A quandry involving Medi-Cal, going from paying badly to not at all

[red-beard]

Originally Posted by artplumber

You know, although you jest, but it would be the right thing to do. If public servants (which is what MD's would become under a single payor system, foot on the neck scenario) MD's should be able to do it too. Furthermore, since education is required that is prolonged and frequently not at the cost of the government, it would be interesting to see what sort of retirement benefits etc could be wrangled from the government, especially since the firefighters/police etc are getting 90% of their base salaries + full healthcare in perpetuity in Cali.

They will be allowed to unionize, but they will be like the Air Traffic Controllers, they will not be allowed to strike, for the public good. When they strike, they will be fired, or in this case, have their licenses revoked.

It will be messy

[red-beard]

Originally Posted by jyl

Are there aspects of the US healthcare system that could be changed to permit US doctors to have the same take-home/net income and the same schedule/stress/life quality as they do today, while receiving substantially lower gross revenue? Put another way, what can be done to substantially lower US doctors' costs of doing business?

Shoot all of the lawyers and politicians?

Let the engineers run the world?

[Tobra]

The price of admission to the Doctor Club is pretty steep, I don't know what the average debt is post medical education, but for me it was significantly more than my first house in Texas, which was a 2000 sq foot waterfront condo on a lake.

IMHO, The government would have to buy out the practice of every single doctor in the country for starters if it is going to be anywhere close to fair, and that shat ain't happenin'

Moses, what city do you practice in?

[Tobra]

Oh, and thank you all for behaving like adults in this thread and saving it from perdition

[Moses]

Originally Posted by Tobra

Moses, what city do you practice in?

I practice in San Ramon, California, basking in the glow of his gracious magnificence; Howard Sokoloff, DPM

[mikester]

What is the alternative to socialized medicine? We're in a capitalized situation now and it the costs are simply too much for the average household to handle. If health care costs were reasonable overall, then we wouldn't be here.

I'm trying to be reasonable and prudent and I don't want my questions to become fodder for some idealized argument.

My feeling is that the insurance system is a big part of the overall problem. It has gamed the mindset of Americans to think that they should pay little out of pocket for health care aside from the insurance premium itself.

My feeling is that if we turned it around, pay for the little things out of pocket. Regular appointments, check ups and such - ordinary and regular medical care - then have insurance for the unexpected or catastrophic. I believe that this would bring the cost of health care down considerably. First it would reduce the cost of doing every day business for Doctors and Hospitals and then they could ostensibly pass that cost savings on to patients (stay with me). Then with insurance no longer covering that every day stuff, the exposure to risk on a policy is greatly reduced. Not EVERY action is something that would be paid for by your insurance. Break your arm though and your covered, get cancer - covered - etc (simply speaking).

We call it insurance but really it is semi-socialized medicine. We socialize it through a capitalist entity that bargains on the price for us. In the end, all the work to deal with that insurance company's paperwork and red tape however costs more money than it saves.

These are just my thoughts, feel free to shoot holes in them but please just because I've put myself out there - does not mean you have to use me as a target. I wouldn't do it if this thread wasn't going so well.

[Moses]

Originally Posted by mikester

What is the alternative to socialized medicine? We're in a capitalized situation now and it the costs are simply too much for the average household to handle. If health care costs were reasonable overall, then we wouldn't be here.

Glad you brought that up. Doctors take 7% of the national healthcare budget!

How much can you save by squeezing us? So where are all those $$$Billions$$$ going?

Pharmaceuticals

Hospitals

Medical Insurance companies.

[red-beard]

Originally Posted by mikester

My feeling is that the insurance system is a big part of the overall problem. It has gamed the mindset of Americans to think that they should pay little out of pocket for health care aside from the insurance premium itself

This is exactly what we are doing. And many doctors will take a discount for cash.

[Nathans_Dad]

Originally Posted by jyl

Are there aspects of the US healthcare system that could be changed to permit US doctors to have the same take-home/net income and the same schedule/stress/life quality as they do today, while receiving substantially lower gross revenue? Put another way, what can be done to substantially lower US doctors' costs of doing business?

Like I said, change the entire society.

Tell the nurses, techs, secretaries, lab people, XRay people, etc that they all get a 50% cut in pay (since that's what you are expecting the doctor to take...or more). That way the doctor has to pay them less and can charge the patient less while maintaining a profit.

Tell the American people to stop expecting to live forever. Tell them that age 80 is a perfectly reasonable age to die. Tell them to stop spending over half of their lifetime healthcare expenditures in the last 5 years of life. Tell people that when granny has metastatic cancer, not to put her in the ICU for the last 2 weeks of her life and run up a $300,000 bill.

Tell people to stop expecting a pill to solve their problems. Probably 60% of the patients I see are on either anti-depressants, narcotics or sedatives...or all of the above. The US population expects to take a drug to get happy, get sad, get up in the morning, go to sleep at night and get a boner whenever they want.

Tell people to stop suing over every little thing (this extends to the whole society, not just medical suits). Go to a no fault tort system much like much of Europe has. Put hundreds of thousands of ambulance chasing lawyers out of business. Maybe they can then do the migrant labor jobs the illegals are now doing.

There, that should get you started. Let me know when you accomplish this and I'll give you the next list.

[Noah930]

Originally Posted by jyl

Are there aspects of the US healthcare system that could be changed to permit US doctors to have the same take-home/net income and the same schedule/stress/life quality as they do today, while receiving substantially lower gross revenue? Put another way, what can be done to substantially lower US doctors' costs of doing business?

1. Defensive medicine. I've been criticized for saying this in the past (though I think it might have been from a non-physician). But I think we're sticking our collective head in the sand if we don't believe this is a big problem. Technology and tests cost money. Doing a $1000 MRI to prove to a patient (not to me) that he's got nothing wrong with him is not cost-effective.

2. Technology costs money. We suddenly want all stops thrown out when it's our (or our family's) health on the line. Do every test. Go all out. Well, that costs money. A lot of it. It's like telling everyone else to go purchase a practical, economical car like a Honda Civic with roll-up windows, entry-level radio, and a miserly 4-banger, and then demanding the big Mercedes with every option box checked off when it's your turn to buy a car. Only it's not your money.

3. Lots of fluff in medicine. There are a lot of technologies that offer minimal or dubious medical benefit. But they sure cost a lot. I have a friend who's an orthopedic surgeon. He does a shoulder scope and maybe gets $1500 or so out of it. The guys who rent the DME (durable medical equipment) afterwards bill for the rental of a cold-unit to be used post-operatively. They bill by the day. For 90 days. We figured out those guys were billing around $4500-5000 for the stupid cold unit. Dubious medical benefit. No risk involved (unless you somehow electrocute yourself in the bathtub). But they sure get a lot from the insurance company for their little ice cooler thingie.

4. Lots of waste in medicine. Due to product liability concerns, everything is either sterilized (good) or single use only. Do you have any idea how much stuff gets thrown out in hospitals in ORs without ever even being used? All in the name of patient safety. But there's got to be a tremendous amount of waste in all that. We use little hand held irrigation pumps in laparoscopic surgery. It's single use. I may have my finger on the button for a total of 5 minutes for a 30 minute cholecystectomy. And then the thing (with its 8 sterile AA Duracell batteries) gets tossed. 8 AA batteries might not be a big deal, but magnify that by tens of thousands of similar examples of daily wastefulness, and, again, stuff adds up.

4. Insurance companies. There's the golden rule: He who has the gold, makes the rules. In medicine, the insurance companies hold the gold. So they use tremendous amounts of bureaucracy to avoid and delay paying claims. From my perspective, it's not just a matter of submitting a bill to an insurance company and getting paid for it...90 days later. Rather, it's submitting a claim. Then being told (several weeks later, when your office billing staff notices that the collection is still outstanding) that the insurance adjuster is missing some piece of paperwork (that your office KNOWS it included). Then the insurance company doesn't get the fax. Then they underpay. Then you appeal. Then they stall. And in the end, if they do pay, it's taken your office a significant amount of time and effort (which costs you and the insurance company money, but without any real forward progress as measured by patient care) to collect on money that should have been paid in the first place. I wonder how much waste comes from that?

5. Primary care types would argue for preventive medicine. It can be a lot cheaper to treat diabetes, than it is to treat the (non-fatal) complications of it.

[Pazuzu]

Cash practice. No slavery, no annoyances, no pro bono work.

Oh, and even in highly UHC Germany, many MANY people spend out of pocket money for private insurance, and the doctors love them for it. Just because Obama wants UHC doesn't mean that the doctors are going to go broke, the private insurance companies are going to jump in to cover the differences like a pig to slop.

[mikester]

Originally Posted by Pazuzu

Cash practice. No slavery, no annoyances, no pro bono work.

Oh, and even in highly UHC Germany, many MANY people spend out of pocket money for private insurance, and the doctors love them for it. Just because Obama wants UHC doesn't mean that the doctors are going to go broke, the private insurance companies are going to jump in to cover the differences like a pig to slop.

And there's a problem with this why? That seems perfectly fine to me.

[artplumber]

Originally Posted by mikester

....

These are just my thoughts, feel free to shoot holes in them but please just because I've put myself out there - does not mean you have to use me as a target. I wouldn't do it if this thread wasn't going so well.

Wrong way 'round Mike though I am glad you're contemplating the position that insurance is bad not good.

What everybody should have is free yearly checkups. Then the patient can discover what is wrong. The insurance, if it exists, should be for anything else.

People can choose to call it quits at 80 as has been suggested, or pay for all the goodies and anything in between. Obviously, one's insurance rates will be higher if you are overweight, smoke, don't take medicines etc etc... The patient might be able to find specialists that will work for free. The relationship will be a lot different if a patient is getting free care (and had to ask for it), than expects the "rich" doctor is being paid by the government and they can do whatever they want and still sue for a big payday.

People may be a lot less inclined to get every test in the book if they have to pay cash. People will become accustomed to "thinking ahead" and having a savings account. People may actually start to take care of themselves.

The government would have to come to grips with rationing care for all those that don't have income (something they are not willing to do because of the political ramifications - "I'm sorry Ms Jones you can't get dialysis" will not go over well at the next election).

[artplumber]

Originally Posted by Pazuzu

Cash practice. No slavery, no annoyances, no pro bono work.

Oh, and even in highly UHC Germany, many MANY people spend out of pocket money for private insurance, and the doctors love them for it. Just because Obama wants UHC doesn't mean that the doctors are going to go broke, the private insurance companies are going to jump in to cover the differences like a pig to slop.

Actually, many insurances try to decrease fees whenever Medicare decreases fees. So no, insurances aren't eager to cover the difference.

[mikester]

Originally Posted by artplumber

Wrong way 'round Mike though I am glad you're contemplating the position that insurance is bad not good.

What everybody should have is free yearly checkups. Then the patient can discover what is wrong. The insurance, if it exists, should be for anything else.

People can choose to call it quits at 80 as has been suggested, or pay for all the goodies and anything in between. Obviously, one's insurance rates will be higher if you are overweight, smoke, don't take medicines etc etc... The patient might be able to find specialists that will work for free. The relationship will be a lot different if a patient is getting free care (and had to ask for it), than expects the "rich" doctor is being paid by the government and they can do whatever they want and still sue for a big payday.

People may be a lot less inclined to get every test in the book if they have to pay cash. People will become accustomed to "thinking ahead" and having a savings account. People may actually start to take care of themselves.

The government would have to come to grips with rationing care for all those that don't have income (something they are not willing to do because of the political ramifications - "I'm sorry Ms Jones you can't get dialysis" will not go over well at the next election).

Why should anything be free?

[red-beard]

Originally Posted by Pazuzu

Cash practice. No slavery, no annoyances, no pro bono work.

Oh, and even in highly UHC Germany, many MANY people spend out of pocket money for private insurance, and the doctors love them for it. Just because Obama wants UHC doesn't mean that the doctors are going to go broke, the private insurance companies are going to jump in to cover the differences like a pig to slop.

Look to Canada. No private practice allowed.

[Moses]

Originally Posted by Nathans_Dad

... when granny has metastatic cancer, not to put her in the ICU for the last 2 weeks of her life and run up a $300,000 bill.

Obama's grandmother was terminally ill with cancer when she got a total hip replacement. She died 2 weeks later. Medicare paid the bill. She didn't get special treatment because of Obama, absurdities like this happen every day.

[Hugh R]

Good topic. When I was a sole practicioner in consulting, a bare bones medical insurance plan for me, my wife and two young kids was $10K/year, with a $2,500/year deductible per person!. For an average family of four that makes about $50K/year, that is unaffordable. Medical insurance could be cheaper if it was for major medical alone. You don't expect your homeowners insurance to cut your lawn, or fix a pipe leak (unless it's catastrophic), or re-roof. Why should medical insurance pay for every single thing about your body, basic hygiene excluded.

[jyl]

"Don't let them ration healthcare" is a argument that I hear a lot. But it sounds like some sort of cost-benefit analysis may indeed be needed, from what I'm reading here. If so, how can this be made politically feasible, and how can it be implemented? Who decides what treatment will be paid for, and how it is decided? Or can you do it through purely economic means (e.g. some sort of lifetime cap on benefits per person)?

[tabs]

There will be rationing of health care, if you are sick and old they will say sorry you are old and sick and not worth saving. As your productive life is over. You want someone to tell you that?

The cost of new medical technology is high...in the old days the doc used to tell ya take an asprin and if your still alive call me in 2 weeks. That was cost effective.

Ben Franklin said 250 years ago that 9 out of 10 men kill themselves in one way or another...eating, drinking, smoking, not taking care of themselves or just plain risky behavior...so what has changed in 250 years?

Hmmm a practice here or a practice there...Hmmm what a decsion to make...Obama is gona be saying to you..."You work for me now!"