Interesting overview of American health care: present status, history and causes

[flintlock]

Re: Interesting overview of American health care: present status, history and causes

I'm not complaining. The average $32,000 wage earner has much less education (and missed opportunity costs while obtaining that education) than I do. New grads have educational loans that must be repaid. I've heard of monthly loan payments that are larger than many mortgage payments. I was just providing some relevant insight for our readers. I do work 60-65 hours a week so my income would be considerably lower if I was able to work less. I would work a lot fewer hours if I could but there is a real shortage of anesthesiologists and the demand on my time is largely out of my control. It is difficult and very expensive to recruit additional staff.

I'd agree you are underpaid for your skills and education. But a lot of jobs have become disconnected in that way. I don't know why. Something more than just simple supply and demand going on here. :confused: The grip of insurance companies and government probably has a lot to do with it.


What can I say? We live in a world where they pay people ridiculous sums for some things and surprising low amounts for others. But hey, at least you'll always have a job. That can't be said for a lot of fields.

[Raz]

Re: Interesting overview of American health care: present status, history and causes

LOL....My point is that the likelihood of getting sued has little to do with the care provided. In one case, I was guilty of walking into the OR about 15 minutes after a surgeon put a screw into someone's spinal cord by mistake. I gave the anesthesiologist doing the case a break while the surgeons figured out what they could do to ameliorate the problem. My name was on the chart, the patient had a devastating injury...BINGO! Everyone must pay!

I actually have a great reputation with the local legal community and have had quite a few requests to provide anesthesia care for attorneys and their families. I give all my patients, regardless of their occupation or ability to pay, the very best care that I can provide (and I am a very good anesthesiologist).

I have a friend who is an OB/GYN. She quit delivering babies because of the damn trial lawyers. As a result her malpractice insurance premiums declined drastically. She was sued four times: two were thrown out, one went to a jury who gave the plaintiff n-o-t-h-i-n-g, and the other one was settled by the insurance company because of the venue in which it was tried. (She used to practice in two counties of our metropolitan area, but stopped in the more urban county because of the type of juries empanneled there.)

"Jackpot Justice" is necessitating Tort Reform, some of which is not good because it reduces the chance of legitimate plaintiff claims being successfully redressed, but such is the nature of a society that is suffering from an ethical and moral collapse - from top to bottom.

[ThePythonicCow]

Re: Interesting overview of American health care: present status, history and causes

such is the nature of a society that is suffering from an ethical and moral collapse - from top to bottom.

Congratulations! You have earned the depressing comment of the day award. ;)

[flintlock]

Re: Interesting overview of American health care: present status, history and causes

I have a friend who is an OB/GYN. She quit delivering babies because of the damn trial lawyers. As a result her malpractice insurance premiums declined drastically. She was sued four times: two were thrown out, one went to a jury who gave the plaintiff n-o-t-h-i-n-g, and the other one was settled by the insurance company because of the venue in which it was tried. (She used to practice in two counties of our metropolitan area, but stopped in the more urban county because of the type of juries empanneled there.)

"Jackpot Justice" is necessitating Tort Reform, some of which is not good because it reduces the chance of legitimate plaintiff claims being successfully redressed, but such is the nature of a society that is suffering from an ethical and moral collapse - from top to bottom.

In my opinion, tort reform is a major point that needs to be addressed in any health care reform. But we really haven't heard much about that this year. I think people who have been wronged by sheer incompetency deserve some redress. But every time something goes wrong? Stuff happens. Its an incredibly complicated and risky business. I can't help but think that sometimes people don't get help because the risk of being sued is too large. Most people go to jobs every day and never have to risk more than a bad performance review. Imagine holding someones life in your hands. That's serious responsibility. I'm surprised we can still find people to do it.

[MulaMan]

Re: Interesting overview of American health care: present status, history and causes

From the general to the nitty gritty:

Meanwhile, I gross between $200,000 and $240,000 a year. I was lucky, I graduated from med school and residency with only $45,000 in debt. Recent grads average nearly $200K in debts. I am grateful that neither of my kids chose medicine as a career. I hope the bankers and lawyers choke to death on their bailouts and bonuses.

I'm glad you talked your kids out of Medicine because who the hell would want to gross only 240K a year, have 100% job security for life, and spend thier careers helping the sick. Having to go to school and get an education sucks also.

Did you push your kids into law or banking? I'll bet that you will proud of them when they make thier first $10 million by screwing a few million grandmas out of a thier life savings, ... your story brings tears to my eyes ... boo hoo ... I'm in medicine and watch bankers make millions in bonuses and I should be too ... boo hoo ... why don't I have a private jet like Bernie does? ... boo hoo ... my life sucks ... welcome to club America ... keep voting for Republican neocons and perhaps we can "de-regulate" medicine so that you too can make $10 million a year... we just need to "lend" patients the money to pay for operations and lock then in a 6% for 30 years...

So are you saying that we should have a capitalist medical system (full de-regulation in which your job gets outsourced to Indians on H1-B visas making 50K (believe me it will) a year or are you saying that we should have a single-payer socialist system and pay doctors the same or more as bankers by law?

kind of consfused where you stand on policy? even though I know it sucks being a poor doctor in America, I see them all time with thier pagers at the BMW dealer and it makes me sad

[flintlock]

Re: Interesting overview of American health care: present status, history and causes

.

So are you saying that we should have a capitalist medical system (full de-regulation in which your job gets outsourced to Indians on H1-B visas making 50K (believe me it will)

This is already happening.

Anyone else notice the huge increase in advertising by doctors these days? What's with that? The local slick color advertising magazines you pick up are all about 50% ads for doctors.

MulaMan, please quit holding back, feel free to speak your mind.

[Master Shake]

Re: Interesting overview of American health care: present status, history and causes

I work at a large, well-known academic medical center. Our infection control group has been monitoring compliance with basic hand hygiene practices for about two years. Even with a well-publicized campaign that all the big wigs embraced and took part in, we're still below 75% compliance, and that's probably an overestimate. Compliance among doctors is the worst, below 50%.

[charliebrown]

Re: Interesting overview of American health care: present status, history and causes

man this is the best piece about medicine I have ever seen written. thank you for being so frank and giving real examples. I don't know if you talk to your patients about their bill, but my I just got a bill for my son's anethesia, and the amout was $1000 for supplies, and $1400 for the anesthesiologist. The time billed was 1.75 hours. So the company is asking $800 per hr. This is in suburban illinois.

I have been an IT consultant before, and typically if you work for a company, that pays benefits, the company will bill you out at something around 50 to 100% of your rate. In the late nineties I was getting paid around $50 per hour and was being billed out at $100 per hour. I got full benefits.

So I don't really think you are over charging, but if the doc I had gets paid the same you are, then $800 / hr seems like there is a bit too much padding by the company that he works for.

Additionally, now I see why the cash customer pays the most because many don't pay. Can we get around this? You know if my doc in this case says I'll work for $60 / 15 minutes if you give me your visa card, we could have made a quick deal. I get a bill for $420, you make $5 per 15 min over the insurance, and you get your money today, not 90 days from now.

Does $1000 for anethesia supplies seem reasonable?
This was out patient surgery.

[reallife]

Re: Interesting overview of American health care: present status, history and causes

I'm glad you talked your kids out of Medicine because who the hell would want to gross only 240K a year, have 100% job security for life, and spend thier careers helping the sick. Having to go to school and get an education sucks also.

Did you push your kids into law or banking? I'll bet that you will proud of them when they make thier first $10 million by screwing a few million grandmas out of a thier life savings, ... your story brings tears to my eyes ... boo hoo ... I'm in medicine and watch bankers make millions in bonuses and I should be too ... boo hoo ... why don't I have a private jet like Bernie does? ... boo hoo ... my life sucks ... welcome to club America ... keep voting for Republican neocons and perhaps we can "de-regulate" medicine so that you too can make $10 million a year... we just need to "lend" patients the money to pay for operations and lock then in a 6% for 30 years...

So are you saying that we should have a capitalist medical system (full de-regulation in which your job gets outsourced to Indians on H1-B visas making 50K (believe me it will) a year or are you saying that we should have a single-payer socialist system and pay doctors the same or more as bankers by law?

kind of consfused where you stand on policy? even though I know it sucks being a poor doctor in America, I see them all time with thier pagers at the BMW dealer and it makes me sad

I wasn't saying any of the things you have suggested??? Please reread my posting and compare it to yours. FYI, my kids are engineers and make a fraction of what I earn. I'm glad they didn't go into medicine because I would have been stuck huge bills and they would have been stuck with truly huge loan repayments. I thoroughly enjoyed my 14 years of education beyond high school. I am well compensated for it. I wasn't making any points on policy so you don't have to be confused. I wasn't making any comment about capitalism vs, socialism. I'm not sure where you got that idea. I voted for Obama. I'm not a poor doctor. I drive a Mercedes not a BMW. LOL (at you)...

[Raz]

Re: Interesting overview of American health care: present status, history and causes

I'm glad you talked your kids out of Medicine because who the hell would want to gross only 240K a year, have 100% job security for life, and spend thier careers helping the sick. Having to go to school and get an education sucks also.

Did you push your kids into law or banking? I'll bet that you will proud of them when they make thier first $10 million by screwing a few million grandmas out of a thier life savings, ... your story brings tears to my eyes ... boo hoo ... I'm in medicine and watch bankers make millions in bonuses and I should be too ... boo hoo ... why don't I have a private jet like Bernie does? ... boo hoo ... my life sucks ... welcome to club America ... keep voting for Republican neocons and perhaps we can "de-regulate" medicine so that you too can make $10 million a year... we just need to "lend" patients the money to pay for operations and lock then in a 6% for 30 years...

So are you saying that we should have a capitalist medical system (full de-regulation in which your job gets outsourced to Indians on H1-B visas making 50K (believe me it will) a year or are you saying that we should have a single-payer socialist system and pay doctors the same or more as bankers by law?

kind of consfused where you stand on policy? even though I know it sucks being a poor doctor in America, I see them all time with thier pagers at the BMW dealer and it makes me sad

Mulaman, you seem to delight in using accusatory rhetoric and enjoy insulting people - even people whose wives are suffering from cancer (as in yours truly).

Were you born an asshole, or have you just been working hard at it your entire life?
You're exhibiting some of the key characteristics of a near-total loser.

You apparently are a very angry person. Who do you blame for whatever problems you have? :confused:

[Ghent12]

Re: Interesting overview of American health care: present status, history and causes

In my opinion, tort reform is a major point that needs to be addressed in any health care reform. But we really haven't heard much about that this year. I think people who have been wronged by sheer incompetency deserve some redress. But every time something goes wrong? Stuff happens. Its an incredibly complicated and risky business. I can't help but think that sometimes people don't get help because the risk of being sued is too large. Most people go to jobs every day and never have to risk more than a bad performance review. Imagine holding someones life in your hands. That's serious responsibility. I'm surprised we can still find people to do it.

I think tort reform is mostly a red herring, and I would disagree that it has not been talked about very much. The talking heads rarely mention it, however almost all of the "angry mobsters" in the Town Hall circus have been mentioning it. My greatest fear would be that tort reform, and just tort reform, would happen to the extent that only the truly mega-rich can even afford the legal fees to have legal rights, or it otherwise takes the rights away from all Americans. However, since all three branches of government are dominated by lawyers, I do not see tort reform ever happening. I would agree that there should be some more well defined legal lanes to drive in, so to speak.

The real market manipulation is FIRE itself. Medical insurance is hardly an example of the free market in action; it's an example of corporate capitalism, aka textbook fascism. Unfortunately, the only type of health care reform that Congress would be allowed to do under the Constitution--which is the removal of state-border restrictions on insurance programs--isn't even being considered! So much for keeping interstate commerce regular.

[reallife]

Re: Interesting overview of American health care: present status, history and causes

man this is the best piece about medicine I have ever seen written. thank you for being so frank and giving real examples. I don't know if you talk to your patients about their bill, but my I just got a bill for my son's anethesia, and the amout was $1000 for supplies, and $1400 for the anesthesiologist. The time billed was 1.75 hours. So the company is asking $800 per hr. This is in suburban illinois.

I have been an IT consultant before, and typically if you work for a company, that pays benefits, the company will bill you out at something around 50 to 100% of your rate. In the late nineties I was getting paid around $50 per hour and was being billed out at $100 per hour. I got full benefits.

So I don't really think you are over charging, but if the doc I had gets paid the same you are, then $800 / hr seems like there is a bit too much padding by the company that he works for.

Additionally, now I see why the cash customer pays the most because many don't pay. Can we get around this? You know if my doc in this case says I'll work for $60 / 15 minutes if you give me your visa card, we could have made a quick deal. I get a bill for $420, you make $5 per 15 min over the insurance, and you get your money today, not 90 days from now.

Does $1000 for anethesia supplies seem reasonable?
This was out patient surgery.

If you respond with the type of surgical procedure your child underwent I could give you a detailed breakdown of the costs.

In general, we charge for anesthesia services based on the procedure and the time we are directly and personally providing care. For example, an appendectomy is 6 base units to start the case and one additional unit for each fifteen minutes. So for an appy that lasted 75 minutes, I would bill for a total of 10 units 9rounding down on the time units). My charge is $70 a unit so the fee would be $700, before discounting. I have negotiated a discounted fee with nearly every insurance company that you can think of. Generally the discounted fee is around $50-55 per unit. By accepting a lower payment, I get a more prompt payment which is easier to collect.

So, if the patient is insured, my actual bill would be $500-$550. The insurance company pays me 80% of the fee and the patient is responsible for the 20% remainder. I have to bill the patient and they frequently stiff me. I send them to collections as a rule. If the patient is covered by Medicare, the gov't pays me $19.50 a unit and I am not allowed to bill the patient for the balance. My fee is therefore limited to $195.00. This is true for any Medicare patient, no matter their economic situation. Warren Buffett pays the same $195 as an impoverished elderly person. Since these patients are often very ill even before they come to surgery I have very little desire to provide anesthesia services to Medicare patients. Given half a chance, I usually try to go home early rather than work for that low of a fee. Medicaid is in the same ballpark.

As an anesthesiologist, I have many hours each week that are non-productive and unbillalble. Time between cases, time wasted waiting for surgeons, equipment, etc is simply lost to me. It isn't possible to increase my workload without leaving my current position and going back to doing much more complicated and risky cases. The only way to increase my income would be if I increased my fees but the fee is almost always discounted anyway. A few years ago, I decided to maximize my lifestyle rather than my income. I forego income and in exchange I limit my working hours and take a lot of time off. Like 12-16 weeks a year off.

I'm in private practice, handle my own billing, and pay all my taxes, practice expenses, fund my retirement, etc out of my gross receipts. Many anesthesiologists are in groups that can charge more because they have more negotiating power. I used to be in such a group. Our undiscounted fee was around $100 a unit (several years ago) so that is probably what you are dealing with in your case.

My contracts with the insurance companies specify that I can not negotiate a separate fee with their clients. I and you have to live by the rules. The patient who is uninsured is responsible for my full fee, which in the case of the appy would be $700. Needless to say, I rarely get anything at all from uninsured patients. They simply don't pay for services that have already been rendered. Nonetheless, I am an ethical person and I provide them the same excellent care regardless of their ability to pay.

I support the efforts to reform the health care industry. I think it is terrible that we have in this country, people who are unable to get the care they need, whether it is because they don't have insurance or whether the care is denied by their insurance company. At the same time, I think it is very important to recognize that health care expenses are largely due to lifestyle decisions that people make. For example, human diseases related to obesity account for about 10% of health care expenditures. That total knee replacement your neighbor had last month? Well, it was probably related to obesity; obesity related to junk food and soft drinks. Smoking more and enjoying it less? Well, society is paying for it! The ONLY way to decrease health care costs is to induce lifestyle changes that promote good health. Anything short of long-term lifestyle change is just shifting the costs around, from the patient to the government, from the insurance company to the patient, from the government to the taxpayer, etc. There is still no such thing as a free lunch!

[charliebrown]

Re: Interesting overview of American health care: present status, history and causes

i'm not going to dispute with my doctor how much he charged, I just wanted to let you know that there is a lot padding between the fee you receive and the amount the patient gets billed. Using your parlance above my son's procedure which was for insertion of sub dermal tissue expanders it was billed at 4 starting units + 3 additional units.

If we get obama care does that mean that you are going to get paid at somewhere near 19.95 per unit for all of your work? Could you run a business on that? That's the rate my mechanic charges me to replace my timing belt!!!

Nobody wants to talk about the nitty gritty of this plan they want to speak in platitudes. The devil is in the details. I have not heard anyone say that the gvt would be setting the costs for services. If the do there is big difference between setting the fee at 19.95 and 80!!.

What are my costs in this plan? my premiums, my max out of pocket, deductible no one talks about that either. I'm sure they will say we can't know that until the plan is set up. but how can I support something if I don't know the details?

I assume your outta there if you have to work for 19.95. How many other will follow?

[BuckarooBanzai]

Re: Interesting overview of American health care: present status, history and causes

Thanks for posting this. Insurance-- whether it is delivered by private or public institutions-- is the problem, not the solution. Refreshing to read an article that makes that point in such a clear and powerful way.

[bpr]

Re: Interesting overview of American health care: present status, history and causes

i'm not going to dispute with my doctor how much he charged, I just wanted to let you know that there is a lot padding between the fee you receive and the amount the patient gets billed.

Indeed. Anesthesiologists in particular are in a difficult position as many times they never actually meet the patients they care for. In emergency surgery, no one thinks to ask who administered the anesthesia. I think a patient is more likely to toss the bill from a doctor they've never heard of than they are from a doctor they met or heard was going to operate on them.

I assume your outta there if you have to work for 19.95. How many other will follow?

Interesting point. The question is, where will he go?

I'm surprised that there isn't much talk of reforming medical school to lower the barriers to entry into the profession. It is as most clearly a racket as, say, law school.