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July 27, 2009

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Dave (in MA)

Nice barely-SFW cleavage in the sidebar ad.

Thomas Collins

Has anyone "costed out" a plan under which charitable hospitals would have a significant increase in their funding to treat the uninsured? The fact of the matter is that, with the medical innovation in our country, those treated in charitable hospitals get decent care.

Before we blow up a system that has provided top notch health care, we should be thinking about simple tweaks to the system (increased subsidies to charitable hospitals and allowing access to out of state health plans are the tweaks I have in mind).

By the way, please spare me the talk about France's system. I suspect that a fair study would conclude that the proportion of at risk patients our system treats is far higher than in France. Furthermore, the demand for medical innovation and end of life care is, I suspect, far greater here than in France.

Neo

Among people who receive assistance, it [the House bill] said, the average subsidy would be $4,600 in 2014, rising to $6,000 a person in 2019.

This is "cost containment" ?
I can see why the CBO is killing the proposal.

Neo

The CBO sends another "love kiss" to the White House.

clarice

Savings as in jobs saved, neo you dummy! Get with Obamaspeak

Thomas Collins

See LUN for John Conyers on reading the 1,000 page House health care bill. I must give Conyers credit for candor on this point!

Old Lurker

Dave, what is SFW? I know what cleavage is...

DrJ

SFW == Safe For Work; usually NSFW is a warning.

Pofarmer

Sure, NOW you post a thread on health care, after I totally hijacked the other one.

Old Lurker

Thanks, DrJ. Was not familiar with that one. And now the cleavage ad is gone anyway.

Pofarmer

I'm gonna bring this over here.

They are the ONE group in all of this that we absolutely CANNOT due without. Sorry that you don't like it that we try to compensate them well.

And there's the rub. Nobody is saying do without Dr's. I'm saying that an awful lot of Dr's, including a lot of mediocre ones, are making gawdawful amounts of money, and charging exhorbitant prices for Procedures. Maybe most of it is in Liability, but certainly not all of it. My wife has an echocardiogram done once a year. A $15 an hour tech does it in a 10x10 room. It costs somewhere north of a grand and takes about 15 minutes. A Veterinary tech will bring the identical machine out to do ultrasounds on cattle for various things, it costs around $25 bucks a head. Why does a Dr get $1,000 to put tubes in a kids ears and it takes a grand total of 5 minutes? The anestesiologist gets another Grand. The nurses make $2 in the same time period. And, yes, at rural hospitals the Docs are getting between $1000 and $1500 just to be "on call" over night, regardless of if they get called or not. On call docs rotate. Also, a lot of rural hospitals, if you stay 3 years, will pay off ALL of a docs student loans, don't know how that is at larger hospitals. There's plenty more, but how are you going to "reform" the health system, if you don't look at what's at the BASE of the system and the ones that do most of the billing? That would be the Docs. Now, I think one HUGE problem here is that the AMA has created a shortage of docs via not allowing enough students into med school. Acceptance into med school is running 43%. Are the other 57% dunces? I serious doubt it, folks not near the top of their class don't even apply. When the fees get as exhorbitant as they have currently gotten, then we have a SHORTAGE of Dr's, and the shortage, like so many other things, has been manufactured. Let the free market work. Unless you are willing to allow that to happen, then, eventually, you WILL come to socialism. Procedures should get cheaper the more common the become. This has happened with Lasix, it is NOT happening with Angioplasty. WHY?

Jane

Po,

For the most part docs have no idea what is charged for things. They don't set the rates - the hospital does. But the real problem is malpractice threats. Docs over treat everyone so the price for the people who can't pay gets spread back on the rest of us.

I also think docs are paid based on a few things. When the resident cardiologist finished her fellowship she had a zillion offers - as much as $600,000 a year to go to Timbuktoo, and as low as $200k. With a half a million in student loans that is not that exorbitant.

I'm in the school that wants my doctors paid well. I also think doctors do commit malpractice and more often than not get away with it. My guess is that it is the bogus cases (defense) that cost all the money.

jimmyk

Also, for every seemingly outrageous charge, remember that, first, in many cases those charges end up being reduced by agreement with the insurance companies; and second, there are many services that are provided for free or virtually nothing, which we easily overlook. Also, the costs are much higher than they appear. There's the equipment involved, the doctor's time in analyzing the results, the malpractice insurance, and (as Jane pointed out) the cost of treating many people for nothing) among other things.

Pofarmer

Now look folks. Trust me, I've seen LOTS of medical bills in the past 5 years. Two years ago on the 4th of July, my middle son fell and cut his hand. He wound up with 3 stitches. We got two bills, one from the Hospital and one from the Doc. The Doc's bill was $400. The Hospital charge was $300. I'll gaurandamntee you everybody got paid the billing amounts on that deal, because it came straight out of my frickin pocket. Are you going to tell me that a Dr. doesn't know what the charge is going to be when it comes directly from his office? C'mon, I was born in the dark but it wasn't last night. When you have a procedure done now you get multiple bills. You'll get one from the Anesthesia doc if that's involved, one from the Physician, one from the ER if that was involved, one from the Surgery clinic, one from the Hospital.

Now we need to QUANTIFY where all the costs are coming from, if we really want to discuss this. I don't think anybody is willing to cough up the information neccessary, though.

They don't set the rates - the hospital does.

No, but they set there OWN rates. See reply above.

Pofarmer

One more than back to the salt mines for the afternoon.

A few years back a good friend of mine and his family went to the Dr's office. They all had the same crud. Nurse practitioner came and said, "yep, you all have X"(whatever respiratory bug was going around) and made them out a prescription for some drug. They were in the treatment room a total of maybe 15 minutes for all 6 of them. All got the same prescription, except dosages for age. They got a bill for SIX 80 dollar office visits. $480 for 15 minutes in the room and 5 minutes writing out prescriptions, and never saw an actual Dr.

There's a point when "well compensated" starts to look a lot like "robber baron".

Pofarmer

And, who gets treated for nothing? Statistically, 85% of the people in my area have health insurance. Many of the ones that don't are on Medicare. Many of the remaining PAY THEIR BILLS, either on time share or cash out of pocket. How many really don't pay?

Jane

Yeah I agree they set their own rates - which I suspect are reduced for the insured (which is completely backassed). SO it cost $400 for 3 stitches because the payback amount is 60% and they need to bill at $400 to realize $240.00

Jim Ryan

Let me get this straight. Millions of young adults unable to afford health insurance are going to have it paid for out of other Americans hides, to the tune of $6K. They don't get sick much. Most of that $6K stays with the gummint.

Say 10 million youngsters can't cough up the dough. That's $60B (10M x $6K) to the government. The youngsters don't get sick much, so estimate they use only $10B in services.

That leaves $50B transfer of wealth from the haves. Only, not to the have-nots. Rather, to the government.

I get it.

Oh, but when they get older, they'll have relatively cheap, quality government health care so that at that point the dough will be used in services?

Uh huh.

boris

By George I think he's got it!

Gorgeous George

"I Want Health Care And I Want Someone Else To Pay For It"

Actually, the BIG PAYERS will be the insurance co's and the Poison Pill salesmen.

They won't be able to gin the game of deselecting the sick from their policies.

As a consequence, they may find their morbidity tables a bit off kilter for a while.

They'll have to take the bad with the good as well as a nice punch to the solar plexus.

jimmyk

How many really don't pay?

A fair question. I have read that hospitals have large unpaid bills, and write off a lot of it, but I don't have hard data. Of course hospitals are generally obliged to provide treatment to anyone who comes in the emergency room. I don't know to what extent they get reimbursed for this service if the patients are uninsured.

matt

Po;

one of the other factors is subsidizing care for which payment will never be received, as in the case of illegal aliens here in California. there is a Robin Hood factor built into many hospitals billing plans. The ones who can afford pay a part of the fees for the ones who cannot.

jimmyk

They got a bill for SIX 80 dollar office visits. $480 for 15 minutes in the room and 5 minutes writing out prescriptions, and never saw an actual Dr.

And I have spoken on the phone with my doctor probably dozens of times and paid absolutely nothing.

The bottom line is, who is getting rich here? For the amount and expense of the education doctors get, for the most part they are not so highly compensated (compared to many professions like lawyers and investment bankers). Hospitals are mostly not-for-profit.

Rick Ballard

"And I have spoken on the phone with my doctor probably dozens of times and paid absolutely nothing."

Don't try that with an attorney.

BTW - That'll be $150. (I'm thinking about going to law school.)

Pofarmer

For the amount and expense of the education doctors get, for the most part they are not so highly compensated (compared to many professions like lawyers and investment bankers).

Let's not pick and choose to decide the most overcompensated Robber Barons, O.K.?

Yes, I know there are a lot of lawyers on this blog, But, C'mon, was John Edwards really worth Hundreds of Millions?

Danube of Thought

Here's some good news from AP:

"WASHINGTON – After weeks of secretive talks, a bipartisan group in the Senate edged closer Monday to a health care compromise that omits two key Democratic priorities but incorporates provisions to slow the explosive rise in medical costs, officials said.

"These officials said participants were on track to exclude a requirement many congressional Democrats seek for large businesses to offer coverage to their workers. Nor would there be a provision for a government insurance option, despite President Barack Obama's support for such a plan."

jimmyk

I don't see that as good news. I'd rather there be no bill at all. There's so much carp left in it, including: barring insurance companies from denying coverage to any applicant; an excise tax of as much as 35 percent on insurance with very high annual premiums, perhaps over $25,000; limiting Flexible Savings Accounts to $2,000 annually; fees on the manufacturers of medical devices and on the makers of both brand name and generic drugs coming onto the market; and on and on.

And get this: "Officials said the legislation under discussion in a series of private meetings would likely cost under $1 trillion, include an expansion of Medicaid, and provide federal subsidies for individuals and families up to 300 percent of poverty...."

"Likely under $1 trillion" inevitably means more like $2 trillion in practice.

abad man

Look at a 40 hour work week for 50 weeks a year. That gives 2000 billable hours a year. Even at $50 an hour that gives a salary of $100,000 a year. In solo practice overhead is going to be around 150,000 to 200,000 a year. so in reality if the doc wants to earn 100,000 a year the doc is going to have to bring in 250,000 to 300,000 a year. that means the doc will have to really earn about $150 an hour, assuming everyone pays, to earn 100,000 a year working 40 hour weeks.

which is probably why most docs work closer to 60 hours a week or/and belong to groups to spread out the costs and shift the curve more to their favor.

I don't think you need to cry for the plight of doctors, but when the time comes that you can earn more working 40 hours a week as a plumber,than 40 as a doctor, you are going to have very well educated plumbers.

larry

My personal GP is seriously considering a different line of work. Between lousy medicare rates pushing down from the top and malpractice insurance pusing up from the bottom he's really getting squeezed. His insurance is about 40% of his gross. I was genuinely shocked to find out he takes home marginally more than I who have AF retirement, SS and a part time job.

Ralph L

Twenty years ago, we rented half a house (for practically nothing) for a few months to a rent-a-ER doc. He was getting about $1,000 a shift in Georgetown, not exactly a violent crime area.
One night he got to set Ethel Kennedy's broken arm.

If our drug dealers and drug users were a little better at finishing the job, we'd have more GSW and OD DOAs and fewer huge, uninsured bills.

In France, as we learned with Diana, they try to treat on scene & en route, unlike our scoop and run method. Bet that saves money, if not lives.

Jack is Back!

For my two cents, I would like to mention my friend who was a OB/Gyn and she delivered my son. Now she is a Gyn without the OB since that is saving her close to $85K a year in malpractice liability insurance costs. Close to 70% of her income when she was delivering babies went to insurance and administrative overhead. And she was in a 7 doctor practice. When you look at the algorithm of medical practice these days it is astounding that anyone could even flow chart it. It is immense and represents close to 35% of our GDP, IIRC. You could sit down and design a nuclear power plant with less people than it would take to run an HMO for 10K patients or a 300 bed hospital, especially when you calculate in all the ancillary overheads and burdens. I think the way to approach this mess of costs, paperwork and efficiencies is to farm it out to WalMart and see what they come up with - nurses in uniform with a badge on it that reads "How can I help you?"

Pofarmer

Most hospitals have more people in the office than on the floor taking care of patients. There has been mucho space at the hospital where my wife works transferred from patient care to office space. Each bed is supporting a lot of folks. And, why so many folks? As Jack says, folks taking care of Hippa, medicare and medicaid, Quality Control, complying with other regs, insurance, and on and on and on. I doubt that Wal Mart would even take it on.

Jane

And if you look at it PO it's all for government mandated stuff and malpractice stuff - both of which will be expanded under any government plan. WE will have hospitals with 4000 offices and 2 beds.

Old Lurker

Doctor calls a plumber to fix a leak in his house. When presented with the bill, the Doc exclaimed "WOW...that's more than I make as a brain surgeon!". To which the plumber replied, "Yes, it's more than I made when I was a brain surgeon too."

Rick Ballard

OL,

Mel provided a link to The End of The End of the Recession last night. Although it uses 72 pages, the content is primarily bullet points, brief explanations and charts. I'd be interested on your thoughts on it. I agree with the four year work off period and I believe that will put an end to Democrat control for at least a decade.

Rick Ballard

Sorry about the italics.

Old Lurker

Going to it right now, thanks Rick.

bad

Rick, if that is the case, it truly is great news.

But Republicans are gonna have to get their act together and be fiscally resposible for a change.

Neo

I saw a commercial featuring Michael J. Fox last night and this same awful thought went through my brain ...

Who will tell Michael J. Fox he needs to die?

...

Sorry Mike. Say Goodbye to Hollywood. Close your Parkinson's Foundation (waste of scarce resources, to wax Singeresque). Just go home to the wife and kids, cut off these expensive meds and please die. Quietly. And for heaven's sake, get yourself buried in private. We don't want any of this Michael Jackson type-hoopla disrupting our favorite programs. We have lives to get on with.

Jane

Nonononono Neo,

Michael J. Fox is a Obamafile. He gets an exception - for the right price of course.

bad

Neo, Ibama's new stem cell policy is gonna cure Michael J. Fox...

bad

WSJ says don't count on the blue dogs to stop the healthcare bill. Their rhetoric doesn't match their vote.

LUN

Barbara

The following excerpt from the AP story (LUN) is troubling:

"The Finance senators were considering a tax of as much as 35 percent on very high-cost insurance policies, part of an attempt to rein in rapid escalation of costs. Also likely to be included in any deal was creation of a commission charged with slowing the growth of Medicare."

So they're going to tax benefits to pay for the program and they're going to limit health care for people over 65. Sounds like Drs. Emanuel and Blumenthal will get what they want.

Rick Ballard

Hoyer Says No Vote By Friday

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