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View Diary: Medicare also going over the "cliff" (108 comments)

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  •  You are a small part in a grand scheme (31+ / 0-)

    of austerity designed to enrich the 1%.

    Besides that, your problems would be solved if we had single payer, instead of having the highest risk pool pay the least for services.

    "To recognize error, to cut losses, to alter course, is the most repugnant option in government." Historian Barbara Tuchman

    by Publius2008 on Mon Dec 31, 2012 at 02:03:22 PM PST

    •  We're all a small part of the big picture- (18+ / 0-)

      but if doctors start turning away patients because of compensation cuts, that's a big problem for a lot of people.

      •  but NOT a problem for the rich (17+ / 0-)

        or the Republicans who have supported and enabled their schemes to bilk the nation for their continuing enrichment.

        Help American return to sanity - vote the GOP OUT OF the House Majority and reduce their numbers in the Senate in 2014 elections. America requires Democratic action in order to survive!

        by dagnome on Mon Dec 31, 2012 at 02:34:35 PM PST

        [ Parent ]

      •  U.S. MD incomes are a big part of the problem. (18+ / 0-)

        They make 50-100 percent more than European, Canadian, Aussie, & N.Z. docs.  Of course, this is mostly true because of the outrageous incomes of the specialists, not the G.P.'s, family docs, general peds docs, etc.  In part, this is just a matter of supply and demand, since we have a ratio of docs to population that is much lower than in most of the wealthy West.  The American medical profession has deliberately created this situation by lobbying against the expansion of the number of places in American medical schools, so that, if it weren't for a large influx of foreign-trained docs in the last 20-30 years, we'd have an even more severe doctor shortage than we have now.  

             Obviously, it's impractical to try to make sudden drastic cuts in current doctors' incomes.  Besides motivating many of them to stop seeing Medicare patients, it's hardly fair to them to suddenly break the implicit contract under which they became doctors.  But they should be put on notice that their incomes are going to be very gradually pinched down to some sustainable level through reduction of Medicare and other insurance re-imbursement levels -- you know, part of that "shared pain" all the wealthy Villagers are always talking about.  And this can be accomplished over the long haul in a very market-based way -- double or triple the number of places in American medical schools and increase the immigration of foreign-trained doctors.  And don't listen to the A.M.A.'s screams about harming the quality of care -- it's bunk, as even a casual examination of cross-country health & longevity figures suggests, as does my 30 years of professional experience as a clinical neuropsychologists working with docs trained in a variety of different countries.  

        •  How about the ridiculous cost of medical school? (16+ / 0-)

          My friend graduated with a quarter million in debt. Until you fix that, there's no way we should be telling doctors they make too much money.

          •  I think you'll find the ridiculousness of the cost (16+ / 0-)

            is becoming the new norm for all higher ed, not just med school.

            Yet another way to separate the sheep from the wolves.

            •  Yeah, the wolves get the higher ed (9+ / 0-)

              so they can better fleece the sheep.

              If it's
              Not your body,
              Then it's
              Not your choice
              And it's
              None of your damn business!

              by TheOtherMaven on Mon Dec 31, 2012 at 08:19:39 PM PST

              [ Parent ]

            •  In other countries Higher Ed. is not nearly as (8+ / 0-)

              costly as the USA.

              "We are a Plutocracy, we ought to face it. We need, desperately, to find new ways to hear independent voices & points of view" Ramsey Clark, U.S. Attorney General.

              by Mr SeeMore on Mon Dec 31, 2012 at 11:38:23 PM PST

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            •  In countries where education is a right... (9+ / 0-)

              ... not an expensive privilege, education from kindergarten through college is free.  If they can't stay home and go to college, they get a monthly stipend for food and rent so they can devote all their time to their studies.  This is the policy in all three Scandinavian countries.

              Medical care is also considered a right for everyone in all three Scandinavian countries, from commoner to king/queen, and it's all paid for - for everyone.  Parental leave for BOTH parents is generous (can be 18 months or so) and paid (at about 80% of their salary), and their jobs are waiting for them when they go back to work.  Sick leave is paid and jobs are waiting when the person gets the doctor's okay to go back to work.

              True.  Their tax rates are high..., but NO ONE has to worry about going into debt for catastrophic illnesses, or if they have to stay home and take care of a sick relative, or when a new baby comes into the family, and no one graduates from college in debt for many years.  Furthermore, no one seems to mind the high tax rate since everyone benefits.

              It works like our Medicare Part A and Part B - NOT-FOR-PROFIT SINGLE-PAYER health insurance [which everyone pays for when they're working (except Medicare Part D which seniors and disabled pay to private corporate insurance companies for prescription coverage - we were told buy this insurance or else), just like they do with FICA/Social Security Insurance.  Social Security recipients continue to pay for Medicare after they receive SSI or SSDI and are no longer in the working world; it's deducted before the remainder is deposited in one's account.

              If we didn't have insurance, medical, and pharmaceutical corporations (along with oil, military-industrial-congressional, and mercenary corporations) standing in line to receive handouts or surgically attached to Treasury Teats so they can pay executive bonuses, shareholders, and funnel profits to offshore accounts, not to mention banks, investment banks, and Casino Wall Street waiting in the wings for our Social Security Trust Fund money, we could have educational and medical systems like the countries that always rate in the top ten in the world for best places to live or where people are listed as happiest or most contented.

              OTOH, they also don't spend huge fortunes on their military budgets.  They have a national service that most able-bodied persons have to go through for a couple of years, but they have it in perspective: it's a phase of one's life, it doesn't define their existence.  They also don't go around invading countries illegally or unconstitutionally.

              They also enforce their laws when corporations start price gouging their citizens.  [Wow!  Novel concept, eh?]

              In terms of education and medical care, the US is lagging behind even some third world countries.  [The last survey I read a couple of years ago we were at #37.]

              Boo-YA.  Yeah, we're #1..., in being the world's bullies and spending money on the military [about 50% of our national budget!] and illegally and unconstitutionally invading other countries and spending money on those same illegal and unconstitutional wars....


              That, in its essence, is fascism--ownership of government by an individual, by a group, or by any other controlling private power.
              -- Franklin D. Roosevelt

              Fascism should rightly be called Corporatism, as it is the merger of corporate and government power.
              -- Benito Mussolini

              Fascism, the more it considers and observes the future and the development of humanity, quite apart from political considerations of the moment, believes neither in the possibility nor the utility of perpetual peace.
              -- Benito Mussolini

              I'm sick of attempts to steer this nation from principles evolved in The Age of Reason to hallucinations derived from illiterate herdsmen. ~ Crashing Vor

              by NonnyO on Tue Jan 01, 2013 at 08:32:38 AM PST

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            •  Yep. My daughter-who makes about $40K per (0+ / 0-)

              year has $90K in school debt.  And she will never make anything anywhere near what an MD makes.

              We need to take a look at why all education is so expensive.

              I fall down, I get up, I keep dancing.

              by DamselleFly on Tue Jan 01, 2013 at 04:55:24 PM PST

              [ Parent ]

          •  and insurance and treating a medical practice as (0+ / 0-)

            a profitable business

      •  Total bullshit (0+ / 0-)

        What a greedy stupid system.  Yeah right I am so worried about doctors being able to drive their fucking Mercedes.  Give me a freakin break.

        "The real wealth of a nation consists of the contributions of its people and nature." -- Rianne Eisler

        by noofsh on Tue Jan 01, 2013 at 02:24:06 PM PST

        [ Parent ]

      •  I lost my gynecologist (3+ / 0-)
        Recommended by:
        Pariah Dog, Mr Robert, david78209

        I live in a Georgia city with about 100,000 population. My previous gynecologist sent out a letter saying he would no longer accept "Medicare patients." I got out the phone book and started calling other ob-gyn clinics and doctors. I found ONE doctor in this whole city who will still accept Medicare patients. I like him. He is an older man, but obviously still competent. He is board certified. But I expect this year that maybe he too will drop his Medicare patients, because of the lack of sufficient bill payments. Then I will have to go further to find a gynecologist, and I have no car. I can take the airport shuttle into Atlanta, 60 miles away, to see a doctor (if I find one there), but that round-trip on the airport shuttle will cost me $68. And Medicare won't cover my transportation expenses. So, doctors refusing Medicare payments is a HUGE problem for the patients like me who are limited in access to larger cities where more doctors may be found accepting Medicare patients. I'm grateful for my doctor here; I just hope he will continue caring for me.

        •  I'm also in a small rural community (1+ / 0-)
          Recommended by:

          and finding a doc who accepts Medicare is not easy, however, I did manage to find one that I like. Unfortunately, he's not affiliated with the local hospital so if I need to be hospitalized I'll end up depending on a hospitalist who's basically an employee of the hospital.

          The only trouble with retirement is...I never get a day off!

          by Mr Robert on Wed Jan 02, 2013 at 01:20:41 PM PST

          [ Parent ]

    •  Excuse me... (20+ / 0-)

      I don't think so...  Unless he is a specialist and/or sees patients as part of a hospital group, he is not that well paid on take home (and even then it may be a small salary).

      Most doctors (young or older) have a huge debt load to pay off (in the range of 180,000 to 250,000), then in the private practice you have to pay for:
         Office equipment (Chairs, tables)
         Computers and software (and you would be surprised how much the software for EMR costs)
         Back office staff (billers, insurance people, receptionist)
         Nursing staff
         Technical staff (if the practice is large enough and the doctor doesn't do his own software/hardware stuff)
         Exam equipment (scales, BP cuffs, exam tables, etc.)
         Lab work materials (Blood draw & tubes, swabs (cultures), collection cups, lab kits, etc)
         Office Rental/purchase

      Most who are in private practice will bring home maybe 50,000-60,000/yr in a decent practice (after 18+ months of starting).  A big practice might bring home 80-100,000/yr (a big practice is seeing patients from 8 am till 6 pm 5 days a week).

      Your comment above is about || that close to being HR'd.  How do I know these things... my partner just finished up med school and is starting a private practice.

      "Death is the winner in any war." - Nightwish/Imaginareum/Song of myself.

      by doingbusinessas on Mon Dec 31, 2012 at 05:16:26 PM PST

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      •  Ty for this comment. you are exactly right. most (8+ / 0-)

        internists, pediatricians and family practitioners are not by any means rich.

        "Say little, do much" (Pirkei Avot 1:15)

        by hester on Mon Dec 31, 2012 at 05:37:28 PM PST

        [ Parent ]

        •  Our primary care pysician works for a (8+ / 0-)

          corporation owned by a very large hospital corporation. The corporation decides whether he can see patients on Medicare, it's not up to him. In exchange, he is relieved from the responsibiity for almost all the things doingbusinessas mentioned in his comment -- billing, hiring staff, buying or leasing equipment and space, etc. In return, he probably doesn't make as much as a fully established physician does, but in the early years, he knew he could make his loan payments. We all make tradeoffs.

          “Social Security has nothing to do with balancing a budget or erasing or lowering the deficit.” -- Ronald Reagan, 1984 debate with Walter Mondale

          by RJDixon74135 on Mon Dec 31, 2012 at 06:14:06 PM PST

          [ Parent ]

      •  Oh the horror! (0+ / 0-)

        I have to laugh. But it's not funny. Reminds me of Romney talking of the 47%. Those poor impoverished docs on food stamps.

        Shorthand they are 1%ers.

        How big is your personal carbon footprint?

        by ban nock on Tue Jan 01, 2013 at 04:44:45 AM PST

        [ Parent ]

        •  now for some whining (6+ / 0-)

          Most of us aren't close to the 1%. Most aren't in the 2% either. Our salaries start with a 1. "Average" salary statistics are very misleading here, with procedural specialists skewing the numbers. Look for median instead.

          We aren't poor. This is true. And every discussion of it seems whiny. I understand that. Now for some whining:

          We aren't nearly so rich as the general perception, however.

          Also, remember that there is a long period of education previously to getting paid.

          Undergraduate prior to medical school. Then four more years of medical school. And med school isn't like some other schools. In 3rd and 4th year, you are actually working (and paying to do so). Your attendance is mandatory and you will have to repeat your rotation if you miss time. Then 3 years of residency (4 or 5 for some specialties). Then potentially another 1-3 years for fellowship. Only some of these are in the lucrative procedural specialties.

          If I just paid off student loans and didn't spend any money on anything trivial like food or shelter, then it would have taken the first 7 years of my full time work to pay off the loans. And full time for a doc is not normal full time. If you count "on call" time, then the hourly wage was less than $10 an hour during my first five years.

          I would have made considerably more money doing something else.

          I still wouldn't go back and change my choice. It ain't based on the cash though.


          The majority of docs want single payer. Shown in repeated polling. We hate dealing with multiple different insurance companies and not knowing which treatments are covered. We hate having to beg insurance companies to cover things. We hate having to figure out whether something is covered or not rather than whether or not it is the best medical option.

          The plural of anecdote is not data.

          by Skipbidder on Tue Jan 01, 2013 at 11:36:53 AM PST

          [ Parent ]

        •  No, we're not (4+ / 0-)
          Recommended by:
          Skipbidder, Alden, Mr Robert, david78209

          I'm really getting sick and tired of people assuming that I'm rich because I'm a doctor. Between time spent doing research and volunteer work and additional advanced training (absolutely choices I made, but that were involved in getting into and paying for medical school, and now getting the required training in my field), I'm closing in on 40yrs old with a new baby, lots of expenses (inc student loan debt), and a shiny $50k/yr salary in one of the most expensive areas of the country. My car is 12yrs old.

          I'm not poor, no. But a 1%-er?? Neither I nor most of the other docs I know are anywhere near that category. Someone is getting rich on health care but for the most part it isn't the practitioners: it's the insurance and pharma companies.

      •  Forgot Malpractice Insurance (1+ / 0-)
        Recommended by:

        Probably the biggest - and a dire situation that will reduce the number of licensed physicians in this county more than any other costs.

        Because incompetent doctors are protected by medical boards - raising insurance for everyone.

        If not us ... who? If not here ... where? If not now ... when?

        by RUNDOWN on Tue Jan 01, 2013 at 10:06:20 AM PST

        [ Parent ]

      •  How about if we forgive the debt of all doctors (2+ / 0-)
        Recommended by:
        my pet rock, Alden

        that spend the first 10 years of their practice on Medicare patients.  Would that help?

        •  That would be a start, except for the other (0+ / 0-)

          licensed practitioners (Nurse Practitioners, Naturopathic Doctors, Doctor Assistants, some Chiropractors) who are NOT in the medicare system.  And the AMA is fighting tooth and nail to keep them out of the medicare system, and reducing their patient load of medicare patients because it isn't worth the cost.  

          All of the ones I mentioned above are not in the medicare system and a lot of them would like to be in it.

          "Death is the winner in any war." - Nightwish/Imaginareum/Song of myself.

          by doingbusinessas on Wed Jan 02, 2013 at 11:00:33 AM PST

          [ Parent ]

      •  you don't need all that to start off (0+ / 0-)

        and a new doc can buy a practice which has the equipment and even staff. But your partner seems to want to perpetuate the old inefficient ways. The problem is that wasting money and time with excesses as you spell out does not lead to good care. It gets in the way of it.

        You can get an excellent EMR program free from the VA and the government has grants for getting it set up or even buying one and customizing it. And most doctors use the medical labs for tests; they are so automated that the cost per test  is lower than a single office can do it.

        But there are a lot of surveys and studies of doctors incomes and the average for primary care doctors runs between $180k to $220k per year. That's take home.

        And that includes doctors who take Medicare patients.

        Why on earth does he want to practice alone?

        I'm asking you to believe. Not in my ability to bring about real change in Washington ... *I'm asking you to believe in yours.* Barack Obama

        by samddobermann on Tue Jan 08, 2013 at 03:41:39 AM PST

        [ Parent ]

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