice" of medicine, it is not wholly supported by a majority of medical professionals. The AMA has done nothing about the rising cost of medical education. At this point, only the wealthy, both American and foreign, can truly afford to go to medical school. The remainder of students must take hundreds of thousands of dollars in loans to pay for this. How will these individuals pay for their debt in the future?
Equating doctors as similar to pilots with big airlines is insulting. While pilots are responsible for many lives on a plane, historically flying has been shown to be safer than driving a car. One should credit the underpayed engineers for this feat. How can you compare the many lives I and my partners have saved and affected to someone who works in an "elective" field. No one really needs to fly. However, most of us need to "live". When the analysts, consultants and politicians eventually "need" our services, unfortunately it is only then that they realize the great value in our current medical system.
I am not sure about the solution however. However, no one has asked their doctor what they want. It is not money. It is the freedom to practice without someone reaching into their pocket trying to prove that the system is broken. Other countries point to their terrific health care systems. However, the top medical institutions are still in America. When a wealthy sheik gets sick in the Middle East, he still seeks care in the US, not Canada, Europe or anywhere else in the world.
In regard to the fact that our country seeks specialists over generalists, I would agree that we need to do better. However, most primary care doctors do not spend the time necessary to discuss risk reduction, weight loss, smoking cessation. It has increasingly fallen into the lap of our specialty. Our patients commonly seek out their specialist over a generalist because they perceive a real difference in quality.
In summary, it is very difficult to argue this issue in a two page editorial. Eventually, we will all be forced to reconcile with a broken system. New models wil emerge, not by a government forced system, but by (I hope) ingenuity and problem solving both by non-physicians and physicians.
Todd Hixon, Contributor 9 months ago
As you point out, there are a lot of aspects to the problem. I am doing what I know works in the very complex and very practical world of business: focus on the big things that matter. It remains true that specialists in the U.S. make twice or more what doctors doing similar work make in other countries, and that adds up to a big part of the unbearably high cost of health care. Since I wrote my post, I have come across far more comprehensive data that reaches the same conclusion. And, while there are some highly respected medical institutions in the U.S., the expert consensus is that overall, U.S. health care is no better than peer countries.
From personal experience, I can say that I know many doctors who want to practice good medicine, avoid the bureaucracy, and live a good life. We are investors in Qliance Medical Group, which is pioneering a low-cost medical home model that provides far more intensive primary care and reduces/avoids the problem you cite (correctly, I think) of primary care doctors pushing wellness intervention off on specialists. Qliance is all about cost effective medicine and letting doctors focus on patients, not bureaucracy. The CEO of Qliance, Dr. Erika Bliss, is truly inspiring. I also know a lot of doctors, particularly radiologists, who are very concerned about their income and have little rapport with patients. I asked one of them, whom I know socially, what he thinks about health care reform. His only response was: "it will cost me money". I asked him to look at the Qliance business model and comment on it. He was complete disinterested (one can only guess why). And I have had really bad experience with Mass General, for example, which is one of those elite medical institutions (and, to be fair, really good experience with Beth Israel).
And I apologize for insulting you with the comparison to pilots; no offense intended. The comparison occurs to me because we put our lives in the hands of pilots, as we do doctors. I am a pilot and I have flown about 4 million miles in commercial aircraft (about a year of flying time). It's not simple to achieve a 99.9999% safety record, which is what commercial aviation delivers. Think about Capt. Sullenberger of U.S. Airways, who put is plane down intact in the Hudson in extreme conditions, walked the aisle with water up to his knees looking for passengers, was the last person out, and saw all his passengers to safety. That commands respect.
some of the comments seems interesting:
William 9 months ago
You are trying to analyze, as have others, something which is multifaceted and very much intertwined with American social and financial values. As president and managing partner of a large cardiology group in the Northeast, I find many of your comments of particular interest.
The cycle of increasing medical costs, I believe, stems from the initial policies put in place in the establishment of Medicare, along with the concomitant increase in the cost of technology. Cardiologists in 1991, the year I graduated medical school, were paid twice what we now receive in net compensation. The cycle started when CMS noted significant cost increases as technology increased. Doctors learned that they could be paid a great deal of money under a fee-for-service policy which rewarded them for doing more. CMS then reduced the fees to attempt budget neutrality. This resulted in doctors trying to make up the "gap" in their potential decrease in income. Of course, CMS then perpetuated the cycle by reducing the fees further and creating onerous rules which required doctors to hire a full staff of billing experts to even get paid.
If you ask doctors what they want, most (at least in our specialty) would say they want to practice high quality medicine without the bureaucratic nightmares, which detract from allowing them to make sound clinical decisions. Although the costs of medical care in the US are high, much of the costs which have lead to this amount are due, in my opinion, to issues which individually appear small in a quantitative analysis. However, in total, these issue add up to a large sum, which when subtracted from the gross revenue of a specialty practice , would allow doctors to reap adequate financial rewards, while providing excellent, outcomes based care.
Our practice employs over 30 people out of 150 employees, whose sole job is to pre-certify cases and procedure, file billing claims and appeals, and ensure compliance with regulations. We also pay large sums to a legal team to review various contracts with payors and contracting organizations.
Your comment about the AMA is a blind one. While the AMA is recognized by the general public as the "voice" of medicine, it is not wholly supported by a majority of medical professionals. The AMA has done nothing about the rising cost of medical education. At this point, only the wealthy, both American and foreign, can truly afford to go to medical school. The remainder of students must take hundreds of thousands of dollars in loans to pay for this. How will these individuals pay for their debt in the future?
Equating doctors as similar to pilots with big airlines is insulting. While pilots are responsible for many lives on a plane, historically flying has been shown to be safer than driving a car. One should credit the underpayed engineers for this feat. How can you compare the many lives I and my partners have saved and affected to someone who works in an "elective" field. No one really needs to fly. However, most of us need to "live". When the analysts, consultants and politicians eventually "need" our services, unfortunately it is only then that they realize the great value in our current medical system.
I am not sure about the solution however. However, no one has asked their doctor what they want. It is not money. It is the freedom to practice without someone reaching into their pocket trying to prove that the system is broken. Other countries point to their terrific health care systems. However, the top medical institutions are still in America. When a wealthy sheik gets sick in the Middle East, he still seeks care in the US, not Canada, Europe or anywhere else in the world.
In regard to the fact that our country seeks specialists over generalists, I would agree that we need to do better. However, most primary care doctors do not spend the time necessary to discuss risk reduction, weight loss, smoking cessation. It has increasingly fallen into the lap of our specialty. Our patients commonly seek out their specialist over a generalist because they perceive a real difference in quality.
In summary, it is very difficult to argue this issue in a two page editorial. Eventually, we will all be forced to reconcile with a broken system. New models wil emerge, not by a government forced system, but by (I hope) ingenuity and problem solving both by non-physicians and physicians.
Todd Hixon, Contributor 9 months ago
As you point out, there are a lot of aspects to the problem. I am doing what I know works in the very complex and very practical world of business: focus on the big things that matter. It remains true that specialists in the U.S. make twice or more what doctors doing similar work make in other countries, and that adds up to a big part of the unbearably high cost of health care. Since I wrote my post, I have come across far more comprehensive data that reaches the same conclusion. And, while there are some highly respected medical institutions in the U.S., the expert consensus is that overall, U.S. health care is no better than peer countries.
From personal experience, I can say that I know many doctors who want to practice good medicine, avoid the bureaucracy, and live a good life. We are investors in Qliance Medical Group, which is pioneering a low-cost medical home model that provides far more intensive primary care and reduces/avoids the problem you cite (correctly, I think) of primary care doctors pushing wellness intervention off on specialists. Qliance is all about cost effective medicine and letting doctors focus on patients, not bureaucracy. The CEO of Qliance, Dr. Erika Bliss, is truly inspiring. I also know a lot of doctors, particularly radiologists, who are very concerned about their income and have little rapport with patients. I asked one of them, whom I know socially, what he thinks about health care reform. His only response was: "it will cost me money". I asked him to look at the Qliance business model and comment on it. He was complete disinterested (one can only guess why). And I have had really bad experience with Mass General, for example, which is one of those elite medical institutions (and, to be fair, really good experience with Beth Israel).
And I apologize for insulting you with the comparison to pilots; no offense intended. The comparison occurs to me because we put our lives in the hands of pilots, as we do doctors. I am a pilot and I have flown about 4 million miles in commercial aircraft (about a year of flying time). It's not simple to achieve a 99.9999% safety record, which is what commercial aviation delivers. Think about Capt. Sullenberger of U.S. Airways, who put is plane down intact in the Hudson in extreme conditions, walked the aisle with water up to his knees looking for passengers, was the last person out, and saw all his passengers to safety. That commands respect.
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