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

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  •  Doctors fee for service is broken. (7+ / 0-)

    Over the past few decades the costs of Doctor visits has gone up out of all reason.  Everybody has high student loans, do teachers in colleges get to pass on the cost of their loans?

    And the idea of liability insurance driving the cost up, doesn't make that much sense.

    Too many anecdotes, all I know is Canada has a working health care system, and we don't.  Insurance, fee for service breaks the system.

    Medicare for all, but the Docs on salary.  Pay off their loans like subsidize the paying off public service workers, forgive after 120 payments.

    •  My Docs are attached to a medical school so they (1+ / 0-)
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      teach as well as work in their clinic. Regular Doc visit $150 specialist $300 - $500. Seriously who can afford those costs?

      The work goes on, the cause endures, the hope still lives and the dreams shall never die. ~ Edward M. (Ted) Kennedy

      by cherie clark on Tue Jan 01, 2013 at 05:43:30 AM PST

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      •  come on. (1+ / 0-)
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        I also am an MD (MD/PhD) at a university center where I do research as well as work in a clinic as a specialist. We see hard cases, usually 2nd and 3rd opinions. An office visit with me is usually 1hr for a return visit, 2hrs for a new visit. We charge somewhere in the $300 range which would be $150/hr.

        Now I have nothing to do with the billing but I'm told we are actually reimbursed somewhere in the 50% range overall which would be $75/hr, thanks to the vagaries of Medicare billing and private insurance reimbursement.

        The local car mechanic labor rate (no parts) is $90-$110/hr.

        I personally have a salary determined by my department and the NIH research grant that I got for myself, which pays me about $50k/yr after everything is taken out. More senior people up to the dept head make about 2x that (he makes about 4x). Keep in mind that we live in one of the 4 most expensive cities in the country.

        I have no hope of owning a home. I drive a 12 yr old car. I still have student loan debt. I just fed my 1 month old son and I hear they're expensive. I know I'm not poor but I am far from rich here.

        I promise you this: doctor salaries are not the problem with American healthcare on the whole.

        •  You're the face of the system (1+ / 0-)
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          It's hard for people to differentiate.  They see that they're paying (or someone is paying on their behalf) 10-50x their own hourly wage and they're often getting ambiguous results.  They don't recognize that you're getting at best $25.00/hr by your description while the rest goes elsewhere.  They feel, correctly, that some people in the system are making out like bandits.  They need a human face for their anger and frustration.

          My own doctor has been exceedingly generous with her time, partly because I am an interesting case and partly because I've previously been victimized elsewhere by a fateful series of careless misdiagnoses and failed super-expensive diagnostic procedures and active, unethical (at best) cover-up of those failures.

          But she's an internist and instructor in hospital-affiliated practice and for most patients in the ordinary course of things, her masters bill much more than $150/hr for her and for others in the practice like her.  This is primary care, remember...

          And actually, I can't remember the last time I visited a primary care physician whose effective billing rate was anywhere as low as $150/hr.  It makes me wonder if you work at an ideologically motivated facility that charges less than market rates.

          And of course, as you touch upon without delving into it, there is the obscenity that insurance companies pay a discounted rate even though they are much more trouble to deal with than self-pay patients, and self-pays end up paying ridiculously inflated fees as reward for being less trouble.  Most recently my insurance company (routinely) settled a hospital bill not for the 50% you mention but for less than 25% of what I would have paid if I had been self-pay.

          Ideology is when you have the answers before you know the questions.
          It is what grows into empty spaces where intelligence has died.

          by Alden on Wed Jan 02, 2013 at 10:17:17 AM PST

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        •  it isn't the pay for the time. (0+ / 0-)

          It's the number of procedures, particularly those which don't even work or work well.

          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 04:27:33 AM PST

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    •  I'd always wished we could have a non-political, (1+ / 0-)
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      non-partisan audit of where each dollar spent on, say primary care in the US went, then compare it against money spent in Canada, the UK, Japan, Switzerland (which has a system similar to the one we'll have next year) and Scandinavia.  I think we'd learn a lot.

      Lots of people think lots of things.  We think that it gets eaten by insurance companies, and surely much of it does - the number of people who work in insurance is pretty large and it's not just the executives - there are an enormous numbers of claims adjustors, salespeople, phone representatives, and all sorts of other people, and they have to eat too.  Certainly, taking the insurance companies out of the picture cuts down on the number of middlemen, but in the UK, it's not that those jobs don't exist - it's that, with the exception of sales, they're done by the NHS rather than private companies.  Hell, even the NHS does outreach, even if not to the extent that our insurers do.  So, in a perfect world, I'm all for eliminating those middlemen, but I'm cautious about thinking that doing so is some sort of panacea (no pun intended ^_^).

      Of course, the GOP is convinced that it's malpractice lawsuits or insurance, and certainly insurance plays a role - all sorts of professionals have to socialize risk in order to practice their profession - although I suspect that the role of malpractice lawsuits is greatly overstated and, of course, many of those people are actually victims.

      The problem is that I don't think we could actually get that non-partisan, non-political study.  The well on this issue has been polluted for decades.  The closest we've come is some of the CBO scoring that we've gotten on various health law proposals, but that's inadequate.

      The other problem, which the massive, gut-wrenching debate over the ACA didn't really resolve, is that when we talk about medical access in the US, we really have two problems, one of access and one of cost.  I think that the ACA will solve the access issue, although inelegantly.  But I don't think we've adequately addressed the cost issue.  Still, it's a far better win than any prior president has been able to accomplish and solving the access issue is an enormous victory for disabled people; when the story of the ACA is written 50 years from now, I think more ink will be spent on the issue of disability in America then was spilled on it a couple years ago.

      "The first drawback of anger is that it destroys your inner peace; the second is that it distorts your view of reality. If you come to understand that anger is really unhelpful, you can begin to distance yourself from anger." - The Dalai Lama

      by auron renouille on Tue Jan 01, 2013 at 06:12:56 PM PST

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