Should MDs take a pay cut to make healthcare more affordable?

[Chimichica]

My vote is for Phizer execs and other drug companies to take a cut first.

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[deleted480308]

My godness and SB still does it 2 years later!

Those libertarian ideologues should have spend their time working out a healthcare plan instead of having abstract philosophical discussions!

I've been clear for years about what should happen. I have a plan, you just don't like it

 

[tarheelpenner]

I think this whole idea is stupid. All of a sudden, I am expected to work 80+ hour weeks, go $300K into debt, and give up all of my free time, but it's unfair that I am making more than the teacher who works 8 hours a day and gets summers off? Not saying teachers aren't a worthy profession, because they absolutely are. My mother is a teacher. All I'm saying is amount of work ~ amount of compensation. The idea that because I chose to work harder and I am compensated more for that, I am stealing from the homeless man off the street or from someone who has less really rubs me the wrong way. Especially because I have personal experience with people getting government assistance and then use that money for drugs, and sit around all day and do nothing. I have a fundamental problem with this.

EDIT: Healthcare is definitely flawed. Just cutting physicians salaries would exacerbate the problem in my opinion. It would encourage less people to become doctors. Quality of care would not increase, whereas access of care would decrease.

 

[787593]

My vote is for Phizer execs and other drug companies to take a cut first.

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Pfizer*

 

[Doctor or bust]

I've been clear for years about what should happen. I have a plan, you just don't like it

what do you suppose would be a good way of handling this issue?

 

[allantois]

what do you suppose would be a good way of handling this issue?

People dying on the street because they are poor

 

[deleted480308]

what do you suppose would be a good way of handling this issue?

everyone pays for, or solicits charity for, all of their perceived needs and you get what you can pay for if you can't find a provider willing to donate services

 

[750335]

everyone pays for, or solicits charity for, all of their perceived needs and you get what you can pay for if you can't find a provider willing to donate services

Really? With something as important as healthcare in a country that can afford it?

 

[deleted480308]

Really? With something as important as healthcare in a country that can afford it?

"the country" affording it implies that somehow there is group ownership of all that money. There isn't. That money is individually owned and my needs do not grant me access to other people's money.

 

[750335]

"the country" affording it implies that somehow there is group ownership of all that money. There isn't. That money is individually owned and my needs do not grant me access to other people's money.

Yes but this isn't them asking you to buy them a house or a car. This is literally life or death, and you think we should leave people who can't stand on their own behind because it is our money? Haven't you ever had someone else's money do something for you (or someone important to you)?

 

[aprilfools]

Really? With something as important as healthcare in a country that can afford it?

Don't want to get too involved in this but technically the "country" can't afford this, or anything else, considering our country's $20T debt.

 

[wizzed101]

Easy solution: increase retirement age to 85 (and thus the age requirement for Medicare). This will solve all problems. SS will also be saved. And when things get bad again increase it to 95. The freed up money can be allocated to gerontology to increase our life span.

 

[deleted480308]

Yes but this isn't them asking you to buy them a house or a car. This is literally life or death, and you think we should leave people who can't stand on their own behind because it is our money? Haven't you ever had someone else's money do something for you (or someone important to you)?

Severity of my need has no relevance to the fact that I have no rights to your wallet

 

[750335]

Severity of my need has no relevance to the fact that I have no rights to your wallet

Wow. I haven't started first aid yet but I assume the type of ego defense this is is there somewhere. Interesting.

 

[deleted480308]

Wow. I haven't started first aid yet but I assume the type of ego defense this is is there somewhere. Interesting.

When you're ready to discuss ideas instead of insinuating insult, let me know

 

[sullen-burger]

Yeaaaaa that's not how the economics of a nations debt and its ability to pay for things works, but what do I know.

 

[aprilfools]

Yeaaaaa that's not how the economics of a nations debt and its ability to pay for things works, but what do I know.

Apparently not much about current events in Greece, Italy or Portugal

 

[Lexdiamondz]

Severity of my need has no relevance to the fact that I have no rights to your wallet

Does that extend towards paying for police? firefighters? the military? roads? schools?

Part of living in a functioning society is the obligation to contribute resources for the betterment of that society as a whole. How much of one's resources may be debatable but the idea that one doesn't have the rights to another's wallet grossly oversimplifies things.

 

[deleted480308]

Does that extend towards paying for police? firefighters? the military? roads? schools?

Part of living in a functioning society is the obligation to contribute resources for the betterment of that society as a whole. How much of one's resources may be debatable but the idea that one doesn't have the rights to another's wallet grossly oversimplifies things.

user fees or tariffs can cover those things, we had all of them long before an income tax

 

[sullen-burger]

Apparently not much about current events in Greece, Italy or Portugal

Lol. Just. No.

 

[787593]

Does that extend towards paying for police? firefighters? the military? roads? schools?

Part of living in a functioning society is the obligation to contribute resources for the betterment of that society as a whole. How much of one's resources may be debatable but the idea that one doesn't have the rights to another's wallet grossly oversimplifies things.

 

[mistafab]

I'd hightly suggest that anyone interested in getting a baseline introduction to the topic of health care costs in the United States reads Time's "A Bitter Pill - Why Medical Bills are Killing Us." It is sure to offend left and right leaning readers.

Without oversimplifying, some of the primary reasons why Healthcare in the United States costs so much (my interpretation) are here:

1. No ability to compete, and no standards for pricing of hospital or laboratory equipment "i.e. Why does a dixie cup at a hospital cost a patient twenty dollars?"
2. No regulation of pharmeceutical prices.
3. The billing systems for insurance and hospitals - which are never transparent or communicated with the patient - are designed in such a way that precludes patients from being able to make good decisions.
4. Medicaid, in an almost ironic twist, turns out to be the most efficient buyer of services provided per dollar. Why is this the case? How can other insurances become more efficient?

No where in there is "doctors paid too much" a problem for people who actually look beyond the surface at health care costs in the United States. 'Doctors are overpaid' is simply a statement designed by lobbyists, set forth by politicians, and propogated by laymen.

 

[Lawpy]

I'd hightly suggest that anyone interested in getting a baseline introduction to the topic of health care costs in the United States reads Time's "A Bitter Pill - Why Medical Bills are Killing Us." It is sure to offend left and right leaning readers.

Nice thanks! I'll add it to the SDN Collection of Healthcare Resources thread soon.

 

[deleted480308]

I'd hightly suggest that anyone interested in getting a baseline introduction to the topic of health care costs in the United States reads Time's "A Bitter Pill - Why Medical Bills are Killing Us." It is sure to offend left and right leaning readers.

Without oversimplifying, some of the primary reasons why Healthcare in the United States costs so much, here are my main take-aways:

1. No ability to compete, and no standards for pricing of hospital or laboratory equipment "i.e. Why does a dixie cup at a hospital cost a patient twenty dollars?"
2. No regulation of pharmeceutical prices.
3. The billing systems for insurance and hospitals - which are never transparent or communicated with the patient - are designed in such a way that precludes patients from being able to make good decisions.
4. Medicaid, in an almost ironic twist, turns out to be the most efficient buyer of services provided per dollar. Why is this the case? How can other insurances become more efficient?

No where in there is "doctors paid too much" a problem for people who actually look beyond the surface at health care costs in the United States. 'Doctors are overpaid' is simply a statement designed by lobbyists, set forth by politicians, and propogated by laymen.

#4 is because they pay less than it actually costs to provide the care in many cases....private insurance would just get "not accepted here" if they tried to pull that

 

[mistafab]

sb - that is the whole point.

Hospitals set whatever price they want for each individual service. Insurance is forced to pay this price, and eventually both parties work out an agreement as to what the transaction amount will be.

Medicaid says "we won't pay more than 2 dollars for a dixie cup," so even if the 'service' of the dixie cup is 20 dollars, medicaid only pays $2. So of course they pay less than the costs to provide care. Because the costs of care is not regulated and the actual pricing of each part of care is up to the billing of each hospital or care organization.

Edit: so to follow up on point #4 - which is something i'd like people to learn more about, is: in the the United States, patients are not part of the transaction between insurance and bills of healthcare. So they walk into the hospital and get a 20$ dixie cup and insurance is supposed to cover it. Since patients are totally cut out from the responsibility of paying, and in fact have almost no way to figure out the actual cost of each item they use, there is no incentive for any player in the market (pharma, equipment, hospital, you name it) to lower the price for the item that they will be paid for. On top of that, patients have no incentive to go out and find cheaper prices for these services since they are not even part of the transaction (except for the yearly or bi-yearly fees of membership they pay). This is why medicaid is so efficient. They literally just say "we don't pay more than X for service ." It is pathetic really, but that is US reality.

#4 is because they pay less than it actually costs to provide the care in many cases....private insurance would just get "not accepted here" if they tried to pull that

 

[deleted480308]

sb - that is the whole point.

Hospitals set whatever price they want for each individual service. Insurance is forced to pay this price, and eventually both parties work out an agreement as to what the transaction amount will be.

Medicaid says "we won't pay more than 2 dollars for a dixie cup," so even if the 'service' of the dixie cup is 20 dollars, medicaid only pays $2. So of course they pay less than the costs to provide care. Because the costs of care is not regulated and the actual pricing of each part of care is up to the billing of each hospital or care organization.

Edit: so to follow up on point #4 - which is something i'd like people to learn more about, is: in the the United States, patients are not part of the transaction between insurance and bills of healthcare. So they walk into the hospital and get a 20$ dixie cup and insurance is supposed to cover it. Since patients are totally cut out from the responsibility of paying, and in fact have almost no way to figure out the actual cost of each item they use, there is no incentive for any player in the market (pharma, equipment, hospital, you name it) to lower the price for the item that they will be paid for.

and I'm saying the "sticker price" of $20 is because that's what it takes to cover the medicaid/medicare not paying the actual price and the emtala non-payers paying nothing. Private insurance can't do that or the hospital would drop them and just bill the patients with "good" insurance as out of network

 

[mistafab]

I looked around for further info and found none. Can you provide any further reading that provides evidence of hospitals having to recoup losses from providing service to medicaid? I am specifically asking about how they are losing money from actual cost of the service (dixie cup is 2 cents, medicaid pays $2, private insurance pays $20 in this example), and not just a "comparitive loss" when using the sticker price as a measure of the value of the procedure/equipment/service provided.

and I'm saying the "sticker price" of $20 is because that's what it takes to cover the medicaid/medicare not paying the actual price and the emtala non-payers paying nothing. Private insurance can't do that or the hospital would drop them and just bill the patients with "good" insurance as out of network

 

[NeuResurgens]

Doctors might be some of the more relatively benevolent members of the healthcare workforce and we're proposing targeting them for the haircut? What about executives of for profit healthcare related companies? Malpractice insurance? How about streamlining the system so that you don't have to pay so much overhead for people whose entire job it is to navigate a practice through billing and regulation compliance?

This is why I think doctors should be more heavily involved in healthcare reform. In spending their time and intellectual energy caring for their patients they become relatively easy targets. Job is stressful enough, docs earn every cent of what they make and are probably worth much more. They are the last people who should be punished for healthcare's high costs because in reality it's not their fault at this point.

 

[Afp0731]

The cost of healthcare today is absolutely outrageous, and this is coming from a pre-med student. Insurance costs are completely out of control, common prescription drugs, like Xarelto (latest blood-thinner) are far too expensive for the average American.

In my opinion universal healthcare is the end-goal. Obamacare hasn't helped much, a vast percentage of Americans can't afford healthcare. Something has to change, for the sake of the system we need to cut insurance companies out and cut doctor pay, there is no other ethical solution.

European countries and Canadians pay their doctors less and America doesn't offer a statistically superior outcome for the majority of illness.

About one percent of healthcare costs in the US go to physicians. Cutting physician salary doesn't address the cost issue.
Also, I'm fairly confident your opinion will change after you realize just what kind of sacrifice you are making to become a physician.

 

[Mad Jack]

On a side note to this, Trump will randomly pop up in older movies (Zoolander, Home Alone, ect) and I practically choke on my popcorn when I see him. It's always so unexpected

Oh god, some things are so hilarious in hindsight.

 

[Mad Jack]

Stupid old thread is stupid.

But TLDR: Those that think cutting physician salaries will magically fix the sheer insanity that is our healthcare system need to read more. Lots lots lots more.

Health care growth in expenditures is so fast that if physician pay were cut in half, the savings would be erased in roughly a year. If we were literally slaves that were paid nothing, the savings would be gone in two years.

 

[aalamruad]

We should get paid more.

Says the guy with a half-mil salary

 

[wizzed101]

I looked around for further info and found none. Can you provide any further reading that provides evidence of hospitals having to recoup losses from providing service to medicaid? I am specifically asking about how they are losing money from actual cost of the service (dixie cup is 2 cents, medicaid pays $2, private insurance pays $20 in this example), and not just a "comparitive loss" when using the sticker price as a measure of the value of the procedure/equipment/service provided.

I literally typed "hospital charging more to recoup medicaid" in google and the first 2 links provided the proofs you were looking for.
http://classic.ncmedicaljournal.com/wp-content/uploads/NCMJ/mar-apr-05/Yarbrough.pdf
[within the NYT article]
The Pricing Of U.S. Hospital Services: Chaos Behind A Veil Of Secrecy

And what the other guy said was pretty much common sense. Why do you even need a "source"? Lucky that there were "sources" otherwise it could've been dismissed.

 

[pseud0]

I believe in single payer but...

My issue is that if they were to suddenly switch to single payer, it's highly likely physician salaries will go way down, which is fine, if you live in a country where the cost of attending medical school isn't like half a million dollars (some have free tuition, others extremely low/only taxes and fees). Med School COA in the US ain't gunna go down if they do single payer. It's quite the conundrum for us.

 

[Eurus_Holmes]

You have caught my attention...What is your point?

 

[Eurus_Holmes]

Don't want to get too involved in this but technically the "country" can't afford this, or anything else, considering our country's $20T debt.

Well I would argue that a healthier people makes for a more productive country which would boost economy. Not to mention that addressing disease early and focusing on prevention takes away (some of) downstream cost of paying for invasive/ risky procedures. Furthermore, since we're talking about the country not being able to afford this or that, I hold the belief that if we are to prioritize our budget to reduce national debt, healthcare certainly should not on top of planned cuts; defense spending comes to mind for example.

 

[deleted480308]

Well I would argue that a healthier people makes for a more productive country which would boost economy. Not to mention that addressing disease early and focusing on prevention takes away (some of) downstream cost of paying for invasive/ risky procedures. Furthermore, since we're talking about the country not being able to afford this or that, I hold the belief that if we are to prioritize our budget to reduce national debt, healthcare certainly should not on top of planned cuts; defense spending comes to mind for example.

why not both?

 

[aprilfools]

Well I would argue that a healthier people makes for a more productive country which would boost economy. Not to mention that addressing disease early and focusing on prevention takes away (some of) downstream cost of paying for invasive/ risky procedures. Furthermore, since we're talking about the country not being able to afford this or that, I hold the belief that if we are to prioritize our budget to reduce national debt, healthcare certainly should not on top of planned cuts; defense spending comes to mind for example.

I didn't say it should be prioritized, but everything has to be cut because of the ludicrous spending of the last 8 years of the Obama administration. That administration paid for a lot of things with a lot of money that this country didn't have, and it astonishing to me that even now seeing the debt crisis in Europe people still do not understand this fact that everything has to be cut. The US needs to bite the bullet now to make things better in the long run before the debt spirals any further out of control.

One of the first things you learn as any kind of first-responder is your safety is what comes first. Its not because you are inherently more important than anyone else, its because (A.) if your safety is jeopardized someone else needs to do something to rescue you (this costs time, money, and could jeopardize the safety of the rescuing party as well) and (B.) if you die you are not around to take care of/protect people as a first responder in the future.

Point B. absolutely applies here. Like I said, the US needs to cut spending now if we want it to be able to continue providing for its citizens in the future.

 

[Eurus_Holmes]

why not both?

First of all, Sir/Madam, let me say that you are one of the most interesting SDNers I have come across.

Now to answer your question, which I think is, why not cut both military and healthcare spending...From a personal point of view, I believe that healthcare is a human right (alongside life, liberty, etc..) for lack of healthcare can take away life or reduce life expectancy, but also constrain our ability to assert agency. I do think it is the responsibility of the nation state to provide said healthcare for its citizens. This is my personal view and I am actually not against cutting healthcare spending because we spend more than any other developed nation which means our main problem is how efficiently we translate money spent into positive outcomes for patients. If cuts can happen without disruption of health coverage then I'm all for it.

Now from a more practical point of view, as I have mentioned, if the end goal is to save money and reduce debt, ensuring equal access to healthcare is a good way to provide able-bodied citizen who will looks for jobs, not go to the ER, etc; this I believe will in the long term reduce healthcare expenses and then you may cut away.

 

[deleted480308]

First of all, Sir/Madam, let me say that you are one of the most interesting SDNers I have come across.

Now to answer your question, which I think is, why not cut both military and healthcare spending...From a personal point of view, I believe that healthcare is a human right (alongside life, liberty, etc..) for lack of healthcare can take away life or reduce life expectancy, but also constrain our ability to assert agency. I do think it is the responsibility of the nation state to provide said healthcare for its citizens. This is my personal view and I am actually not against cutting healthcare spending because we spend more than any other developed nation which means our main problem is how efficiently we translate money spent into positive outcomes for patients. If cuts can happen without disruption of health coverage then I'm all for it.

Now from a more practical point of view, as I have mentioned, if the end goal is to save money and reduce debt, ensuring equal access to healthcare is a good way to provide able-bodied citizen who will looks for jobs, not go to the ER, etc; this I believe will in the long term reduce healthcare expenses and then you may cut away.

you misunderstand...there is no EMTALA under a govt that properly recognizes rights, so someone going to the ED doesn't actually cost "the nation" anything. So you aren't saving money by increasing tax funded preventative in my scenario

 

[ridethecliche]

I believe in single payer but...

My issue is that if they were to suddenly switch to single payer, it's highly likely physician salaries will go way down, which is fine, if you live in a country where the cost of attending medical school isn't like half a million dollars (some have free tuition, others extremely low/only taxes and fees). Med School COA in the US ain't gunna go down if they do single payer. It's quite the conundrum for us.

There are ways to address this. You can have tiers of pay based on experience so that physicians in the current climate, i.e. those that are neck deep in debt, aren't going to fight against the changes. The cost of education going down helps just about everyone. Frankly, it's a joke these days and has outpaced just about everything.

Also, as has been previously mentioned healthcare staff salaries are a tiny part of the pot. They might be the easiest to go after, but by no means are they significant. The sheer redundancy of for-profit insurance companies has a much larger overhead and cost of upkeep. The other thing is that everyone basically pays different prices for the same services rendered by the same physicians. It doesn't really make all that much sense.

 

[mistafab]

While you took offense for someone you don't know on the internet - you actually posted an excellent reading on your second link. It is really interesting how they wrote about a "consumer-directed" healthcare. It was also interesting that the sticker price was, as suspected, a completely arbitrary sum that no one actually pays, but only the uninsured are billed for.

I'd like some more articles about health care cost in the United States. Hopefully the more reading we do the better we can understand the problem. As future physicians (or aspiring physicians at the least), it is good to learn about how health care is delivered in the united states, and how cost is distributed on a macro level. Does anyone else have further reading on hospital pricing, distribution of cost, or health economics to share?

I literally typed "hospital charging more to recoup medicaid" in google and the first 2 links provided the proofs you were looking for.
http://classic.ncmedicaljournal.com/wp-content/uploads/NCMJ/mar-apr-05/Yarbrough.pdf
[within the NYT article]
The Pricing Of U.S. Hospital Services: Chaos Behind A Veil Of Secrecy

And what the other guy said was pretty much common sense. Why do you even need a "source"? Lucky that there were "sources" otherwise it could've been dismissed.

 

[osprey099]

No

 

[Tenk]

Says the guy with a half-mil salary

Part of my job is LITERALLY bringing the dead back to life. We deserve more.

 

[Eurus_Holmes]

I didn't say it should be prioritized, but everything has to be cut because of the ludicrous spending of the last 8 years of the Obama administration.

Well now that's just partisan cherry picking. Spending bills are passed by congress, a congress that Obama admin had less and less power over as years went by (cf. midterms). Furthermore, it looks like you're mentioning change in debt since he took office and ignoring percent change in public debt which puts Obama admin below Bush admin and close to the last few admins except Reagan's. Not to mention that we had a bit of an economic crisis in 2008...


That administration paid for a lot of things with a lot of money that this country didn't have, and it astonishing to me that even now seeing the debt crisis in Europe people still do not understand this fact that everything has to be cut.
The US needs to bite the bullet now to make things better in the long run before the debt spirals any further out of control.

Why does it have to be all or none? You think we'll just cut and things will be better? Certainly, austerity is needed but if you de-fund environmental agencies, education, biomedical research, healthcare, how are you making things better for the future you mean to protect? For example Neurological diseases currently cost us billions (~800 billions/year) and that number is likely to grow exponentially in the next decades; unless we invest in translational research now, we're bound to pay way more later. So Idk what you mean when you say bite the bullets now, because there are issues of our time that must me addressed now or there will be no future to protect (I'm looking at you global warming!)

One of the first things you learn as any kind of first-responder is your safety is what comes first. Its not because you are inherently more important than anyone else, its because (A.) if your safety is jeopardized someone else needs to do something to rescue you (this costs time, money, and could jeopardize the safety of the rescuing party as well) and (B.) if you die you are not around to take care of/protect people as a first responder in the future.
Point B. absolutely applies here. Like I said, the US needs to cut spending now if we want it to be able to continue providing for its citizens in the future.
Agree with all this, but once again there is a grey area somewhere in there.

 

[MedicineZ0Z]

The cost of healthcare today is absolutely outrageous, and this is coming from a pre-med student. Insurance costs are completely out of control, common prescription drugs, like Xarelto (latest blood-thinner) are far too expensive for the average American.

In my opinion universal healthcare is the end-goal. Obamacare hasn't helped much, a vast percentage of Americans can't afford healthcare. Something has to change, for the sake of the system we need to cut insurance companies out and cut doctor pay, there is no other ethical solution.

European countries and Canadians pay their doctors less and America doesn't offer a statistically superior outcome for the majority of illness.

False

Canadians actually pay their primary care docs WAY more. There was an move of Michigan & New York family docs into Ontario. My relatives & friends there conclude while specialists make a bit less (less compensation for procedures), primary care makes much more across the board.

Europe - they also work less hours.

Why not look at Australia? Where specialists make the same $$, primary care makes more than USA & their healthcare is better.

Anyway, typical premed preaching nonsense socialism.