Healthcare next industry to take big hit

A preliminary healthcare plan floating in Congress is likely very different than whatever plan passes...if one does at all. It is far too early to make projections of losses in the healthcare industry. Much more information is needed.

the stars have aligned for some national plan. i think if you look at the 3 players in the arena-payors(big business and gov't), patients(everybody) and providers(smallest and weakest) it takes no stretch of the imagination as to who is going get hit the hardest. i left practice 5 years ago as i saw the writing on the wall.

Yes, and if you went into a coma in 1993 you would have sworn that healthcare was going to be "fixed" then. Making assumptions about politicians' plans, especially healthcare, is a dangerous game. Remember, by the time any sort of plan will be close to being voted on it is going to be some time and many in the house will be looking towards 2010 and how they can get reelected first and foremost and what votes will not piss off their supporters. Right now, the deficit is trending towards a big concern, so I wouldn;t count my healthcare votes just yet. There is much to this battle to play out still.

I've always thought U.S. doctors were overpaid.

nyc10023 - could you please enlighten us to why you think they are overpaid?

When visiting a relative in the hospital recently, I recognized a Canadian accent in a palliative medicine specialist, and got to talking to him about why he's practicing in the US, not Canada.

I thought the conversation would lead to "happy Canadian patients [which is true], unhappy Canadian doctors" but in fact he moved to the US for other reasons, and envied his Canadian doctor sister, who enjoys practicing medicine there substantially more than he does here.

The conversation didn't get to the particular point, but I gathered he wasn't earning substantially more than she.

nyc10023-some docs are but most have seen pretty steep income declines, with more to come. i would imagine even lower reimbursements will be the final straw for practitioners over age 50. when you consider the long hours, liability etc docs are far from being overpaid.

I have been reading horrible things, such as LPNs being reassigned to administrative positions so that those positions cost less, and the LPNs being replaced with non-licensed aids, the sort who usually are employed in sub-par nursing homes.

And Wal-Mart and Duane Reade having doctor's office hours, which i have very mixed feelings about, as at least it provides cheap ready access to medicine, but what does it do to the quality of medicine generally. Who goes to med school to become a doctor at Wal-Mart? And nurses replacing doctors as general practitioners. There is a huge shortage of doctors in this country.

i think that plastic surgeons may be overpaid, but i think that in general doctors should be highly compensated. their work requires a great deal of education, precision and involves high levels of stress. the health care in this country has gone from being some of the best in the world to a state of near collapse in a breathtakingly short time.

aboutready, among other reasons that doctors should be well-compensated is that they generally have very short useable career spans -- they are middle-aged by the time they can practice, and for some specialties malpractice insurance is impossible beyond "a certain age".

I thought the whole point to the Wal-Mart, etc., clinics was to receive first-line treatment -- from nurses and medical assistants only, not actual doctors.

Duane Reade has doctors hours. Really.

I guess its better than working in a methadone clinic or prison...by not much

"And Wal-Mart and Duane Reade having doctor's office hours, which i have very mixed feelings about, as at least it provides cheap ready access to medicine, but what does it do to the quality of medicine generally."

future patients will include be many of those postponing treatment of chronic diseases cause they are uninsured. they go to the emergency room, and wait till 4am, 5 am. ... to see a nurse that doesn't even know them. so... cannot get worse than that. go to the emergency room of st luke's (amsterdam and 113th) to see for yourself. if you have a real emergency, you just cannot use a hospital close to a neighborhood with too many uninsured people. they are too crowded and nurses will advice you not to show up again.

I don't know why being a doctor at DR should carry such a big stigma. I went to one recently so that I could have a prescription before the weekend, just in case my ear infection got worse. My doctor takes off at noon on Fridays. It was 3pm Friday, and I didn't want to have things worsen over the weekend without a prescription in hand. As a professional-turned-housewife, I appreciate the fact that being a doctor at DR may be great for working couples. Certainly, if that option had been available to me as a non-doctor, I would have gotten over the stigma quickly.

I agree that some specialists should be compensated for knowledge, skill, etc. Not internists or family practitioners. I also have no issues with NPs taking over doctors' roles. And to a large extent, the market has already corrected for this. In order to provide healthcare for many, the "Cadillac" treatment that many are used to in saturated NE/urban environments may end.

For your well-insured person in NYC, without a chronic/terminal disease, healthcare here is amazing compared to Canada. It's not free, but it's prompt, tests on demand (if you know how to ask). Oodles of specialists willing and happy to take your money.

10023, it is an expensive proposition, becoming a doctor. the stigma is in the pay, as it can't possibly compensate for the cost of the education. there have always been doctors willing to postpone income to work at clinics, etc., but when the DR becomes a primary source of care, you see what is happening today, a shortage of doctors. not that many people receive "cadillac" treatment these days, unless they are paying their own bill, without insurance and they have means.

i agree they can be convenient.

"Oodles of specialists willing and happy to take your money. "

Which is why our health care is so outrageously expensive in the first place. Many of the problems diagnosed and often misdiagnosed could be caught and treated far more cheaply through longer examinations by general practitioners, by far the lowest-paid of the doctor bunch.

If Obama really wants a national health care program, the only way to do so is going to begin competing with the big for-profit insurers, who are going to lobby like hell to see that never comes to pass. The current proposals are totally bass-ackwards and play to too many interest groups.

EV: that's all well and fine in theory, and true for the population as a whole. Which is why I'm still an advocate for a universal health-care system. However, when it comes down to my personal health - and I've never needed anything until the last 5 years, I can assure you that the oodles of specialists have made a difference. I can't make the case that this is an efficient or fair system, but I've been glad to have the option of paying a few thousand dollars to be taken care of.

AR: That's a structural problem with the system. Free-market rates (more or less) for education, free-market rates (more or less) for medical care. We tinker with one aspect, and make health-care socialized/nationalized/whatever but we don't at the same time make medical education cheaper...

EV: yes, chronic problems (BP, diabetes, etc.) of the general pop. is best delivered by preventative care. But (and yes, it's anecdata), I've been in more than one situation now past the age of 30, where I've needed care or an immediate answer to a question - and having an abundance of fee-taking specialists in NYC has helped.

Actually, the cost of education for MDs is massively subsidized, and has been for a very long time.

But if you had the option of paying a couple of hundred dollars to be taken care of and had only needed to see one-third of those specialists, wouldn't you and everyone else be both happier and healthier? I'm not arguing that specialists don't do a good job - only that many of them do not do a necessary one. Personally I'd much rather not have to make five different appointments with three different specialists.

I'm all for a universal health care system. As long as we just tinker, health care will just continue to balloon in cost. The whole system needs an overhaul, and that is what we won't get on account of entrenched interests.

Not as massively subsidized as the rest of the West & Japan. Where it's virtually free compared to what a doctor can make. I don't know how France, Japan or Germany structure their primary care system but I know most picky NYCers would not be happy with the systems in UK and Canada. Unless of course, you get hit with something like cancer and assuming you're in the pipeline at a good hospital, then you're mighty glad to be there.

Anyone here who thinks that the health care plan in Congress is going to have an impact on RE values is a fool. Many doctors are very rich. If you want to know how rich, just take a look at the house below, owned by surgeon at Columbia: (it's the large one with the red roof)

http://www.zillow.com/homedetails/14-Edgewater-Rd-Cliffside-Park-NJ-07010/64550885_zpid/

The same doctor also owns the house directly next door, which he bought for $2.5 million last fall, so I assume he owns close to $6 million worth of real estate.

EV: I should have been more specific. I didn't need to see a bunch of specialists - just one kind, in each case. However, because there are so many specialists of every type in NYC, the wait for an appt (esp. with the non-insurance taking kinds) was zero. This is not the case in many other health systems. Also, I didn't need a referral. It was instantaneous. And sadly, no I wouldn't rather have the option of paying a couple of hundred dollars less/monthly (whichever you mean) and reducing the overall # of specialists, because my wait time would have increased.

As someone has lived and has relatives in 2 public health systems (UK and Canada), it is not a system I want to live under (right now, with small children & in my reproductive phase).

If you are interested in healthcare stuff, Gopnik (Adam?) and Malcolm Gladwell had a debate in 2000 (Wash. post has a transcript) about pros & cons of US vs. nationalized healthcare. Interesting as both were raised in Canada and now live here (in NYC).

The other thing to keep in mind, is - unless you've had the need to see a specialist, you don't (or I didn't) appreciate how lucky we are in NYC with our abundance of doctors. Yes, I know it helps to be insured and have some money.

Gladwell has since recanted his views, but I don't disagree with his 2000 viewpoint.

My doctor in NYC is already a "concierge doctor"....for a yearly fee (in addition to your insurance) you have his cell phone number, special and priority visiting hours, and he will accompany you to the hospital in an emergency! Already being practiced in California and Florida.
This is what will happen in the medical profession.

As far as social healthcare, I am familiar with the one in Italy. Tests are not immediate (unless it's an emergency)...you have to WAIT...even a year or longer. The care is not what we are used to in the USA! If you need a specialist, you either wait for months or you PAY and the specialists are very happy to see you. Many will perform minor surgeries in their offices since the wait for hospital surgeries is very long. Again, you have to pay out of pocket.

As far as Canadian healthcare, there was a very interesting article a few years ago in the NY Times (written by a Canadian doctor) and I never forgot this line, "A dog will get an MRI faster in Canada than a human"!!!

10023, I think the situation has deteriorated significantly here since 2000. And when I tried to make an ENT appointment for my daughter recently, the wait was three weeks. and not everyone lives in NY, or another large urban medical research center.

I lived in Japan in the mid-80s, and had cause to use their nationalized system (as long as you were a resident for a certain number of days, you were covered). It put ours to shame.

alanhart, i know a bunch of doctors who have very steep debt loads from their education. certain programs (md/phd) are hugely subsidized, but not all.

alpine, once again you're an idiot. surgeons are among the highest paid doctors.

In my case, my potentially life-threatening emerg. was diagnosed and treatment started in 5 hours. I can well imagine the situation in Canada/UK. I would not have died so the morbidity would have been the same for patients like me but instead of a 1-week hospitalization & treatment, I would have had emergency surgery with potential for adhesions and other annoying (though non-life threatening) long-term effects. Would have been out of commission for longer.

AR: yes, that's why I said NYC/maj. urban centers. Rural anywhere sucks for healthcare under any system. I don't know how the Japanese do it, but they have a great, almost luxurious system (according to some relatives).
I don't know what your daughter has, but I can tell you that a 3-week appt with a good ENT person in Canada would be like a dream. A very, very good dream. Try 1 year, unless you're connected.

The standard of care is different (not worse, just different). I only know about pregnancy and L&D. Differences are:

1) Amnios are not standard, even past the age of 40. In NYC, everyone insured 35 and over gets one. Period.
2) Epidurals are not standard, and not given as a matter of course. I think most people would have a huge issue with that here.
3) Breech births are not nec. C-sections, as they are here.

I know that in the Netherlands, most women still give birth at home, so I also assume no epi, etc.

I think that our expectations are so different with regard to healthcare that it may be impossible to take the best of the nationalized systems out there and to apply it to ours.

Unless, of course, you're an uninsured person and get no care at all. Your wait time would not necessarily go up: you wouldn't have to run around to a bunch of different places.

Apologies for my lack of clarity on the hundreds of dollars, but I was responding to your statement: "but I've been glad to have the option of paying a few thousand dollars to be taken care of." I was suggesting that you could have saved yourself some money.

"However, because there are so many specialists of every type in NYC, the wait for an appt (esp. with the non-insurance taking kinds) was zero."
Interesting; I've usually found that it's a wait of at least a week to get into the specialists I need to see, and I have no significant health problems, so my big complaint is having to make six different appointments to get one stupid thing checked out. When you work full-time, making multiple appointments is a really big problem. And, doesn't the zero wait time suggest some overcapacity at the specialist level?

Alpine.....maybe the doctor inherited alot of money? Not every MD makes tons of money, I know very rich ones and ones that make average salaries.

The pregnancy comments were about std practice in Japan.

EV: of course, it sucks to be uninsured. But I'm talking, selfishly, from my personal perspective and that of my family's. We're insured. If we were not, you'd bet your bottom dollar that we'd hightail it back to Canada/UK.
I'm a weakling, when I feel discomfort or realize that I need to see someone, I want that someone now. I don't think
I could trade that for being a few hundred or thousands (under 10k, anyway) richer.

There is overcapacity in NYC, but they manage to make a living tending us neurotic New Yorkers.

I have a doctor in my family who makes $500,000 a year, so I would not worry about them too much.

I have insurance that I pay a couple of thousand for a month, almost nobody takes it so i pay off plan anyway ($500 for a three-minute dermatologist visit, who tells me my daughter has a small cyst, hands me the card of a plastic surgeon, and tells me that if that doctor doesn't take my insurance i'm on my own finding another).

when my daughter had appendicitis the insurance company denied coverage for the ambulance, saying that my child who could not walk should have been taken in a taxi. denies 50% of the anesthesiologist's bill, saying it was above standard cost (like i could shop around). all told, i spent about $4000 for that emergency.

when my daughter had an asthma attack at night, just denied coverage entirely. said i should not have taken her to the emergency room. this is bc/bs. and i paid for my epidural.

Right, but you got that epidural. It's just not so clear-cut to me that NYCers would rather have the same level of services that I see our family getting under socialized HC systems. Again, I don't know how the Japanese keep their costs down. Maybe their costs are kept low because the expectation of services are so different. Can't say.

AR, that insurance company sounds like a nightmare (name names here and now), and the premiums are much much higher than I'd expect. Isn't your health insurance a Big Law group plan?

yes, but in terms of the other costs mentioned, i could afford them. many people can't. and this is WITH insurance.

wow AR, i hope you don't get denied really big ticket ones (that at least is a good catastrophic insurance).

3 years ago, when my husband's employer changed of structure we ended up with cobra for few months. we were finally facing the total cost of premiums (you pick up both employee and employer type under cobra). i hadn't used any health care at all for years (besides a couple of injections) so i really considered just giving it up as i really wanted a HSA but they really don't make any sense in nyc.

i compared state wise and a young healthy person in new york didn't really had any cheap options as supposed to california or utah. i was looking for a catastrophic type of insurance, high deductible lowest premiums possible. mandates and community rating might be to blame. if we go for a universal system with mandates for the young and healthy, are they going to make sure that those people have the possibility to opt for the lowest premiums possible? that's a priority in some states, for some weird reason not new york, even though 1 in 4 of those in their 20s are not insured.

I think we're talking at cross-purposes here. My point is, either way you're screwed. You can't afford it now under the current system, or there is rationed universal healthcare and you get denied anyway. I've just accepted that with a family, and being in my reproductive phase, I will be paying 5k/year out of pocket. That number will likely increase. I can't tell you how many Canadians and Brits I know would love to pay 5k out of pocket to get the extras. Especially the Canadians, because there is very little in the way of private parallel healthcare providers there.

i guess i just don't agree that, in nyc at least, those extra-pay options won't be available. i pay almost $24k in premiums, and probably another $6k on top of that (daughter is prone to injury/illness).

admin, NYC is outrageously expensive. my husband, as a partner, is self-insured and pays his own premiums, but at least it is a group rate.

It depends on the nature of the healthcare system that is adopted. The UK system might be better than the Canadian, as it allows for private free-taking physicians & hospitals. The private hospitals are not as good as state in some aspects, so you have to know how to navigate.

I'm not including the premiums because in Canada, that is a major portion of provincial tax. Much higher than NYS, and kicks in at a lower income bracket. Not sure what the healthcare levy in the UK is called. We would actually pay more in Canada but not have any private options. The Canadian/UK systems are definitely much, much better for the majority of the population here than what we currently have. It would not be so great for us.

"at least it is a group rate."

but being the average health of the american population so "not good" (obesity, high blood pressure, diabetes, ...) why would a group rate be lower than a rate to an ultra healthy person? i don't get that about ny, the inability to deliver cheap individual rates to those that are healthy hence, many of those opt out.

admin, risk spreading. not saying it's a great system, but that's the basis for it.

nyc10023, i hear what you're saying. but it would be much, much better for many. and i don't think there's any chance a health care reform bill will pass that will eliminate, or even reduce by much, your extra pay options here.

but an insurance company DOES spread its risk among their entire client base, it's not rational for them to restrict risk spreading at the single client (employer) level.

a smart insurance company would kill to have those young healthy ones individually to help them lower the risk of the groups that get an average risk level instead of a very low one.

Ah, I forgot that there was a 3rd thing I could pontificate forever about besides schools & RE. Health care!
We're so screwed because the entire culture & society is set up to hobble and make any health care system expensive. All the religious nuts who rail against freely available BC and sex ed. Then setting us up for very high (though Brits are worse, I think) teen pg rates, which then skews our infant mortality & prenatal care stats.
Our high-tech, non-evidence based delivery of health care which lets us think that the key to good health is tests (though as a neurotic person I like them) and more tests instead of eating less, eating less meat, moving more. Individual selfish behaviors like using reproductive tech illegally and/or improperly to have multiples at very advanced maternal ages.

"eating less meat"

be a good citizen, support your farmers lol

Support your local farmers. NY, PA are set up perfectly to be great agri states. Not CA and other Western states, whose agribiz is terrible for the water situation out west.

Reinsurance, admin, reinsurance. I haven't heard of insurance cos pooling single payers into groups to obtain reinsurance for those risks. perhaps they do, i didn't do a lot of health reinsurance work (just organ tranplant carve-outs, depressing stuff), but i'm not aware of any. and that would be your answer, if true.

alpine, i always feel bad for you when i read se because the other kids pick on you so much, but my god, you are such a doofus.

AH, missed your comment earlier, was looking for alex09s evidence of alpie's doofusosity, and noted it.

It is Blue Cross/Blue Shield, and it covers about 350 people in the US, but as his firm is based overseas, doesn't get the advantage of the total firm size. And yes, it sucks.

Interesting thread. I agree with all that said it is too early to tell what'll happen with regards to NYC real estate. Wipe out all MD purchasers and I doubt they'd leave a dent in the market. Most MDs with kids were priced out a long time ago. The higher earners are a small minority.

As an MD "insider" I know first hand that costs are out of control and over-utilization is indeed a big problem. See Atul Gawande's article in the New Yorker about the hospital system in Texas.

There are MANY reasons why the system is broken and needs to be fixed. I, of course, don't agree that we are overpaid. We all had choices in careers and intelligence enough to get there. I saw the hedgies and i-bankers and knew moving money wasn't how I wanted to contribute. I did however want to make a financially sound career choice. Take that away and there will be less doctors period. There will be care in some form but it won't be the best and the brightest giving it. I'm not ok with that as an MD or a patient. There are countless MDs I know ready to walk if their incomes fall any further. There are soooo many other simple ways to fix the system, here are just a few:

1) Lose weight and exercise- half the patients I see have obesity-related issues that would RESOLVE COMPLETELY if they were not obese. If you don't then you should have to pay more into the system.

2) Stop smoking- same concept above. You want to poison yourself, you should be able to pay for it.

3) Let your loved ones go when it is there time. 70% of all expenditures are in the last 2 weeks of life!!

These things will never happen, I realize that, but they should. Put a dent in all 3 and most of the budget issues would be solved.

Oh and alpine...nevermind.

Agree with all 3. It's funny how many MDs I know are overweight, although not obese. Physician, heal thyself.

I am a big fan of Atul Gawande. Brilliant writer.

I don't know how people can still think that ALL doctors are overpaid - most of us are not, and certainly we don't live large in NYC. After finally finishing all of my medical training including residencies and fellowships at 38 years of age (i.e. about 1/2 my life), I will be moving to New York to practice. I certainly don't get to take off any afternoons and I spend many of my non work hours studying and keeping current by reading the medical literature. I can afford a 1 bedroom apartment on the Upper West Side. Please remember when you comment on Drs incomes that most of us have given up many years of our lives in order to do this, that we pay the equivalent of a morgage paymnet to pay off medical school loans, that we delay earning any sort of reasonable income for years after people in other professions do, pay enormous malpractice insurance, live under threat of being sued, and have an effective hourly wage significantly lower than most other professions. Certainly many more people in the business sector who finish college at 22 years of age will earn much more than us much sooner, and have many more earning years, and years for investments to earn money. I love what I do, as do most of my colleges, but we work really hard to earn the moderate income that is paid to us.

bc/bs is a horrible plan. How are you paying thousands in premium? You can get aetna for less than a thousand a month and most of the visits are covered with low copay/ded

evnyc
about 2 hours ago
ignore this person
report abuse "Oodles of specialists willing and happy to take your money. "

Which is why our health care is so outrageously expensive in the first place. Many of the problems diagnosed and often misdiagnosed could be caught and treated far more cheaply through longer examinations by general practitioners, by far the lowest-paid of the doctor bunch.

If Obama really wants a national health care program, the only way to do so is going to begin competing with the big for-profit insurers, who are going to lobby like hell to see that never comes to pass. The current proposals are totally bass-ackwards and play to too many interest groups

In response to your 1st paragraph:
GP won't spend quality time with the patients (as AR said) because how would they pay their daily overhead if the insurance company pays only $15/visit? Only way to cover the expense is to see 100 patients a day doing superbilling.

2nd paragraph:
National healthcare may work if our govt shifts the profit from the insurance comp/hospitals -> Doctors.
Doctors will get paid enough to spend enough time with the patient. Non-profit/govt run insurance care would work.

Yeah, I was thinking the same thing. I've been very happy with Oxford / United Healthcare, which I think is one of the pricier ones in terms of premiums ... but I bet you could do better in their non-group plan than in the BC/BS one you're in now.

alanhart, for a family plan? the firm got a quote from United Healthcare, which was somewhat lower than BC/BS (not much), but wouldn't put an upward cap on increases going forward. his firm has a number of people with chronic health issues (raising the rates) and they don't want to change carriers because those people have found doctors providing coverage under the existing policy.

I don't think it would be that much cheaper to go non-group, from what I've read about coverage costs in NYC.

The bottom line is that not so long ago we had a health care system that was flawed but much, much better than the one today. Insurance companies are rapacious beasts. I have a friend who works in the business side of one of the big carriers. She's spending most of her time overseas these days (India, Asia) drumming up business. That's something we can export, our health care insurance system. Hah.

You guys are missing one of the biggest drivers of healthcare costs in this country which is lawsuits. However, nobody talks about tort reform. My husband is a doctor and malpractice is a sizeable and growing expense for him. If we could cut down on the number of faulty lawsuits, we could significantly lower the over head costs of Doctors and the system... but none of the politicians are ever even willing to mention the topic.

Oxford/United healthcare is actually pretty good.
You should look for United healthcare/oxford Freedom direct IN-NETWORK plan. If you already have a strong relationship with your GP, ask if he participates with oxf/united. Very low premium for good coverage.

You cannot help the poor by destroying the rich.
You cannot strengthen the weak by weakening the strong.
You cannot bring about prosperity by discouraging thrift.
You cannot lift the wage earner up by pulling the wage payer down.
You cannot further the brotherhood of man by inciting class hatred.
You cannot build character and courage by taking away people's initiative and independence.
You cannot help people permanently by doing for them, what they could and should do for themselves.

.....Abraham Lincoln

It's not that we don't like the idea of a single payer system, it's just that the cupboard is bare.
No bones for the dog, no $ for health care for the masses.
You can print more but, your going to need a giant wallet.

EAO,
Bush said, tried and made an attempt but he didn't even get anywhere.
Malpractice, HIPAA regulation, workmen's comp, insurance, electronic compliance, medical equipment license, professional license, professional dues, etc, etc. Our govt is introducing few more taxes this year for medical professional this year.

falco, we can't afford not to take care of the issue. have you seen what it takes away from GDP? stunning.

plus, people unable to provide health care for their loved ones, particularly their children, just might pick up the pitchforks. the administration is hugely afraid of this issue. the U6 is at 16% and rising, lots and lots of people out there without health insurance in a time of unusual stress. a recipe for disaster.

I don't buy the malpractice argument. If the AMA made a good effort to weed out its worst players, and provided transparency regarding patient satisfaction for each doc, I bet the number of cases would plumment.

"Insurance companies are rapacious beasts." ... I wish I could remember the name of the author/book that discussed this, and the exact numbers presented. But I think it was something like Medicare's non-medical spending is something like 13%, while the health insurance industry's non-medical spending from health insurance revenues is something like 35%.

AH, was that the study that pointed out how much insurance companies spend trying to deny claims? that was both funny and very sad. the insurance companies are doing their best to make the policy holders expect as little as possible.

there are also a number of studies that show a lack of causality between med mal claims and insurance rates. there is a correlative effect, but some of the increase in rates has been caused by the increased cost of reinsurance.

when my daughter had her appendix out they drew an X on the spot. and explained that due to some doctors having misread the charts in the past, they now felt it prudent to do so for all patients.

I guess it's easy to confuse a patient's left appendix with her right appendix.

hehe good one :)

one does have to wonder.

The issue with malpractice is the amount of $$ spent on faulty suits without any penalty to the suer. True, there are some "bad eggs" out there, but good doctors also get sued all the time and in most cases the insurance companies will settle versus fighting the claim. All of this results in spiraling costs.

My husband was sued by a patient who's life he actually saved after a misdiagnosis. The lawyers just sued ever doctor involved regardless of their role. My husband was eventually dropped from the case but not after countless hours spent with his lawyer and incredibly high legal expenses. This is a huge profit center for the legal industry, that they protect at all costs. In the end we all pay.

http://www.slate.com/id/2145400/

Ezra Klein is quite credible.

"including legal fees, insurance costs, and payouts, the cost of the suits comes to less than one-half of 1 percent of health-care spending. If anything, there are fewer lawsuits than would be expected, and far more injuries than we usually imagine."

appendix?
Isn't that at the back of the book?

along with the "foot"notes.

great discussion guys. as someone who had been in practice for 25+ years i can tell that it is the insurance companies who drove me away. my father owned a garbage business and restaurant and the mafia came around to collect their fees on a weekly basis. as long as my father paid there was no problem. i am sure he passed that cost on to his customers. the hmo's are a modern day mafia-they add cost to the system without delivering much in return. unlike the mafia they muck around in your clinical and business decisions.

the only way to ensure healthcare for all is through a single payor system that is means tested, easy to use and pays doctors a decent salary. nothing else will work. what congress is proposing is similar to the law in massachussetts. it is not working there and it is a small homogenous state. hard to imagine the same plan on a national level.

"Oodles of specialists willing and happy to take your money. "

I very recently read an article (NY Mag I think) which talked about a whole range of specialists who for years had not had to deal with insurance at all because they had essentially moved away from "practicing medicine/treating illness" to doing only elective stuff which people paid for themselves (cosmetic surgeons, dermatologists, dentists, etc) and in the past 6 months had to re-join the ranks of "regular" doctors because their patients had uttered the words that they had never done before "is that covered?".

30yrs,
au contraire, joining the ranks of "regular docs" is not really a possiblity. Most health insurance co. have 'closed' panels of doctors and as far as I know, no open enrollment has exsisted in this town for some time. If your on a panel you can not 'chery pick' which patients you'll take the insurance and which you wont. Docs that chose the 'no-insurance' route are not committed to their business plan weather they like it or not. Medicare not withstanding. If you take medicare you must present with uniform fees for all your patients. Failure to do so is a federal crime that can end in significant fiscal fines and even jail time. Most docs don't want to deal because of the significant learning learning curve that comes with medicare charting/billing and coding.

My pet peeve: the absolute cutting edge treatment for anything has become the "entitlement" of the masses. Ungodly amounts of money is spent on dubiously effective, extremely costly procedures because everyone thinks that they have the right to anything which might sure whatever it is they have, with no cost / benefit analysis involved. But even worse, I think what is really wrong with the health care system is the refusal by most in this country to accept that people die. While I haven't seen any actual studies, i have presented the following to just about every doctor friend I know and none of them have disputed it (and some have heard the same thing, but like me don't know for sure where it can be attributed to): On average, in this country 80% of the total health care dollars spent for the entire life of a person are spent in the last 2 weeks of their life. This is because no one wants mom/dad/gandpa/grandma/som/daughter/whatever to be allowed to pass away, even if it is inevitable. Routinely people who having living wills giving very specific instructions to be allowed to go without any heroic measures taken are ignored because when the time comes, family members override that decision. And for people who haven't made such arrangements up front, of course they are kept alive as long as humanly possible, with all sorts of ultra expensive hospital treatments in those last 2 weeks.

Well, think of this, if we assume the above is true, we could reduce Health Care costs in this country simply by eliminating the spending in the last 2 weeks of people's lives once it's clear that not matter what is done, odds are that there will not be any appreciable extension of any sort of "quality" life ..... BY 80% !!!!!!!!!!! And even if it's only half of that number, it's still 40% !!!!! THOSE ARE HUGE NUMBERS.

And that's the reason (very generally) why systems like Canada's work and ours doesn't or is so expensive: it's not the "greedy HMO's", unless you really thin the profit margin they are making is like 70% (and I think anyone who thinks that is the case doesn't know what they are talking about). It's the waste in the system. There is so much unnecessary (depending on what you think is necessary vs unnecessary) spending on all sorts of things in our system which is what is driving costs up, not excess profiteering by any particular group (insurance companies, drug companies, doctors, hospitals, etc.). Not that any/all of those groups aren't engaged in some excess profiteering, but that's not where the problem is; and focusing on their portion of the problem is a smokescreen as to where the real problem lies: which is with people's expectations of what is a realistic level of care, or more to the point "extraordinary care", as an entitlement.

Except that when I or a member of my family gets sick, we are all of a sudden not the "masses" anymore. Sorry, that horse is out the barn door with the Internet and people googling treatments for their condition. I am more than okay with euthanasia and cutting off treatment in terminal cases.

falcogold1,
Just regurgitating what was in the article. (I looked and I think this was the article: http://nymag.com/news/intelligencer/57067/)

nyc10023: exactly my point.

You're talking about repressing human nature, 30yrs. I can see cutting off treatment in last 2 weeks being more palatable. Strangely enough, religious people seem to have a harder time letting go of life.

find me the politican with the guts to even bring this up.

That's the Alpha and Omega. It's way too politicized here.

"On average, in this country 80% of the total health care dollars spent for the entire life of a person are spent in the last 2 weeks of their life."

What's your source for that? Link?

After watching the movie "Sicko" I can't wait for the day that the private health care insurance companies go out of business. I will be dancing in the streets!

So, the same people who brought you the enormous efficiency and fiscal resposibility of the post office will now take charge of a universal health. If it works out anywhere as well as the post office I'll be amazed! I could sit here all day taking pot shots at the health care system but, if you want to see universal health care at work in this country all you need to do is examine the largest single health care provider on the plant...the Veterans Administration. They provide universal single payer health care to veterans and their families. Ever have a veteran in your family? Ever experience the VA first hand? It is a nightmarish collection of incompetent noncohesive nitwits executing a plan with little compasion or motivation. In the VA if your really sick, your really screwed. Are there good docs at the VA? Sure there are! If your lucky enough to get one and, if your lucky enough to recieve all the necessary diagnostic testing before you drop dead then I guess it's an OK system. It's also a system that has taken years to develop and hone into the massive inefficient shit hole it has become. Any new change to health care is nothing short of wishful thinking. Wait and see. This is going to be the Clinton approch 'take two'. All the best intentions will slowly drift down the drain as piorities and economic whoes take center stage. Universal Health Care........what a beautiful dream. Throw in free lap dances and I promise to change my opinion.

alpine,
So you made your decision based on that lazy fat@ss' movie, "Sicko"?
Sorry but Canadian Healthcare system does not work. It's expensive, inefficient and you are better off paying and receiving treatments in the US.

My mother was diagnosed with breast cancer few years ago. My mother had to wait 2.5months for a mammogram because of the waitlist. She could not seek a private care as it's illegal in Canada. Her GP works only 2.5days a week and she must make her appointments 6months in advance, otherwise she does not get one.

The movie "Sicko" shows what that fatfack wants to show and make you believe. I am glad you liked it.

falco, sadly, medicare is a far better system for most people than the current private insurance one. I don't know how old you are, if you have kids, etc., but our current health care system is literally in the shitter for most people.

and my father-in-law is part of the VA system. has had superb free health care. he has been type-two diabetic his entire adult life, has had bladder cancer, has had two toes amputated recently. he is a princeton grad who has VA care and has absolutely nothing bad to say about it.

ba294, sadly i don't think we're capable of reinventing the health care wheel, as this moment. but it is sad, because there is a shitload of money being paid for health care, and where the fuck is it going?

I love streeteasy and this thread hits close to home. It was nice to see desflurane's post(I guess gas is your speciality). I agree with everything that was said there. Yes I am a doc, ENT by the way. Am overjoyed by my job and the professional satisfaction that I have daily. It's not easy, but it is a lot of fun. While I love my job, some of my partners(who by the way do very well financially) are much less so.
So much that has been posted on this thread is just plain wrong! But I do believe that what is wrong here is what people do believe. And I do believe that the people that post here are on the upper half of the IQ scale. I've been doing this medicine thing for 22 years including six years of residency. Getting back to the original premise of the post, the MD impact is small, and what really churns the NYC market is the explosion of Wall Street salaries which docs could not nearly compete with even with mid to high six figure salaries. I do better than most financially and am very fortunate, but what you could buy with a very good salary for years could not compete with a several million dollar bonus. So even with Wall Street being down, unless prices come way down we are small potatoes. We will have little impact no matter what.
Oh and by btw, Alpine you are just misinformed about so many aspects here. The health care costs for the last several weeks of someones life in this country are immense. We have known for years that 70%-80% of all health care dollars are spent on 20%-30% of the population, and most of that is spent in the last several weeks of someone's life.

yo skip: I remember reading somewhere a few years back that on average, the Country spends 5 times the amount of dough on the last 5 days of life as compared to the first 5 days of life. Any truth to that?

yup, something like that.

and skip, oddly affordability in the city wasn't just restricted for you. i'll never forget some ahole on SE opining that anyone below a top partner at a law firm had been priced out. and that there was "more wealth than you know, dude" to take up the income slack. where did aifamm go? the great proponent of you don't have any clue how much real wealth there is here? maybe he worked for WaMu?

Putting aside all issues regarding ethics, family wishes, culture, etc. ... is it really possible to determine at the time it begins WHEN someone's last two weeks will be? Otherwise that statistic doesn't come as much of a surprise.

was going to say the exact same thing. my thoroughly non professional guess is that the answer is sometimes with less than absolute certainty. sick humor: new job title---determinator of two weeks to go. eesh.

oddly, alanhart, i think in many cases one can tell. but this is not necessarily the point, because it costs relatively little to keep a person alive and with minimal pain and no proactice care. it's just usually some home aid and a hell of a lot of personal care by the family.

AH: I suspect for a large number of people in their 70s, 80s and beyond, it's not too difficult to tell when their last year is. What you do with that information, and how you use it to ration health care...

"alpine,
So you made your decision based on that lazy fat@ss' movie, "Sicko"?
Sorry but Canadian Healthcare system does not work. It's expensive, inefficient and you are better off paying and receiving treatments in the US."

Really? So then how do you explain this???

Country Comparison :: Life expectancy at birth

1 Macau 84.36 2009 est.

2 Andorra 82.51 2009 est.

3 Japan 82.12 2009 est.

4 Singapore 81.98 2009 est.

5 San Marino 81.97 2009 est.

6 Hong Kong 81.86 2009 est.

7 Australia 81.63 2009 est.

8 Canada 81.23 2009 est.

9 France 80.98 2009 est.

10 Sweden 80.86 2009 est.

11 Switzerland 80.85 2009 est.

12 Guernsey 80.77 2009 est.

13 Israel 80.73 2009 est.

14 Iceland 80.67 2009 est.

15 Anguilla 80.65 2009 est.

16 Cayman Islands 80.44 2009 est.

17 Bermuda 80.43 2009 est.

18 New Zealand 80.36 2009 est.

19 Italy 80.20 2009 est.

20 Gibraltar 80.19 2009 est.

21 Monaco 80.09 2009 est.

22 Liechtenstein 80.06 2009 est.

23 Spain 80.05 2009 est.

24 Norway 79.95 2009 est.

25 Jersey 79.75 2009 est.

26 Greece 79.66 2009 est.

27 Austria 79.50 2009 est.

28 Faroe Islands 79.44 2009 est.

29 Malta 79.44 2009 est.

30 Netherlands 79.40 2009 est.

31 Luxembourg 79.33 2009 est.

32 Germany 79.26 2009 est.

33 Belgium 79.22 2009 est.

34 Saint Pierre and Miquelon 79.07 2009 est.

35 Virgin Islands 79.05 2009 est.

36 United Kingdom 79.01 2009 est.

37 Finland 78.97 2009 est.

38 Jordan 78.87 2009 est.

39 Isle of Man 78.82 2009 est.

40 Korea, South 78.72 2009 est.

41 European Union 78.67 2009 est.

42 Puerto Rico 78.53 2009 est.

43 Bosnia and Herzegovina 78.50 2009 est.

44 Saint Helena 78.44 2009 est.

45 Cyprus 78.33 2009 est.

46 Denmark 78.30 2009 est.

47 Ireland 78.24 2009 est.

48 Portugal 78.21 2009 est.

49 Wallis and Futuna 78.20 2009 est.

50 United States 78.11

https://www.cia.gov/library/publications/the-world-factbook/rankorder/2102rank.html

AR: correct as always but...what you are suggesting requires a maturity and point of view about life that many are apparently not capable of on their own. the problem becomes who handles this decision when the individual and the family are floundering.

nyc10023: who is "you?"

I have had the unfortunate experience of losing about 20 friends and family over the last 2 years. Except for the one's who got killed, in every case one of my friends who is an internist "called" the "less than 2 weeks" simply from me describing over the phone what *I* could see. From talking to him and other docs, there's TONS of times where "everyone" knows the best thing to do would be to send the patient home with pain meds. Last June, my business partner of 17 years was in Sloan Kettering and they told the family it was time to send him home with pain meds. So they searched around till they found Maimonides in Brooklyn who was willing to take him and try heroic measures, which I knew he didn't want. Ironically when he was first diagnosed with ling cancer (he smoked 2 packs a day Camel no filters for 30 years) he was told he had 12 months with chemo and 6 months with no chemo and he told me he was going to do 6 months with no chemo because 12 months of poor quality life was not how he wanted to go out. But his family pressured him into going with chemo. Almost immediate complications shutting down his kidneys; he ended up with 3 months of very low quality life.

So here's a perfect example of what I'm talking about: what he wanted was no chemo, no heroic measures, and if he got what he wanted probably would have cost a modest amount for a home nurse and some morphine the last few months/weeks. instead he went through a whole bunch of very expensive treatments to lower the quality and quantity of the last of his life. While this is the worst of what i have to tell, it's not like this is the only example I can give out of the 20, and when I've told the story to doc friends/acquaintances the almost universal reaction is "I'm sorry to tell you how typical that is".

Please, stop commenting on the Canadian health care system unless you've read the Gopnik v. Gladwell argument in the Wash. Post. Basically explains everything.

In summary, Canadian system good for improving health of gen. population bcs of universal access, preventative measures. Bad if you have a specific fast-moving disease like a heart attack.