The Public Option

[schrute]

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On page 16 of the current House bill for the public option:
<O😛</O😛
"Except as provided in this paragraph, the individual health insurance issuer offering such coverage does not enroll any individual in such coverage if the first effective date of coverage is on or after the first day" [of the year the legislation becomes law].
<O😛></O😛>
IE: if you have health insurance through your job, you quit / get fired, start up a small business, decide not to work for a year, whatever… the only "option" you have is the public one unless you're willing to pay the fees tacked on to a private plan that is required to meet the "Exchange-participating health benefits" regulations (page 19).

While the option supposedly levels the playing field in terms of preventing private insurers from jacking up premiums when people fall ill, that doesn't mean insurers aren't goingn to cover the costs for the risks they are assuming, vis-a-vis higher premiums from the get-go.

Thoughts.

 

[pathstudent]

On page 16 of the current House bill for the public option:
<O😛</O😛
"Except as provided in this paragraph, the individual health insurance issuer offering such coverage does not enroll any individual in such coverage if the first effective date of coverage is on or after the first day" [of the year the legislation becomes law].
<O😛></O😛>
IE: if you have health insurance through your job, you quit / get fired, start up a small business, decide not to work for a year, whatever&#8230; the only "option" you have is the public one unless you're willing to pay the fees tacked on to a private plan that is required to meet the "Exchange-participating health benefits" regulations (page 19).

While the option supposedly levels the playing field in terms of preventing private insurers from jacking up premiums when people fall ill, that doesn't mean insurers aren't goingn to cover the costs for the risks they are assuming, vis-a-vis higher premiums from the get-go.

Thoughts.

Who cares what happens! No matter what Doctors will always be in demand and will always make a good living. Even if you only earn 160K when you were expecting to earn 200K, you are still doing better than 99% of the planet.

I am sorry I don't believe that maintaining a system where pathologists earn 200K a year and radiologists 700K a year is justified when many children don't even have insurance. I don't think the voting populace is going to side with the pathologists over the children.

Healthcare is bankrupting the nation and it is just too fricking bad if doctors have to take a 25% or greater pay cut. The needs of the many outweigh the needs of the few or the one.

 

[yaah]

The needs of the many outweigh the needs of the few or the one.

khaaaaaaaaaaaaaaaannnnnnnn!!!!!!!!!!

 

[MOHS_01]

Who cares what happens! No matter what Doctors will always be in demand and will always make a good living. Even if you only earn 160K when you were expecting to earn 200K, you are still doing better than 99% of the planet.

I am sorry I don't believe that maintaining a system where pathologists earn 200K a year and radiologists 700K a year is justified when many children don't even have insurance. I don't think the voting populace is going to side with the pathologists over the children.

Healthcare is bankrupting the nation and it is just too fricking bad if doctors have to take a 25% or greater pay cut. The needs of the many outweigh the needs of the few or the one.

Marxist ignorance. 👎

No one has a "natural right" to any good or service provided by an individual aside from that which the individual is willing to provide. To legislatively force one into indentured servitude "for the common good" is socialist BS.

Epic fail. Let your evaluations reflect it. Please, speak up and speak loudly, proudly proclaiming your views to the entire world on all your rotations. Failure to do so demonstrates overt cowardice and moral inferiority.

 

[pathstudent]

Marxist ignorance. 👎

No one has a "natural right" to any good or service provided by an individual aside from that which the individual is willing to provide. To legislatively force one into indentured servitude "for the common good" is socialist BS.

Epic fail. Let your evaluations reflect it. Please, speak up and speak loudly, proudly proclaiming your views to the entire world on all your rotations. Failure to do so demonstrates overt cowardice and moral inferiority.

That is not true. The government can guarantee healthcare just as they guarantee the right to free speech or freedom of religion or the right for kids to be schooled.

You might feel the way you do, but that doesn't mean the millions of people who elect our officials agree with you. You don't have to provide your services, so go get another F'n job that will still pay you over 150K a year. Excepting someone to pay you 800 for spending 15 minutes looking at 12 "quadrant" prostate biopsies and saying "negative for malignancy" and paying you 1600 to process the tissue, might not be reasonable with the nation in financial crisis.

The facts are on the ground and we elected Obama and Pelosi. If they decide healthcare is an unalienable right, it is so.

 

[MOHS_01]

That is not true. The government can guarantee healthcare just as they guarantee the right to free speech or freedom of religion or the right for kids to be schooled.

You might feel the way you do, but that doesn't mean the millions of people who elect our officials agree with you. You don't have to provide your services, so go get another F'n job that will still pay you over 150K a year. Excepting someone to pay you 800 for spending 15 minutes looking at 12 "quadrant" prostate biopsies and saying "negative for malignancy" and paying you 1600 to process the tissue, might not be reasonable with the nation in financial crisis.

The facts are on the ground and we elected Obama and Pelosi. If they decide healthcare is an unalienable right, it is so.

Perhaps you need to educate yourself further on what an "unalienable right" is student. An "unalienable right" is one that cannot be given or taken away; it is bestowed upon man by his Creator. An "unalienable" right is not contingent upon the whims, fancies, follies, flavor of the day, customs, prevailing beliefs, or even the law of a society. In fact, what you (and the millions calling for such a compulsory system) advocate tramples on unalienable rights in lieu of legal rights (and political pandering).

Educate yourself prior to spouting from the mouth. You will expose your ignorance less.


ps I don't "except" anyone to pay me those fabricated fees... by the way, where do you pull your figures from??????

 

[Sulfinator]

The facts are on the ground and we elected Obama and Pelosi. If they decide healthcare is an unalienable right, it is so.

Now that is an untrue statement. I assume that you are speaking in hyperbole here and don't really believe that Obama and Pelosi have that kind of totalitarian power. Either way you meant it, it's gratuitous and unconstructive commentary. I agree that there is a lot of greed and disparity in this country that pervades more than just the health care industry/system. I think something does need to be done about it (like a major cross-cultural shift in values and ethics), but emotionally-charged, sensational statements like that are counterproductive.

 

[pathstudent]

Perhaps you need to educate yourself further on what an "unalienable right" is student. An "unalienable right" is one that cannot be given or taken away; it is bestowed upon man by his Creator. An "unalienable" right is not contingent upon the whims, fancies, follies, flavor of the day, customs, prevailing beliefs, or even the law of a society. In fact, what you (and the millions calling for such a compulsory system) advocate tramples on unalienable rights in lieu of legal rights (and political pandering).

Educate yourself prior to spouting from the mouth. You will expose your ignorance less.


ps I don't "except" anyone to pay me those fabricated fees... by the way, where do you pull your figures from??????

Absolutely unalienable rights are contingent upon the whims of the day/time. The unalienable rights we all learn about in grade school in the declaration of independence were a creation of humans influenced by the era they were living in.

In any case, if Congress declares healthcare a right of all americans and the president signs it, it is so. It doesn't matter if you think it is not.

 

[Torsed]

That is not true. The government can guarantee healthcare just as they guarantee the right to free speech or freedom of religion or the right for kids to be schooled.

The 4th Amendment only ensures that prisoners are guaranteed healthcare. No one else is promised healthcare in the U.S. Constitution. Healthcare, regardless of any political dogma or arguing is not a legal right. I've lived in some very crappy areas and went to med school in a markedly crappy area and my main arguement about government run healthcare is that it would probably be somewhat better than they run the housing projects (HUD? anyone?). Everyone likes throwing the name "VA" around, but that is a pretty flawed system that reminds me of the Canadian System, often times vets have to travel to another state for care such as Orthopedics or a prostatectomy because it isn't offered at the local VA. My Institution is getting specimens from the local VA because their pathologists are overwhelmed, so I think government officials using the VA as a guiding light is flawed.

I sincerely believe if medical malpractice reform was a reality instead of something plantif lawyers chuckle about in the Club Sauna, medical costs would drop, case in point: when was the last time you went to a Tumor Board and DIDN'T see 20 CT scans or 10 MRI's on the same person, versus our 30 dollar glass slides (and don't forget the dollar for the paper and toner), and we ponder the 700k figures offered prevoiusly for radiologists?

I think screaming at pathologists for healthcare costs is pretty futile, I cannot think of a more regulated and most likely efficient field in all of medicine, I do not believe that many can argue that our profession is more on the low end of costs in the grand scheme of things, nor can I think of field where so few serve so many.

 

[MOHS_01]

Absolutely unalienable rights are contingent upon the whims of the day/time. The unalienable rights we all learn about in grade school in the declaration of independence were a creation of humans influenced by the era they were living in.

In any case, if Congress declares healthcare a right of all americans and the president signs it, it is so. It doesn't matter if you think it is not.

Read a book. You are speaking of "legal rights", not "unalienable rights". There is a clear and definable difference, and your ignorance on the matter does not change that in any way. In fact, if the government (i.e. your heroes Pelosi (who was not voted on by the people of the country, just one small pocket of left coast nutties) and BHO) should ever choose to mandate participation in this plan or somehow otherwise coerce participation (you know, the Chicago way), they would indeed be trampling upon the natural, unalienable rights of the labor who provides such services. In fact, it is these very unalienable rights that serve as the limiting force on law and your beloved legal rights.

It doesn't matter if you think it is not.

 

[exPCM]

If you suppose that health care is a basic right then I suppose you could say food is a basic right as well. Perhaps the government should give people all free food at the grocery stores and then the government should reimburse the grocery store at whatever rate the government see fit in a manner analogous to what they are doing with physicians. How many grocery stores do you think would just shut down instead of putting up with such nonsense?

 

[digitlnoize]

If you suppose that health care is a basic right then I suppose you could say food is a basic right as well. Perhaps the government should give people all free food at the grocery stores and then the government should reimburse the grocery store at whatever rate the government see fit in a manner analogous to what they are doing with physicians. How many grocery stores do you think would just shut down instead of putting up with such nonsense?

Exactly.

Go into a restaurant and demand that the chef make you food. Then leave without paying. The government will reimburse the restaurant and a pre-determined "fair" rate. Food is a right after all, isn't it?

How about housing? Isn't that a "right"? I think everyone should get a free house and the government should pay for it.

Oh, and everyone should be able to do whatever profession they want. You wanna be a surgeon? Sure! Go for it! Freedom to do what makes you happy is a right? Right?

Here's the US Constitution: http://www.usconstitution.net/const.html#Preamble

Please point out the part where it says that free healthcare is a "right".

I'd also like to point out that the Declaration of Independence, while an important historical document, is NOT United States Law. Just because Jefferson, et al. defined "certain unalienable rights" it does not mean that those are sanctioned by the US Government.

What about the right of doctors to "pursue happiness"? What about our right to liberty? Indentured Servitude was outlawed by the 13th amendment, and for doctors to be forced into the employ of the USA amounts to little more than that.

 

[MOHS_01]

It's actually worse than "being forced into the employ" of the government -- it opens up Pandora's box for something just this side of slave labor, creating a monospony whereby individuals are forced to deliver goods and services at a price determined by the consumer. Employees could unionize; a network of individuals cannot without running head first into anti-trust law. They have us, and they know it. Keep the piecemeal pay system, thereby forcing providers to deliver a given quantity of services... and bare none of the legal burden associated with employer status. Beautifully tragic, yet there are a plethora of ******s amongst our ranks who applaud its inception.

 

[Adrian Cocot]

On page 16 of the current House bill for the public option:

"Except as provided in this paragraph, the individual health insurance issuer offering such coverage does not enroll any individual in such coverage if the first effective date of coverage is on or after the first day" [of the year the legislation becomes law].

IE: if you have health insurance through your job, you quit / get fired, start up a small business, decide not to work for a year, whatever… the only "option" you have is the public one unless you're willing to pay the fees tacked on to a private plan that is required to meet the "Exchange-participating health benefits" regulations (page 19).


Thoughts.

http://justoneminute.typepad.com/main/2009/07/well-it-is-sort-of-an-option.html

Apparently these passages are being misread, resulting in lots of delightful WHARRGARBL!

 

[gavilan]

Who cares what happens! No matter what Doctors will always be in demand and will always make a good living. Even if you only earn 160K when you were expecting to earn 200K, you are still doing better than 99% of the planet.

I am sorry I don't believe that maintaining a system where pathologists earn 200K a year and radiologists 700K a year is justified when many children don't even have insurance. I don't think the voting populace is going to side with the pathologists over the children.

Healthcare is bankrupting the nation and it is just too fricking bad if doctors have to take a 25% or greater pay cut. The needs of the many outweigh the needs of the few or the one.

We've got aggro!

 

[schrute]

http://justoneminute.typepad.com/main/2009/07/well-it-is-sort-of-an-option.html

Apparently these passages are being misread, resulting in lots of delightful WHARRGARBL!

How is it being misread?

Just as I said, people will still be able to purchase qualifying private plans, the point being that "qualifying" means they will be required to adhere to a strict set of Federally-mandated criteria in terms of what is covered, what is not covered, premium prices, etc...no one is sure of the details of what these criteria will be, but people are delusional if they can't see this for what it is:
a wedge in the door for the incremental establishment of a national healthcare plan that will INdirectly crowd private insurance out of the market, save the few who can afford exorbitant premiums.

If people can get something for cheaper, they will. If it's 'free' (ie. paid for by someone else)...even better. Once we head down this road, there's no turning back, as the road will become widened, paved, and a permanent fixture of our GDP.

The mentality of pathstudent is not an outlier, and despite how utterly unintelligent such a mentality is, it can pull the lever just as well as the mentality which it opposes. IE: votes are votes, and if staying in power means pandering to the ignorant, naive, self-serving, instant-gratifying, I'll-take-mine-any-way-i-can-get-it masses while simultanously satisfying some underlying progressive ideal of moral-relativism, all the better...

People don't want to spend money on healthcare because there's no sense of return on the investment, but also because we've been sucked into the mentality that health insurance is the way to go, despite the fact that every other form of insurance is based NOT on the inevitible (as healthcare is), but the unlikely...the tragic...the unforeseen. Everyone is GUARANTEED to need healthcare, to varying degrees, throughout their life. And rather than assume the responsibility for a health savings account, thriftiness and foresight/financial planning, people would rather spend the money on items that result in mental / physical / social happiness.

This is just a factor in the equation, but it cannot be ignored because it's a harder problem to tackle than simply imposing legislation on tangible targets or letting the governement assume responsibility (look to Mass. for a great example of govt. taking charge of the health system).

 

[Psychopathology]

I am sorry I don't believe that maintaining a system where pathologists earn 200K a year and radiologists 700K a year is justified when many children don't even have insurance.

Do you really think that 200K a year is a lot of money for a 30 year old plus physician who has been working harder than most college graduates for the past eight or nine years, has a boatload of debt, and very little to absolute nothing in savings and assets? What kind of a lifestyle do you anticipate for yourself? How long do you think you'll be able to work before you are ready to or need to retire?

What percentage of healthcare coin actually goes to doctors and how hard have these doctors had to work over the turn of the century for reimbursement as compared to their predecessors?

Is the median physician salary a burden on society or a drop in the healthcare expenditure bucket?

If anything, doctors have worked harder and accepted greater sacrifices to accommodate a larger, sicker, and strikingly litigious and less compliant patient load. They have been fighting an uphill battle. So, why punish physicians further? They've bent over backwards and now you want to bend them over the other way.

 

[gungho]

methinks it's "inalienable" not "unalienable".

 

[MOHS_01]

methinks it's "inalienable" not "unalienable".

Yeah, they're interchangeable... but if you look at the Declaration it is unalienable, however awkward sounding as it may be today.

 

[gungho]

Yeah, they're interchangeable... but if you look at the Declaration it is unalienable, however awkward sounding as it may be today.

yep, you're right-here i've been laboring all these years under a wrong assumption. my apologies.

 

[digitlnoize]

Yeah, they're interchangeable... but if you look at the Declaration it is unalienable, however awkward sounding as it may be today.

As a former resident of Jefferson's hometown of Charlottesville, I can tell you that there is CONSIDERABLE scholarly debate over this word. In some drafts of the declaration it is UN and in others it is IN.

I believe the copy on display in the Library of Congress does say UN.

Anyways...don't bother argueing about it. According to the Jefferson-ologists...you're both wrong...lol

 

[2121115]

Get real. Pathologists are not bankrupting the healthcare system. And 200k doesn't make you rich by any means when you are starting in the sort of financial situation in which most doctors start their professional life.

Doctors get paid less and less money every year, yet healthcare costs keep going up and up. How do you explain that if doctor reimbursement is the problem? Where is all this money going? Even if all this money was going for unneccessary testing, doctors would still be making out well. But doctors' salaries keep going down every single year.

Healthcare reform started out as a good idea, but there will be SO MANY unintended consequences from this change that we are going to end up with a system that is just as broken, if not moreso, that the one we have now. What we are seeing now is the definition of "change for the sake of change".

 

[Psychopathology]

Doctors get paid less and less money every year, yet healthcare costs keep going up and up.

And the workload goes up and up. Competition for medical school admission and post graduate training positions continue to increase. We're working harder, training longer, sacrificing more for our educations, and we're accepting less. Nobody has it worse right now than the uninsured, but we are certainly experiencing our own losses, frustrations, and uncertainty. We're starting down a slippery slope. How are the insurance companies, pharmaceutical companies, and junk food manufacturers holding out? The law makers who think nothing of slashing physician salaries continue to enjoy pay raises in the face of a failing economy and unpopular decisions. The tobacco industry has suffered its share of bumps, but not without the kind of resistance that I wish physicians were capable of mounting to defend our prospective reimbursements. We are looking out for the best interests of our patients. We are obligated to provide the best care and to produce the most honest and thoughtful work of which we are capable, but we are also professionals.

Where is all this money going?

I'm also very interested to learn more about this. I'm baffled that Washington has taken the time to study this and has concluded that physician reimbursement deserves the most scrutiny and reform.

we are going to end up with a system that is just as broken, if not moreso, that the one we have now.

I think of what is becoming of public education and I shudder fearing what may become of our profession and of our patients if key politicians have their way.

 

[schrute]

The AMA weighs in, unfortunately:

http://online.wsj.com/article/SB124804389935663419.html#printMode

 

[Dermbound00]

I am going to ramble for a second----

Regardless of your political party and views, does all this spending really make you feel sick to your stomach? Why does our government continue to spend money that we do not have? It is completely out of control.

Now universal healthcare? I agree that in a perfect world everyone would have food, shelter, true love, and adequate health coverage, but at what expense? Shouldn't we work on providing food for everyone in our country before we tackle healthcare for everyone?

Before we go into exorbitant taxing, why dont we work on reducing healthcare costs? What are the solutions? Why isn't anyone doing anything about tort reform which I believe would eliminate a considerable amount of spending, waste, and redundancy?

We all hear that payments for Medicaid/Medicare are laden with fraud, and abuse mostly due to the complexity of the system. Why not reform the payment system and schedule to make it more understandable and simple? I do not claim to have all the answers here but wouldn't these two issues go a considerable way in reducing healthcare expenses?

Instead our government looks to the brilliant idea of increasing taxes on the rich. If I am poor, middle class, or upper middle class, I am all for having universal healthcare paid by someone other than me; however, if we all have to share the burden, universal healthcare does not seem to be that good of an idea anymore.

I know the last thing I want is having the inefficiency and bureaucracy of government run anything, especially healthcare.

The problem also is that physicians have never efficiently come together to form a unified group to stand up for our profession and livelihoods. Instead physicians just bend over and take it, similar to what the majority of pathologists across our country do for clinicians.

 

[pathstudent]

The AMA weighs in, unfortunately:

http://online.wsj.com/article/SB124804389935663419.html#printMode

That's because the AMA is all run by internists and they will get their pay increased by cutting payments to specialists.

 

[yaah]

The sooner the government just admits that they are going to have to raise taxes in some fashion to fund whatever they want to do, the better. They are treating health care like it is still 1960 when people spent far far less of their income on it, and it was much less complicated. The government is trying to have it both ways - health care for everyone but without any real sacrifices (except on part of people who work in health care, of course, and anyone who actually has to pay for their own health insurance). And it seems to me as though they are just hoping it will all work out. If they reform the tax code that will be a good start. They won't even have to "raise" taxes to do it.

 

[LADoc00]

The needs of the many outweigh the needs of the few or the one.

Could make the very same argument for slavery and the cotton industry in Pre-Bellum Southern States.

Someone needed to make the raw material for t-shirts in the pre-industrial era.

Your logic is so puerile I actually feel like a tool for responding to your pathetic attempt at a troll.

 

[LADoc00]

I am going to ramble for a second----

Regardless of your political party and views, does all this spending really make you feel sick to your stomach? Why does our government continue to spend money that we do not have? It is completely out of control.

Short answer: No. In fact it makes my stomach tickle with delight. The US government is running itself into the ground and rest assured when the music stops, the Fed will in no way be prepared to stop the aftermath of utter currency debasement like we have never seen.

Given the ties foriegn central banks have via t-bonds to the value of the US dollar, we will experience nothing short of a total worldwide fiat currency meltdown on the order of Nicholas Cage's flick "Knowing". Yes, fire and brimstone.

BUT, there will be a select few with the access to commoditized goods who will run everything, flashback to protofeudalism, go wiki that because its coming...and its bringing Hell with it.

 

[Dermbound00]

Why can't any reporter stand up and ask him about the ridiculous lawyers and tort reform? You think our justice system is blind and fair? You better believe that those with money are considerably better off. Those with money can get better lawyers, can stick out a lawsuit much longer, can get better shelter, can get better food, and yes can get "better" healthcare.

You want to know why a doctor has to order a thousand tests including redundant tests? They are covering their butts!!! Because in the event they did not, a lawyer would be at their door the next morning. Why can't anyone see that?

I did like his back tracking when the reporter asked him if all Americans would get coverage identical to him and the senators.
That will be the next lawsuit. Some poor guy without insurance, but with the government run plan, doesnt get the million dollar workup and dies because of it.

You know what? There are too many damn people in this world. That is the first problem. We dont have the resources for everyone unless you can support yourself. Stop the uncontrolled frivolous lawsuits, yet he does not want to touch the lawyers.

I just looked at a 140 slide case today for second opinion for a tumor board, and we are not billing for it. Took me half a day to entirely look at that case, burn out my retina, and put my name on the line for our clinicians. Being a newly trained graduate and fellow, I do not have the power to say this is complete and utter BS, but I am getting to that point. You think a government run plan is going to pay for a second opinion? Many providers will not pay for it today.

 

[pathstudent]

Could make the very same argument for slavery and the cotton industry in Pre-Bellum Southern States.

Someone needed to make the raw material for t-shirts in the pre-industrial era.

Your logic is so puerile I actually feel like a tool for responding to your pathetic attempt at a troll.

Listen Bucko, when people read quotes from MDs claiming that working for 240K instead of 300K or 160K instead of 200k is equivalent to "slavery" and "indentured servitude" (has as been stated by posters in this thread) that is going to seem like a huge joke considering the median household income is 50K.

I am a realist. And I know that in the US it is always considered OK to take money from physicians. If the country is going broke and millions of people are without insurance and if it takes cutting medicate (and hence private insurance payments) 20% to fix that, then the people as a whole will support that.

The federal gov't made medicine incredibly lucrative in the 80s and what the federal gov't giveth the federal gov't taketh away.

We are destined to become like teachers, fireman, and cops. Public servants who deserve much more than they get paid. Hopefully you enjoy your job. If you want to be rich, I would spend my time learning how to hit a curveball, writing a hit song, inventing a new product, or designing a hot new website/blog.

When I was deciding to apply to medical school in the 90s, there was an article in the WSJ that was titled "momma don't let you babies grow up to be doctors", and it foretold everything that is happening now and that is soon to happen.

 

[Dermbound00]

I would strongly advise if you have any intelligence at all, become a lawyer. Make 200-500 an hour. No one regulates you. Just basically financially rape anyone that comes into your office. Plus, with this government run plan, you will have millions of new clients getting lesser care than the more wealthy folks, ready to attack the physician that did not order the big workup.

 

[Dermbound00]

Can I also ask why the Cleveland Clinic is the model we should all strive for? They only take private insurance and throw the poor people out on the streets and send them to the other nearby hospitals.

 

[LADoc00]

Listen Bucko... If you want to be rich, I would spend my time learning how to hit a curveball, writing a hit song, inventing a new product, or designing a hot new website/blog.

Bucko, LOL nice one. 1985 called and they want their expression back!

Im already rich and honestly positioned to where I really dont give a crap. But you are deadly wrong on who is going to get jacked on this run.

It wont be long until all providers adopt a concierge system. Basically instead of amplifying coverage via this plan, he will contract it, forcing the poor into smaller and smaller numbers of public-run county hospitals.

See, our collective national psychology has changed such that no one is really willing to take one for team, in any sense. We have come into the Me-generation, the Gen Ys who crap on the Au Bon Pain at the Brigham. Young docs want the lifestyle, the la dolce vita.

And while Barry Obama might have succeeded where FDR failed in instituting a national "take one for the team" healthcare plan at the height of nationalistic furvor, it is laughable to think it could work now.

It may come to pass, I dont underestimate the ability of politicos to steamroll agendas in DC. But soon there will be loopholes, places where mad amounts of money will leak out of the public system. The cunning will get rich, the stupid/clueless will remain mediocre.

This will be true domestic "blowback". What will eventually spring up will be akin to black market mercenary-style, basically pay me enough and I *might* help you..if the country itself even survives the crisis.

Atlas IS shrugging. Fairly incredible to see really.

~Peace.

 

[pathstudent]

Bucko, LOL nice one. 1985 called and they want their expression back!

Im already rich and honestly positioned to where I really dont give a crap. But you are deadly wrong on who is going to get jacked on this run.

It wont be long until all providers adopt a concierge system. Basically instead of amplifying coverage via this plan, he will contract it, forcing the poor into smaller and smaller numbers of public-run county hospitals.

See, our collective national psychology has changed such that no one is really willing to take one for team, in any sense. We have come into the Me-generation, the Gen Ys who crap on the Au Bon Pain at the Brigham. Young docs want the lifestyle, the la dolce vita.

And while Barry Obama might have succeeded where FDR failed in instituting a national "take one for the team" healthcare plan at the height of nationalistic furvor, it is laughable to think it could work now.

It may come to pass, I dont underestimate the ability of politicos to steamroll agendas in DC. But soon there will be loopholes, places where mad amounts of money will leak out of the public system. The cunning will get rich, the stupid/clueless will remain mediocre.

This will be true domestic "blowback". What will eventually spring up will be akin to black market mercenary-style, basically pay me enough and I *might* help you..if the country itself even survives the crisis.

Atlas IS shrugging. Fairly incredible to see really.

~Peace.

but can pathologists adopt a concierge system, especially if they are contracied to hospitals run by profit driven corporations?

 

[schrute]

Listen Bucko, when people read quotes from MDs claiming that working for 240K instead of 300K or 160K instead of 200k is equivalent to "slavery" and "indentured servitude" (has as been stated by posters in this thread) that is going to seem like a huge joke considering the median household income is 50K.

I am a realist. And I know that in the US it is always considered OK to take money from physicians. If the country is going broke and millions of people are without insurance and if it takes cutting medicate (and hence private insurance payments) 20% to fix that, then the people as a whole will support that.

The federal gov't made medicine incredibly lucrative in the 80s and what the federal gov't giveth the federal gov't taketh away.

We are destined to become like teachers, fireman, and cops. Public servants who deserve much more than they get paid. Hopefully you enjoy your job. If you want to be rich, I would spend my time learning how to hit a curveball, writing a hit song, inventing a new product, or designing a hot new website/blog.

When I was deciding to apply to medical school in the 90s, there was an article in the WSJ that was titled "momma don't let you babies grow up to be doctors", and it foretold everything that is happening now and that is soon to happen.

If I may&#8230;LA's point, which you grossly misinterpreted, is the asininity of your embrace of frankly Marxist (not to mention naïve) logic. "The needs of the many"&#8230;give me a break. You're not a realist, you're a proletariat zeitgeist.

Despite the utopian desire to play Robin Hood and use egalitarianism as a means to justify income redistribution, our country was not founded on the principles of socialism.

Lucky for you, President Obama embraces this logic and the desire to, as he stated in 2001, "&#8230;break free from the essential constraints that were placed by the Founding Fathers in the Constitution." It's a belief that is planted firmly in the notion that the government should exist explicitly to perform services on your behalf, regardless of the fact that it was never intended to do so. As Andrew McCarthy notably writes:

<O😛</O😛
"In point of fact, the Constitution does state a few important things government must do on our behalf. But they are things like providing for the common defense &#8212; things it must do for everyone equally, just as the "negative liberties" are things it mustn't do to anyone equally, like suppress political speech or conduct unreasonable searches. But President Obama sees government not as guarantor of freedom but as caretaker, providing certain guaranteed outcomes (a "fair" wage, a "decent" home, "adequate" health care, etc.) regardless of how industrious and responsible his charges seem to be. That isn't American law, because American law, at its core, is about equal protection &#8212; equal treatment before the bar of justice. Uncle Sam is not a rich relation. He's an empty vessel, filled only by what Americans pay in. He can't give to one without taking from the other. And if the other doesn't want to give, Uncle Sam has to press his thumb on the scales of justice.

That is not the rule of law, it is the rule of lawyers. It is the claim that something extraneous to the law, to the antecedent rules we all agree to live by, should be dispositive in a given case. And that something is the lawyer-turned-judge's subjective sense of right and wrong, of fairness stemming from the judge's unique life experience. The president euphemistically calls this "empathy," but it is nothing more than the lawyer unconstrained by the law.

 

[Pingu]

Listen Bucko, when people read quotes from MDs claiming that working for 240K instead of 300K or 160K instead of 200k is equivalent to "slavery" and "indentured servitude" (has as been stated by posters in this thread) that is going to seem like a huge joke considering the median household income is 50K.

A person with a median household income of 50k has probably also not invested the time and money that a physician puts into their career either.

Take the money spent to become an MD, whether you got loans or had your parents pay, as well as the 12 years minimum of education (4 college, 4 med school, 4 residency) as well as the effort and sacrifices made. If those resources were applied to starting a business or another career path, the financial rewards would be equivalent.

I'll be happy to sign out cases for 50k...when you give me the last 12 years of my life back as well as the hundreds of thousands of dollars (plus interest) that my parents spent on my education. 😀

 

[Pathwrath]

American medicine is a mess, but I don't think physician incomes are the problem. If you're looking for waste, it's usually not a good idea to go after the people who provide complex and demanding services, even if they are a relatively powerless group.

Those who can, will walk, as LADoc noted. Those who can't will predictably reduce their output and quality commensurate with the commoditization of their profession. I don't think this is specific to a particular generation or profession, either. Soviet-style medicine is nothing new.

And I say this as a doc sympathetic to the uninsured. The losers will be the poor patients reformers are trying to help. Rich patients will always be provided for.

 

[yaah]

Physician income is not the problem - but it is the "easy" fix, unfortunately.

 

[LADoc00]

Physician income is not the problem - but it is the "easy" fix, unfortunately.

As many have pointed out, all the doctors in America could work for free and Medicare would still go bankrupt.

 

[Kitra101]

As many have pointed out, all the doctors in America could work for free and Medicare would still go bankrupt.

I just wanted to throw this out there in case no one else is paying attention:

Obama time and time again shows the nation just how little he actually knows about medicine. However, he thinks he knows enough to decide how healthcare should be run. It is just amazing to me. We really need someone to keep him honest and get his facts straight because without it he is fear mongering and using the physicians as scape goats to increase his popularity in hopes of a re-election. Here is just the latest example:

At his last town hall meeting, he used the example of the greedy doctor who is presented with a child who has a sore throat. Obama says because of the procedure based pay incentive, the child's doctor (AKA pediatrician) will decide to forgo conservative management of the sore throat and skip right to a T and A for the child's viral pharyngitis, strep, EBV or whatever. Let me ask you all the same question I wish I could ask Obama (the know it all health guru) - When was the last time you heard of a pediatrician performing a T and A? Obama - the answer is NEVER. ENTs perform such procedures. The pediatrician gets no financial incentive to refer this child to the ENT. In fact, in referring the child to the ENT, the pediatrician is doing so because he/she feels that this surgery is indicated. If Obama had taken his own advice and consulted evidence based medicine, he would have found that there is extensive debate in the literature for when a T and A is indicated and he would realize that the T and A would only be done for reasons to benefit the patient (according to current medical theory). Shame on you Obama for demanding that we abide my evidence based medicine when you refuse to do fact checking on your own claims. You would rather try to incite rage against the physicians amongst the general public to drive your political agenda. I wish someone was out there to get this kind of information out of medical related message boards and somehow to the general public. Bush had all of his off beat comments fact checked and reported on major news stations and by comedians like Jon Stewart. Perhaps Obama's honeymoon should be over and it is time to turn up the heat on him and his obvious lack of information.

 

[Dermbound00]

Obama is highly intelligent, charismatic, and an excellent public speaker. He often speaks though "without all the facts."

I still do not understand why no one stands up and grills him about tort reform and the effect of our litigious society and money hungry shark lawyers and their effects on healthcare cost, watse, and redundancy.

Physicians though do not unite and fight for their profession and their patients. They just take it. Take it from the government, the lawyers, the businessmen and whoever else cares to dominate them. They let everyone and anyone without a medical degree dictate to them how medicine should be run.

 

[yaah]

As many have pointed out, all the doctors in America could work for free and Medicare would still go bankrupt.

Yes, but that would delay the bankruptcy a few more election cycles.

 

[Kitra101]

Just FYI I found a copy of the transcript online and here is Obama's word for word quote:

"Right now, doctors, a lot of times, are forced to make decisions based on the fee payment schedule that's out there. So if they're looking and -- and you come in and you've got a bad sore throat, or your child has a bad sore throat, or has repeated sore throats, the doctor may look at the reimbursement system and say to himself, "You know what? I make a lot more money if I take this kid's tonsils out."

Now, that may be the right thing to do. But I'd rather have that doctor making those decisions just based on whether you really need your kid's tonsils out or whether it might make more sense just to change -- maybe they have allergies. Maybe they have something else that would make a difference."

Really? How much more obvious does it have to be that he has no idea what he is talking about, yet wants to dictate how medicine should function. He is worse than the insurance companies dictating how to practice. For the love of medicine and science, someone please stop this train wreck! People slammed Bush for not knowing what is going on, and this is even more ridiculous!

 

[LADoc00]

Everyone get their signs ready when Obamacare becomes law:

 

[paleman]

stock up acorns while you can .. winter is coming