My doctor friends drive to the country club in their new Porsches and Range Rovers and complain to each other that they make so little money that they should have never gone into medicine.
My doctor friends drive to the country club in their new Porsches and Range Rovers and complain to each other that they make so little money that they should have never gone into medicine.
In reply to DILYSI Dave:
I am so glad they extended health insurance until someone turns 26. Number one with this current economy who knows when I will get an engineering job. Number 2 it keeps the option of going to grad school and having health insurance open.
I do have to wonder how much of that rate raise comes from the insurance companies giving a middle finger to the new health care bill. Also I figured I would point out at least in England if you want private insurance, you can get it yourself.
z31maniac wrote: ^It's tough for sure. Something else that needs to be addressed in this country is our lifestyle and diets. People continue to act like being the fattest, laziest nation on earth with an aversion to exercise and something like 1/3 of people being obese isn't a problem. But my anti-gov't interference says we shouldn't regulate what people eat. But, if you choose to down McD's like water, why should I have to pay for those choices? I'm trying to think of the name of the healthcare book I read a few months ago that makes some really good points about the top 6 medical conditions (including asthma and diabetes) that could be easily prevented/treated, that currently soak up TONS of resources.
You'd just be shooting yourself in the foot, healthy people are far more burdensome to the health care system, because they don't have the decency to die of a coronary before they need expensive, constant care from 80-death.
z31maniac wrote: Something else that needs to be addressed in this country is our lifestyle and diets. People continue to act like being the fattest, laziest nation on earth with an aversion to exercise and something like 1/3 of people being obese isn't a problem. But my anti-gov't interference says we shouldn't regulate what people eat. But, if you choose to down McD's like water, why should I have to pay for those choices?
this might be one of the simplest and easiest to understand arguments against a health insurance/care system that other people pay for and the unintended consequences of removing the customer from paying for the services they use.
Josh wrote:z31maniac wrote: ^It's tough for sure. Something else that needs to be addressed in this country is our lifestyle and diets. People continue to act like being the fattest, laziest nation on earth with an aversion to exercise and something like 1/3 of people being obese isn't a problem. But my anti-gov't interference says we shouldn't regulate what people eat. But, if you choose to down McD's like water, why should I have to pay for those choices? I'm trying to think of the name of the healthcare book I read a few months ago that makes some really good points about the top 6 medical conditions (including asthma and diabetes) that could be easily prevented/treated, that currently soak up TONS of resources.You'd just be shooting yourself in the foot, healthy people are far more burdensome to the health care system, because they don't have the decency to die of a coronary before they need expensive, constant care from 80-death.
I've seen a few articles to that effect. But I want to see real data. Not conjecture.
WilberM3 wrote:z31maniac wrote: But my anti-gov't interference says we shouldn't regulate what people eat. But, if you choose to down McD's like water, why should I have to pay for those choices?this might be one of the simplest and easiest to understand arguments against a health insurance/care system that other people pay for and the unintended consequences of removing the customer from paying for the services they use.
It's a good point. However, we already spread out the cost of McD's diners across everybody by way of insurance.
In theory, if everybody set aside what they pay for health insurance (assuming they got it in their paycheck if they didn't have insurance through work), they'd come out ahead if they paid out of pocket for routine stuff (ignoring the oddities of medical billing and rate negotiations). The problem is that one non-routine item would mean bankruptcy, chronic injury, or premature death, depending on the issue and the reaction to inability to pay.
I really dislike the notion of insurance discounts for doing what the insurance company says because it doesn't seem to me like slippery-slope paranoia to see it changing to having to do what they want to avoid insurmountable surcharges. But it may be that this is the path for passing on the repercussions of individual choices to the individual while maintaining the possibility of health insurance.
Ew. I just creeped myself out.
I was about to try to write something about the difficulties of sorting out what is a reasonable penalty/discount for given behaviors, but I got overwhelmed thinking about choosing between the bureaucracy of the government version and the viciousness of the private version.
^Yes, it's spread out. But it raises the cost for people who choose not to do that.
Seems an almost impossible line to draw, but I'm sure the actuaries could figure it out pretty quickly.
Josh wrote:z31maniac wrote: ^It's tough for sure. Something else that needs to be addressed in this country is our lifestyle and diets. People continue to act like being the fattest, laziest nation on earth with an aversion to exercise and something like 1/3 of people being obese isn't a problem. But my anti-gov't interference says we shouldn't regulate what people eat. But, if you choose to down McD's like water, why should I have to pay for those choices? I'm trying to think of the name of the healthcare book I read a few months ago that makes some really good points about the top 6 medical conditions (including asthma and diabetes) that could be easily prevented/treated, that currently soak up TONS of resources.You'd just be shooting yourself in the foot, healthy people are far more burdensome to the health care system, because they don't have the decency to die of a coronary before they need expensive, constant care from 80-death.
IPAB just might take of the pesky octogenarians:
http://www.healthcarelawreform.com/tags/ipab/
http://en.wikipedia.org/wiki/Independent_Payment_Advisory_Board
http://spectator.org/archives/2011/04/22/ipab-is-an-acronym-for-death-p#
Or, maybe not:
http://hotair.com/archives/2011/03/10/two-house-dems-defect-on-ipab-after-embarrassment-on-senate-budget-vote/
One thing is certain - when funding dries-up (by increasing the number of patients without increasing availability of services) health care will face rationing.
Do you want your poison administered by a number-crunching panel of bureaucrats or by number-crunching insurers? Hey, how about both?
tuna55 wrote: Privatized health insurance (idealized, not today): Dr. accepts health insurers which he feels pay enough for various items and are easy enough to work with that he doesn't need five secretaries to get paid Socialized health insurance: Dr. realizes that since socialized medicine accounts for some 90% of his available patients (what I would presume is an unavoidable eventuality), he has no choice but to accept federal insured folks. Federal government realizes that the Dr. has no choice and inevitably through political grandstanding and back deal making marginalizes the Dr.s cost down to nil. No more competition, no reason for insurers to try and better the Dr/patient relationship.
Unfortunately, that later model accounts for much of how things work in the current private model. It goes like:
Dr./hospital realizes that insurance company A accounts for 30% of the market. Dr. can't sustain his business if he cuts off that share of the market. Insurance company A knows this and undercuts prices paid to Dr. Dr./hospital makes up for losses by charging more to individuals and people with insurance companies that are a smaller portion of the market. Insurance company A profits.
Under the current system, insurance companies tell doctors how much they can charge. The largest companies have the clout to negotiate prices that are below or at cost for the Dr./hospital. The only way to make up the difference is to charge everyone else dramatically more than cost.
I forget what state it is, somewhere on the east coast I think, that has adopted a strategy where the state government discusses with hospitals and physicians on what their services cost and what is appropriate to charge for them, and then sets that as the price that all insurance companies pay. It eliminates one company having a major price advantage over another and forces them to compete on things like customer service. Seems like a pretty reasonable system to me, but I've not experienced it first hand.
z31maniac wrote: ^Yes, it's spread out. But it raises the cost for people who choose not to do that. Seems an almost impossible line to draw, but I'm sure the actuaries could figure it out pretty quickly.
I'm concerned about even that aspect of calculating the costs of these behaviors and the assumptions taken on the way to the hard numbers, but I suspect you're right.
I'm more concerned about the trip from the hard numbers based on a variety of behaviors (and testing for them; unless McD's is going to report to the insurance entity, we end up looking at people's health rather than the actual behavior, and then we're billing people for not having naturally low cholesterol, but I digress...) to the decisions about the specific carrots and sticks.
Specifically, referencing my previous post, I'm concerned that the government version would be 453 pages with appendices for which condiments you had on your burger, and the private version would simply make it untenably expensive to eat anything that was likely to ever cost the insurer anything at all...
BTW, I'm in the process now of signing up for the fitness bonus program through my insurer (have to go get poked and prodded). It's mostly painless for me apart from the needles, since I should theoretically get money back for being a cyclist, which I do anyway. But I still find the reach into my personal life a little unsettling.
In reply to Salanis:
Well you're not wrong. My point is simply that there may be good answers that don't involve socializing the system. Essentially, you're complaining that it's already too socialized. How does car insurance not dictate the repair cost of car wrecks? I am not asking that as a leading question, I want to know.
In Reply to Salanis.
^That is somewhat how it works, but not quite. At any point, the provider has the option to no longer be contracted and charge whatever they want. I see lots of "out of network" claims come through
The dollars that we pay out on procedures would probably stagger you. Would you think that $100 for a 15 minute consultation would be ok? Because that's what we often pay. I think it's fair to say that they made their profit on that.
Otto Maddox wrote: My doctor friends drive to the country club in their new Porsches and Range Rovers and complain to each other that they make so little money that they should have never gone into medicine.
It's all because of the big bad insurance companies that have been federally mandated to pay out 91-93 cents on the dollar to providers. (Forget the exact number)
How dare they make a 3-4% profit BEFORE the "health care reform" bill. (What a ridiculous misnomer.)
tuna55 wrote: In reply to Salanis: Well you're not wrong. My point is simply that there may be good answers that don't involve socializing the system. Essentially, you're complaining that it's already too socialized. How does car insurance not dictate the repair cost of car wrecks? I am not asking that as a leading question, I want to know.
I don't know the answer, and I'm not suggesting that socialized medicine is it.
I'm more pointing out that it seems like what people are saying their problems are with socialized medicine are similar to the problems with the current U.S. model.
I think one of the toughest things with the issue is that there is not a single major culprit for all of our problems, and therefore isn't a single big fix.
^In reply to 92Celica:
You're right about there being greedy unscrupulous doctors out there. I saw a doctor to get my physical for my NASA competition license and he and his office pissed me off. I figured I'd go in for an hour, get the physical and be done (I'm a young, healthy guy). Instead, I was not informed prior that my first appointment would only be a consultation, and my insurance and I would be charged the full price of a visit in order for his assistant to take my height/weight/bp and have him hand me a slip to get some blood tests done. Any other business would be required to list prices and give an estimate before rendering service. Heck, there's another potential for cutting health care costs. Let people know what costs are going to be so they can make an informed decision, rather than treating them with more procedures than necessary and springing an enlarged bill on them. In the end he told me exactly what I already knew: I'm a young healthy guy, my blood pressure is a bit on the higher side of healthy, and I need(ed) to wear corrective lenses to drive.
That also cuts costs for insurance companies, and ties up doctors time less with each individual, allowing more people to be treated.
I do think a system that requires people to pay a certain amount for medical care makes sense. Just having a basic co-pay controls people from running to the doctor every time they get a cough. Socially or privately controlled, co-pays make sense.
Salanis wrote: I do think a system that requires people to pay a certain amount for medical care makes sense. Just having a basic co-pay controls people from running to the doctor every time they get a cough. Socially or privately controlled, co-pays make sense.
For that reason I really like the low premium, high deductible type options...
^My last 8 minute visit (Seriously) with my doctor was for a cough. They weighed me (huh? why?), checked my blood pressure, and listened to my lungs, then prescribed me a steroid Inhalant.
Total charge from doctor? $126. Ok, that didn't surprise me that much, because i work in the business.
Insurance paid $78.
Are you serious? Even if they only billed for a 15 minute consultation (they did), insurance is paying them over $300/hr.
It's not so much the greed of the doctors... or even individual doctors. It's because the insurance companies are actually paying these outrageous amounts, and who in their right mind turns down money?
Salanis wrote: I do think a system that requires people to pay a certain amount for medical care makes sense. Just having a basic co-pay controls people from running to the doctor every time they get a cough. Socially or privately controlled, co-pays make sense.
definitely. the more people understand the costs of services they use (and especially directly pay for) the smarter they'll be about using them. i'd argue that copays need to be significantly higher than the $15 they often are now. last year my GF had to get a TB test for her nursing program, her school insurance wouldnt cover it, and she doesnt have private insurance separately so she said she was paying up front cash (well check i think). rather than trying to bill an insurance company or send a bill to her later they cut the fee IN HALF right there on the spot. guaranteed capital with no headaches getting paid wins.
I am! I was too busy working to listen to all the liars in the idiot box.
if you believe that health care is more a function of socially distributed responsibility, and less a function of individual responsibility, then you can't complain about health care costs associated with insurance plans' premiums as a principal.
After all, their primary function is to socially mitigate health cost risk across all their insureds. Thats how they make money, they make a bet on this risk, and invest whatever earnings the risk returns.
The more people are responsible for their own health care, the more the burden of cost shifts on the un-healthy, and away from the healthy. Wether or not this is your world view is a seperate discussion, but this is the fact of what happens.
This is why lots of so called consumer activist groups(APHA and other liberal minded organisations, Consumer Union, etc) hated on the HSA plan, where you can save for your own health care costs without income tax penalty in a special account.
OK, I didn't read this whole thing, so pardon me if I restate something. I know at least a little about what some doctors make. My wife works for an internist and does a lot of his billing. He has to average something like $93 a patient to break even, not make a profit, break even. Medicare pays between $25 and $50 a visit depending upon what is billed, and usually take longer than private insurance to pay. Malpractice and business insurance for him are through the roof as it is for most doctors, plus there is a fair amount of overhead for staff and equipment.
Since he is part of a larger group of doctors (around 50 or so I think) they share many of the building's bills and thus have a lower operating cost than if they went it alone. All doctors aren't rolling in the cash the way they are made out to be. For sure they aren't paupers, but many aren't rich either in the way most think. There are months where the office my wife works in struggles to make a profit at all.
On the other side, a family friend is on the board of a local hospital, and it too struggles at times. For sure they make money, but they also have a HUGE outflow of cash every month. And like it or not, illegals place a burden to the tune of millions a year on that one hospital alone.
There are plenty of isses with health care in this country, but the problem is, no one seems to be addressing the right ones.
Dont forget, that doctor either has to share office staff in that building by entering into an agreement with the building's group, or also has to employ his own clerical office to handle all those claims.
92CelicaHalfTrac wrote: ^My last 8 minute visit (Seriously) with my doctor was for a cough. They weighed me (huh? why?), checked my blood pressure, and listened to my lungs, then prescribed me a steroid Inhalant. Total charge from doctor? $126. Ok, that didn't surprise me that much, because i work in the business. Insurance paid $78. Are you serious? Even if they only billed for a 15 minute consultation (they did), insurance is paying them over $300/hr. It's not so much the greed of the doctors... or even individual doctors. It's because the insurance companies are actually paying these outrageous amounts, and who in their right mind turns down money?
Okay, here's a wrench into the mix..my current doctor does not take insurance at all. (and this reflects upon madmallard's comments about paying the staff to handle the paperwork as well) None whatsoever, whether private-or public! As a result of not having to hire staff to handle the paperwork, his fees are only slightly more than what my co-pay had risen to under my health plan at (where I used to) work. Co-pay for a general visit under current rules, $50. His fee for a general visit, $60. His fees for lab tests (and I'll admit..so far, all I've had to have is blood tests..$120 for the usual high blood pressure stuff) seem to be far less than what my friends are co-paying, or what I've paid for other stuff. My last ER trip (my first plantar fasciitis attack happened so fast that I went to bed with a heel that itched, and woke up in the morning unable to walk) was approx. $700. Insurance covered $400 of that. For my previous condition (well-paid professional), the guy was perfect. His fees are so low, that I didn't mind paying slightly more than what my co-pay would have been..just because I supported what he was doing. Also, by doing this, he can run his own practice, without joining one of the Mega-Lo-Mart style places madmallard mentions in his 5:08p post. Old-school individual attention, rather than "assembly line medicine".
If I had remained in a good paying job, I would never leave this guy.
friedgreencorrado wrote: Okay, here's a wrench into the mix..my current doctor does not take insurance *at all*. (and this reflects upon madmallard's comments about paying the staff to handle the paperwork as well) None whatsoever, whether private-or public! As a result of not having to hire staff to handle the paperwork, his fees are only slightly more than what my co-pay had risen to under my health plan ...
thank you! Insurance is NOT the end-all, be-all. Neither is social medicine.
if it was, guys like these wouldn't make it as practicing doctors.
Now add an average 2 income household using an HSA (which is essentially cash to a doctor like this), and the only thing the government did was allow the household to save for their medical free of income tax. No different than exempting income tax on a health insurance premium.
Combine the cost reduction of eliminating paperwork with this and a HSA and I think I would be content.
I'm not so worried about me. I'm a well-paid professional with an HSA (and now tempted to go find a doc like FGC's).
I'm worried about people like my friend who had a stroke at 35 and whose health insurance simply said "not our problem". Or the friend who didn't have health insurance and found out she had a football-sized tumor in her abdomen.
As long as it makes fiscal sense to not insure these folks and these conditions, unregulated private insurance companies would just wash their hands of them. I want there to be something in place so that my friends get something other than "go die".
How do we build a system so that individuals' choices affect primarily themselves (predictable Big Mac fallout), but we still spread out the cost of the anomalous and "unearned" issues across the many?
You'll need to log in to post.
