What will Pain Medicine Look Like Under Socialized Medicine?

[drusso]

Government headed for close to half of nation's health tab

https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2018.05499

"Rising prices for health care goods and services are expected to account for nearly half the spending growth, said the report, with the rest driven by a mix of factors, including an aging population and more intensive use of services. “The baby boom generation is expected to shift from private health insurance coverage to Medicare coverage during the projection period,” said Andrea Sisko, an author of the report."

---

Members don't see this ad.

 

[lobelsteve]

This was my plan 10 years ago:

Pain docs are govt employees, make 90% MGMA with COLA.
Only pain docs can Rx schedule 2 opiates other than 26 pills from surgeon, ER. Oncology cn Rx for cancer when active treatment.
PCP can Rx Ultram only.
Only pain doc can do procedures, including SCS and kypho.
Cannot own clinic, lab, imaging, ASC.

 

[drusso]

This was my plan 10 years ago:

Pain docs are govt employees, make 90% MGMA with COLA.
Only pain docs can Rx schedule 2 opiates other than 26 pills from surgeon, ER. Oncology cn Rx for cancer when active treatment.
PCP can Rx Ultram only.
Only pain doc can do procedures, including SCS and kypho.
Cannot own clinic, lab, imaging, ASC.

Good God. Those who do not understand history are doomed to repeat it...

 

[hyperalgesia]

This was my plan 10 years ago:

Pain docs are govt employees, make 90% MGMA with COLA.
Only pain docs can Rx schedule 2 opiates other than 26 pills from surgeon, ER. Oncology cn Rx for cancer when active treatment.
PCP can Rx Ultram only.
Only pain doc can do procedures, including SCS and kypho.
Cannot own clinic, lab, imaging, ASC.

I agree but govt monopoly will drive MGMA to 15% what it is today. 90% MGMA under socialized medicine will be about 60k/year.

 

[Ducttape]

Yes.... and he was probably paid off by th AMA to say that.

And later denied that he opposed Medicare.

 

[lonelobo]

 

[drusso]

Yes.... and he was probably paid off by th AMA to say that.

And later denied that he opposed Medicare.

Socialized Medicine is not working in Colorado...

Colorado hospital prices jump despite Medicaid expansion, reports say

"There was a “hope” that these policies would curb costs, but it was not a “well-designed hope,” said Cari Frank, a spokeswoman with Center for Improving Value in Health Care."

 

[Gauss]

Socialized Medicine is not working in Colorado...

Colorado hospital prices jump despite Medicaid expansion, reports say

"There was a “hope” that these policies would curb costs, but it was not a “well-designed hope,” said Cari Frank, a spokeswoman with Center for Improving Value in Health Care."

medicaid expansion does not equal socialized medicine nor does it promise lower costs. every system on the planet struggles with controlling medical costs. what are the outcome goals of this particular policy? improve life expectancy? reduce indebtedness from medical bankruptcy?
Healthy Change? - HumbleDollar

 

[lonelobo]

Maybe if Regenexx Treatments costs were lower we could at least wipe out chronic pain

 

[drusso]

medicaid expansion does not equal socialized medicine nor does it promise lower costs. every system on the planet struggles with controlling medical costs. what are the outcome goals of this particular policy? improve life expectancy? reduce indebtedness from medical bankruptcy?
Healthy Change? - HumbleDollar

If we're not controlling costs by "bending the curve" or "making investments" in social determinants of health, then why are we doing it? I'll tell you why...it's a boondoggle. Medicaid expansion lined the pockets of "Big Hospital" and paid for hospital CEO second homes and luxury cars, but did little to create effective markets or reform monopolistic practices.

Healthcare Reform Creates Provider Monopolies | The Lund Report

 

[drusso]

Maybe if Regenexx Treatments costs were lower we could at least wipe out chronic pain

Some health plans are seeing cost savings...

https://regenexxbenefits.com/meredith/

 

[lobelsteve]

I agree but govt monopoly will drive MGMA to 15% what it is today. 90% MGMA under socialized medicine will be about 60k/year.

Show me a time when a government employee got a pay cut. And immunity from medmal.

 

[Dr. Ice]

Bernie Sanders wants to save Social Security by raising taxes on people making more than $250,000 — CNN Politics

Our next president. He rose a boat load of money in record time. I’m just gonna work at Starbucks..

 

[lobelsteve]

Bernie Sanders wants to save Social Security by raising taxes on people making more than $250,000 — CNN Politics

Our next president. He rose a boat load of money in record time. I’m just gonna work at Starbucks..

The Cabinet? Under President Schultz?

 

[Dr. Ice]

The Cabinet? Under President Schultz?

Schultz has no chance..I picked Starbucks cause I like the coffee and always wondered what it would be like to work for another made to order speciality. Certainly made to order coffee is easier than made to order healthcare..

 

[Disciple]

Show me a time when a government employee got a pay cut. And immunity from medmal.

Why would we expect the pay to be substantially more than at the VA?

 

[Disciple]

If we're not controlling costs by "bending the curve" or "making investments" in social determinants of health, then why are we doing it? I'll tell you why...it's a boondoggle. Medicaid expansion lined the pockets of "Big Hospital" and paid for hospital CEO second homes and luxury cars, but did little to create effective markets or reform monopolistic practices.

Healthcare Reform Creates Provider Monopolies | The Lund Report

They can't stick it to hospitals, insurance companies or big pharma, so, the middle class gets screwed, as usual.

 

[hyperalgesia]

Show me a time when a government employee got a pay cut. And immunity from medmal.

Well maybe... But I hope you're using MGMA RVU numbers. Because govt salary competitive with actual MGMA salary is a never event. It might be competitive in the sense that said employee did x number of RVUs in a 40 hour work week and got the same $$ as a private doc, who did the same work in 10 hours. The rest of the time is spent paying off all the bureaucrats to allow you to treat patients.

 

[lobelsteve]

Why would we expect the pay to be substantially more than at the VA?

Va needs to die so veterans can get real care. No doc would sign up unless the price was right. The folks making million plus right now would be cut off at the knees.

 

[hyperalgesia]

I think the real issue has always been selling capitated care politically. But already you have places where HMOs offer competitive care to MCB. MACRA moves it further. And eventually it will ALL be HMO/capitated care. Then you can potentially have "Medicare for All", even though, of course, it's not Medicare as we currently know it.

 

[hyperalgesia]

Va needs to die so veterans can get real care. No doc would sign up unless the price was right. The folks making million plus right now would be cut off at the knees.

You're saying VA docs making million plus?

Salaries of all VA employees (and other federal employees) are public record.
See for yourself: Search Federal Employee Salaries

 

[lobelsteve]

You're saying VA docs making million plus?

Salaries of all VA employees (and other federal employees) are public record.
See for yourself: Search Federal Employee Salaries

VA docs are overpaid for the amount of work they do. But I am referring to the needle jockeys and drug dealers who own their UDS, imaging centers, ASCs and those guys are making millions at the expense of the patient. Go to a local pain conference and see how many Ferrari, Bentley, Aston, 911s are parked out front.

 

[Ducttape]

They can't stick it to hospitals, insurance companies or big pharma, so, the middle class gets screwed, as usual.

because the system as it is set up highly encourages financial corporations with no true interest in individual or community health to reap financial reimbursement as the primary goal.

the difficulty is how to imagine or make medicine go back in to the hands of the doctors and patients, with Big Pharma and Big Hospital being truly subsistence, while providing care for everyone....

 

[drusso]

VA docs are overpaid for the amount of work they do. But I am referring to the needle jockeys and drug dealers who own their UDS, imaging centers, ASCs and those guys are making millions at the expense of the patient. Go to a local pain conference and see how many Ferrari, Bentley, Aston, 911s are parked out front.

I see hospitals doing the same thing: Owning labs, ASC's, SOS, etc. Despite their lavish government subsidies, costs haven't come down.

 

[lobelsteve]

I see hospitals doing the same thing: Owning labs, ASC's, SOS, etc. Despite their lavish government subsidies, costs haven't come down.

No motivation to lower costs. They are there for profits. If we limit who can profit and how much they can profit from healthcare, we can make a system work.

 

[Disciple]

This was my plan 10 years ago:

Pain docs are govt employees, make 90% MGMA with COLA.
Only pain docs can Rx schedule 2 opiates other than 26 pills from surgeon, ER. Oncology cn Rx for cancer when active treatment.
PCP can Rx Ultram only.
Only pain doc can do procedures, including SCS and kypho.
Cannot own clinic, lab, imaging, ASC.

I think we know how that would turn out.

Pain doctors make $120K annually, report full panels (not accepting new patients) and in general, don’t give a crap, while looking for side jobs to supplement their income.

 

[lobelsteve]

I think we know how that would turn out.

Pain doctors make $120K annually, report full panels (not accepting new patients) and in general, don’t give a crap, while looking for side jobs to supplement their income.

It only works if starting salary is 500k

 

[Ligament]

Patients will wait 12 months for a pain consult, just like in Canadaland.

Unlike Canadaland, we would make zero money as we do not control our numbers like Canadian physicians do. Somehow the canadian docs have maintained control of the system and limit their numbers, thus keeping their pay relatively high and lifestyle very nice. It is very difficult to practice in canada unless you did all your training in Canada. We of course will allow an endless flood of new docs and IMGs into the country driving down salaries.

 

[hyperalgesia]

Patients will wait 12 months for a pain consult, just like in Canadaland.

Unlike Canadaland, we would make zero money as we do not control our numbers like Canadian physicians do. Somehow the canadian docs have maintained control of the system and limit their numbers, thus keeping their pay relatively high and lifestyle very nice. It is very difficult to practice in canada unless you did all your training in Canada. We of course will allow an endless flood of new docs and IMGs into the country driving down salaries.

I also think Canada and some of the other countries liberals cite have different, less $$-minded cultures. We have a pretty aggressive capitalist culture here in the US and it's not gonna be all "kumbaya", like in the liberal day dreams.

 

[SSdoc33]

Patients will wait 12 months for a pain consult, just like in Canadaland.

Unlike Canadaland, we would make zero money as we do not control our numbers like Canadian physicians do. Somehow the canadian docs have maintained control of the system and limit their numbers, thus keeping their pay relatively high and lifestyle very nice. It is very difficult to practice in canada unless you did all your training in Canada. We of course will allow an endless flood of new docs and IMGs into the country driving down salaries.

much like we cant find americans to pick fruit or clean houses, we cant find or dont have enough hospitalists to staff the hospitals we do have or man the neighborhood clinics. getting a new patient appointemnt for a PCP can take months. your argument is completely xenophobic and flat out wrong.

now, if we were to pay primary docs like they deserve to be paid, then limiting the numbers may make sense....

 

[hyperalgesia]

much like we cant find americans to pick fruit or clean houses....

You can't find them? They are everywhere. It's just that liberals made it illegal for them to work.

These skills are worth 5 dollar/hour and liberals have determined it's better these people don't have a job than to make so little...

Collateral damage of "social justice"...

 

[drusso]

much like we cant find americans to pick fruit or clean houses, we cant find or dont have enough hospitalists to staff the hospitals we do have or man the neighborhood clinics. getting a new patient appointemnt for a PCP can take months. your argument is completely xenophobic and flat out wrong.

now, if we were to pay primary docs like they deserve to be paid, then limiting the numbers may make sense....

Patients Face Monthslong Waits to See Specialists at New York City Hospitals

 

[Ducttape]

agree with drusso -
and that's in our current capitalistic system.

You can't find them? They are everywhere. It's just that liberals made it illegal for them to work.

These skills are worth 5 dollar/hour and liberals have determined it's better these people don't have a job than to make so little...

Collateral damage of "social justice"...

what are you talking about? ssdoc is talking about the many jobs that Americans will not work in, ie migrant/seasonal jobs.

or working in a Trump hotel.

 

[SSdoc33]

You can't find them? They are everywhere. It's just that liberals made it illegal for them to work.

These skills are worth 5 dollar/hour and liberals have determined it's better these people don't have a job than to make so little...

Collateral damage of "social justice"...

?? i dont follow

 

[hyperalgesia]

?? i dont follow

A lot more Americans would be working low skilled jobs if there were no minimum wage.

 

[SSdoc33]

A lot more Americans would be working low skilled jobs if there were no minimum wage.

no.

wow, you are really living in a fantasy land.

a lot more americans would claim to be "disabled". you really think there are people out there just lining up to pick strawberries or work at mcdonalds for 5 bucks an hour? farmers cant get american citizens to work the farms. how many domestics do you see working at mcdonalds?

 

[jsaul]

A lot more Americans would be working low skilled jobs if there were no minimum wage.

you are not making any sense

 

[hyperalgesia]

no.

wow, you are really living in a fantasy land.

a lot more americans would claim to be "disabled". you really think there are people out there just lining up to pick strawberries or work at mcdonalds for 5 bucks an hour? farmers cant get american citizens to work the farms. how many domestics do you see working at mcdonalds?

Then why have a minimum wage, if Americans wouldn't work for less anyway?

 

[lonelobo]

Then why have a minimum wage, if Americans wouldn't work for less anyway?

Empathy is not your strong point

 

[Ducttape]

Then why have a minimum wage, if Americans wouldn't work for less anyway?

the simple reason: Why Is Minimum Wage Important?

the real reason:
Why We Need A Minimum Wage

The real reason why we need a minimum wage has nothing to do with the welfare of workers or the availability of jobs. Welfare is adequately ensured by in-work benefits, and the State is perfectly happy to create the illusion of employment in order to please voters. No, the minimum wage is necessary to protect taxpayers from the rational desire of firms to get something for nothing.

The simple fiscal argument for minimum wage legislation goes like this. Both the UK and the US have systems of in-work benefits that top up wages to a level sufficient to live on. So from firms’ perspective, when there is slack in the labour market (unemployment) they have little incentive to pay wages high enough to live on. And from workers’ perspective, they have little incentive to demand higher wages, especially if the consequence might be unemployment. If there is no minimum wage, therefore, then the co-existence of unemployment with in-work benefits drives down wages to below subsistence level. As the majority of government tax income comes from households, not firms, over time this becomes unsustainable: all unskilled workers become in effect employees of the state, and the higher skilled are forced to subsidise the wages of the unskilled through rising taxes. There would inevitably be calls for in-work benefits to be cut, probably supported by demonization of the poor. Unskilled workers would be subject to the same accusations of “fecklessness” and “scrounging” as the unemployed already receive. So in-work benefits without a legislated minimum wage are fiscally unsustainable and socially divisive when there is persistent unemployment.

 

[hyperalgesia]

Empathy is not your strong point

On the contrary. Someone wants to work but their work product is only worth 7 bucks / hour.

Your minimum wage makes it illegal for someone to hire him at his value. You sweep him under the rug and forget about him. This is not empathetic.

 

[lonelobo]

A Doctor who makes Specialist money arguing against a minimum wage ( in some cases a whopping $7.25) is "rich" indeed.....yes you are full empathy, your parents must be so proud

 

[Ducttape]

On the contrary. Someone wants to work but their work product is only worth 7 bucks / hour.

Your minimum wage makes it illegal for someone to hire him at his value. You sweep him under the rug and forget about him. This is not empathetic.

without minimum wage, there is no incentive for that patient to work at all. go on some form of disability. live off of the government dole. sell drugs on the street.

and there is nothing illegal about hiring someone to work for "7 bucks / hour" and paying them closer to a living wage, at over your preconceived notion that his work is devalued at $7/hour. might as well hire an illegal immigrant for that kind of work....

oh snap nm.


how little do you value someone else's work?

 

[Doctodd]

Mcdonalds just builds computer kiosks...end of minimum wage problem. Instead of hiring 2 high school kids, they only hire 1.

 

[deleted480308]

without minimum wage, there is no incentive for that patient to work at all. go on some form of disability. live off of the government dole. sell drugs on the street.

and there is nothing illegal about hiring someone to work for "7 bucks / hour" and paying them closer to a living wage, at over your preconceived notion that his work is devalued at $7/hour. might as well hire an illegal immigrant for that kind of work....

oh snap nm.


how little do you value someone else's work?

Depends on the person and the work. Some work outputs aren’t worth minimum wage

 

[deleted480308]

without minimum wage, there is no incentive for that patient to work at all. go on some form of disability. live off of the government dole. sell drugs on the street.

and there is nothing illegal about hiring someone to work for "7 bucks / hour" and paying them closer to a living wage, at over your preconceived notion that his work is devalued at $7/hour. might as well hire an illegal immigrant for that kind of work....

oh snap nm.


how little do you value someone else's work?

And the govt shouldn’t pay people to not work, the incentive to work is avoiding starvation. We all should have to provide value equal to our desired wage

 

[hyperalgesia]

Mcdonalds just builds computer kiosks...end of minimum wage problem. Instead of hiring 2 high school kids, they only hire 1.

You have just been excommunicated from the Empathy R Us Club.

 

[hyperalgesia]

A Doctor who makes Specialist money arguing against a minimum wage ( in some cases a whopping $7.25) is "rich" indeed.....yes you are full empathy, your parents must be so proud

Your preventing a person from working is NOT empathetic. What if I said the minimum wage should be 100/hour? Would I be EXTRA empathetic? You stingy bastard!

 

[lonelobo]

Lets see you don't believe in Minimum wage which at Federal rate is $15000/year full time, or medicaid for the poor.......Yes we need more people like you to make this country Great!

 

[Doctodd]

Not sure I support giving somebody who invests nothing in their training and has zero skills anything more than $5 an hour. People who invest 3 to 6 months of training should get $15-$20 an hour. Coincidentally that’s what plumbers assistants and electrical contractors assistants and boat builders make. Why should anybody working at McDonald’s or Burger King or some or barista make more than $5 an hour?