What is up with the Anesthesiology Forum???

[HealthHare]

If there was a true free market healthcare system in this country resulting competitive forces would decrease physician pay way more than any socialist program could. Physicians would become even more of a commodity. What people fail to realize is that medicine has always had some socialist aspects regarding it. Look a organizations like the AMA or any other specialty board. They are nothing more than trade unions that lobby to prevent managed care from further commoditizing healthcare providers and services.

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[LawNonTrad]

Well, this makes more sense now.

Sorry for the confusion. I went back and added a couple of things to the post you quoted as well.

Again, obviously some classes of physician are making more under our distorted system than they would in a free-market and some are making less. But our system isn't changing anytime soon because the will to change (either to pure free-market or to single-payer) isn't there. So obviously if I'm an orthopod and a hospital offers to pay me $450,000 a year, I'm not going to look at them and say well honestly my hospitalist friends at this hospital are making only 190k and I feel bad that I'm making twice as much as them, so I'd rather you paid me the same. That would be stupid because they'd just pocket the money.

 

[loveoforganic]

Loveoforganic, that's not the point. It's irrelevant because what I'm talking about is the current health care infrastructure in our country. It is obviously not a free market so to hear doctors bandy about terms like entitlement when it comes to their salary is rather ridiculous. Even if they aren't directly working in socialized medicine (VA) or corporatized medicine, they're still a cog in that system and their salary is not their true dollar value. Obviously, orthopedists are not 3 times as valuable as family practice doctors, yet they make 3 times as much. That wouldn't happen in a free market system. The only way to have your dollar value accurately measured is in a free, competitive market.

Edit: So you're right that U.S. medicine will likely never be one, and that means that doctors should not attempt to justify their artificially inflated salaries imo.

Would you respond the same way to a marine feeling entitled to his $30k/yr?

Yes

How would you overcome the lack of transparency and public's inability to understand what the cost comes from? What about emergency situations? Would EMTALA have to disappear?

 

[morning]

What I hear you saying is that no one is "entitled" to make any amount of money. Which is the correct assessment. However, I am "entitled", as in: "it is my natural right," to make what I can make. The entitled argument about what is "owed" because of such and such is complete and utter nonsense. I'm not owed anything more than someone is willing to pay me. You may complain out the rigged system that allows the gas trolls to make 400K/yr, but its NOT their fault they get paid that much. What are they supposed to say, "Heeeeeeyyyyy, guy, this is too much money. I'm not taking it!"

???

You're right about that.

I support the right of physicians to unionize and bargain, but I doubt that would be successful because most are not salaried. Who do they bargain with? The government and each individual insurance company? And from what I've seen most physicians don't WANT to be salaried, nor would they go on strike, which would blunt the effect.

Other than that, it's hard to see where and how they can raise their salaries.

 

[LawNonTrad]

If there was a true free market healthcare system in this country resulting competitive forces would decrease physician pay way more than any socialist program could. Physicians would become even more of a commodity. What people fail to realize is that medicine has always had some socialist aspects regarding it. Look a organizations like the AMA or any other specialty board. They are nothing more than trade unions that lobby to prevent managed care from further commoditizing healthcare providers and services.

Exactly! If we went pure free market then consumers would benefit as a whole but physicians would not like it because part of a free market system would involve opening up the gates and allowing any foreign physician who could pass our boards to immigrate to this country. Watch how fast physician salaries would drop if the number of physicians in this country suddenly doubled in a two year span.

The same result would happen as has happened by deregulating/freeing any other industry. Look what happened to the aviation industry when we deregulated it.Ticket prices fell through the floor, but pilots now get the shaft when it comes to pay (hey the money has to come from somewhere). Same thing would happen with medicine. Trade-offs, opportunity costs, perverse incentives, sexy health care macroeconomics. All day, every day, baby.

 

[LawNonTrad]

Would you respond the same way to a marine feeling entitled to his $30k/yr?

I wasn't responding to jdh in a negative way, I was responding to premed gunner. I agree with jdh. And yes I guess I would, because we do have a volunteer, socialist military. I personally feel that people in our military are entitled to higher pay, but with current enlistment targets being met even at the ****ty pay levels...

I've never met a Marine though who told me, hey, I make 30k a year and I'm entitled to it. People don't join the Marines for the pay, at least not anyone that I've ever met. They join out of patriotic duty, sense of direction, college money, the reasons are varied. Of the enlisted Marines I've met, most of them are of such a high caliber of intelligence and drive that I'm sure they will be able to obtain a higher paying job after leaving (especially with the college money).

 

[jdh71]

How would you overcome the lack of transparency and public's inability to understand what the cost comes from? What about emergency situations? Would EMTALA have to disappear?

People who fix cars have the approximate model. It's not that hard to wrap your mind around.

EMTALA probably should disappear in many ways. Specifics to those ends I would need to think more about. EMTALA is essentially coercion. Western society is strange in that when a guy attempts to jump his quad over a number of parked cars, and misses crashing into a building, we don't all stand and applaud survival of the fittest in it's finest demonstration of how the weak do not survive, but rather we all rush in and try and save that guy, and if that guy cannot pay for his medical bills, it matters not to us.

Much of the problem with the disucssion in general is the a priori assumption that we have a "right" to healthcare.

 

[jdh71]

You're right about that.

I support the right of physicians to unionize and bargain, but I doubt that would be successful because most are not salaried. Who do they bargain with? The government and each individual insurance company? And from what I've seen most physicians don't WANT to be salaried, nor would they go on strike, which would blunt the effect.

Other than that, it's hard to see where and how they can raise their salaries.

I'm having a hard time following you here. Were you making a new point, or repsonding to an old one. I'm not trying to be a dick, just trying to understand.

 

[jdh71]

I wasn't responding to jdh in a negative way, I was responding to premed gunner. I agree with jdh. And yes I guess I would, because we do have a volunteer, socialist military. I personally feel that people in our military are entitled to higher pay, but with current enlistment targets being met even at the ****ty pay levels...

I've never met a Marine though who told me, hey, I make 30k a year and I'm entitled to it. People don't join the Marines for the pay, at least not anyone that I've ever met. They join out of patriotic duty, sense of direction, college money, the reasons are varied. Of the enlisted Marines I've met, most of them are of such a high caliber of intelligence and drive that I'm sure they will be able to obtain a higher paying job after leaving (especially with the college money).

Another point about those in the military that we should not gloss over are some of the fringe benefits. Yes base salary, especially for enlisted with only a few years is low, BUT you have access at all time to food, shelter, clothing, and healthcare.

 

[surftheiop]

Lol, only 300K

I doubt I will ever break 170k based on my current interests.

Although someone making 300k complaining about money certainly is telling about what that person's priorities might have been when choosing a field and likely explains the general poor mood on the gas forum.

 

[deleted307836]

If there was a true free market healthcare system in this country resulting competitive forces would decrease physician pay way more than any socialist program could. Physicians would become even more of a commodity. What people fail to realize is that medicine has always had some socialist aspects regarding it. Look a organizations like the AMA or any other specialty board. They are nothing more than trade unions that lobby to prevent managed care from further commoditizing healthcare providers and services.

Wayyy too many people overlook this/aren't able to see it.

A good video which illustrates this point:

[YOUTUBE]http://www.youtube.com/watch?v=3E29LD98ruo[/YOUTUBE]

 

[PremedGunner]

v

 

[deleted307836]

yes capitalism would drive down the average salary of doctors, but in a capitalist system, the best doctors would be making millions, since the best doctors would be able to charge whatever they want and they would have rich clientele.

Although I think you're "figure" of millions is highly unlikely in that scenario...

what would be wrong with that, even if it were the case?

 

[catalase]

Yes

 

[FSAP]

I really like their guns thread.

If there was a true free market healthcare system in this country resulting competitive forces would decrease physician pay way more than any socialist program could. Physicians would become even more of a commodity. What people fail to realize is that medicine has always had some socialist aspects regarding it. Look a organizations like the AMA or any other specialty board. They are nothing more than trade unions that lobby to prevent managed care from further commoditizing healthcare providers and services.

Health care is an inelastic product. IMO a free market system will actually raise individual physician profits because the demand greatly outweighs the supply for the services they provide.

 

[Mr Karatepants]

Wayyy too many people overlook this/aren't able to see it.

A good video which illustrates this point:

[YOUTUBE]3E29LD98ruo[/YOUTUBE]

While this video brings up a few good points, it also presents a simplistic and altogether incomplete perspective on health economics/payment systems/market forces. There are several statements in there that are deceptive/unacceptable, IMO.

 

[HealthHare]

A free market system would probably see the death of the stand alone PCP office. It would be far more efficient to have mega clinics with several docs seeing more patients in less time than one doc in his or her office. The only doctors that would make money out of this system would be those in charge of large clinics and surgery centers. All others would be merely salaried employees at the mercy of market forces.

In order for this system to benefit physicians, the processes of medical education would have to be radically changed. Medical education should start at the undergrad level and should last for 4-6 years followed by a standard residency. Also, the money the gov't will be saving from a free market system should be used to subsidize medical education for virtually all students. So, for instance if avg PCP salary decreases to 80k it wouldn't be so bad to a prospective PCP doc since he or she would have incurred little opportunity cost. Also to further protect physician interest it should be regulated that all clinics and surgery centers should at least be part owned by a physician. This would keep more of the capital generated from docs in the hands of docs.

I feel like this would be a decent model for satisfying both docs and patients.

 

[PremedGunner]

Although I think you're "figure" of millions is highly unlikely in that scenario...

what would be wrong with that, even if it were the case?

not really, doctors would be entrepreneurs and the best doctors would charge the highest. they would treat royalty, heads of state, saudis, corporate elites, etc.

nothing wrong with this, in fact i was trying to support capitalism.

 

[HealthHare]

not really, doctors would be entrepreneurs and the best doctors would charge the highest. they would treat royalty, heads of state, saudis, corporate elites, etc.

nothing wrong with this, in fact i was trying to support capitalism.

This would essentially turn medicine into fields like law and I-Banking where a few of the best who went to top schools make the most money. This might not be a bad thing, but I can't see too many docs being supporters.

 

[deleted307836]

This would essentially turn medicine into fields like law and I-Banking where a few of the best who went to top schools make the most money. This might not be a bad thing, but I can't see too many docs being supporters.

Most patients don't care where you went to school. I personally don't care if my dentist graduated from Columbia, UPenn, or a state school -- she was selected on the basis of recommendations, and yes, cost. And in this system, the majority of doctors would still have to have to appeal to a large demographic in order to remain competitive.

BTW, the "best" American doctors already DO charge top dollar for their services -- and take cash. I bet there are many cardiologists who do this and serve a more affluent/high-profile clientele who "seek out" the best.