Half of primary-care doctors in survey would leave medicine

[Duppers]

Source: cnn

Doctors cite red tape from insurance companies, government agencies

By Val Willingham

(CNN) -- Nearly half the respondents in a survey of U.S. primary care physicians said that they would seriously consider getting out of the medical business within the next three years if they had an alternative.

The survey, released this week by the Physicians' Foundation, which promotes better doctor-patient relationships, sought to find the reasons for an identified exodus among family doctors and internists, widely known as the backbone of the health industry.

...In the survey, the foundation sent questionnaires to more than 150,000 doctors nationwide.

Of the 12,000 respondents, 49 percent said they'd consider leaving medicine. Many said they are overwhelmed with their practices, not because they have too many patients, but because there's too much red tape generated from insurance companies and government agencies.

And if that many physicians stopped practicing, that could be devastating to the health care industry.

...With lower reimbursement from insurance companies and the cost of malpractice insurance skyrocketing, these health professionals say it's not worth running a practice and are changing careers. Others say they're going into so-called boutique medicine, in which they charge patients a yearly fee up front and don't take insurance.

...One of President-elect Barack Obama's health care promises is to provide a primary care physician for every American. But some health experts, including Pocinki, are skeptical.

"People who have insurance can't find a doctor, so suddenly we are going to give insurance to a whole bunch of people who haven't had it, without increasing the number of physicians?" he says. "It's going to be a problem."




Read more: http://www.cnn.com/2008/HEALTH/11/17/primary.care.doctors.study/index.html

---

My family's primary care physician is leaving his practice the end of Dec, claiming that he has saved enough millions (his words) to retire at 51 and that he is just tired.

[no_hypocrisy]

1. My father preemptively retired at the advent of managed health by companies.

He'd been practicing solo since 1955 and had mostly Medicare patients, some of whom he'd treated for decades.

He left and could have stayed another 5-10 years. But he couldn't accept having a third party (insurance) debate his choice of medical care, pharmaceutical treatment, and hospitalization of his patients. It wasn't ego. He CARED each and every person who trusted him literally with his/her life.

And FWIW, he wrote off dozens of patients who couldn't pay him. And made housecalls in the middle of the night no matter what.

[Duppers]

17. bless him

I would like to think that most physicians are like your dad. You must to be so proud of him. :thumbsup:

[liberalhistorian]

80. That's what my former GP I had when I lived in

OH said. He couldn't take dealing with insurance company "pointy-headed bean counters" as he called them, trying to dictate his practice to him and trying to tell him how to treat his patients. He couldn't take how so many of his patients would often be denied the treatment he KNEW they needed and didn't have the out of pocket money for. He finally went to work at one of the city's free clinics where he could do some good without having the bean counters hanging over him all the time.

Unfortunately, he sold his practice to a soulless medical group with a philosophy totally opposite from his. No one gets in without full insurance and full payment upfront of all fees, no matter what. And their care is totally dictated by the insurance companies, the doctors there now couldn't care less.

[Lorien]

91. My father sold his practice years ago for the same reasons as those

given in the article. All of his time and the time of his secretaries was being eaten up by dealing with the insurance companies (government agencies were never much of a problem). The malpractice insurance rates were the straws that finally broke the camel's back. I think he would have been happier practicing for another 14 years or so, but he just couldn't afford to. It's disgusting; he can't afford to treat patients, I can't afford to teach any longer-the most needed jobs in America aren't being filled because the system makes it nearly impossible to survive by doing them!

[Blue_Tires]

127. my father also got tired of the shit and retired 4-5 years early in 2006

[greymattermom]

2. Big changes are in store

The other factor rarely mentioned is that many women with MDs either don't practice or practice part time. Fortunately there are thousands of well trained Indians ready to take residency positions in the US, so all that's needed is to increase the number of those, which pay about 40K per year for an 80 hr work week. The Indians arrive with no debt and a strong family structure to help them find a place to live while they study for USMLE, and they can work for less than American students because of the lack of debt. The other way the problem is being solved is that nurse practioners will be seeing routine patients, as they already are at your local drugstore.

[desktop]

5. Why is giving our jobs to foreigners fortunate?

Flooding this country with foreign immigrants to take away American jobs is not fortunate. Americas health care system needs to be completely revamped in the same manner as France. If there is a shortage of doctors, we need to train more, not import more, other countries do it and so can we. The last thing we need is the take away of American jobs and give them to imported immigrants.

[fasttense]

8. I think it is fortunate that American doctors will have to compete

with cheap foreign workers just like the rest of America.

I have two doctors in my family and they are making millions and regularly vote Republicon. They are currently blaming the 5% reduction in their income on Obama.

But I must say, that some of the best doctors I have had the privilege of knowing were from India.

[desktop]

15. So you are anti jobs for Americans, I bet you love outsourcing to

If your doctors are making millions, that's the problem to fix, not giving our jobs away to other nations.

[fasttense]

38. No, you misunderstand.

NAFTA, and many trade agreements, include protections for doctors and other medical specialists. These same protections are not given to you and me.

The bushes purposely protected rich doctors in order to secure their support against nationalized health care. It has worked so far. However some doctors have seen through this manipulation.

Unfortunately the doctors in my family put money ahead of the suffering of others. They are rabid Republicons because bush has protected their million dollar incomes. If they had not been protected, I think they might have done something about the health care crisis.

I really don't want American jobs to leave this country. But if everyone had to compete for jobs as most of us do, then we would have very few Republicons.

[JDPriestly]

129. American doctors have to pay back huge loans for medical school

and often for undergraduate school. My daughter is an American-trained doctor. She lived with us while in medical school. The doctors trained in other countries do not have the knowledge of skills that American-trained doctors have. Further, they are not screened by the interviews that American students have to take to get into medical schools. I have found that American doctors communicate better with me, care more about me and, in my opinion, are much better doctors than foreign doctors. Just because a doctor can pass a few American examinations does not mean that the doctor has the kinds of skills or the intellectual curiosity or the honesty or integrity that is developed in American doctors.

In medical school, my daughter was drilled and drilled to think about her ethical obligations to her patients. Young American doctors on the whole are given that same background, that same tough love.

Very few of the foreign doctors that I have seen have the same training and integrity as the American doctors. There are exceptions, but they are the exceptions that prove the rule. I do not want a doctor who cannot understand what I am saying. I do not want a doctor whose accent or language I cannot understand.

[elias7]

25. Making millions? What specialty are they in?

Average primary care (family practice, internal medicine, pediatrics) salaries are under $200k. I believe there is a lot of misinformation out there regarding how much money MD's make. As someone told me long ago, "If you really want to make money, don't go into medicine".

http://mdsalaries.blogspot.com/2008/07/2008-md-salary-survey-by-mh-pulmonology.html

[fasttense]

39. My brother-In-law just sold his practice to a Baltimore Hospital for

$3 million. He is a urological surgeon.

Not make money in medicine? Are you kidding? Tell Former Senator Bill Frist you can't make money in medicine.

All the big money around here in rural east TN is in medicine.

[WriteDown]

40. Geez!!!! nt

[elias7]

62. Bill Frist was a cardiothoracic surgeon, not a primary care doc

If you see what these guys do, they earn every penny of what they make. They certainly work harder, have incredible technical skill, and put themselves risk to an infinitely higher degree than a hedge fund guy who makes orders of magnitude more money.

[wolfgangmo]

72. Say it with me. Surgeons are not family physicians.

Say it again. They are completely different animals and making less that 200K per year when paying off HUGE student loans and having only about 20 or so productive years to save for retirement when starting work at age 30 to 40 .

We are on the cusp of losing our primary care docs. It's a problem.

[uppityperson]

90. Family Physicians vs specialists. There is a huge difference in income.

My primary family physicians are hurting bad. Been bought out be local "health care" group which now includes most family physicians and hospital in area. They are stressed since they must shove people through as fast as possible, providing minimal health care but doing the numbers.

No, they aren't making lots of money.

[peaches2003]

110. Some make millions, most don't

You can't generalize about what docs make. Some specialities can and do make millions. Primary care? Forget it! My son is an internist, treats everyone who comes to his office including many Medicare patients for which he gets paid the minimum and the govt has now just reduced that amount again. Works 14+ hours a day after 12 yrs of formal education and now continuing ed, fights insurance companies half his day and makes a lot less than you think, certainly less than $200K. His income will go down this year- going to a primary care doc is one of the first things people cut down on in a recession. You have to love medicine and your patients to be a primary care physician and also love exhaustion- physical and mental.

[melm00se]

112. just so we can

have some basis in facts, go here:

http://www.bls.gov/oes/current/oes_nat.htm#b29-0000

[JDPriestly]

130. How many years did he train? How many parties did he forgo while

in college and medical school? What kinds of hours did he work while in residency -- for very little pay? How many years of earning nothing did he keep going and going to school and keep working and working on his residency and specialty training? What kind of life does he have when he is not working? How much student loan debt did he have to pay back?

Unlike the CEOs and Wall Street brokers, doctors earn their livings, every cent of it.

[WriteDown]

131. Yes...

because business school is free and is all about partying. :eyes:

[JDPriestly]

132. I went to law school. Doesn't compare to medical school.

Doesn't compare to residency. Doesn't compare to the long hours that doctors spend in their offices every day.

[WriteDown]

136. My sister went to vet school....

and it is probably twice as "hard" as medical school. But business school is a different kind of hard than both med and vet school. You also aren't necessarily guaranteed a job afterwards.

[happyslug]

134. A minimum wage worker will earn over 2/3rd of a million dollars in his or her lifetime

Thus anyone who makes more then minimum wage will "Earn Millions", it may be just $14,000 a year but it adds up over time.

$ 7.15 (present minimum wage) x 2080 hours in a 40 hour 52 week year equals $14,872. Multiple that number by the age people who are turning 18 today (67 years of age) by 18 you get 49 years of labor or $728,728 dollars earned during his or her lifetime. Reversing the calculation but Starting with 1 million dollars and assuming 50 years (Extra year do to work in high school), that comes to just $20,000 a hear, and divide that by 2000 hours (treating the extra 80 as vacation) you come to just $10 a hour. In simple terms anyone who is earning more then $10 an hour will earn at least one million dollars in his lifetime (assuming no inflation). Median Income is only about $42,000 a year or about $21 a hour. Median income is the point where half the population is making more then that number and half less. Median is TWICE as high as is needed to earn a million dollars so we can safely say MOST Americans will earn MILLIONS of Dollars.

A million dollar is not much money any more.

[crikkett]

32. they might have to do their own ironing.

[NashVegas]

48. Just, Perhaps, But Not Fortunate

Middle and upper-middle class white collar workers stood by and profited from the Reagan revolution that turned huge numbers of our population into "invisible people," and now they're finding out what it's like to have their ass on the line.

This is why we had to bailout Wall Street. Because all these people are complicit in the screwing over of people who depend on a steady weekly paycheck for their most basic necessities, and when the house of cards started coming down, they knew they were fucking, fucking, fucked.

The uber-rich will be just fine if Wall Street comes down. The upper middles, who don't meet at the country club once a week and make deals on the green, they depend on high stock prices and good dividends.

[awoke_in_2003]

52. How in the hell can an American doctor...

compete with $9.62? (From your numbers- $40k and 80 hours a week). Might as well save the huge college loans and just go work at Home Depot. Yeah, how fortunate for us, we can get our medical care for under-qualified foreign doctors :sarcasm:

[greymattermom]

83. resident salary

For a 5 year program after the M.D. That's 9 years of no or very low pay before the real money starts.

[wolfgangmo]

70. If your relatives are making millions a year.

Then they are not in general or family practice. And so they are not what this article are talking about. If our medical system become dependent on foreign trained doctors then we are setting up the next generation to problems if those foreign doctors decide that they can get a better deal elsewhere. Our health care could dry up like a fart in the wind.

The medical "elites" are often in it for the money. I have as of yet met a family physician who didn't get into it to help patients and who don't resent the red tape.

Our clinic does not bill insurance for patients because we can't afford to. There are not enough hours in the day to fight every decision with some uneducated $12 an hour bureaucrat who gets a bonus for denying treatment to patients and denying payment to physicians. For our sanity we decided to stop billing insurance companies.

And so we take cash on the barrel head and concentrate on helping as many people as we can. More physicians are doing this because they are tired of seeing patients for 35 hours a week and then spending another 35 hours a week on the phone or writing letters to get through the red tape to get treatment for patients and to get paid. Even when we had treatments pre-authorized in writing the insurance companies would turn around years later and then deny them. A colleague of mine just got a letter from BC/BS that said that 3 years of pre-authorized treatments have been "disallowed" and so they are suspending payment from all future covered patients until that money is paid back. That clinic may become cash only soon. They can't afford not to.

We have also looked realistically at moving our clinic and employees to another country. So far we haven't but we are keeping the option on the table and we revisit it often. If you think things are bad now, you ain't seen anything yet.

[Mojorabbit]

95. My husband is a family physician in private practice

and he certainly is not making anywhere near a million, not even close. He also votes Dem. We have three employees that we pay good wages to. The last thing we need are foreign Drs. coming in. What are they going to pay their employees if they are making a low salary? How are they going to pay their malpractice insurance and make a living on a low salary? That is the dumbest thing I have ever heard. The only way that will work is if they are employees of a hospital and it decreases the standard of living for everyone.

[greymattermom]

82. actually

I'm in favor of raising resident salaries and lowering their work week so Americans can compete. I help train neurosurgery residents and they have admitted falling asleep in the OR.

[Rydz777]

30. I have great respect for the ability of Indian trained

professionals, but when we draw upon developing countries to staff our professions, especially medicine, we are depriving the countries of origin of skills that are needed there too.

One problem I have with Britain's National Health Service is that it recruits heavily from developing countries for doctors and nurses. In a way it is a way of extracting subsidies from poor countries to support services in a developed country.

[Duppers]

85. nurse practitioners

All hail the nurse practitioners, who, btw, have provided some of the best health care to my family. Seriously.

[WriteDown]

3. Saved enough millions????????????

Nationalize medicine and cap doctors salaries at 100K!!!!!!!!!

[DUlover2909]

6. $100k today is the same as $70k in 2001 with US dollar devaluation.

I don't really think that is fair. Doctors are very important to everyone. They try to help us and they work very hard to get their diplomas. Why should they make so much less than CEO's of failing companies that ask for a government hand-out?

[WriteDown]

13. Most Dr's...

are arrogant, self-serving egotists who went into medicine for the prestige, money, and trophy wife. I'd be willing to look at any plan that limits the field to anyone who truly loved helping people.

[elias7]

26. Wrong. You have no idea what you are talking about.

[RattusRattus]

28. First

My sister is not a trophy wife. Second, while that doesn't describe all Dr.s I know, I can say of the surgeons I've seen, they're either money grubbing whores, or some other type of whore (my former boss liked to pretend she was a "scientist" by going to conventions, but not actually running her lab).

That said, something needs to be done about medical liability. If Dr.s salaries need capped, then the amount people can get out of these lawsuits also needs to be capped, with obvious exceptions made, such as if someone dies due to the negligence of the Dr. Sometimes they get sued for doing the best they can with difficult circumstances, and making a mistake. A lot needs to be changed about health care. I have a friend who works as a programmer, dealing with the insurance companies who are reporting medicare/medicaid expenses, and they are constantly rewriting things to keep the companies from cheating and getting more money than they should. It needs to be less profitable to commit fraud. Though, I'll admit, I think there are white collar crimes that should be punished by the death penalty. Like the executives from Enron, whose actions caused thousands of people to lose their pensions, I think that's as heinous as killing someone.

[elocs]

41. I would guess that you have some kind of personal problem with doctors

and are using it to justify your proposal. Capping doctors salaries at $100 grand is one of the most absurdly stupid ideas I have ever heard. Why would anyone want to go to medical school for years and incur tens and tens of thousands of dollars in student loans to have their salaries frozen? Why would they go into medicine and where would the many more physicians be found that would be needed for a national health plan? Limit medicine to only those who truly loved helping people and see what happens to the availability of healthcare in this nation. I am guessing that nobody else here at DU would want to see their salaries frozen.

I must say that your prejudiced and narrow minded description of physicians in no way reflects the experiences I have had with my doctors over the years who have given me outstanding treatment.

[WriteDown]

42. The reason would be simple...

"Why would anyone want to go to medical school for years and incur tens and tens of thousands of dollars in student loans to have their salaries frozen? Why would they go into medicine and where would the many more physicians be found that would be needed for a national health plan?"

They would do it due to a genuine love of helping people. Something sorely lacking in today's field of medicine.

[elocs]

43. You really, really need to get in touch with reality.

Yes, that would be nice, but for any kind of national health plan with many more doctors than we now have. Deliberately doing something that reduces the number of physicians needed is stupid and will only hurt those who need healthcare the most. The wealthy will always be able to find a doctor.

Again, you use your prejudiced and insulting, broadbrush description of physicians to represent them all. I am sorry you have apparently known few caring doctors because I have known many and I would say most.

[WriteDown]

44. Luckily....

I am comforted by the REALITY that when we have a nationalized healthcare system, Dr's salaries WILL be capped. You may want to start learning to accept that.

[elocs]

46. What part of there will not be enough doctors if you cap salaries do you not understand?

You are seriously not in touch with reality as it will be in the U.S. concerning healthcare and physicians' salaries. It will not happen.

[WriteDown]

50. No...

It will happen. Just as Canada and Great Britain have realized caps are necessary.

[JonQ]

60. And they, especially britian, have a chronic shortage of doctors

only partially made up for by importing thousands of foreign and questionably competent doctors from the third world. This is not a desirable outcome and it certainly isn't sustainable in the long run.

[WriteDown]

64. But Britains system

is still eminently more favorable to our own. No system is ever going to be perfect, but theirs is the way to go. I am also a proponent of mandatory checkups for patients since preventative care is sorely needed.

[JonQ]

67. Favorable how?

I don't consider a shortage of doctors leading to long waiting lines and poor conditions to be desirable. Being guaranteed treatment that does not exist is not superior to being unable to afford actual treatment.

And if patients refuse to show up for their mandatory checkups what then?

That's my biggest concern with UHC, once the government says your health is it's responsibility then doesn't it have the right, or obligation, to govern your life to make you as healthy as possible? Awfully slippery slope there.

[WriteDown]

71. Like I said...

There is no perfect system, but in GB at least you are not charged for emergency care.

If you'd like to suggest another way, then I am all ears.

As far as missed visits are concerned, I would recommend a tax penalty. That person is basically neglecting their own health and will end up costing everyone else more money in the long term.

[JonQ]

73. You aren't charged here

for emergency care if you can't afford it. That's why our emergency rooms are always full.

And I would suggest keeping it the way it is, with government relief in the form of subsidized medical insurance for those who legitimately can't afford it. We don't like to talk about it, but some people without healthcare actually can afford it but choose not to (not all, but some and I have no sympathy for them, they made their choice).

And what about people who can't afford the tax penalty? Jail?

[wolfgangmo]

78. Sorry chum

Neither Britain nor Canada caps salaries.

Neither. Britain allows national health care docs to moonlight at private clinics for more money and Canada has no limit at all because all of the docs there are NOT employed by the government. Your facts are wrong. Sorry.

[WriteDown]

81. Uh....

Yes they do. And so does Japan. I would not be against the moonlighting idea though.

[Lydia Leftcoast]

97. Japan caps compensation for specific treatments, NOT doctors' salaries

Get your facts straight.

[WriteDown]

107. See post 106 nt

[wolfgangmo]

137. Uh, no they don't

We have colleagues from med school who are practicing in both Canada and Britain. Neither have capped salaries.

In Canada not 1 doctor in the country works as a physician for the government. They all have their own private practices or are hospitalists.

Where the heck are you getting your info?

[JonQ]

57. Great idea

set it up so that after sacrificing 10 years of their lives (4 years undergrad, 4 years medschool, 2 years internship) and being hundreds of thousands of dollars in debt, and busting their asses in the library for most of that time, and enjoying 80 hour weeks and being on call even when they're off work they get to be rewarded with a warm feeling in their gut.

But I have to ask, what if we as a nation happen to need more than the half dozen doctors this plan would actually produce?

[soothsayer]

75. Yes, and a call to healing. Back when medicine was an art, not a science, much less a BUSINESS,

doctors were more compassionate. Then it became a money making racket (for some, not all) and we have today's cold system.

[LanternWaste]

58. Unless of course you have a 1,500 plus sample...

Appears to be yet another opinion based on little more than mere anecdotal evidence I would hazard, yet stated as an absolute.

Unless of course you have a 1,500 plus sample...

[wolfgangmo]

74. that is not my experience and I know a lot of docs

I own a clinic and run into a lot of docs and see them both socially and professionally. Most of them work their asses off for their patients even when they are not "on the clock."

I think you may be drawing from a small statistical universe for your generalization, although it may be true in your experience. I just don't see it.

[Ramsey]

79. Guess I forgot about my trophy wife...

Except that I am a heterosexual female doctor, so I don't really want one. Oh, and I have been an academic physician for my entire career, treating cancer patients, doing cancer research, teaching residents and medical students in one of the best medical education systems in the world, so that my patients can have highly trained and qualified physicians care for them. All for less than half the salary of my private practice colleagues.

But yes, I see your point, all doctors are arrogant assholes with trophy wives who just want to make more and more money. By all means, give my job to a poorly trained foreign doctor who has no clue about current standards of care, I am sure you will be happy with your quality of care.

Get real, what fantasy world do you live in. Very few doctors make millions. No primary care doctors can do so. Most doctors are comfortable, but not uber-wealthy. All doctors spent about 12 more years in school than the average American, during which time they made no money and racked a large mortgage worth of debt. Most people still go into medicine to care for people, not because they are going to get really rich.

[bmbmd]

121. No trophy wife? Too bad.

I got mine thirty one years ago. She put me through med school. She raised my four kids. She teaches junior high art. She campaigned for Obama. She puts up with me. She is my encourager, my best friend, my true love. I don't know what I would do without her. Trophy, indeed.

You, dear doctor, will have to be satisfied with doing a thankless job in too many hours for too little compensation for a public that thinks they know everything about you and your profession. I may be flat worn out from the toll this job has taken, but I am still enough of a gentleman to tip my hat to you, to thank you for you dedication to your art, to admire your passion for the teaching of medicine and the aquisition of data, and to wish you the very best in your career.

[uppityperson]

92. Some are, but not "most". Most I know work their butts off because they want to help people.

I do know some surgeons and specialists and indeed even some fp's who do fit that description, but not "most" by a long way.

Did you hear the story about people lined up at the Pearly Gates, waiting to get into heaven? 1 guy kept breaking out of line to go to the front and complain about how Important He Was and why should he have to wait in line. Kept getting told to get back in line since it didn't matter, everyone was equal in the line.

Suddenly a person in surgical scrubs walks up, passes the line, waves to (whatever the gatekeeper's name is) and went through the Gates. The Important guy rushes to the front again, complaining mightily, only to be told "That's God, he thinks he's a doctor."

[Lorien]

94. Oh bullshit

I have many doctors in my family. None of them have huge egos, or a trophy wife, and they all got into it because they wanted to help people. My dad has a fair amount of money, but he's not "rich" by GOP standards by any means. My own GP is a young woman from Brazil; single mom, works 80 hours a week and is constantly exhausted-but she can't say "no" when her patients need her, so she's there at all hours. Paying for malpractice insurance and health care for her staff has sucked away any "riches" she ever might have come by, and she doesn't charge her poorest patients for office visits. She knows how hard times are for all of us.

I can honestly say that I have only personally known ONE doctor who is a self centered, egotistical jerk. He was a guy who used to share an office with my father. MOST doctors go through years of med school and endless hours interning because they want to make a difference in the world by helping people.

[desktop]

14. You want doctors to make as much as CEOs

The American health care has collapsed for the average American and you want to pay doctors like CEOs? We need to fix the system not destroy it. Granted doctors are a small part of the financial problem, but it's time to face reality, the health care system has to be nationalized, and yes that means socialized. We need to train doctors at our expense and then pay them up to $200K or even $400K for some, but average people are making 40K with college degrees if they're lucky to have a job at all.

[Changenow]

22. They have earned a decent living

but to say they are worthy of the criminal compensation of the corporate CEO is quite another matter.

[LanternWaste]

56. As are teachers and law enforcement officers.

"Doctors are very important to everyone..."

As are teachers and law enforcement officers. Seems to me the three are in the same position as to their priority in the American social fabric...

[MichellesBFF]

7. DR's

Nationalize medicine and cap doctors salaries at 100K!!!!!!!!!

You're also going to have to provide low cost (or no cost) education if you go with this idea, the amount of debt that most DR's graduate with is staggering.

[iamjoy]

10. I'd Go For That

I'd go for something that pays the cost of medical school (or pays back the loans) for a good doctor willing to serve where needed.

[WriteDown]

11. When I was at Carolina....

Many Dr's graduated debt free due to their fathers taking care of their tuition. Not all Dr's have loans.

[wolfgangmo]

139. So we should count on someones Daddy...?

To make sure that we have good health care.

That sounds suspiciously like the Bush "family plan" to me, and we all know how that turned out.

[Thothmes]

27. That means the tax payers also inherit the

liability insurance fees.

[wolfgangmo]

138. Government gets the liability insurance?

What?

No they don't. The docs will keep that .

However, given that the high liability rates in America are based in large part on payouts that are based in large part on continuing medical care, which is not a factor in single payer systems, both the payouts and the insurance premiums are affordable.

Sorry, but your argument is based on misinformation.

[sentelle]

35. a cap is fine...

As long as there is a method that can be employed to incentivise welness.

Some of the high cost of healthcare is the cost of curing things that preventative medicine would cure. But there is no money in preventative medicine.

Its easier to prevent heart disease, than it is to cure a heart attack. Its less expensive too. If this cap, provides an incentive bonus for doctors who helped their patients get healthier, like in NIH, I'd be for it.

[pitohui]

45. i would support the no cost education plan based on merit only

i would strongly support a plan where doctors' educations are paid for, it seems to me that anyone studying medicine needs to be a high quality scholar and should receive a high quality scholarship, however, in exchange for the free education, under my plan it would be required that the doctors would contribute some portion of their practice each month to public care

i would look to costa rica, where doctors provide public service AND still are permitted enough time for private activities like cosmetic surgery, so that everyone receives care but the doctor who wishes can still, one day, be a multi bazillionaire

oh, and folks in costa rica live longer than us too -- could it be because they can see a doctor and i usually can't, even w. hubby's insurance? or when i do see a doctor, i'm rushed in and out in less than 5 minutes?

[Lydia Leftcoast]

100. Yes, I was startled to hear from a friend who traveled in Costa Rica

and was involved in a car accident there. She was treated just fine in a clean, modern hospital, and the only charge was $15 for the crutches she still needed to walk with if she was going to fly home in time to start work.

[customerserviceguy]

54. I'd go for figuring out how to help them get low-cost malpractice insurance, as well

If malpractice premiums have to come out of the $100K, you'll have no one practicing medicine in this country.

[wolfgangmo]

140. Single payer will take care of malpractice.

Here's why.

Malpractice premiums are based on the perceived risk of a mistake and the cost of litigation and settlement. The largest part of any settlement is, by far, the cost of future medical care. In a single payer system everyone is covered so that amount is not figured into any settlement and thus the premiums are MUCH lower in single payer systems.

[annabanana]

9. It's not the Doctors salaries that are killing us... it's the cut the insurance

companies take along with the red tape they tie the doctors in...

[Duppers]

18. Yes. That's the point of the article.

IMHO.

[uncle ray]

65. they are tied together.

when the doctors say they'd do something else if there was an alternative, i doubt the alternative they have in mind is a practice where they are low paid and free of red tape. it's obvious they mean if there was an alternative where they can come out filthy rich they would do something else. they tolerate the red tape to get rich. i suspect if you removed the profit motive both for the doctors and the HMOs, much of the red tape would simply disappear.

[wolfgangmo]

141. Your assumption that all doctors are only in medicine to get filthy rich.

Makes as much sense as saying that all liberals are traitors, when we all know that only some of us are {smiles}.

Seriously though what most primary care docs want to do is to spend more than 50% of their time taking care of patients and spend the other 50% studying, learning, and getting better at being doctors. Now, they spend that 50% of their time fighting to get paid and fighting to get necessary care approved for their patients.

It's a problem and scapegoating one of the victims is not the solution. The real culprits here are the private insurance companies who are putting the squeeze on docs and at the same time raising your premiums while denying you the coverage you paid for.

[w4rma]

12. Why should doctors have their salaries capped while there are other professions that provide nothing

for people, except to move money around, that don't? Like insurance company execs.

[Duppers]

16. ...

I don't think they should be capped at 100K either. They truly work very hard, harder than most people do!

In the case of my doc, he is a very competent Internist but, unfortunately, he's also a hard-nosed rightwinger who brags about his money and once argued with me (during an appt.) about Paul Krugman. No, I'm not joking --he did! (I haven't seen him since Prof. Krugman won a Nobel, but my hubby advise against my rubbing his nose in it.) He called my son (applying to Harvard & MIT for grad in '09) immature! He knows shit about my son.

Needless to say, I'm won't miss him, BUT -here's the kicker- He saved my husband life! So, I have very mixed feelings.

[Zuiderelle]

66. LOL! Yes, that's what I want... a doctor who can hardly make ends meet.

That would hardly even cover most doctors' yearly malpractice insurance.

[lostnfound]

4. Back in 2002, 70% were "satisfied" with their careers.

70% out of 12,000 surveyed nationwide: http://www.ucdmc.ucdavis.edu/news/happy_docs.html

I wonder whether it has changed. And after seeing Sicko, I wonder if docs in countries like Canada and France are happier or less happy. The CNN article seems like a scare tactic with a misleading headline -- is it the spectre of universal health care, or is it the current insurance system, that is driving them away?

[Duppers]

19. Good pt. It's the current insurance system ...

..that's driving them away. At least that's what the article is stating (I think).

[Xipe Totec]

20. This is what happens when bean counters are allowed to practice medicine

it drives real doctors away.

Thank you Ronald Reagan, for putting health care in the hands of insurance accountants.

[Duppers]

23. Truth!

"Conservatives love to complain about government bureaucracies, but insurance companies are masters of the bureaucratic art.

Defenders of these carriers, whether health carriers or long-term care carriers, rely on ideology, on rationalization, or on industry promises to defend the present system.

Meanwhile lawyers get rich, the people running the carriers get very rich, and those who thought they were covered are drowned in paperwork, excuses, and bills they cannot pay.

So there, I think, we have the real difference between a public and private health care system.

In a public system bureaucracy is just waste. But in a private system, bureaucracy is a profit center.

As the debate over health care heats up, this is the point I’ll remember most."

http://healthcare.zdnet.com/?cat=36&paged=2

[pitohui]

47. look at your insurance filing, it's the current insurance situation

have you read any of your statements lately? i go to the doc and pay a $25 co-pay, and later the insurance co. comes in and their share of the bill is something like $1.38

seriously i had a check-up recently where the insurance co. paid my doctor all of $1.38!

no wonder he doesn't have time to chat

most of the docs around here make money from cosmetic procedures that they push heavily in their ads and their waiting rooms, cosmetic procedures that you pay for in full up front, or on your credit card, or by taking out a loan where it appears strongly to me that the doctor also gets a cut for selling the financing...they are not making money from practicing MEDICINE, they are making money by being glorified beauticians and loan officers

saving lives is their part time gig on the side at this time of century -- no wonder they're unhappy, there are only so many face lifts and botox treatments that you can sell

as for dentists, as dental insurance is mostly worthless, YEARS AGO they cut back to working part time and just billing the fuck out of you for cosmetic treatments ...if you have a severe dental problem, don't bother to get it treated here by some part-timer who spends more time on the golf course than keeping up with dentistry, you're better off heading to mexico where the dentist works every day, has his own lab, and keeps getting the experience...

[Oak2004]

126. Odd... I come from a family of dentists, and they all worked (or are working) full-time

And the only surviving dentist (my younger brother) keeps up with dentistry so much that, after 20 or so years in practice, he's earned certification as a dental anesthesiologist. That's about the third major certification he's earned since he left dental school.

Either you have been stuck with some really bad dentists (they do exist), or you are selling professionals short. If so, aim your fury where it belongs, which is, largely, the insurance industry. My brother has a small, one-dentist, practice, and two full time employees whose job is to make sense of dental insurance red tape.

[wolfgangmo]

143. Clinic owner here.

It is private insurance. I know of 2 colleagues who have emigrated to Canada because they say they make almost as much money, have 1/2 the overhead and don't spend half of their time going to war with the insurance companies over payment and patient treatment.

Our clinic doesn't bill insurance anymore and we only take cash on the barrelhead. Why? Because the docs, who had huge student loan debt were only taking home about $30,000 after expenses. Most of them couldn't afford to buy a house.

And it wasn't because they don't work hard, care a lot, and give freely of their time. They want to be docs, but primary care docs are getting forced into a position of not being able to afford to be docs.

When a high school graduate driving a garbage truck makes more than a doctor, the priorities need to be straightened out. We MUST take private insurance inefficiencies out of the system or it will collapse.

[Oregone]

21. The free market will fix this

[Duppers]

24. you forgot the sarcasm icon

nt

[Oregone]

37. Why do I need it anymore?

In a post-Bush world, anything I say is pretty much sarcasm

[phillysuse]

29. And no one is going into primary care either -

My son's a medical student - he loves pediatrics but as he says most pediatricians work very hard and rarely make over 100,000 despite the years of school, training and the loans.
And none of his friends want to go into primary care - the ones who do will be the students not good enough to get residencies in fields that pay better like radiology, orthopedics, dermatology and plastic surgery.

And meanwhile insurance companies like Wellpoint and Aetna are outsourcing surgical procedures to India which will bring down salaries for orthopedic surgeons and cardiovascular surgeons.

Medicine in the US is in a downward spiral.

And even if Obama gets additional health insurance cards to people, it may not improve access since access depends on their being physicians available to treat patients. Same thing happened in Massachusetts - more people were now insured and wait time to see for pediatricians, family docs and gynecologists went up because there aren't enough of them.

[WriteDown]

36. Don't take this the wrong way...

But if your son loves pediatrics then why would he not pursue that field? Does he really NEED to make over 100K? This is part of what I was talking about.

[wolfgangmo]

144. This work is critical and hard.

Your premise is that we should drive down salaries for docs, which would, IMHO, do to medicine what Reagan did to education.

Frankly I don't want the least common denominator as a doc. Do you?

The low average debt of a medical school grad is over 250K. Which means that they will be paying about $1500 a month in student loan debt for 30 years, at which time they will be ready to retire. Add to that the fact that they haven't been able to even start saving any money until they are well into their 30's and you have a perfect storm.

Sure, lets cap their salaries and make sure that the ones who do graduate can't save for retirement or own a home. Oh and they get to work 70 hours a week on average. Let's run your numbers. 100 k per year is about 40% tax bracket or about $60k gross. That is about $5000 a month. Subtract 1500 in student loans debt and we have $3500 a month. Most docs are private contractors who pay their own overhead . And now we have about 1750 per month take home. Take out a mortgage at $1000 a month and you have $750 to play with. Groceries is going to be about $400 is they economize and we have $350. Car payment brings that down to about $150 per month or $37.50 per week.

So they are gong to be working about 70 hours per week and they will get a surplus to $37.50 per week to spend as they wish. If they have the time or energy to go to the store.

Who the fuck would put up with the time and stress? Very few. If you get your way then thank god Mexico and Canada are nearby, because that will be the only places we could even find a primary care doc.

[WriteDown]

146. See post 142.

[IsItJustMe]

31. Bull SHIT!!!! Talk is cheap. Reminds me when half of the Clinton voters said they would not vote

for Obama.

[investintrains]

33. 1000 vegan MD's

www.pcrm.org

[ayeshahaqqiqa]

34. The whims of insurance companies drive MDs nuts

I work for an MD and we never know if an insurance company or Medicare or Medicaid is going to cover a lab test or not. The response we often get is "Go ahead and run the test and we'll decide whether we cover it based on the results." Now one of the main reasons to run a lab test is to help Doc figure out what's wrong with a person--are her symptoms caused by hyperlipidemia, for example? When the lipid test comes back normal, that rules it out as a cause for her symptoms. But what is happening more and more is that the insurance won't pay if the test comes back normal. This is ridiculous, imho.

[pitohui]

51. ok but MDs also need to disclose this

i do not want the test run if it will not be covered by my insurance

a friend recently had a test run for colon cancer, they needed to tell him up front that his insurance had been cxl'd (the ins. co. gave the excuse that they cx'd him "because of katrina" altho what the fuck a hurricane has to do w. colon cancer i have no clue) -- well, obviously, if the insurance was cxl'd it was not right to do the test, because if my friend did have cancer, he would not be able to get any other insurance and thus he would not be able to get treatment and thus he would die with or without the test, in that case better not to know

when the receptionist or whoever runs the insurance card and finds out that something is wrong, they need to inform the patient right away...not AFTER the procedure or test is done...please understand that many people, probably MOST people, can't afford these tests and procedures that are always performed at a price that is NEVER disclosed to the patient up front

another case, a colleague's wife had a baby, they told her during pre-natal that it was covered by her insurance, what they didn't say was that between the pre-natal care and the time she gave birth -- the hospital no longer accepted the plan -- they admitted her anyway and then billed her for thousands upon thousands of unexpected dollars at a time when she most vulnerable -- i honestly think that hospital and everyone involved in that scam should be prosecuted for fraud, because if they had been honest, she would have gone to another hospital where she was covered, but they wanted to take her house -- it's more profitable than taking the dribs and drabs from the insurance co. after all!



in no other area is it allowed to "spring" a price on a patient who is sick or injured, even sometimes unconscious, and has no idea of what the price is or whether or not it's in their budget to pay

costs should be capped and disclosed UPFRONT until such time as we have a universal health care system where patients do not have to be pestered about costs

[peaches2003]

115. You are so right!

Happened to me. Had a biopsy come back negative (thank God), but BCBS refused to pay because it was negative- said it was an unnecessary lab test because the result was negative. How the hell do you fight this kind of robbery.

[ayeshahaqqiqa]

124. I hate BCBS

they are the worst of the insurance companies I have to deal with.

[peaches2003]

128. We are both on Medicare now

and have never had a thing denied and have had the best of care with all our regular docs, including major surgery for both of us. Now....if Obama will do something about that donut hole! :crazy:

[wolfgangmo]

145. Get your coverage from a bookie.

At least they pay off when they lose a bet.

[mopinko]

49. half of respondents- NOT HALF OF DOCTORS.

they had a less than 10% response rate. so that means less than 5% of surveyed drs. i would presume that some of those that failed to respond are unhappy, but i also thing that there could be a strong correlation between being unhappy and participating in a survey about unhappy drs.

[Duppers]

86. yes, the title of the article is misleading

but following DU rules, I had to state the title as given on cnn.

[yardwork]

53. Our health care system HURTS primary care doctors. It's inhumane.

The secret behind all the yelling about "socialized medicine" is that the U.S. government already meddles to a very great extent in the practice of medicine - especially primary care medicine.

We need reform and we need it now.

[Duppers]

87. hear hear!

thanks

[nichomachus]

55. Not all doctors are millionaires -- and many don't make all that much money

What the HMOs pay doctors per patient visit is ludircous -- we're talking less than $50, sometimes much less. In some cases, they get $15-20. This is why a lot are starting to refuse insurance. My old doctor will file the insurance claim for you, but takes only cash or check at the time of treatment.

However, a friend who is living temporarily in Spain had a serious back problem last week. He went to the ER and was seen right away. They worked on him for four hours, prescribed some meds, took some x-rays, and lined him up with a specialist. He just got the bill -- 100 euros. In the US, you'd be looking at a minimum of $5,000.

[msongs]

59. require prices of ALL fees be presented in advance IN writing - fixed with NO adjustments

once the patient agrees in writing. No changes allowed. All medical services and their costs should be listed and available to patients statewide.

I am not saying all providers must charge the same fixed prices, just that each provider make available their own prices so that patients can compare prices in advance of selecting a provider for specific services.

That's how retail works, choice to the customer.

Msongs

[lisainmilo]

61. Here is a site: Physicians for National Healthcare

A friend of mine told me about this site.

http://www.pnhp.org/


I believe if doctors are doctors for the money alone, they should not be doctors. You have to have a sense of empathy for humankind if you are to care for another human being.
Unfortunately the insurance and pharmaceutical corporations have lessened the empathy for the sick with their primetime commerical ads (costing millions) and the numerous "hoops" doctors and healthcare facilities have to jump through in order to get paid. It has not been the doctors running my healthcare, it is the insurance and pharmaceutical companies running my healthcare.
I also believe that whatever the cost of going to school, a person in his or her particular field, must be able to payback the loan(s) and make a decent living for years to come, "CAPS" must reflect and sustain this. Just my opinion though. :-)

[Duppers]

88. Thank YOU!

nt

[bertman]

63. To say that a medical doctor should only make $100K is insane. I know plumbers and

building contractors who make more than that a year and I sure as hell don't want them diagnosing my medical problems.

When someone spends as much time and energy, and has the brains to satisfactorily complete medical school, an internship and a residency, they deserve to make more money than a plumber or building contractor. And that's not factoring in the damage they can do if they're incompetent or misdiagnose a malady.

Sure, some doctors are arrogant. So are some athletes, lawyers, business owners, laborers, administrators. Get my point?

It's not about whether they are arrogant or not, it's about them being trained to properly diagnose and treat diseases and to help prevent disease. My wife's life was saved a by a surgeon who removed her appendix just as it ruptured. Do I begrudge him his $350,000 per year earnings? HELL NO. Do I begrudge the millions of dollars an oncology specialist will earn over his/her years in practice healing those unfortunate to have cancer? HELL NO. Do I feel jealous or covetous of the doctor who makes hundreds of thousands of dollars a year because he helps thousands of people to heal and become healthier every year. HELL FUCKING NO!!

We reward people for the work they do based on the training it takes to do that work, the skill it takes to be good at what they do, the successful outcomes of the work they do.

I am happy that my doctors make a big fat salary and live in nice homes and are able to afford the "good life". Because I'm incapable of being a doctor due to my inability to conquer chemistry and because I don't want to spend my days dealing with other peoples' pain, disease, discomfort and misery, I will gladly pay my share to reward those folks who are capable of doing that and who do it well.

[WriteDown]

68. As we nationalize healthcare, sacrifices are going to...

be have to be made. Maybe not a cap at 100K, but maybe 150K. Mandatory doctor visits. Reduced ability to sue doctors and hospitals.

[bertman]

76. That's bullshit. Where are you getting this idea?

This kind of crap is why so many medical professionals get bug-eyed when we start discussing universal health care.

What kind of work do you do and how much do you get paid, WriteDown? I'm curious. You seem to have all the answers about how our health-care professionals should be paid. Why don't you share your info with us so we can analyze whether you need to make some sacrifices too.

[WriteDown]

77. Great Britain and Canada nt.

[Lydia Leftcoast]

101. Your assertions have already been debunked upthread

There is no cap on doctor's earnings in Canada, only on compensation for specific procedures. The same in Japan.

In Britain, NHS physicians are salaried (the one interviewed in Sicko seemed to live comfortably) and are allowed to pick up private patients as well. There is also a parallel private system for procedures not covered by the NHS.

[WriteDown]

106. Exact same result....

Read up....

http://mdsalaries.blogspot.com/2008/04/doctor-incomes-in-japan.html

[Duppers]

89. I agree.

I posted that opinion above.

[mopinko]

98. another big fat are you crazy.

even $150K. people, lots of people can live on that, and think it is big money. but it is chump change for someone with a doctorate. the principle at my local elementary school makes that.
really, i am on the other side of that, and i am here to tell you you cannot get an h1b indian code monkey for that kind of money. (no slur intended with the monkey part. it is just that it is a fairly mindless job.) you might be comfortable. you might have a decent retirement fund. you might even get to take a vacation. but you are not going to raise a family, and send your kids to a good college on that kind of money.

[Libertyfirst]

135. Thank you for your post.

I have had very serious accidents and critical illnesses. All but one of dozens of doctors have been superior in every way. It was clear that most of them cared about doing a good job and they were also supportive of my family. They were kind. My primary care doc is the gold standard for what a primary care physician should be. And he lives a few blocks from me so if he has made millions he damn sure hides it well.

[Delphinus]

69. I wonder if

HR 676 (Medicare for All) passed if they would change their minds.

[tjahome]

84. I have lurked long enough...

This is my first post. Most of the time I find that what I want to write about is already written, and written better than I could at that!

However, when it comes to health care, I can't seem to reconcile what my doctor friend told me:

If we nationalize health care (which he assumes would be a national repayment system much like medicare) he will be the first to close his practice and open a cash only business. He said this would create a "welfare" type medical system for those who can't afford to pay cash. Therefore, assuming greed rules, the best doctors would service only the rich, and specialists would not be available in large numbers for the "welfare" system. My friend is a huge liberal, but is still paying off loans ten years into his practice.

Obviously I don't want this to happen, but I have heard it is pretty status quo in Britain.

[pitohui]

96. you've never been to britain have you? stop drinking the kool aid, kthnx!

if your doctor friend (who doesn't exist but say he does) really did open as a cash only business, and his fellow doctors did the like, you do understand that the price he would be able to charge for medical services would be greatly slashed

reason -- there is only a tiny percentage of the population that is in the upper 1% of all income earners -- in fact that percentage is only 1%!!!! -- and that tiny percentage is not going to use your doctor friend's services, they are going to continue to use the exclusive services of the very few top "celebrity" doctors, surgeons, and hospitals that, guess what, they already use

the doctor who goes back to "cash only" in this marvelous economy where people can't even pay for pills and food the same week, much less the doctor's visit too, will soon be in the business of accepting barter -- as actually used to be in the case pre 1940s -- let's see your doctor pay off his beemer in chickens, tee hee

the median income of americans is around $40K per year, if doctors go back to the real world, where the insurance industry isn't providing "price support" for their outrageous charges, there would be a de facto "cap" on what doctors could earn almost immediately

if "cash only" was more profitable your doctor "friend" would already be "cash only"

it ain't -- because the "cash only" patient doesn't actually have the cash

oh, and by the way, since you know NOTHING about health care in the u.k. perhaps it is better not to comment on the subject -- if the british system is so terrible i wonder why they live so much longer than we do -- sorry, pal, the math don't lie but people do -- and when i hear tall stories about "friends" and then i check the statistics, i guess i'm gonna believe those lyin' statistics every gee-dee time

in "sicko" moore visited the home of one of the nhs docs -- in an expensive area of london called greenwich which you in your dreams and your doctor "friend" in his dreams could never possibly afford to live in a million bazillion years so, yeah, keep drinking the kool aid about how doctors and patients are worse off under a socialized plan

you are a dupe for the insurance bureaucracy and should be ashamed of parroting such arrant nonsense

the profit gained by the insurance bureaucracy is stolen from your pocket, my pocket, AND your doctor friend's profit -- it is a layer of bullshit wherein someone is taking money for standing between you and your health care and providing ZERO of scientific/medical value in return

[ItNerd4life]

103. LOL. You don't live in the UK either, but feel free to criticize other peoples perceptions

I don't live in the U.K. nor Canada. However, I have family in Canada. The stories that many people like to ignore are true. How do I know this, because many have happened to my family or friends.
these include: Not being able to get knee transplant surgery because of their weight. Having to weight 3 weeks to see the doctor for a heart murmer that was causing dizziness. Being told they had to weight 3 months for back surgery (they came to the U.S. and paid for it themselves).

These horror stories are the downside of Universal Healthcare. It is why Obama is not pushing for Universal Healthcare, but a solution that combines the best practices of the capitalism and government regulation/oversight.

Please don't be so derogatory of others just because they disagree with your opinion.

I don't care if the person has only 1 post, even if they are lurking freepers I don't criticize them.

Intelligence is supposed to prevalent within the liberal community, but it's not intelligent to insult other people.

[tjahome]

105. Thanks ItNerd

I knew I would lambasted for my low post count, but didn't realize I would be called a liar.

[ieoeja]

111. Apparently you don't live anywhere.

3 week wait to see someone about a heart murmer? That is pretty fast.

No knee transplant because of weight? My brother here in the States couldn't get medicine (not an operation, just the pills) for his hepatitis C until he was sober a full year. Even now he can't get it because he is on home detention which makes no sense. But that is American medicine for you.

3 months for a back surgery? I have numerous relatives who have waited months for various surgeries. My best friend had to wait two months to have a broken hand fixed.


And that is not why Obama is not pushing universal healthcare. He said he would support it if we were starting from scratch. He is not because he prefers low-risk, incremental changes rather than big, bold initiatives and the risks associated therewith.

[tjahome]

104. Wow! Thanks for the lashing!

I wonder about your stability.

Let me get this straight, you start off your post by calling me a liar and then expect me to be swayed by your opinions? Well, for those reading, and not you pitohui, I will give my opinion. Yes, this is my opinion.

1. Every argument you make is assuming the current medical system. I prefaced my doctor friend's opinion with "if we nationalized health care". You argue based on current system, not a nationalized system.
2. Cash only medicine is already thriving. Ever heard of plastic surgery? Ever heard of "elective" procedures? Ever driven by a walk-in clinic? Bleh, waste of my breath.
3. My doctor buddy is very real, and I would give you his name and number if I thought you could maintain your composure in an adult conversation.
4. I lived in London while attending the London School of Economics. You will call me a liar, but I lived on Queensgate in Kensington and took the blue line to the Gloucester stop on the way home, the same line from Gloucester to Holborn on the way to class. I experienced British free medicine while on the rugby team. The health care system is horrible. I hurt my knee, and luckily I could afford to go to a private hospital instead of dealing with their equivalent of a resident. Plus, the surgery that was necessary (which I flew back to the United States for) couldn't be scheduled for three weeks. We had it scheduled and performed here in Florida in two days.
5. Insurance bureaucracy? I don't have insurance. I pay cash. I employ myself. I am 32, so I luckily do not have very high medical bills. I do have catastrophic insurance, but that doesn't kick in until I am out of pocket $10,000. Cheap though.

I'm a rational adult. I have made valid points. My doctor buddy's points are valid as well. So, if you can reasonably assuage my fear that a nationalized system for those who would be affected by it wouldn't be a crappy "welfare" system without the best doctors I am all ears.

[ieoeja]

113. You should re-read pitohui.

1. He was talking about what would happen if the doctors did this en masse "if we nationalized healthcare".

2. Cash only medicine is thriving ... for those high-end specialists. Pitohui said that. You said that. You also tossed in walk-in clinics. The whole point of your argument is that the good doctors will go to cash only, and you use walk-in clinics as an example? That is actually a perfect example of what pitohui asserted. He is pointing out that a general practioner going to cash-only would be competing, not only against walk-in clinics, but against all the other doctors who switched en masse to cash-only "if we nationalized healthcare". So he'd end up making shit compared to what he could make from the gov't.

3. Your doctor buddy probably is real. Joe the Plumber was real too. He was a fucking idiot, but he was real.

4. Three week wait for surgery? Ask around. You will find there is nothing uncommon about that here in the United States either. It took me two or three months to get cancer surgery. My best friend took two months to get his broken hand operated on. I've had a couple other surgeries which only took one or two weeks. That is the norm.

5. If you have no insurance and can afford your own healthcare, then your situation doesn't really apply to the average person, does it?

[tjahome]

116. You make good points

I will not re-read pitohui. As for your comments, which I appreciate:

1. Doctors would not do this en masse, a doctors curriculum vitae would finally come into play, and only the best doctors would attract the cash payers. Remember, the cash payers must be dissuaded from using the free health care they would otherwise have a right to (and are paying for through their taxes).
2. I am not sure where you live, but here in Florida the walk-in clinics are really quite good. The level of service is phenomenal. Again, see #1, I think competition will severely limit those who go to cash only.
3. My doctor buddy is a good guy with common concerns. Any comparison with Joe the Plumber is not germane.
4. I was speaking about emergency surgery (which I define as surgery needed now to avoid further damage). My knee surgery was emergent in nature.
5. I certainly do not have the same amount of money as the rich people who will be creating this policy. If I am disqualified based on my net worth, then we have the wrong people in Congress.

I guess my concern comes down to this: will we be complaining ten years from now when there is a separate system of health care for poor people and rich people? Don't for a second think that medical insurance companies wouldn't still exist. They would simply be in business to pool risk for the wealthy "cash payers".

(The Laser Spine Institute (Tampa, FL), and any Lasik offerer are good examples of such cash only clinics already in existence)

[ieoeja]

117. Why don't the good doctors go to cash-only today?

And why did your knee require emergency care?

[tjahome]

118. Some are...

My doctor friend is now at my desk...

1. The exceptional doctors already are. For instance, many pioneering surgeons are opening practices that only accept cash from the patient (such as the Laser Spine Institute, Tampa Florida). Then those patients take the bill and make a claim to the insurance company. That way, the doctors are not at all involved in the negotiation side of things. Around 50% of those patients receive any reimbursement from the insurance company. ; or

2. No need to. The insurance companies pay good rates and doctors are doing very well financially.


That being said, I have a friend who quit humans and moved on to animals. Talk about a field that needs regulation...

[ieoeja]

119. So what would universal healthcare change?

And if the exceptional doctors already are ... doesn't that mean we already have the two-tiered healthcare you spoke of.

Why would you classify your required knee surgery as an emergency?

[tjahome]

122. All about scale

You are correct, the exceptional doctors already are, but the demand for private health care would increase dramatically, thousands-fold, if we were to nationalize the system. You see, those that can afford luxury value it and spend for it (and there are a lot more of those people than you think, 7% of all households, or 9.3 million, have NET worth of more than $1mm).

My main concern is that my CHOICE of where I go for medical advice and procedures will be decided by the government. I have no problem with socialized medicine (I believe we already have it to some degree, it is illegal for a hospital to turn someone away in the ER based on ability to pay). However, if the government makes it illegal for me to pay my own money for medicine I believe my rights are being curtailed.

I blew out my ACL and tore both meniscus. Each day I put pressure on the knee, or walked, I was doing more damage to it. That is an emergency procedure in my book. The JOI (Jacksonville Orthopedic Institute) did my surgery almost immediately. I do believe the best JOI docs would go cash only if we nationalized medicine.

[ieoeja]

123. Who is suggesting that?

NOBODY has EVER suggested making private practice illegal. Where in the world did you hear nonsense like that?

For that matter, there are private practitioners in England. So you could have saved yourself the cost/time of a jet ride over the pond.


What you just described for your knee sounds very much like my best friend's experience with his hand. He was also told that if he did not have pins inserted immediately, it would do more damage requiring more effort to fix. But since he can't afford to pay for his own healthcare like you or I, he had to wait until the insurance approved it. And it took them two months to do that.

And that was here in the good ol' USofA.

[tjahome]

125. Irrational Fear

I guess I have an irrational fear that the government would make it illegal for a licensed practitioner to not accept government patients. That would in affect limit my choice. I understand nobody has introduced this as a viable option, but given the past eight years, I operate under the assumption that anything can happen. Furthermore, like I said earlier, it is illegal for a hospital to turn away anyone based on ability to pay. If the government can make that law, why can't they force all doctors to accept public patients?

My school insurance did not cover private doctors in England, therefore I can home for my surgery. Plus, I was able to visit my stateside friends.

Your friend's situation (careful, pitohui would claim your friend is imaginary) is problematic. I believe the insurance company is guilty of bad faith.

[wolfgangmo]

148. Great. [sarcasm alert]

Now we only have to make sure that every american can afford to go overseas for economics and have enough money to fly overseas on short notice and then pay cash for surgery.

Problem solved. America is saved.


But for the rest of us. We would like to be able to see a primary care doc at least once a year for a checkup. Or maybe be able to not have to decide to get some pills or food. Or have to file bankruptcy and sell out house because our kid got sick.


But hey, at least you are OK. Whew. I was worried.






Seriously tho', you keep making assumption that don't have to be so. If you are fearful then be fearful, but I am asking you to challenge your assumptions and our assumptions and especially the assumptions that keep our very expensive and very bad system going.

[tjahome]

150. You are missing the point of this sub-thread

We were talking about the eventual two tiered health care system this country would develop if we nationalized.

[blindpig]

114. Maybe Cuba will help us out

if we ask nice.

[wolfgangmo]

147. Cash only medical clinic owner here.

We are a clinic which provides primary and general family practice, but we have an integrated natural care niche. . If your friend is primary care and has nothing to distinguish himself then he will be toast very soon. If he takes only insurance patients he may find that his income will drop 90% immediately and his expenses will remain the same.

I say this from experience and we took 4 years to make the transition.

There is an assumption I would like to questions, the 'welfare system'. America spends on average $7200 per year per person on health care. Canada spends only $3600 and provides access in a very sparsely populated country . Does their system need fixing? Yes. Do they ever consider getting rid of universal single payer in Canada? No. Because it works for most people.

YOur friend is worried that the system would be just like the underfunded medicare system here. It doesn't have to be. With more being spent in the US than in any other country we can afford to have really GOOD universal care, IF WE GET THE INEFFICIENT PRIVATE INSURANCE COMPANIES out of the equation. Good luck talking to him about this. I have a brother in law with the same opinion. .

[RobMan]

93. Agreed....but consider this as well

I've never posted here, but lurked for a number of years.  By
way of background, I am the CEO of a physician owned PPO
network in a rural state, and have access to statistical
information regarding physician/hospital reimbursement, as
well as the profitability and margins for private commercial
and self funded health benefits delivered in a broad
geographic region.  Suffice it to say, healthcare delivery and
financing is a multilayered and complex issue that cannot be
fully explored in one posting.  However the postulation that
there is a crisis in the delivery of primary care nationally,
both in training and retaining practioners willing to enter
and stay in the field of general medicine, is a real one.

Consider this actuarial table regarding median national
physician incomes:

Specialty	                 Years 3>	Max
Allergy/ Immunology		$221,000	$487,000
Anesthesiology: General		$275,000	$448,000
Anesthesiology: Pain Management	$370,000	$651,000
Anesthesiology: Pediatrics	$311,000	$378,000
Cardiology: Interventional	$468,000	$811,000
Cardiology: Invasive		$395,000	$647,000
Cardiology: Noninvasive		$403,000	$599,000
Critical Care		        $215,000	$320,000
Dermatology		        $308,000	$452,000
Emergency Medicine		$216,000	$295,000
Endocrinology		        $187,000	$260,000
FP - Sports Medicine		$208,000	$363,000
FP - Urgent Care		$198,000	$299,000
FP (w/o OB)		        $135,000	$239,000
FP (with OB)		        $204,000	$241,000
Gastroenterology		$349,000	$590,000
Gynecology		        $213,000	$358,000
Hematology/Oncology		$245,000	$685,000
IM (Hospitalist)		$172,000	$245,000
Infectious Disease		$178,000	$271,000
Internal Medicine		$176,000	$238,000
Maternal/Fetal Medicine		$322,000	$610,000
Medical Oncology		$257,000	$455,000
Medicine/Pediatrics		$168,000	$271,000
Neonatal Medicine		$310,000	$381,000
Nephrology		        $269,000	$447,000
Neurology		        $228,000	$345,000
Obstetrics/Gynecology		$261,000	$417,000
Occupational Medicine		$185,000	$290,000
Ophthalmology		        $314,000	$511,000
Ophthalmology Retina		$469,000	$716,000
ORS - Foot &. Ankle		$392,000	$791,000
ORS - Hand & Upper Extremities	$459,000	$770,000
ORS - Hip & Joint Replacement	$491,000	$715,000
ORS - Spine Surgery		$670,000	$1,352,000
ORS - Sports Medicine		$479,000	$762,000
Orthopedic Surgery		$342,000	$670,000
Otorhinolaryngology		$311,000	$516,000
Pathology		        $321,000	$610,000
Pediatrics		        $175,000	$271,000
Pediatrics - Cardiology		$282,000	$607,000
Pediatrics - Critical Care	$259,000	$398,000
Pediatrics - Hematology/Oncology$217,000	$251,000
Pediatrics - Neurology		$189,000	$362,000
Physiatry		        $244,000	$313,000
Podiatry		        $168,000	$292,000
Psychiatry		        $169,000	$238,000
Psychiatry - Child and Adoles	$189,000	$265,000
Pulmonary Medicine + Critical 	$288,000	$417,000
Radiation Oncology		$385,000	$787,000
Radiology		        $354,000	$911,000

Note the disparity in incomes as it relates to subspecialty
care, wholly driven by a globally accepted Medicare based
reimbursement system focusing on procedures and episodic care,
rather than health, quality and outcomes.  Don't be fooled
folks, physicians are deeply imbedded as a lobbying group (via
the AMA and other professional associations) in the
continuation of high cost reimbursement for specialty care. 
Primary care physicians are a declining group within their own
associations, with limited ability to advocate for a
rebalancing of reimbursement as it relates to overall care
delivered to the US population.

There are tremendous fortunes being made from the delivery of
healthcare.  Hospitals, Commercial Insurance Carriers,
Academic Medical Centers, Pharmaceutical Companies, Research
& Development Centers, Medical Technology Vendors....and
yes Physicians; all are making profits that should make the
average citizen very concerned.  The cost of delivering per
capita care in the US vs. other industrialized countries is so
much higher it is crippling our economy.  There is no panacea
for solving what is probably the most critical problem facing
our country after the current financial crisis......this is no
joke....it really is the most problematic thing we will face
as a nation in the next 10-15 years. However, the beginning of
a real dialogue will be based on (1) universal access to
healthcare, (2) cost and utilization control, and (3) a
balancing, redistribution, and yes capitation of profit within
the system.

Reengineering our delivery system is a question of social
responsibility and fairness, a discussion which US physicians
in general are sorely lacking in promoting.

[pitohui]

99. these are obscene incomes, the median american income is around $40K a year

this is just obscene, no wonder doctors seem not to care, they don't CAN'T care, we are so far removed from being a part of their class that they can't possibly see us as equal human beings

in a capitalist world, where a person is judged worthy based on their earnings, it doesn't surprise me that the doctor looks right through me and sees me only as another "unit" to be worked thru as quickly as possible -- how do i really feel about the rights and emotions and fears of an insect?

the person earning $700K a year simply doesn't and can't care, in any real sense, for the person earning $35K a year, we all went to high school, we all know this -- a person earning $400K or even $200K is not going to be for social justice unless they are very unusual, they are benefiting from social INjustice and so they are always going to pull for the hateful status quo

something has got to change, so that we can meet as equals

i'm sorry, a doctor is NOT smarter and does NOT work harder than my husband, whose job also saves and protects lives, and he does NOT deserve 20 times the income -- this kind of thing just promotes more and more social injustice and inequality

if the problem is the student loans, only accept TOP qualified students into med school and give them grants/scholarships -- and by the way crushing student loans are a problem for everyone not just doctors who seem, at the end of the day, to have no problem paying for greens fees to turn our trees into golf courses and a fleet of automobiles and sometimes even an airplane!

[peaches2003]

120. Your post is a sad statement

about yourself and your view of society and other people. You are so wrong about the majority of doctors. They couldn't do the work they do if they only did it for the money and felt about their patients as you think they do.

I've been fortunate to have met several of my son's patients when they had absolutely no idea who I was. All they could talk about was how much he "cared" about them, how much time he spent with them in an ordinary office visit, and how fortunate they were he was looking after them. One of these patients was a young black girl and the other an older gentleman whose cancer my son had discovered. Both patients about as far from my son in income and "class" (your word not mine) as could be. I truly feel sorry for you if you have not found a primary care physician who is in a profession they love. Most primary care docs want a good income for their families' sake, but they also want to serve their patients no matter who they are.

[Thickasabrick]

102. Meh....let them quit...it's about the money for them....not about the patients.

[gravity]

108. Doctors have the most secure jobs out there

I doubt that many will actually leave the business unless they saved enough to retire, especially in this economy. This article is really over exaggerating the problem.

[LostinVA]

109. Very interesting, very similar spam in this thread

[KamaAina]

133. What? Internists don't like serving as gatekeepers for HMOs?

What a bunch of whiny ingrate malcontent commie pinkos!! :sarcasm:

edit: header

[Londoner]

142. NHS salaries in the UK

Here's a link to information about current NHS salaries in the UK

http://www.nhscareers.nhs.uk/details/Default.aspx?Id=553

A London General Practitioner earns about £110k a year now. (roughly $165k). I dont think they will starve any time soon. As a lawyer who works in our legal aid service (means tested help with fees for those with criminal defence or social welfare law or family law problems) I look on with envious eyes. When I started practising 25 year ago my salary was abut 66% that of my medical friends and now its just 33%.

Of course training doctors is a long and expensive business - takes around 6 years in the UK. In recent years students in Britain have been forced into taking out repayable loans for their support and fees, but the fees are heavily subsidised (currently just £3000 a year for home students) and students from poor households get the fees paid free.

Why not train up a generation of doctors for a US National Health Service with heavily subsidised fees for those who will sign up to work for it for 15 years after practising. Or make the package attractive for new entrants who get a wage and 7.5% of their student loans repaid each year they stay in the service as an incentive.

I don't understand the debates you all are having in the US about different types of insurance. The savings in the numbers of people employed to sell insurance, do actuarial assessments, argue about avoiding liability, process and pay bills, collect instalments would probably be enough to fund half of your health service. Why not a proper universal system. We have our own pen pushers trying to design ways of meeting government performance targets... this year it may be getting waiting lists down for one set of ops then the focus will change to something else. I doubt the red tape and bureaucracy gets to 20% of administrative cost of the private insurance racket though.

As for doctors leaving in their droves if medicine was socialised. This was said in 1948 but almost nobody quit the service. The best teaching hospitals and a lot of the best facilities for researching and treating complex conditions are in the public sector. So if you are a consultant who wants to make your name you are probably gonna have to work for the NHS even if you have a lucrative private business on the side.

For monied people BUPA and the private insurance sector are seen as useful for routine operations where the main advantage is that you can get a private room and have a bit more control about how quickly you are treated, even timetable your own appointment. But even the 5% or so of people who bother to pay for private health insurance are bloody thankful that the NHS is here for emergencies, all those difficult expensive conditions and for terminal and geriatric care. Nobody earning less than £60k plus a year would think about buying private health cover and its only given to top managers as an employment perk. The NHS is universal and has the dogged support of the UK public. The government simply can't afford to let it get run down because the middle classes are devoted fans and tax paying funders of it. The Tories have played around with ideas water it down to a service of last resort but politically this is too hazardous so they have backed down time and again on this agenda.

Good luck with this. Since I started meeting Americans on the net I found out so far at least 3 personal tales of medical tragedy or hateful bureaucracy impeding much needed treatment. This is totally incomprehensible to any European.

[Sgent]

149. Primary Care Physicians

in the US make 30-40% less than here than they do in the UK. GP's in the UK average 220,000, here they average 155,000. The hassles, malpractice, etc. are also much higher here.

No wonder we are seeing them abandon the profession.