Nov 17, 2009
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I'm TIRED of people referring to residents of having a COST. They are slave labor and very cheap. They are not a cost. If anything is a cost, it's the attendings physicians-insurance duopoly.

Here are some issues that I have to help reduce the cost of medical care in the USA from $2.5T to $1.5T:
1. Have more physicians and more residency spots. By having more physicians, the prices would go down. I don't know by how much prices would go down to, and how much would get saved. But economists all agree with this.

I BLAME THE AMA FOR LIMITING THE NUMBER OF PHYSICIANS AT 18,000/YEAR AND BEING ANTI-COMPETITIVE.

2. 9 out of the top 10 chronic diseases are preventable. Eliminate the corn and potato subsidies. Tax cigarettes more heavily, like they do in NYC at $14/pack! Tax coca cola and sugary drinks, in general, and McDonalds and other fast foods. Re subsidies: This is about $10B, only. Moreover, the prices of corn products and HFCS would increase *slightly*. But that $10B is money, and money is fungible.

These chronic diseases must cost a LOT. I'm reading a book, and they claim that Diabetes Mellitus, which is at 8.4% in the USA costs us ~$150B. Our rates are 3x higher than the global population. So we can save $100B by having a DM rate that's similar to that of other nations. Let's be pessimistic and say that we can save $50B "only."

DM is only one disease. There are 8 other diseases, including cancer. The cost savings would be at least $450B/year total including the DM's pessimistic calculation.

THE FAULT BEHIND THESE DISEASE SCOURGES ARE BIG BUSINESSES LIKE COKE, PEPSI, MCDONALDS, AND PHILLIP MORRIS.

3. Have a public option, and have this public option compete with the private insurers! This would reduce costs by 20%. So the $500B is saved right there.

I BLAME THE REPUBLICAN PARTY FOR BLOCKING THESE EFFORTS.


Everything else is just details.
 
Jun 22, 2010
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I'm TIRED of people referring to residents of having a COST. They are slave labor and very cheap. They are not a cost. If anything is a cost, it's the attendings physicians-insurance duopoly.

Here are some issues that I have to help reduce the cost of medical care in the USA from $2.5T to $1.5T:
1. Have more physicians and more residency spots. By having more physicians, the prices would go down. I don't know by how much prices would go down to, and how much would get saved. But economists all agree with this.

I BLAME THE AMA FOR LIMITING THE NUMBER OF PHYSICIANS AT 18,000/YEAR AND BEING ANTI-COMPETITIVE.

2. 9 out of the top 10 chronic diseases are preventable. Eliminate the corn and potato subsidies. Tax cigarettes more heavily, like they do in NYC at $14/pack! Tax coca cola and sugary drinks, in general, and McDonalds and other fast foods. Re subsidies: This is about $10B, only. Moreover, the prices of corn products and HFCS would increase *slightly*. But that $10B is money, and money is fungible.

These chronic diseases must cost a LOT. I'm reading a book, and they claim that Diabetes Mellitus, which is at 8.4% in the USA costs us ~$150B. Our rates are 3x higher than the global population. So we can save $100B by having a DM rate that's similar to that of other nations. Let's be pessimistic and say that we can save $50B "only."

DM is only one disease. There are 8 other diseases, including cancer. The cost savings would be at least $450B/year total including the DM's pessimistic calculation.

THE FAULT BEHIND THESE DISEASE SCOURGES ARE BIG BUSINESSES LIKE COKE, PEPSI, MCDONALDS, AND PHILLIP MORRIS.

3. Have a public option, and have this public option compete with the private insurers! This would reduce costs by 20%. So the $500B is saved right there.

I BLAME THE REPUBLICAN PARTY FOR BLOCKING THESE EFFORTS.


Everything else is just details.
more doctors = lower salaries

more healthy people= less business
 

bigal40

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Why don't you pull some more numbers out of your ass and let us know how to save 2 trillion or even 3 trillion dollars.
 

p30doc

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Get rid of the middle man (insurance companies), healthcare costs go down massively, and physician income goes way up. Also tort reform.
 
OP
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Nov 17, 2009
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Get rid of the middle man (insurance companies), healthcare costs go down massively, and physician income goes way up. Also tort reform.
I agree with this revolutionary idea. There is more overhead with having to have insurance.

Tort reform - however - only seems to be driving costs up by like 1%-2%.

Defensive medicine is costing us ~$46B according to one report in WSJ, I believe.

The biggest problems are CULTURAL, and involves our thinking that cheeseburgers, french fries with ketchup, and coca-cola is a normal American meal, among other things.

Also, cigarette smoking is horrible. A cigarette smoker is depicted as the all-American Marlboro Man, but the reality is that cigarette smoking has socialized the costs of bad health, and there is nothing more un-American than socializing/nationalizing our bad health choices.


Finally, WE NEED MORE DOCTORS IN GENRAL AND PRIMARY CARE PHYSICIANS IN PARTICULAR. Why are specialists getting paid too much? Why don't they do more primary care work? In a free market economy, the following would happen:
1. There would be more of both types.
2. Specialists would also perform more non-specialist type of work.
3. There would FINANCIAL INCENTIVES to even go into PCP.
4. Privatized residency programs!!!
5. Privatized MD schools!
 

DeadCactus

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If we're going to reform anything, it should be to make economics a pre-req for medical school. And maybe some more math. Maybe that would be enough to drown out the moronic thought processes all the non-quantitative, hand-wavy logic espoused by supposedly educated individuals...
 

MilkmanAl

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I've got my own solutions. I present to you Al's Healthcare Reform:

1. Ban drive-throughs, and put treadmills in front of the cashiers at every fast food restaurant.

2. Have separate medications for Medicaid patients that are half combined OCP, half whatever med they were prescribed.

3. Require cigarettes to be laced with delicious bleach.

4. Free lap bands for everyone!

5. Legalize punching malpractice lawyers in the face.

6. Euthanasia? I think you mean Euthan-awesome.

There you have it: 6 easy steps to solving our health care problem.
 

seelee

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"The defect in this one was bleach." - Napoleon Dynamite
 

kdburton

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Tort reform - however - only seems to be driving costs up by like 1%-2%.

Defensive medicine is costing us ~$46B according to one report in WSJ, I believe.
Without tort reform people will keep practicing defensive medicine, so tort reform is indirectly responsible for this $46B you speak of

The biggest problems are CULTURAL, and involves our thinking that cheeseburgers, french fries with ketchup, and coca-cola is a normal American meal, among other things.

Also, cigarette smoking is horrible. A cigarette smoker is depicted as the all-American Marlboro Man, but the reality is that cigarette smoking has socialized the costs of bad health, and there is nothing more un-American than socializing/nationalizing our bad health choices.
So how do you think you're going to stop this? People still smoke in NYC and it costs them almost $1 per cigarette. Should we make fast food and cigarettes illegal? That sounds like communism to me. Even if you eliminate diabetes, lung cancer, yadda yadda yadda then other chronic diseases are just going to become the more prominent ones that physicians deal with (patients aren't going to live forever w/o health problems if they stop eating fast food).
 

Droopy Snoopy

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I've got my own solutions. I present to you Al's Healthcare Reform:

1. Ban drive-throughs, and put treadmills in front of the cashiers at every fast food restaurant.

2. Have separate medications for Medicaid patients that are half combined OCP, half whatever med they were prescribed.

3. Require cigarettes to be laced with delicious bleach.

4. Free lap bands for everyone!

5. Legalize punching malpractice lawyers in the face.

6. Euthanasia? I think you mean Euthan-awesome.

There you have it: 6 easy steps to solving our health care problem.
Yes!
 

werd

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I'm TIRED of people referring to residents of having a COST. They are slave labor and very cheap. They are not a cost. If anything is a cost, it's the attendings physicians-insurance duopoly.

Here are some issues that I have to help reduce the cost of medical care in the USA from $2.5T to $1.5T:
1. Have more physicians and more residency spots. By having more physicians, the prices would go down. I don't know by how much prices would go down to, and how much would get saved. But economists all agree with this.

I BLAME THE AMA FOR LIMITING THE NUMBER OF PHYSICIANS AT 18,000/YEAR AND BEING ANTI-COMPETITIVE.

2. 9 out of the top 10 chronic diseases are preventable. Eliminate the corn and potato subsidies. Tax cigarettes more heavily, like they do in NYC at $14/pack! Tax coca cola and sugary drinks, in general, and McDonalds and other fast foods. Re subsidies: This is about $10B, only. Moreover, the prices of corn products and HFCS would increase *slightly*. But that $10B is money, and money is fungible.

These chronic diseases must cost a LOT. I'm reading a book, and they claim that Diabetes Mellitus, which is at 8.4% in the USA costs us ~$150B. Our rates are 3x higher than the global population. So we can save $100B by having a DM rate that's similar to that of other nations. Let's be pessimistic and say that we can save $50B "only."

DM is only one disease. There are 8 other diseases, including cancer. The cost savings would be at least $450B/year total including the DM's pessimistic calculation.

THE FAULT BEHIND THESE DISEASE SCOURGES ARE BIG BUSINESSES LIKE COKE, PEPSI, MCDONALDS, AND PHILLIP MORRIS.

3. Have a public option, and have this public option compete with the private insurers! This would reduce costs by 20%. So the $500B is saved right there.

I BLAME THE REPUBLICAN PARTY FOR BLOCKING THESE EFFORTS.


Everything else is just details.
i don't think you know what you're talking about, and i think all 3 of your assertions are totally off-base.

the ama doesn't limit residency spots, the ACGME accredits residency programs and the # of positions grows each year. the growth is limited by the standards enforced for resident training in the US as well as hospitals' ability and willingness to meet those standards and desire to train additional residents. there's also no reason to think that having more doctors would decrease health care costs. while prices of individual services may (or may not) go down with more doctors, additional providers would meet previously unmet demand, and lower prices would create additional demand for services, and the total cost spent on healthcare would certainly go up.

if i have time later i'll elaborate on the other stuff, but i really think you don't understand the topics you're asserting so confidently about.
 
Last edited:

DoctwoB

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I'm TIRED of people referring to residents of having a COST. They are slave labor and very cheap. They are not a cost. If anything is a cost, it's the attendings physicians-insurance duopoly.

Here are some issues that I have to help reduce the cost of medical care in the USA from $2.5T to $1.5T:
1. Have more physicians and more residency spots. By having more physicians, the prices would go down. I don't know by how much prices would go down to, and how much would get saved. But economists all agree with this.

I BLAME THE AMA FOR LIMITING THE NUMBER OF PHYSICIANS AT 18,000/YEAR AND BEING ANTI-COMPETITIVE.

2. 9 out of the top 10 chronic diseases are preventable. Eliminate the corn and potato subsidies. Tax cigarettes more heavily, like they do in NYC at $14/pack! Tax coca cola and sugary drinks, in general, and McDonalds and other fast foods. Re subsidies: This is about $10B, only. Moreover, the prices of corn products and HFCS would increase *slightly*. But that $10B is money, and money is fungible.

These chronic diseases must cost a LOT. I'm reading a book, and they claim that Diabetes Mellitus, which is at 8.4% in the USA costs us ~$150B. Our rates are 3x higher than the global population. So we can save $100B by having a DM rate that's similar to that of other nations. Let's be pessimistic and say that we can save $50B "only."

DM is only one disease. There are 8 other diseases, including cancer. The cost savings would be at least $450B/year total including the DM's pessimistic calculation.

THE FAULT BEHIND THESE DISEASE SCOURGES ARE BIG BUSINESSES LIKE COKE, PEPSI, MCDONALDS, AND PHILLIP MORRIS.

3. Have a public option, and have this public option compete with the private insurers! This would reduce costs by 20%. So the $500B is saved right there.

I BLAME THE REPUBLICAN PARTY FOR BLOCKING THESE EFFORTS.


Everything else is just details.
1. Residents do have a cost. Their salary is low, but they cost the hospital in benefits, malpractice, time the attendings spend teaching and not treating, etc.. A new intern definitely costs the hospital more than they would bring in without the medicare subsidy, while a chief resident or fellows bring in more than they cost.

More physicians will not decrease costs. More physicians (under the current system) will increase utilization, increasing overall costs, even if it would drive salaries down. Docs would order more tests, perform more procedures, to make up the lost revenue from increased competition. Take some economics, its called the income effect. For example, # of specialists is one of the highest predictors for increased healthcare cost in the area, while you're arguing that more docs would increase competition and drive down prices. To put it bluntly, you're wrong.

2. Sure, put all the blame on big business. Anyone with half a brain and an internet connection can easily learn that fast food is bad for you, cigarettes are bad for you, not exercising is bad for you, etc. But they do it anyways. I'm not a big phil-morris-co or McD's fan, but individuals are responsible for their own actions. I don't want to live in a nanny state country where I can't buy or do anything that is "bad" for me. I do, however, believe in making people bear the consequences of their actions (jack up insurance premiums for smokers, fatties, etc.)

3. You just pulled that number out of your ass. A public option would either A. be funded by the government, have an unfair advantage and drive others out of business. or B. Be self sustaining, subject to the same constraints/costs as private business, and thus have to have similar prices to private insurance.
 

MossPoh

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You know that private insurance companies get a nice little government subsidy already right? I fail to see a real purpose in most insurance companies. We, or the employer pay these premiums which then go into a for-profit company with obscene amounts of overhead and administration. What is the point of that profit-minded middle-man?

Anyway, I don't get why this person posted. I don't really care either. Things are complex and there are multiple ways to achieve the desired effect.
 
OP
Z
Nov 17, 2009
259
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1. Residents do have a cost. Their salary is low, but they cost the hospital in benefits, malpractice, time the attendings spend teaching and not treating, etc.. A new intern definitely costs the hospital more than they would bring in without the medicare subsidy, while a chief resident or fellows bring in more than they cost.

More physicians will not decrease costs. More physicians (under the current system) will increase utilization, increasing overall costs, even if it would drive salaries down. Docs would order more tests, perform more procedures, to make up the lost revenue from increased competition. Take some economics, its called the income effect. For example, # of specialists is one of the highest predictors for increased healthcare cost in the area, while you're arguing that more docs would increase competition and drive down prices. To put it bluntly, you're wrong.

2. Sure, put all the blame on big business. Anyone with half a brain and an internet connection can easily learn that fast food is bad for you, cigarettes are bad for you, not exercising is bad for you, etc. But they do it anyways. I'm not a big phil-morris-co or McD's fan, but individuals are responsible for their own actions. I don't want to live in a nanny state country where I can't buy or do anything that is "bad" for me. I do, however, believe in making people bear the consequences of their actions (jack up insurance premiums for smokers, fatties, etc.)

3. You just pulled that number out of your ass. A public option would either A. be funded by the government, have an unfair advantage and drive others out of business. or B. Be self sustaining, subject to the same constraints/costs as private business, and thus have to have similar prices to private insurance.

Thanks for your reply.

You mention that: "Take some economics, its called the income effect. For example, # of specialists is one of the highest predictors for increased healthcare cost in the area, while you're arguing that more docs would increase competition and drive down prices. ".

I read about the income effect on Wiki, and it states: "the income effect is the change in consumption resulting from a change in real income." I'm not sure I understand where you're going with this.

You also mention that: "# of specialists is one of the highest predictors for increased healthcare cost in the area, while you're arguing that more docs would increase competition and drive down prices."

I would hope that this is the case! Specialists cost more to perform their duties than PCPs. I would hope that one area full of orthopedic and cardiovascular surgeons would have more costs than another area of only Family Doctors and other PCPs.

You mention that: "Individuals are responsible for their own actions...I do, however, believe in making people bear the consequences of their actions (jack up insurance premiums for smokers, fatties, etc.)"

Are children responsible for their own actions, or are we magically responsible for our own actions once we attain (societally approved age of) adulthood? It is to my belief that Big Business has been our Gaurdians, and that they have a lot of power over us. They are, in a way, our New Parents. They sell to us what they have determined to be maximally profitable. Period. Their profits are only measured in dollar terms, but not so much by other non-financial methods.

I am not disagreeing with you here, but I am saying that these Big Businesses have more of a duty since they have more power than the consumers that they serve.

Who do you think has more power: Big Insurance with their massive lobbying powers or the daughter who's pleading to the customer service at Amica about pre-conditions as her mom's dying? The only recourse that this daughter has is to change insurance providers. This is barely a dent for Amica. They have to screw over all their customers simultaneously in order for there to be a mass exodus of customers.
 
OP
Z
Nov 17, 2009
259
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You know that private insurance companies get a nice little government subsidy already right? I fail to see a real purpose in most insurance companies. We, or the employer pay these premiums which then go into a for-profit company with obscene amounts of overhead and administration. What is the point of that profit-minded middle-man?

Anyway, I don't get why this person posted. I don't really care either. Things are complex and there are multiple ways to achieve the desired effect.

I agree with you in that insurance adds overhead by introducing middle-men into the picture.
 
OP
Z
Nov 17, 2009
259
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i don't think you know what you're talking about, and i think all 3 of your assertions are totally off-base.

the ama doesn't limit residency spots, the ACGME accredits residency programs and the # of positions grows each year. the growth is limited by the standards enforced for resident training in the US as well as hospitals' ability and willingness to meet those standards and desire to train additional residents. there's also no reason to think that having more doctors would decrease health care costs. while prices of individual services may (or may not) go down with more doctors, additional providers would meet previously unmet demand, and lower prices would create additional demand for services, and the total cost spent on healthcare would certainly go up.

if i have time later i'll elaborate on the other stuff, but i really think you don't understand the topics you're asserting so confidently about.
The AMA through their anti-competitive subsidiary, the LCME set the total revenues for the residencies in the USA.

Moreover, the AMA is one of the biggest lobbies in the USA.

The AMA sets the number of MDs and the number of residents through their LCME.
 

justaregularmed

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The AMA through their anti-competitive subsidiary, the LCME set the total revenues for the residencies in the USA.

Moreover, the AMA is one of the biggest lobbies in the USA.

The AMA sets the number of MDs and the number of residents through their LCME.
It's clear you don't know what you're talking about, why do you keep going?

You are aware that the federal government pays a certain amount for each resident right? (medicare), you cant just randomly increase the number, someone has to pick up that tab (taxpayer or china).

"Public option" just makes doctor -> insurance company -> patient into doctor -> federal government -> patient, also good luck suing the government if they screw you over, hope that goes well.

LCME = Medical Schools, ACGME = Residency. Get it right at least.

You do realize this year there were ~52,000 applicants for ~25,000 residency spots, right? Do we really need more people graduating medical schools. We already have 3,000ish U.S. seniors not matching.

please see the following regarding your OP and subsequent responses:

[YOUTUBE]5hfYJsQAhl0[/YOUTUBE]
 
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OP
Z
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Without tort reform people will keep practicing defensive medicine, so tort reform is indirectly responsible for this $46B you speak of.
The total cost of defensive medicine as a result of not having tort reform is only about $50B, which is only 2% of the total costs of healthcare.
 

werd

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The total cost of defensive medicine as a result of not having tort reform is only about $50B, which is only 2% of the total costs of healthcare.
based on my experience in medicine, i think this is a gross underestimate of the real cost. this may be the direct cost that's paid out in lawsuits or settlements, but regardless, i'd say the real cost is about an order of magnitude larger.
 
OP
Z
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based on my experience in medicine, i think this is a gross underestimate of the real cost. this may be the direct cost that's paid out in lawsuits or settlements, but regardless, i'd say the real cost is about an order of magnitude larger.

You're going by gut-instincts and empirical observations but you're not backing anything with solid numbers.

My numbers are widely-published on the Net, and the research was made by non-partisan and very prestigious entities.
 

MilkmanAl

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That's just kind of common sense, man. If people are scared of being sued, they're going to do everything in their power to not get sued, and that includes possibly/probably unnecessary tests and stuff. There aren't numbers for that because it's impossible to figure.
 

Instatewaiter

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You're going by gut-instincts and empirical observations but you're not backing anything with solid numbers.

My numbers are widely-published on the Net, and the research was made by non-partisan and very prestigious entities.
Pot. Kettle. Black.

what numbers?
 

mike1618

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I read I book = I am now an expert and feel like I should tell the whole SDN community about it.
 

Zoom-Zoom

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You're going by gut-instincts and empirical observations but you're not backing anything with solid numbers.

My numbers are widely-published on the Net, and the research was made by non-partisan and very prestigious entities.
Those numbers might be solid but as you said, they don't recognize the indirect costs. How much time is spent filling out unnecessary paperwork to cover your ass, as a physician? Loads. That's one example. The real costs are tremendous.
 

Ableton

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1. Have more physicians and more residency spots. By having more physicians, the prices would go down. I don't know by how much prices would go down to, and how much would get saved. But economists all agree with this.
I'm pretty sure this would just make matters worse. If anything, our system would benefit by contracting the number of residency spots to fit the number of US MD graduates. This would essentially "force" those less qualified into primary care and alleviate some of the shortage.
 
OP
Z
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It's clear you don't know what you're talking about, why do you keep going?

You do realize this year there were ~52,000 applicants for ~25,000 residency spots, right? Do we really need more people graduating medical schools. We already have 3,000ish U.S. seniors not matching.
Where are your sources for this? I'm very skeptical that ~27,000 won't have any opportunities this year.
 
OP
Z
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Exactly!! More doctors = lower salaries and the debt of med school is not going down but rather rising. The AMA, physicians, and AAMC never will put ourselves in a position where there is an over production of physicians.

also too many seats and who is to guarantee you will get the best candidates in if there are too many seats that just anyone could get in. The AMA would never allow this and I'm glad for it.

Just something to think about for those of you that thinjk increasing physicians in general is the answer.

I do think that the other stuff you said is spot on.

First of all, thank you for replying to me in a polite tone. This topic seems to be emotionally charged for some, because some people here feel threatened.

Second of all, if we had more physicians, we both agree that salaries would go down, and prices would go down as well. This is not a bad thing. A bigger problem to your hypothetical of having too many bad MDs if we allow more MDs to graduate is that the current pool of sick people aren't getting enough care (due to excessively high costs and wait times, etc.). I even had a poll here in which I ask you guys what is a bigger problem: (a) having many mediocre docs or (b) having very few but very competent docs. The overwhelming majority seemed to think that (b) was a bigger problem.

I agree with you as well, that the doctors are not allocated in the right medical focuses or the right geography. The distribution of MDs is skewed towards the rural areas. I agree with you on this as well.
 

seelee

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First of all, thank you for replying to me in a polite tone. This topic seems to be emotionally charged for some, because some people here feel threatened.

Second of all, if we had more physicians, we both agree that salaries would go down, and prices would go down as well.
Independent of whether or not it is a "good thing". Your prediction that more doctors = less money would only be true if there was more supply than demand. Most likely the total amount spent on physicians would increase (because the number of physicans (while increasing) would still be << the number of patients). The trend in our healthcare system is increasing demand, which means that the number of patients would be increasing as well, requiring an even bigger increase in the number of physicians before the cost comes down.
 

DoctwoB

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First of all, thank you for replying to me in a polite tone. This topic seems to be emotionally charged for some, because some people here feel threatened.

Second of all, if we had more physicians, we both agree that salaries would go down, and prices would go down as well. This is not a bad thing. A bigger problem to your hypothetical of having too many bad MDs if we allow more MDs to graduate is that the current pool of sick people aren't getting enough care (due to excessively high costs and wait times, etc.). I even had a poll here in which I ask you guys what is a bigger problem: (a) having many mediocre docs or (b) having very few but very competent docs. The overwhelming majority seemed to think that (b) was a bigger problem.

I agree with you as well, that the doctors are not allocated in the right medical focuses or the right geography. The distribution of MDs is skewed towards the rural areas. I agree with you on this as well.
Wrong. Wrong. Wrong. More docs = better access/less waiting time and lower doc salaries, but increased overall health expenditures.
 

seelee

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Wrong. Wrong. Wrong. More docs = better access/less waiting time and lower doc salaries, but increased overall health expenditures.
Only until the supply became greater than the demand (probably won't happen with the current trend in legislation).
 

chinocochino

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:laugh: You speaketh the truth!

I've got my own solutions. I present to you Al's Healthcare Reform:

1. Ban drive-throughs, and put treadmills in front of the cashiers at every fast food restaurant.

2. Have separate medications for Medicaid patients that are half combined OCP, half whatever med they were prescribed.

3. Require cigarettes to be laced with delicious bleach.

4. Free lap bands for everyone!

5. Legalize punching malpractice lawyers in the face.

6. Euthanasia? I think you mean Euthan-awesome.

There you have it: 6 easy steps to solving our health care problem.
 

bamtuba

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The total cost of defensive medicine as a result of not having tort reform is only about $50B, which is only 2% of the total costs of healthcare.
I am totally going to try using this line of reasoning with the IRS next May.

IRS: "Sir, where is our money?"
Me: "Well, you see, I owe you $5k for 2010, and really that is ONLY .00000000000000000000000000001 % of the national budget (figure from an unbiased source not readily available on the internet...)."

IRS: "..."
Me: "Um, yeah, so you don't need my money, get it now?"

This should end well. :thumbup:
 
OP
Z
Nov 17, 2009
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Wrong. Wrong. Wrong. More docs = better access/less waiting time and lower doc salaries, but increased overall health expenditures.
I can understand your point. Here is an example of what you're describing:
There are 1000 people total population, and 2 MDs. The 998 non-MDs and 2 MDs get 0.5 medical procedures a year (500 total procedures a year), and the total cost is $5000.

All of a sudden, there are 4 MDs (and 996 non-MDs). They all get more procedures - let's say 750 total procedures for all 1000 of them. The total cost of all these procedures is now going to be about $6250.

So...
1. The total amount spent on healthcare in this system is UP.
2. In the first case, the 2 MDs earned $2500 each. In the second case, their salary was $1563.
3. However, the price per procedure droped from $10/procedure to $8.33/procedure.
4. The second case maybe better because more people are getting healthcare. Perhaps more preventive medicine - who knows.
NOTE: ALL MY NUMBERS ARE HYPOTHETICAL.

This is kind of analgous to Reagan's tax cuts: Even though he cut taxes, the tax REVENUE went up because more people were spending their money and stimulating the economy.

I like this "Reaganesque Approach".
 

DoctwoB

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I can understand your point. Here is an example of what you're describing:
There are 1000 people total population, and 2 MDs. The 998 non-MDs and 2 MDs get 0.5 medical procedures a year (500 total procedures a year), and the total cost is $5000.

All of a sudden, there are 4 MDs (and 996 non-MDs). They all get more procedures - let's say 750 total procedures for all 1000 of them. The total cost of all these procedures is now going to be about $6250.

So...
1. The total amount spent on healthcare in this system is UP.
2. In the first case, the 2 MDs earned $2500 each. In the second case, their salary was $1563.
3. However, the price per procedure droped from $10/procedure to $8.33/procedure.
4. The second case maybe better because more people are getting healthcare. Perhaps more preventive medicine - who knows.
NOTE: ALL MY NUMBERS ARE HYPOTHETICAL.

This is kind of analgous to Reagan's tax cuts: Even though he cut taxes, the tax REVENUE went up because more people were spending their money and stimulating the economy.

I like this "Reaganesque Approach".
Closer, but still wrong. More docs doesn't mean the cost per procedure goes down. The cost per procedure is set by medicare (or more specifically, by the medicare RUC committee). More docs = more procedures/office visits, which leads to higher costs because COST/PROCEDURE IS NOT DETERMINED BY SUPPLY. If anything, more docs doing a given procedure means more incentive for innovation for new techniques for that prodcedure, leading to new/more expensive tech for that procedure (see lap cholys for example).

Also, more docs leads to less busy practices, leading to higher overhead per patient, leading to higher costs.
 

Instatewaiter

But... there's a troponin
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What Zut fails to realize is that medicine is not a free market system- and hasn't been for decades.
 

seelee

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Closer, but still wrong. More docs doesn't mean the cost per procedure goes down. The cost per procedure is set by medicare (or more specifically, by the medicare RUC committee). More docs = more procedures/office visits, which leads to higher costs because COST/PROCEDURE IS NOT DETERMINED BY SUPPLY. If anything, more docs doing a given procedure means more incentive for innovation for new techniques for that prodcedure, leading to new/more expensive tech for that procedure (see lap cholys for example).

Also, more docs leads to less busy practices, leading to higher overhead per patient, leading to higher costs.
Not to be a stickler, but the RUC sets the price not the cost. The cost is inherent, and can only be affected by a change in either supply or demand, the non-market status of healthcare not withstanding.
 

DoctwoB

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Not to be a stickler, but the RUC sets the price not the cost. The cost is inherent, and can only be affected by a change in either supply or demand, the non-market status of healthcare not withstanding.
You're right, when i said cost I meant cost to insurers or society, which as you pointed out is the price.
 
OP
Z
Nov 17, 2009
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Closer, but still wrong. More docs doesn't mean the cost per procedure goes down. The cost per procedure is set by medicare (or more specifically, by the medicare RUC committee). More docs = more procedures/office visits, which leads to higher costs because COST/PROCEDURE IS NOT DETERMINED BY SUPPLY. If anything, more docs doing a given procedure means more incentive for innovation for new techniques for that prodcedure, leading to new/more expensive tech for that procedure (see lap cholys for example).

Also, more docs leads to less busy practices, leading to higher overhead per patient, leading to higher costs.
Overhead is but one factors affecting cost. There are situations in which overhead could INCREASE but the total cost has decreased. For example: when Microsoft first started during the '70s, their overhead was, at one time, a million bucks. Today, it's about $10B bucks.

Another example: An expanding company relocates from Newark to Manhattan. Their rent has increased substantially, but their overall profit margins and revenues have increased.

However, do you not think that the RUC would ever reduce the price for procedures? They are trying to reduce them by 29% from what I understand here.
 

DoctwoB

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Overhead is but one factors affecting cost. There are situations in which overhead could INCREASE but the total cost has decreased. For example: when Microsoft first started during the '70s, their overhead was, at one time, a million bucks. Today, it's about $10B bucks.

Another example: An expanding company relocates from Newark to Manhattan. Their rent has increased substantially, but their overall profit margins and revenues have increased.

However, do you not think that the RUC would ever reduce the price for procedures? They are trying to reduce them by 29% from what I understand here.
1. Well duh. Bigger company/practice has bigger overhead. Overhead as a percentage of revenue is what I am talking about. Ratio of variable cost to fixed cost decreases as volume increases.

2. 2nd example: . . . . . What?

3. RUC is not trying to reduce fees by 29%. The Medicare SGR calls for reductions in physicians fees (across the board, including primary care) every time a global budget is exceeded (which happens every year). Congress knows that drastically cutting Medicare reimbursement means fewer docs accept Medicare, which means angry senior citizens, which means your a** is voted out of office. So they pass a last minute fix to prevent the medicare cuts. They do not, however, repeal the SGR, as that would cost a ton of money (which they are spending anyways, by putting off medicate cuts, but "on paper", repealing the SGR would cost a fortune).

Do yourself a favor. Take a health policy class. Read up on Medicare and Medicaid financing and insurance reimbursement. Take an intro economics course. Read about the problems and benefits of third party vs. single payer. Then come on forums and "fix" healthcare. There are some very smart people working in health care reform, working against some very established interests (Pharm, insurance cos, and in some cases doctors and nurses). While US healthcare is far from perfect, it is entirely possible to make the situation worse instead of making it better. If there was a quick and easy magic bullet that made everyone happy, we would have used it already.
 

bcat85

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I'm TIRED of people referring to residents of having a COST. They are slave labor and very cheap. They are not a cost. If anything is a cost, it's the attendings physicians-insurance duopoly.

Here are some issues that I have to help reduce the cost of medical care in the USA from $2.5T to $1.5T:
1. Have more physicians and more residency spots. By having more physicians, the prices would go down. I don't know by how much prices would go down to, and how much would get saved. But economists all agree with this.

I BLAME THE AMA FOR LIMITING THE NUMBER OF PHYSICIANS AT 18,000/YEAR AND BEING ANTI-COMPETITIVE.

2. 9 out of the top 10 chronic diseases are preventable. Eliminate the corn and potato subsidies. Tax cigarettes more heavily, like they do in NYC at $14/pack! Tax coca cola and sugary drinks, in general, and McDonalds and other fast foods. Re subsidies: This is about $10B, only. Moreover, the prices of corn products and HFCS would increase *slightly*. But that $10B is money, and money is fungible.

These chronic diseases must cost a LOT. I'm reading a book, and they claim that Diabetes Mellitus, which is at 8.4% in the USA costs us ~$150B. Our rates are 3x higher than the global population. So we can save $100B by having a DM rate that's similar to that of other nations. Let's be pessimistic and say that we can save $50B "only."

DM is only one disease. There are 8 other diseases, including cancer. The cost savings would be at least $450B/year total including the DM's pessimistic calculation.

THE FAULT BEHIND THESE DISEASE SCOURGES ARE BIG BUSINESSES LIKE COKE, PEPSI, MCDONALDS, AND PHILLIP MORRIS.

3. Have a public option, and have this public option compete with the private insurers! This would reduce costs by 20%. So the $500B is saved right there.

I BLAME THE REPUBLICAN PARTY FOR BLOCKING THESE EFFORTS.


Everything else is just details.
I read this and immediately went "this guy must still be a pre-med." and indeed. There you are. You ought to go back to the pre-medical forum and argue about this stuff with other people who don't know what they're talking about but have a strong opinion nonetheless.
 

seelee

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So on a side note did any of the med students in here watch the election coverage yesterday???

Looks like the house of representatives is back in the hands of republicans and first on the agenda is to repeal the healthcare bill.
Yeah, I did. And while repeal was a big theme it's not going to happen until after 2012. The republicans aren't going to make that big of a push only to have it vetoed.

Right now the best option lies with the Supreme Court.
 

seelee

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I see I see. Just thought I'd ask what people thought about it.

Are most of you on here for or against the healthcare reform as it is going?
I think everyone agrees that there needs to be reform. It seems that the basic breakdown is whether reform should involve more or less government involvement.

I, for one, maintain that the majority of the problems would be resolved if market forces were allowed to work in the health care industry. If legislation were passed that incentivized people to accept responsibility for purchasing their own healthcare and health care insurance, i.e. more involved in the actual financial exchange, then they would act more prudently in their lifestyles and utilization of resources. Market forces would lower prices, create more options for care, and spark innovation.
 

AlexMorph

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I've got my own solutions. I present to you Al's Healthcare Reform:

1. Ban drive-throughs, and put treadmills in front of the cashiers at every fast food restaurant.

2. Have separate medications for Medicaid patients that are half combined OCP, half whatever med they were prescribed.

3. Require cigarettes to be laced with delicious bleach.

4. Free lap bands for everyone!

5. Legalize punching malpractice lawyers in the face.

6. Euthanasia? I think you mean Euthan-awesome.

There you have it: 6 easy steps to solving our health care problem.
We can just go ahead and end the thread right here. All problems will be solved with these steps.
The dumbest people in this country breed at the highest rates. We need to eliminate that, but sadly, the Constitution prohibits that practice in all sorts of ways.
 

DoctwoB

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I think everyone agrees that there needs to be reform. It seems that the basic breakdown is whether reform should involve more or less government involvement.

I, for one, maintain that the majority of the problems would be resolved if market forces were allowed to work in the health care industry. If legislation were passed that incentivized people to accept responsibility for purchasing their own healthcare and health care insurance, i.e. more involved in the actual financial exchange, then they would act more prudently in their lifestyles and utilization of resources. Market forces would lower prices, create more options for care, and spark innovation.
Ah yes, the old "The free market will fix everything" approach. Which I love how you start your free market argument by saying "if legislation were passed. . . ." You just want a different form of regulatory environment. Not to say your ideas are bad, I actually support increased cost transparency, the HSA + catastrophe insurance model over traditional insurance, etc. But to claim this is the "free market solution" is incorect.

Free market for healthcare would mean a lot of things, some good, some bad. Demand is quite inelastic for that emergency trauma surgery, so market price = million bucks. On the other hand, people would opt for the cheaper, proven alternative instead of the super expensive experimental treatment more often, or mabye forgo that 8th round of futile chemo.
 

link2swim06

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To the OP...

1. Doctors (far majority) dont set their own prices, there is NO supply and demand. Add more doctors means more care which = more money. You obviously have never taken economics bc the whole point of supply and demand is there is a product (service in this case) whose price is controlled by market demand. In medicine the customers (patients) are not the one who control procedure cost...its mainly the people who write medicare payments rates (this makes general medicine independent market forces).

2. Smoking DECREASES overall lifetime healthcare cost. When people die at 50 from MI we dont have to pay for there hip replacements and extensive hospital stays in their later years. Please read the conclusion of this study if you dont believe me http://www.nejm.org/doi/full/10.1056/NEJM199710093371506

Therefore your proposal of stopping people from smoking would INCREASE costs.

3. I heard 80% of statistics people make up are false.....like where in the world are you coming up with these numbers??

4. Also how does farm subsidies even relate? You admit that the price would only slightly change, so how is this affecting healthcare. You cant argue that if you cut something tangentially related with no significant affect that is saving healthcare dollars.

5. How is the government offering a public option saving anything? Its going to equate to more healthcare which will mean costs. Furthermore you realizes other "government" health insurances pay worth crap. This is going to mean an overall reduction in physician pay.

And yes lets blame big business, the very companies who have employed and paid tax money to the US.

-----------------------------------------

Here are three clear fire things.

1. Pass extremely harsh tort reform laws....decrease in def medicine = huge savings.

2. Give tax cuts for preventive visits, bc getting a physical with an NP costs a hell of alot less than if you have an undetected disease which if left untreated would require an expensive surgery or hospital stay.

3. Make a government mediated electronic patient record system. Soooo much money is wasted by re-running expensive tests or imaging. Having this would increase care quality also.
 
OP
Z
Nov 17, 2009
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You make very good points. And as I said before on the issue of the OPs discussion of needing more doctors. I still believe the problem is not the amount we produce but the distribution of those doctors.

Sadly, there are places no one wants to live like the middle of nowhere places. that is where there will always be less doctors.

Also I totally agree on both of your bullet point number 3s above. Especially the 2nd bullet point number 3 you made. We have such antiquated technology. if we go to computer based systems, things would be so much easier to wade through. for instance, some doctors still use all paper files. its really sad because if they'd do it computerized it would be easy to pull up any time things are needed rather then wading through papers among papers in big fat paper files to find something.


Surprisingly, improved data capture and IT infrastructure will *NOT* reduce the cost of health care, according to a Harvard study.

http://www.eurekalert.org/pub_releases/2009-11/pfan-pos111709.php
 

link2swim06

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Surprisingly, improved data capture and IT infrastructure will *NOT* reduce the cost of health care, according to a Harvard study.

http://www.eurekalert.org/pub_releases/2009-11/pfan-pos111709.php
This study fails to address a nationwide IT system. The study did a survey of individual hospitals it said. My point its not the idea of paper vs IT for cost savings but rather global access to a patient's record/ imaging results.

For example.... someone goes to family care doctor A to get test A, B, C, and D. Then three days later gets admitted to a hospital. They proceed to repeat tests A-D becuase they dont have direct access to family care doctor A's records.
 

CyberKnife19

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I'm TIRED of people referring to residents of having a COST. They are slave labor and very cheap. They are not a cost. If anything is a cost, it's the attendings physicians-insurance duopoly.

Here are some issues that I have to help reduce the cost of medical care in the USA from $2.5T to $1.5T:
1. Have more physicians and more residency spots. By having more physicians, the prices would go down. I don't know by how much prices would go down to, and how much would get saved. But economists all agree with this.
I BLAME THE AMA FOR LIMITING THE NUMBER OF PHYSICIANS AT 18,000/YEAR AND BEING ANTI-COMPETITIVE.
2. 9 out of the top 10 chronic diseases are preventable. Eliminate the corn and potato subsidies. Tax cigarettes more heavily, like they do in NYC at $14/pack! Tax coca cola and sugary drinks, in general, and McDonalds and other fast foods. Re subsidies: This is about $10B, only. Moreover, the prices of corn products and HFCS would increase *slightly*. But that $10B is money, and money is fungible.
These chronic diseases must cost a LOT. I'm reading a book, and they claim that Diabetes Mellitus, which is at 8.4% in the USA costs us ~$150B. Our rates are 3x higher than the global population. So we can save $100B by having a DM rate that's similar to that of other nations. Let's be pessimistic and say that we can save $50B "only."
DM is only one disease. There are 8 other diseases, including cancer. The cost savings would be at least $450B/year total including the DM's pessimistic calculation.

THE FAULT BEHIND THESE DISEASE SCOURGES ARE BIG BUSINESSES LIKE COKE, PEPSI, MCDONALDS, AND PHILLIP MORRIS.

3. Have a public option, and have this public option compete with the private insurers! This would reduce costs by 20%. So the $500B is saved right there.

I BLAME THE REPUBLICAN PARTY FOR BLOCKING THESE EFFORTS.


Everything else is just details.
Re: #1 and #3
"If you're young and a republican you have no heart. If you're old and a democrat you have no brain" - Winston Churchill

Oh, young grasshopper. Clearly you have not been through the pains of medical school and residency. Clearly you have not worked at an inner city hospital and seen 80% of your patients on Medicaid w/"disability" (though they have no real disability other than being obese, lazy and empowered by our current welfare system), still smoke 1 ppd, drink a fifth of alcohol/day (those two things, probably $20/day), have a cell phone nicer than mine, yet are frequent flyers with CHF exacerbations (or whatever) b/c they say they don't have enough money to pay for their BP meds and diuretics...you are ignorant not because you lack intelligence, you just haven't "been there".

Don't get me wrong, I love being a physician and consider it a privilege to have such tremendous impact in the lives and well being of others. Fortunately for me, I have found my calling in caring for the patient population which I have the utmost sympathy and compassion for, those stricken with cancer. Admittedly, there are many forms of cancer that are self-induced, but I will not get into that at this point.

That being said, given what one has to go through to get to this point:
1. Years of delayed gratification
2. $250,000 in medical school tuition/costs @ 7.5% interest rate (thanks, government)
3. Opportunity cost of giving up 9 years of salary/life for med school + residency
4. I could go on and on...

I feel like I should be well compensated for the aforementioned reasons. Best of luck to all of you. :)