Radiology is short too?

[IMGASMD]

https://forums.studentdoctor.net/threads/stat-rad.1485263/

Just saw this on EM forum. Seems like they can’t get a stat read for their films.

Hospitals doesn’t have radiology in house or can’t get a stat read….. admins all should go straight to hell.

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[deleted1162863]

Pyramid of Capitalist System - Wikipedia

en.wikipedia.org

 

[nimbus]

U.S. Diagnostic Imaging Services Market Size & Growth [2030]

The U.S. diagnostic imaging services market is projected to grow from $130.38 billion in 2023 to $206.84 billion by 2030, at a CAGR of 6.8%

www.fortunebusinessinsights.com

“RESTRAINING FACTORS​

Shortage of Skilled Workforce Affecting the Penetration of Diagnostic Imaging to Restrict Market Growth

One of the major factors limiting the U.S. market growth is the shortage of a skilled workforce. As per the result of the AAMC public opinion survey, in 2019, around 35.0% of Americans reported that they had difficulty finding doctors from the past three years before the pandemic. In comparison to 2015, this represented an increase of 10.0%. The major reason for this shortage is physical retirement and a surge in the accessibility to healthcare.

However, based on the AAMC, enrollments in medical schools have increased by 30.0% since 2002. But the acceptance rates are still low, and selective medical schools such as Harvard accept only 3.8% of the applicants. The average medical school acceptance rate is around 7.0%. Thus, the shortage of skilled workforce seems to be the biggest restraint in the growth of the number of diagnostic imaging procedures being conducted in the U.S. Furthermore, concerns regarding the side effects of medical imagingprocedures are expected to restrain the market growth.”

“Fortune Business Insights says that the U.S. market stood at USD 122.41 billion in 2022 and is projected to reach USD 206.84 billion by 2030.”

 

[aneftp]

U.S. Diagnostic Imaging Services Market Size & Growth [2030]

The U.S. diagnostic imaging services market is projected to grow from $130.38 billion in 2023 to $206.84 billion by 2030, at a CAGR of 6.8%

www.fortunebusinessinsights.com

“RESTRAINING FACTORS​

Shortage of Skilled Workforce Affecting the Penetration of Diagnostic Imaging to Restrict Market Growth

One of the major factors limiting the U.S. market growth is the shortage of a skilled workforce. As per the result of the AAMC public opinion survey, in 2019, around 35.0% of Americans reported that they had difficulty finding doctors from the past three years before the pandemic. In comparison to 2015, this represented an increase of 10.0%. The major reason for this shortage is physical retirement and a surge in the accessibility to healthcare.

However, based on the AAMC, enrollments in medical schools have increased by 30.0% since 2002. But the acceptance rates are still low, and selective medical schools such as Harvard accept only 3.8% of the applicants. The average medical school acceptance rate is around 7.0%. Thus, the shortage of skilled workforce seems to be the biggest restraint in the growth of the number of diagnostic imaging procedures being conducted in the U.S. Furthermore, concerns regarding the side effects of medical imagingprocedures are expected to restrain the market growth.”

“Fortune Business Insights says that the U.S. market stood at USD 122.41 billion in 2022 and is projected to reach USD 206.84 billion by 2030.”

This is where I despise manipulation of data. The total usa med school applicant pool for med schools (I’m assuming Lcme) is around 55-60k potential students. For around 22-23k lcme slots.

So it’s really a 33%? Acceptable rate overall.

I know how how data metrics etc are manipulated for the general public because people see 7% acceptance rates for med schools. That’s bs data.

This is how the world works. The c suites drive a lot of fake data to make it look any way they want for their own agenda.

Case in point. The fear monger “pre existing condition” the communist socialist Obama claims 15% of usa can be denied health care. The realty was it was really less than 1-2% max of the general population that could be denied healthcare. Obama jacked up the premiums for self employed people like me (when I was self employed) tripled it because of data manipulation.

The general public and probably half the people on these forums believe what’s fed to them. I’ve explained the how fake then 15% potential pre existing condition exclusion populations was fake data. It’s because most people with pre existing conditions already had health care via employers or govt entities that absorbed pre existing conditions. And only very few self employed people were excluded from healthcare due to pre existing. And even at that. There was a 12 month exclusion period 95% of the time.

So don’t believe the 7% overall acceptance rate for med schools. It’s 33%.

 

[qwerty89]

Stat Rad

Just saw this on EM forum. Seems like they can’t get a stat read for their films.

Hospitals doesn’t have radiology in house or can’t get a stat read….. admins all should go straight to hell.

Attending radiologist in Southern California here. We are 2 weeks behind on routine outpatient studies.

 

[Angus Avagadro]

Attending radiologist in Southern California here. We are 2 weeks behind on routine outpatient studies.

Wow! I was pissed when my wife's group was only 5 days behind on outpatient exams. Yet the C suite tells us their main mission is quality patient care and that's why we need them. Disgusting. The Docs work just about every day, always looking for volunteers to read on the weekends. It's why she just retired.

 

[aneftp]

U.S. Diagnostic Imaging Services Market Size & Growth [2030]

The U.S. diagnostic imaging services market is projected to grow from $130.38 billion in 2023 to $206.84 billion by 2030, at a CAGR of 6.8%

www.fortunebusinessinsights.com

“RESTRAINING FACTORS​

Shortage of Skilled Workforce Affecting the Penetration of Diagnostic Imaging to Restrict Market Growth

One of the major factors limiting the U.S. market growth is the shortage of a skilled workforce. As per the result of the AAMC public opinion survey, in 2019, around 35.0% of Americans reported that they had difficulty finding doctors from the past three years before the pandemic. In comparison to 2015, this represented an increase of 10.0%. The major reason for this shortage is physical retirement and a surge in the accessibility to healthcare.

However, based on the AAMC, enrollments in medical schools have increased by 30.0% since 2002. But the acceptance rates are still low, and selective medical schools such as Harvard accept only 3.8% of the applicants. The average medical school acceptance rate is around 7.0%. Thus, the shortage of skilled workforce seems to be the biggest restraint in the growth of the number of diagnostic imaging procedures being conducted in the U.S. Furthermore, concerns regarding the side effects of medical imagingprocedures are expected to restrain the market growth.”

“Fortune Business Insights says that the U.S. market stood at USD 122.41 billion in 2022 and is projected to reach USD 206.84 billion by 2030.”

“
During the 2022-2023 admission cycle, 22,712 of the 55,188 students who applied to medical school matriculated. That means approximately 42% of medical school applicants were accepted into a program, which has increased from last year, according to the AAMC.

From 2013 to 2022, the number of female medical school applicants increased from 46.2% to 56.5%. In the 2022-2023 academic year, 13.1% more women applied to medical school than men. “

Never believe the 7% data. I am always fair and balance just like Fox News America’s most watched news network.

 

[rowsdower88]

Case in point. The fear monger “pre existing condition” the communist socialist Obama claims 15% of usa can be denied health care. The realty was it was really less than 1-2% max of the general population that could be denied healthcare.

Source for this?

There are a lot of little ways to "deny healthcare". It doesn't seem like there is a hard metric available to determine which populations have been denied healthcare based on pre-existing conditions. For example: prior to the ACA, pre-existing conditions could force someone with limited means to chose a cheaper insurance plan with a higher deductible or forgo insurance entirely. Such a person probably wouldn't be "denied" care in a strict sense, but they would be disinclined to seek out preventative care options. If the system as designed prior to the ACA results in less preventative healthcare provided, is that "denying healthcare"? I tend to think so.

 

[doctalaughs]

Source for this?

There are a lot of little ways to "deny healthcare". It doesn't seem like there is a hard metric available to determine which populations have been denied healthcare based on pre-existing conditions. For example: prior to the ACA, pre-existing conditions could force someone with limited means to chose a cheaper insurance plan with a higher deductible or forgo insurance entirely. Such a person probably wouldn't be "denied" care in a strict sense, but they would be disinclined to seek out preventative care options. If the system as designed prior to the ACA results in less preventative healthcare provided, is that "denying healthcare"? I tend to think so.

Whatever the numbers are, there is no denying the ACA made healthcare WAY more expensive to people who actually work for a living. Sure, some people on Medicaid and subsidized state-enrolled plans get more “affordable” (ie taxpayer funded) care— at the expense of others.

At the same time the ACA did nothing to rein-in the abusive looting and massive waste in our crazy system perpetuated by pharma, insurance, private equity etc.

A missed opportunity that made our insane system even more broken.

The only saving grace is that ACA is making voters who actually vote mad enough to possibly repeal it. When you pay 2k a month for a family employer sponsored plan and then still have a 10k deductible while the people who get on Medicaid through various looopholes are paying 2 dollar copays - it makes people pretty mad.

 

[Arch Guillotti]

communist socialist Obama

What is wrong with you? Whatever your beliefs are, keep the ridiculous inflammmatory rhetoric out of a thread like this.

 

[nimbus]

This is where I despise manipulation of data. The total usa med school applicant pool for med schools (I’m assuming Lcme) is around 55-60k potential students. For around 22-23k lcme slots.

So it’s really a 33%? Acceptable rate overall.

I know how how data metrics etc are manipulated for the general public because people see 7% acceptance rates for med schools. That’s bs data.

This is how the world works. The c suites drive a lot of fake data to make it look any way they want for their own agenda.

Case in point. The fear monger “pre existing condition” the communist socialist Obama claims 15% of usa can be denied health care. The realty was it was really less than 1-2% max of the general population that could be denied healthcare. Obama jacked up the premiums for self employed people like me (when I was self employed) tripled it because of data manipulation.

The general public and probably half the people on these forums believe what’s fed to them. I’ve explained the how fake then 15% potential pre existing condition exclusion populations was fake data. It’s because most people with pre existing conditions already had health care via employers or govt entities that absorbed pre existing conditions. And only very few self employed people were excluded from healthcare due to pre existing. And even at that. There was a 12 month exclusion period 95% of the time.

So don’t believe the 7% overall acceptance rate for med schools. It’s 33%.

You are conflating the overall medical school acceptance rate for applicants with the acceptance rate for any given medical school. They are 2 different things and hopefully you understand the difference. An applicant can apply to 50 medical schools, be rejected by 49 of them, and still matriculate into a medical school.

31 Easiest Medical Schools to Get Into - Medical Schools with Highest Acceptance Rates - Global Scholarships

[…]

globalscholarships.com

https://www.usnews.com/education/best-graduate-schools/the-short-list-grad-school/articles/medical-schools-with-the-lowest-acceptance-rates

 

[rowsdower88]

Whatever the numbers are, there is no denying the ACA made healthcare WAY more expensive to people who actually work for a living. Sure, some people on Medicaid and subsidized state-enrolled plans get more “affordable” (ie taxpayer funded) care— at the expense of others.

You're just describing a social safety net. Of course things should be made cheaper for those with less means, most Americans agree with that concept. Things like medicaid and medicare are predicated on that concept.

 

[doctalaughs]

You're just describing a social safety net. Of course things should be made cheaper for those with less means, most Americans agree with that concept. Things like social security, medicaid and medicare are predicated on that concept.

I have no problem with some form of safety net. However, you can’t create incredibly perverse incentives to not work or hide income to get into “subsidized” care, which is what happened.

Bottom line- care became drastically LESS affordable for the middle and upper middle class (which means basically worse care, if you can’t afford it).

If I made between 75k and 175k a year, it would be a huge incentive to either work less, or hide income to get onto the government dole in this system.

To some extent- even with a safety net- you need to get incrementally more when you pay more.

 

[rowsdower88]

I have no problem with some form of safety net. However, you can’t create incredibly perverse incentives to not work or hide income to get into “subsidized” care, which is what happened.

Bottom line- care became drastically LESS affordable for the middle and upper middle class (which means basically worse care, if you can’t afford it).

If I made between 75k and 175k a year, it would be a huge incentive to either work less, or hide income to get onto the government dole in this system.

To some extent- even with a safety net- you need to get incrementally more when you pay more.

Yeah, I guess I'm just going to need to see sources to understand what you're talking about. The initial post was on eliminating pre-existing conditions from consideration for insurance purposes.

Is that the policy you're against?

When you say "care became drastically less affordable for the middle and upper class", I would just point out that healthcare expenses have been increasing above inflation for decades. What evidence do you have that suggests the ACA dramatically worsened that trend? And even if that's the case, I still would probably argue that the benefits accrued to poorer individuals are still greater than the costs to wealthier individuals.

People hide income from the government all the time. Even on this forum people openly brag about it (there was a thread a few weeks ago about docs with 10-20% effective tax rates).

 

[IMGASMD]

Anesthesia forum never disappoints. How did we get from radiologist shortage to governmental fail in less than 10 responses always makes me chuckle.

So I was listening to some podcast about how we spent more money administering social safety programs than actually just giving that money to the people who need it. For someone to quality for benefit they need to be under some sort of private agency to either “work” (less than minimum wage sometimes or something else entirely than what they were trained for. (Social worker for example)) or actively “looking” (same as above description). So if one needs to work for less than minimum wage or something that the person has zero interest or training for to get above water. How does one ever able to get out? I wonder.

Like some of you, I pay $2000+/month for family of three. Just recently my SO got a government job for 1/2 of pay than previous private sector job, but will qualify almost free healthcare….

Not a strong point that I am making here, but there are plenty trade offs in life, and there’s no prefect solutions. If you want to serve the people for less pay, you do get some benefits. If you want to make as much as you want in life, then there’s certainly some disadvantages in being a capitalist.

 

[rowsdower88]

Anesthesia forum never disappoints. How did we get from radiologist shortage to governmental fail in less than 10 responses always makes me chuckle.

So I was listening to some podcast about how we spent more money administering social safety programs than actually just giving that money to the people who need it. For someone to quality for benefit they need to be under some sort of private agency to either “work” (less than minimum wage sometimes or something else entirely than what they were trained for. (Social worker for example)).

Like some of you, I pay $2000+/month for family of three. Just recently my SO got a government job for 1/2 of pay than previous private sector job, but will qualify almost free healthcare….

Not a strong point that I am making here, but there are plenty trade offs in life, and there’s no prefect solutions. If you want to serve the people for less pay, you do get some benefits. If you want to make as much as you want in life, then there’s certainly some disadvantages in being a capitalist.

Easy way to reduce administrative costs? Reduce means testing for social programs.

Means testing is more popular on the right than the left, yet it is largely responsible for ballooning administrative costs and reducing help to those who actually need it.

The case against means testing

Programs that use it can impose inordinate burdens on the people they’re trying to help.

www.vox.com

 

[nimbus]

Easy way to reduce administrative costs? Reduce means testing for social programs.

Means testing is more popular on the right than the left, yet it is largely responsible for ballooning administrative costs and reducing help to those who actually need it.

The case against means testing

Programs that use it can impose inordinate burdens on the people they’re trying to help.

www.vox.com

But the 2 largest and most expensive social welfare programs, social security and Medicare, are not means tested. Even rich retired radiologists participate. Social security is partly to blame for the radiologist shortage. Make those old ****ers work . Only the poor suckers who die young don’t get to reap the benefits.

 

[HemeOncHopeful19]

I just briefly looked over this thread but I think it should be noted that the thread linked in the OP is talking about a SPECIFIC (private equity) company called “Stat Rad” and not “stat reads” in general

 

[Bertelman]

Could it be that this problem is far more complicated than just "not enough doctors" "hospital admins won't pay them" "ACA" "Obama" "socialists" or whatever your boogeyman happens to be?

Maybe many many more studies are being ordered, and radiologists are inundated with worthless crap.

 

[HemeOncHopeful19]

Easy way to reduce administrative costs? Reduce means testing for social programs.

Means testing is more popular on the right than the left, yet it is largely responsible for ballooning administrative costs and reducing help to those who actually need it.

The case against means testing

Programs that use it can impose inordinate burdens on the people they’re trying to help.

www.vox.com

When you say “get rid of means testing” do you mean a UBI type set up or just going by the honor system?

I’m not sure how one could be in favor either way after seeing the COVID19 relief programs

 

[rowsdower88]

But the 2 largest and most expensive social welfare programs, social security and Medicare, are not means tested. Even rich retired radiologists participate. Social security is partly to blame for the radiologist shortage. Make those old ****ers work . Only the poor suckers who die young don’t get to reap the benefits.

Social Security administrative costs for 2022: 0.5% of total expenditures. That's by virtue of not means testing.

Social Security Administrative Expenses

Table of Administrative Expenses

www.ssa.gov

For comparison, Red Cross is about 3% according to charity navigator.

 

[rowsdower88]

When you say “get rid of means testing” do you mean a UBI type set up or just going by the honor system?

I’m not sure how one could be in favor either way after seeing the COVID19 relief programs

I literally said "reduce" not "get rid of".

Edit: There are probably some social programs that we can safely "get rid of" means testing though. I would probably support universal school breakfast/lunch programs for example as opposed to the current program most states have which means tests for poor kids. There are probably good second and third order effects from such a program.

 

[IMGASMD]

I just briefly looked over this thread but I think it should be noted that the thread linked in the OP is talking about a SPECIFIC (private equity) company called “Stat Rad” and not “stat reads” in general

My thought was if ED cannot get their studies read, for whatever reason, isn’t great for patients.
I wasn’t taking a shot at anyone.

But then a radiologist chimed in. @qwerty89, saying they also have problem keeping up.

Even if it was an isolated company problem, sounds like there are more than 1 hospital which is affected. And the patients care can be affected.

 

[pgg]

Could it be that this problem is far more complicated than just "not enough doctors" "hospital admins won't pay them" "ACA" "Obama" "socialists" or whatever your boogeyman happens to be?

Sounds like the real boogeyman is the ER!

 

[pgg]

You are conflating overall medical school acceptance rate for applicants with the acceptance rate for any given medical school. They are 2 different things and hopefully you understand the difference. An applicant can apply to 50 medical schools, be rejected by 49 of them, and still matriculate into a medical school.

31 Easiest Medical Schools to Get Into - Medical Schools with Highest Acceptance Rates - Global Scholarships

[…]

globalscholarships.com

https://www.usnews.com/education/best-graduate-schools/the-short-list-grad-school/articles/medical-schools-with-the-lowest-acceptance-rates

He's raging about others using statistical manipulation to make a point, as he uses statistical manipulation to make a point.

 

[Lecithin5]

There’s evidence that the proliferation of midlevels (and consequentially an increase in ordering of diagnostic studies) is exacerbating the problem.

 

[doctalaughs]

The main problem is a weird fantasy that everyone should get the same “level” of care no matter what they pay into the system. This fantasy doesn’t work when the “standard” of care is a head CT for every minor bump, 500k/ yr immunotherapy for most cancers, 100 k/yr psoriasis drugs and patients that expect a huge work up or super-expensive drugs/ procedures for for any sniffle yesterday.

There should be a basic level of care guaranteed to everyone— but we have to acknowledge that baseline is not going to be the same level of care as something more expensive…..

 

[BLADEMDA]

I am a little confused about the comments so far on this thread. The ACA did make costs go way up but at the same time mandated coverage for many things like colonoscopy, breast screenings, etc.

Medicare is the best option for those over 65 because private health insurance on the exchange would cost a fortune. Have any of you over the age of 50 ever priced a gold level healthcare plan on the exchange? I urge you to compare the quality of a gold plan and cost vs a typical W-2 employee plan. You may change your mind about the role of Medicare for those over 65.

The majority of seniors, age 65 and older, couldn't afford the cost of healthcare on the private market. So, I don't agree with "means testing" for a govt. "entitlement" which I have paid more than my fair share. I'm paying the extra Medicare tax for years now and I have been paying into SS for decades.
The idea that politicians will now restrict my access to those things I have fully paid into will not be well-received. The typical American pays a fraction of his/her Medicare costs based on their W-2 earnings over a lifetime. A high W-2 wage earner on the other hand more than pays for him/herself over a 30 year career.

 

[BLADEMDA]

How Much Will Future Retirees Receive in Lifetime Social Security and Medicare Benefits?

Typical millennial couples born in 1995 who retire in 2060 are scheduled to receive about $2.2 million in lifetime Social Security and Medicare benefits.

www.taxpolicycenter.org

 

[BLADEMDA]

We find that high wage earners contributed to the tax systems more than their expected benefits, for both Medicare and Social Security programs, while low wage workers can expect more benefits than paid taxes over lifetime, especially among older generations. Thus, Medicare and Social Security play a vital role in reducing inequality.

 

[BLADEMDA]

Medicare 2022 Part B premium adjustments​

All figures in USD

Individual tax return	Married file jointly	Adjustment	Payment
Above 91K up to 114K	Above 182K up to 228K	68	238.10
Above 170K and less than 500K	Above 340K and less than 750K	374.20	544.30
Above 142K up to 170K	Above 284K up to 340K	272.20	442.30
Above 114K up to 142K	Above 228K up to 284K	170.10	340.20
91K or less	182K or less	0	170.10
500K or more	750K or more	408.20	578.30

 

[BLADEMDA]

Medicare 2022 Part D premium adjustments​

All figures in USD

File individual tax return	Married file jointly	Income-related monthly adjustment*
91K or less	182K or less	0
500K or more	750K or more	77.90
Above 91K up to 114K	Above 182K up to 228K	12.40
Above 114K up to 142K	Above 228K up to 284K	32.10
Above 142K up to 170K	Above 284K up to 340K	51.70
Above 170K and less than 500K	Above 340K and less than 750K	71.30

Note: *In addition to Part D premiumSource: Centers for Medicare & Medicaid Services

 

[BLADEMDA]

Your premium will change based on income as follows:​
Your annual income​	Your monthly premium in 2023
Individuals	Couples
Equal to or below $97,000	Equal to or below $194,000	$164.90
$97,001 -$123,000	$194,001 – $246,000	$230.80
$123,001 – $153,000	$246,001 – $306,000	$329.70
$153,001 – $183,000	$306,001 – $366,000	$428.60
$183,001 – $499,999	$366,001 – $749,999	$527.50
$500,000 and above	$750,000 and above	$560.50

 

[ambiturner]

The main problem is a weird fantasy that everyone should get the same “level” of care no matter what they pay into the system. This fantasy doesn’t work when the “standard” of care is a head CT for every minor bump, 500k/ yr immunotherapy for most cancers, 100 k/yr psoriasis drugs and patients that expect a huge work up or super-expensive drugs/ procedures for for any sniffle yesterday.

There should be a basic level of care guaranteed to everyone— but we have to acknowledge that baseline is not going to be the same level of care as something more expensive…..

The stuff we hemmed and hawed over as wasteful when I was in medical school look meaningless compared to the jaw dropping prices for drugs and lab tests now. No medical system could survive the expectation that these therapies be offered to everyone regardless of life expectancy or expected productivity.

By comparison, radiologists, anesthesiologists, and pretty much every other doctor are essentially no more expensive than they used to be, and arguably cheaper when adjusted for inflation. Maybe there’d be less of a shortage if people felt more valued and stopped cutting back or retiring.

 

[vector2]

The main problem is a weird fantasy that everyone should get the same “level” of care no matter what they pay into the system. This fantasy doesn’t work when the “standard” of care is a head CT for every minor bump, 500k/ yr immunotherapy for most cancers, 100 k/yr psoriasis drugs and patients that expect a huge work up or super-expensive drugs/ procedures for for any sniffle yesterday.

There should be a basic level of care guaranteed to everyone— but we have to acknowledge that baseline is not going to be the same level of care as something more expensive…..

A couple interesting facts:

1% of Americans account for 22% of the entire country's health care expenditures
5% of Americans account for a full 50%
Every income bracket of Medicare beneficiary eventually ends up using more in healthcare than they put into the system


I suspect your post is geared mostly toward the grievance you have with younger, poorer, working-age people using a lot of resources, but if you really want to save money then we all have to have a tough conversation about 1. throwing a million dollars worth of care at 90yos in the ICU / 90yos with incurable cancer, 2. making richer older folks pay for their own insurance even though they paid into medicare their whole lives

 

[doctalaughs]

A couple interesting facts:

1% of Americans account for 22% of the entire country's health care expenditures
5% of Americans account for a full 50%
Every income bracket of Medicare beneficiary eventually ends up using more in healthcare than they put into the system


I suspect your post is geared mostly toward the grievance you have with younger, poorer, working-age people using a lot of resources, but if you really want to save money then we all have to have a tough conversation about 1. throwing a million dollars worth of care at 90yos in the ICU / 90yos with incurable cancer, 2. making richer older folks pay for their own insurance even though they paid into medicare their whole lives

You are incorrect in whom I am aiming at — in that I think EVERYONE who doesn’t pay enough to support this bloated system has to come to reality.

The 90 yo with incurable cancer or endless ICU care is welcome to it…. if they are paying for it. Same with the 30 yo on Medicaid who wants a 100k/yr psoriasis drug.

We can’t make X the “standard of medical care” even if it’s more effective than Y unless it’s both age appropriate AND resource appropriate (for whatever tier of care you paid for). This mindset needs to change and also be translated to med-mal landscape.

 

[chessknt]

I am a little confused about the comments so far on this thread. The ACA did make costs go way up but at the same time mandated coverage for many things like colonoscopy, breast screenings, etc.

Medicare is the best option for those over 65 because private health insurance on the exchange would cost a fortune. Have any of you over the age of 50 ever priced a gold level healthcare plan on the exchange? I urge you to compare the quality of a gold plan and cost vs a typical W-2 employee plan. You may change your mind about the role of Medicare for those over 65.

The majority of seniors, age 65 and older, couldn't afford the cost of healthcare on the private market. So, I don't agree with "means testing" for a govt. "entitlement" which I have paid more than my fair share. I'm paying the extra Medicare tax for years now and I have been paying into SS for decades.
The idea that politicians will now restrict my access to those things I have fully paid into will not be well-received. The typical American pays a fraction of his/her Medicare costs based on their W-2 earnings over a lifetime. A high W-2 wage earner on the other hand more than pays for him/herself over a 30 year career.

You may find your Medicare doesn't get you much when providers won't take you because the reimbursement is so bad.

Assume you make 400k*30 years*2.9% tax=350k in Medicare taxes. You don't think you'll gobble that right up if you get sick? A single stroke/heart attack is going to nearly hit that number assuming there are no complications.

 

[chessknt]

You are incorrect in whom I am aiming at — in that I think EVERYONE who doesn’t pay enough to support this bloated system has to come to reality.

The 90 yo with incurable cancer or endless ICU care is welcome to it…. if they are paying for it. Same with the 30 yo on Medicaid who wants a 100k/yr psoriasis drug.

We can’t make X the “standard of medical care” even if it’s more effective than Y unless it’s both age appropriate AND resource appropriate (for whatever tier of care you paid for). This mindset needs to change and also be translated to med-mal landscape.

Which political party said death panels again circa 2008 that shut down all rational conversation about creating limits to care in the USA?

 

[vector2]

You are incorrect in whom I am aiming at — in that I think EVERYONE who doesn’t pay enough to support this bloated system has to come to reality.

Fair enough.

The 90 yo with incurable cancer or endless ICU care is welcome to it…. if they are paying for it. Same with the 30 yo on Medicaid who wants a 100k/yr psoriasis drug.

We can’t make X the “standard of medical care” even if it’s more effective than Y unless it’s both age appropriate AND resource appropriate (for whatever tier of care you paid for). This mindset needs to change and also be translated to med-mal landscape.

I know what you're getting at but just fyi using psoriasis as an example is terrible, mostly because in addition to the sometimes debilitating cosmetic issues it also causes physical symptoms, both dermatologic and systemic, which require treatment.

That being said, let's forget the 90yo with incurable cancer or the 30yo with psoriasis for a sec. What do you think we should do with the poor 40yo with cancer who requires a $300k biologic? Is that included in your "basic level of care" package, or do we only throw the cancer treatment kitchen sink at the 40yos who won the birth lottery and who can afford the highest tier plan?

Lot of moral hazard questions when we start talking about "appropriate (for whatever tier of care you paid for)"....

 

[doctalaughs]

Fair enough.

I know what you're getting at but just fyi using psoriasis as an example is terrible, mostly because in addition to the sometimes debilitating cosmetic issues it also causes physical symptoms, both dermatologic and systemic, which require treatment.

That being said, let's forget the 90yo with incurable cancer or the 30yo with psoriasis for a sec. What do you think we should do with the poor 40yo with cancer who requires a $300k biologic? Is that included in your "basic level of care" package, or do we only throw the cancer treatment kitchen sink at the 40yos who won the birth lottery and who can afford the highest tier plan?

Lot of moral hazard questions when we start talking about "appropriate (for whatever tier of care you paid for)"....

Oh I’m well aware of the debilitating nature of psoriasis (I’m a dermatologist). But whether we are talking the 40 yo with cancer or the old people that are withdrawing more money than they are paying, or anything else — we need to be able to pay for these things and the answer is not to increasingly redistribute money.

We need to bring down the costs of meds/treatments and at the same time make this a tiered system with a basic level of care and clearly spell out what you get at higher levels of pay. And keeping grandma on the vent forever shouldn’t be covered at any level (except by complete self-pay). You want newest cutting level immunotherapy and biologics? - sorry you have to pay more like anything else in life. Is there some miracle drug that cures cancer (rather than extending life a couple years)? Well maybe that goes into the basic level care funded by taxes.

And yes, I’m all for the death panels- I’m not siding with any party on this issue. And the ACA was a step backwards not forwards.

 

[nimbus]

Oh I’m well aware of the debilitating nature of psoriasis (I’m a dermatologist). But whether we are talking the 40 yo with cancer or the old people that are withdrawing more money than they are paying, or anything else — we need to be able to pay for these things and the answer is not to increasingly redistribute money.

We need to bring down the costs of meds/treatments and at the same time make this a tiered system with a basic level of care and clearly spell out what you get at higher levels of pay. And keeping grandma on the vent forever shouldn’t be covered at any level (except by complete self-pay). You want newest cutting level immunotherapy and biologics? - sorry you have to pay more like anything else in life. Is there some miracle drug that cures cancer (rather than extending life a couple years)? Well maybe that goes into the basic level care funded by taxes.

And yes, I’m all for the death panels- I’m not siding with any party on this issue. And the ACA was a step backwards not forwards.

That all sounds very sensible until you get cancer yourself. Or your wife or your child gets it.

The whole point of any type of insurance is to pool risk. A few people will get more than they put in. The vast majority will not.

 

[BLADEMDA]

If the rest of the first world can offer Humira, Cosentyx, Skyrizi and countless other Biologic drugs so can the USA. The idea we will deny a 60 year old woman breast cancer treatment which will prolong her life is cruel and absurd. One can argue that these drugs cost too much and we need to limit the price we pay for them like Canada and the UK but denial of treatment isn't on the table.

What's next? No more TAVRS? No more CABG/AVR on 75 year olds? No more kidney transplants if you are over 65? We are the richest country on earth; so, while I support common sense like limiting ICU expenses at the end of life I do not support denying care to Americans who want to extend their lives by 5-10 years. I would rather pay for these expenses than build another missile or send money for endless wars overseas. Healthcare may not be a right but it certainly is necessary for the pursuit of happiness.

 

[nimbus]

We spend about 18% of GDP on healthcare, 17% of GDP on housing and real estate, 5% of GDP on food and agriculture, 3% of GDP on autos and transportation. This order of priorities seems reasonable to me.

For comparison, we spend about the same amount of money on our pets that we do on medical imaging.

Healthcare Spending in the United States Remains High

Healthcare spending in the United States totaled 18.3 percent of gross domestic product (GDP) in 2021

www.pgpf.org

Real estate industry accounted for 16.9% of GDP in 2021

A new study from NAR found that each home sale at the median, generated $113,000 of economic impact in 2021

www.realtrends.com

USDA ERS - Ag and Food Sectors and the Economy

The U.S. agriculture sector extends beyond the farm business to include a range of farm-related industries. Agriculture, food, and related industries contributed 5.5 percent to U.S. gross domestic product and provided 10.4 percent of U.S. employment; Americans' expenditures on food amount to...

www.ers.usda.gov

US Economic Contributions

Automakers and their suppliers are America’s largest manufacturing sector, responsible for 3% of America’s GDP.2 No other manufacturing sector generates as many American jobs.

www.americanautomakers.org

https://www.morganstanley.com/ideas/pet-care-industry-outlook-2030

 

[Dr. Rude]

For comparison, we spend about the same amount of money on our pets that we do on medical imaging.

The mental and physical health benefits of companion animals is substantial. It is also an individual discretionary choice. Most people will get far more of a benefit from their dog than any medical imaging that they will ever have.

 

[Bertelman]

I really love the ride of this thread.

 

[nimbus]

The mental and physical health benefits of companion animals is substantial. It is also an individual discretionary choice. Most people will get far more of a benefit from their dog than any medical imaging that they will ever have.

I mostly agree. It’s true for most people until the day comes when a test, a procedure, or a drug becomes more important. Day to day, I enjoy our 2 dogs and 4 formerly feral cats more. But without some very expensive and sophisticated medical imaging, I’d have a much shorter expected lifespan and I’d possibly be too disabled to enjoy the pets. I’m a dog-walking, talking, driving and still working medical miracle and there are a lot of others too. The pets ARE discretionary. The medical imaging and the medical care were not. If I had a choice, I wouldn’t have gone through all that and wouldn’t choose to keep going through it. But as it is for many people, there is no alternative (unless I go to a woo-woo naturopath or faith healer)

Sometimes I think we lose sight of how important our jobs are. And how important drugs, tests, and medical procedures can be.

 

[vector2]

— we need to be able to pay for these things and the answer is not to increasingly redistribute money.

Every form of healthcare in this country, public or private, involves redistribution of money. And as our populace ages and the birth rate drops, this will only increase.

I agree with you that we need to get the cost of expensive drugs and treatments under control, and the first step in accomplishing that goal is to start pooling risk (and negotiating drug prices) as an entire country. Then we can talk about draconian tiering and rationing for citizens who aren't at the end of the life / need expensive futile care.

Seriously, let's discuss UnitedHealth's $20 billion in annual net income before we discuss turning down 40yos' cancer biologics.

 

[doctalaughs]

Every form of healthcare in this country, public or private, involves redistribution of money. And as our populace ages and the birth rate drops, this will only increase.

I agree with you that we need to get the cost of expensive drugs and treatments under control, and the first step in accomplishing that goal is to start pooling risk (and negotiating drug prices) as an entire country. Then we can talk about draconian tiering and rationing for citizens who aren't at the end of the life / need expensive futile care.

Seriously, let's discuss UnitedHealth's $20 billion in annual net income before we discuss turning down 40yos' cancer biologics.

Oh I don’t disagree with you that disgusting profits from insurance and pharma need to be looked at.

We also need a system where drugs get valued or approved based on their actual efficacy and improvements over prior drugs.

If biologic X is actually 50% better than Y in head to head studies- maybe it’s worth 100k/yr. If it adds only 2 months to terminal cancer diagnosis, not sure we should be paying 500k.

 

[vector2]

Oh I don’t disagree with you that disgusting profits from insurance and pharma need to be looked at.

We also need a system where drugs get valued or approved based on their actual efficacy and improvements over prior drugs.

If biologic X is actually 50% better than Y in head to head studies- maybe it’s worth 100k/yr. If it adds only 2 months to terminal cancer diagnosis, not sure we should be paying 500k.

This is essentially what the UK does with their "£ per QALY" system. The use of quality-adjusted life year is fraught with a bit of peril, but I'm not sure if there are many other ways to structure a universal basic health care plan more fairly.

 

[Dr. Rude]

Oh I don’t disagree with you that disgusting profits from insurance and pharma need to be looked at.

We also need a system where drugs get valued or approved based on their actual efficacy and improvements over prior drugs.

If biologic X is actually 50% better than Y in head to head studies- maybe it’s worth 100k/yr. If it adds only 2 months to terminal cancer diagnosis, not sure we should be paying 500k.

The problem is that the drug companies will argue, "Would you rather have 1970s drugs at 1970s prices? or 2020s drugs at 2020s prices?"
The argument is not without totally without merit. Research, development, clinical trials, risks of liability, etc. cost a fortune. If you want to lessen the reward for success, you need to look at the cost of failure. That said, drug company margins are pretty fat compared to most industries.