Price controls coming for health care

Interesting statement nyc1234 about how a system for the indigent is being marketed to the middle-class. What if that is what the middle-class can afford in this country, going forward? Yes, if you have a good group policy in a well served metropolitan area, the level of care that you are getting probably surpasses that of someone else of the same income in any other country? But we are looking at premiums of 24k annually, high out of pocket costs in this scenario. Middle class people are afraid and rightly so of bankruptcy if they get really sick even with a good employer provided plan.

Without some very basic universal option, what is the solution?

Re: my earlier post saying the US subsidizes the rest of the world's price controls:

"America's Stunningly Overpriced Healthcare System In 2 Charts"

Read more: http://www.businessinsider.com/healthcare-spending-as-a-share-of-gdp-2012-11#ixzz2DvB3RBDp

Working backwards, thanks for the compliment.

I've run my own business for the past 20 years, and I make more money than most doctors.

Everybody wants more money than "they deserve." Who are you to determine how much other people "deserve"? Do plastic surgeons "deserve" more money than primary care physicians? Who determines it?

If that is not "arrogance" (Count 1) then I don't know what is.

I never made any statement about any P/L of any private practice, and I don't think you can show otherwise.

"if you don't see how capping a medication's margin at 20% is insane...."

Insane? You've got to be kidding.

http://biz.yahoo.com/p/sum_qpmd.html

See the column "Net Profit Margin." A 20% margin is well above average for most industries. Moreover - look at the chart - the net profit margin of major drug manufacturers is 16.70%.

FYI (since you don't seem to know) the net margin is gross margin - taxes - interest. Gross margin = sales revenue - cost of sales.

You can apologize now for your arrogance (Count 2).

If your "1 out of 5" comment is related to a 20% margin (1 / 5 = 20%), then you don't know what a "margin" is, or a "breakeven point." See above for the definition, but you will note that 50% of small businesses do fail in the first year, and 95% in the second year, because people don't know what they're doing, don't have good business plans, or don't have enough capital.

As is obvious from your comments, NYC ("have run several private practices"; "have partial stake in"; "easily see from my P/L statements and margins"), you look at medicine as a profit-making enterprise. You want to maximize your profit. Fair enough. But that means that, to you, fee-for-service makes absolute sense, and OF COURSE you would oppose systems that do away with it. You would then have to actually manage a budget and just couldn't order tests and perform procedures and write prescriptions and make money for every single step. That is why the US system is so expensive - the incentive is for physicians and hospitals to over-prescribe and over-perform. (Not out-perform.)

But the VA is the future. Sorry, but it is.

Aside: it seems you've worked in a lab, for the VA, chairman of a specialty at an NYC hospital, have run (and still do) several private practices. You must be a) very old, and b) forgot to take accounting, economics, and finance at school.

BTW there was an uproar when Margaret Thatcher introduced a radical new notion into the National Health Service in the 80's: BUDGETS!

Oh, no! Not BUDGETS for doctors! Can't be done! Impossible! Heresy!

But they worked out just fine.

She also liberalized the system and allowed doctors who had served enough time with the NHS to open up private practices that took private insurance that can be bought alongside NHS coverage.

Works like a champ.

I know - I used it when I lived there.

I think Steve's theory is-- if you post enough BS and rephrase it over and over then you are right., the expert. not NY1234 who clearly is more informed in this topic. Then maybe Steve took a continuing Ed course at NYU medical

Oh, Brooksie - so bitter that Mittens lost! So bitter that banks don't keep most of their originated mortgages on the books, but rather securitize them.

There is an entire branch of economics called "Healthcare Economics." I suggest you take one.

10023 and Jason are right - the problem with healthcare in the US is a) the cost; and b) the allocation of resources.

Just look at the pictures, Brooksie. You don't need to know how to read - it's in the pictures.

Steve you are the one that said " banks buy MBS to hedge duration risk"
MBS are negatively convex. If you paid attention in your continuing ED on MBS, call MBS 101 you should have grasped that concept. Instead you post the slides in SE! Obviously you did not understand your continuing ED class which by the way 15 years old! Lol!
I could have taught that class, Too funny.

Yes, yes, yes Brooksie. Sorry you lost that argument. I don't think I mentioned the convexity of bonds in it, however, in fact I'm sure I didn't, but you can read about it here:

http://www.people.hbs.edu/shanson/MBS_Paper_20120906_FINAL.pdf

You could have taught the class on that, I agree: you always go on and on and on about things you don't know anything about, so what would one more be?

Stick to healthcare economics, another topic you know nothing about.

I acknowledge that in my present circumstances, having a high deductible PPO plan in doctor-dense NYC is good for me. Were I to get seriously ill today, I am happy to have my "Cadillac" plan. I have read a lot of the free-market stuff - don't disagree with 1234 on his points. What he fails to acknowledge that having even a VA-level backup would be a relief for many. Job loss, divorce, crippling health expenses are what confront many middle-class people today.

Anecdata - many of the doctors I know personally in the US, Canada, UK do not think they make enough $, especially if they are the sole/main income provider. There is obviously a strong tension between wanting to get paid as much as possible in our capitalist society and their job which is providing a public good. Not sure if there is a way to resolve this.

10023, EVERYBODY thinks he should make more money. Even gazillionaires and Mitt Romney. They also think they shouldn't pay tax.

That doesn't make the healthcare market properly structured. I had a high-deductible PPO plan in NYC, and the maximum out-of-pocket expenses were $25,000 A YEAR: the free-rider problem, among many others. The fact of the matter is that medical bills cause 60% of bankruptcies in the country:

http://www.cnn.com/2009/HEALTH/06/05/bankruptcy.medical.bills/

We're all paying for that. and for expensive emergency room treatment, especially of people who don't have insurance:

http://www.publicintegrity.org/2012/09/20/10811/hospitals-grab-least-1-billion-extra-fees-emergency-room-visits

Sure it's great for NYC as a doctor who thinks only about the bottom line (not all doctors are like that) but in a properly structured healthcare market, these things wouldn't happen.

Actually I don't oppose universal health care. I am also ok with capitation.

I simply would like a free market in terms of price and quality. I should be able to bid Medicare to provide service at a lesser rate than the hospitals or other inefficient operators. I would like this option for all insurance pools. This would force practices and doctors to cut costs. What I don't like is any system which kills competition. The idea of shutting down private small business practices to force patients to larger private hospital clinics, which will charge significantly higher prices is not something that makes any economic sense.

Brooks: Fire up your fighter jet.
You can land in the nearest empty parking lot next to stevie's place in Florida.
Hoist him in and take right back off.
Eject him over a town with no major hospital and let's see what happens to him.
*SPLAT*!!!

On that, nyc, I don't disagree with you at all, except that it won't work as the market is currently structured. It is true that hospital-centric care might not be a panacea, but if there are medical practices they will have to be larger and more structured around standard protocols.

As the VA shows, though, hospitals are not necessarily "inefficient operators"; they are, however, operators burdened with unfair costs such as providing unreimbursed care to the indigent. That's why I laugh at all of those southern states that say they aren't going to extend Medicaid.

Their hospitals and healthcare providers will force them to, because if the federal and state governments don't, they will have to.

Brooks, I think what Truth is trying to say is that as ridiculous as stevejhx may be, your credibility has been shot.
Can you give us an opinion about Sutton Place?

But not shot out of an imaginary Air Force fighter jet.
By an imaginary, decorated veteran of military action in the sky.

Those real Air Force vets are home watching the Military Channel. There are a few of those channels on cable t.v.
They have their own discussion groups.
Brooks' shit would not fly with them.

Funny Steve, again post a 50 page link when you don't understand somthing too funny. Lol

"many of the doctors I know personally in the US, Canada, UK do not think they make enough $"

And yet they in fact make, on average, several times the median income for their respective countries. They are not POORLY paid.

Did you get past page 2 of that 50-page link, Brooksie? Because if you did you would see how MBS's are used to hedge duration risk.

And since you're SOOOOOOOOOOOOOOOOOOOOOOOO SMAAAAAAAAAAAAAAAAAAART, Brooksie, can you tell us why MBS's have negative convexivity, when they are not callable?

Because the answer to that question lies at the heart of understanding why everything you posted about MBS's is ignorant.

We're waiting.

And Jason is right - doctors make A LOT of money. Of course they are well-educated and they should make a lot of money, but they are hardly underpaid.

Gee, no word from Brooksie on the negative convexity of MBS's, and no apology from Riversider on his gerrymandering ridiculousness.

Guys! Where is the right-wing when you need a laugh?

>And Jason is right - doctors make A LOT of money. Of course they are well-educated and they should make a lot of money, but they are hardly underpaid.

Doctor today is way different than 20/30 years ago.
Of course back then it was easy to make fun of someone who seemingly worked 2 days a week and was on the golf course all day and banging nurses all night.

The reality today is they cant work enough hours to cover all the insurance they have to carry and god forbid they have a bad minute, let alone a bad day, career over.
And the forms, requirements and hoops to jump through just to get paid, you proabably have to add 2 years of government business administration to the years of medical school.

And lovliest of all, if your really tops in your profession, you get a disease named after you. Isn't that lovely?

Im no doctor and none in the family, but it doesnt take a genius to see that tide has turned.

PS: Internationally, I think engineers are the worst paid.
This opinion is based on the amount of foreign engineers Ive met driving NYC cabs.

There you go, truthskr.
Bring the truth out to the masses, or at least to stevie.

stevie is still seeking apologies.
Great way to waste your valuable time, stevie.

Well I'm related to & know a lot of doctors, and their salaries are falling, even for the top professions. They also work very hard and take their jobs very seriously (for the most part, from personal experience).

The insurance is not really the issue, though they'd have you believe that. Their reported salaries are net of insurance.

That said, physicians in the US are still vastly overpaid compared to their counterparts around the world:

http://assets.opencrs.com/rpts/RL34175_20070917.pdf

Though the report is oldish, it is from the Congressional Research Service, and fee-for-service is the culprit.

Only think this proves Steve is that you have absolutely no understanding of MBS.

>absolutely no understanding of MBS.

Very, very important stuff to understand.

Very important.

Nyc1234 makes perfect sense to me; agree with each of his/her posts here.
Side note: Brooks2 credibility not destroyed with me. I believe he is a pilot and VFW. I also now see that he is likely/certainly caonima from reading price chopper thread, but I don't hold it against him; I can understand why someone might want an un-PC alter ego on this site.

Your first mistake, Brooksie, is when you said that you "think." Your second mistake is not answering the question about MBS convexity.

The average per capita income in the US is $48,328 according to the IMF.

The average per capita income in the world is ~$7,880 by the world bank.

Since the goal here is equality with the rest of the world, why don't we all take 84% pay cuts? After all, the studies show that the happiness quotient in the US is not at the top, but in the middle. Steve, you on board here?

In fact, as you can see from Steve's data, our nurses are also "overpaid", let's cut their salaries as well. Doctors account for less than 15% of all healthcare costs; in my practice, I'm usually able to keep 10% of revenue if everything works out perfectly (a small glitch turns this into a massive negative number). We are not the large cost centers that people expect when they look at the numbers. Also keep in mind this data is annual, not per hour, nor is it per patient. I still work 80+hr weeks (although this is not expected to generate pity, I like what I do). The point is that my income would fall by about 75% if I were to just work the average hours and see the average number of patients that are seen in many of these other countries. By the way, in the Netherlands, according to your data, specialists make more than in the US.

You want to cut doctors' salaries? How about we cut bankers, lawyers, congressman, businessmen, etc? This is what you want, right? To bring down those that are successful to your level, since you are unable to bring yourself up to theirs?

Stevejhx - I respect your points and see consistency in your posts here. I am wondering what future you see in your preferred approach for R&D for rare diseases? Is this something you are willing to forego? Also, under your model, who will be our future doctors? Do you think the best and brightest will continue to choose medecine? Do you care? Because so much is lost in e-mail via inability to convey tone, I want to make clear that I am not judging but rather am trying to fill in gaps in my understanding of your position.

Well first, 1234, the report that I posted is for OECD countries, not "in the world."

Second, nobody said that "the goal here is equality with the rest of the world." I don't know where you get that from.

"our nurses are also "overpaid", let's cut their salaries as well."

You already did as per your post above, that "CEOs and unions are not enemies, they simply both want more money than they deserve."

"in my practice, I'm usually able to keep 10% of revenue"

You really need to be more consistent, because you said, "if you don't see how capping a medication's margin at 20% is insane, then obviously you have never run a business."

"You want to cut doctors' salaries?"

It's not me - it's what the data say.

"How about we cut bankers" - check.
"lawyers" - they don't really make that much money.
"congressman" - ditto.
"businessmen" too broad a class.

"To bring down those that are successful to your level, since you are unable to bring yourself up to theirs?"

Now, now, 1234, here are average physician salaries:

http://www.profilesdatabase.com/resources/2011-2012-physician-salary-survey

I already make more than most of them, though not all, and I don't really need to make any more than I currently do.

Novice, there is already government support to research rare diseases and to support orphan drugs.

Our future doctors will be anybody who is interested in the medical field - just because you don't make $500,000 doesn't mean you won't want to be a doctor. Scientists have similar backgrounds and for the most part make a lot less money. Go here:

http://www.indeed.com/salary?q1=PhD+Scientist&l1=new+york%2C+new+york

and see what the average PhD scientist earns - it is about a third of what a doctor earns, with a similar education.

NYCNovice: Here's a way to fill a gap:
Use Brooks' bullshit.

Stevejhx - fair enough. I am familiar with gov't research - one of most interesting dinner table companions I've ever been privileged to eat with was Dr. Tony Fauci. I felt bad for him that he was seated next to me and tried to have host change seating. Also one of my oldest/dearest and most talented friends is a professor of molecular biology at a research university - she has never been in it for the money.

Truth - Why are you so sure Brooks2 is not veteran pilot? His temperament is consistent with the two that I know.

NYCNovice - right now the US is subsidizing the rest of the world in regards to all this. We pay 2X as much for medical devices, drugs, etc, on top of higher administrative costs. I would like that to end.

Right, except that in our capitalist society, to win is to have the most $. Sure, $ won't appeal to some but I think it will change the face of medicine to not have the possibility of making today's wages.

NYCNovice: Would the two that you know be wasting time on streeteasy starting discussions and ranting about over-priced RE listings? You may need to read back on more se discussions if you haven't seen the beauts that Brooks started. Ranting, raving, cursing about apartments listed for high asking prices.

The more than two former, decorated Air Force combat pilots that I know,
know Brooks is full of it.

Jason - I agree that US is subsidizing rest of world re med devices and pharmaceuticals, but that is okay with me.
NYC10023 - Agree.

nyc1234 ++

>Jason - I agree that US is subsidizing rest of world re med devices and pharmaceuticals, but that is okay with me.

What exactly do you agree with? What exactly is our subsidy? Pharma and med device companies are in business to make profit. They aren't selling at a loss in markets.

Brooks will do a fly-over in his fighter jet to drop your report card, nyc1234.
Kindly post your position here on streeteasy.
Then, get ready for the drop!

HB - Congress commissioned a study on this in around 2004 that I did some work on by providing input re IP laws of certain other countries. As I recall (though not with any great clarity), conclusion of study was that single payer system (gov't) in other countries and IP laws in other countries keep drug prices significantly lower than they are in the US. Once a drug has come to market, cost of production can be covered with small profit margin by selling at low price in other countries, but not at a price that would incentivize big pharma to develop new drugs. My imperfect understanding is that high prices in U.S. cover R&D of not only successful drugs, but also all the drugs that never make it to market. I also have a sibling who works for one of the big pharma companies, and I believe everything she tells me.

@stevejhx

I am ok with 10% net in my practice. The risk is not like researching a drug. You may go through 500 drugs to find the "one". The 499 that don't make it are not going to be subsidized by a 20% margin on the 1 that works.

On the other hand, there is a high probability that a doctor does not need to open 500 practices to profit on one. 10% is fine.

Now keep in mind, although I do not vote, I have been a life-long democrat and understand the concept of socialized medicine, and, to an extent, support it. I also believe that our budget is way out of wack and that we need to cut costs significantly, particularly in healthcare. I am not from a "line" of doctors and have not been indoctrinated with many of these ideas. In fact, before medical school, I used to think doctors were significantly overpaid. It was not until I came out on the other side, at the age of 30, with $310k in debt, that I realized how much money I would need just to get back on track. Don't forget to take all of these concepts into account for your 2016 run as President of Trolls.

With this personal anectode aside, this is how capitation works. You get paid $ times X patients. You are paid to not do things. So, therefore, you don't. Usually, in your own practice, because you feel an obligation to your patients, and want to develop a solid decent reputation, even if you have to order tests or do things that hurt your capitation pay, you do them. After all, you see the patient, face-to-face. If you screw up a few times and miss things, your reputation spreads and it can collapse your practice (maybe not in a rural setting).

In the hospital setting, the doctors are not deciding the treatments/testing. Independent 3rd parties are also not making these treatment decisions. A set of financial controllers, dictated in the interest of the "shareholders" are making these decisions. I don't mean through a set of intermediaries, either. I mean the CFO will call you in and ask you to change your treatment & diagnostic standards to make sure they meet their profit margins. You then march back to your patients with a straight-face and simply don't order any more tests. By the time the patients are dead and the fall-out has occurred, the C-suite has extracted enough bonuses to "go on to the next one".

You want this system, fine, but don't dress it up to be something it isn't.

There is a simple solution for this. Simply tell the C-suite and financial side that they will be held personally, financially, and legally responsible for any medical decisions they make which result in harm to the patients. After all, with even one bad mistake, I can lose my license and be personally sued for a mistake; the lawyers can actually empty out my personal checking and savings accounts, if they want, and they can completely destroy my ability to earn a cent after 9 yrs of post-grad training.

So, if the C-suite, wants to pull the decision on EVERY single patient, let's hold them accountable.

You know what you would get? What we have now.

just finishing my work-day and slightly grammatically challenged at this point. so apologies for the record use of commas

@NYCnovice

this is exactly how it works, minus the sister part, because my sister is always telling me things i can't believe.

HB - Congress commissioned a study on this in around 2004 that I did some work on by providing input re IP laws of certain other countries. As I recall (though not with any great clarity), conclusion of study was that single payer system (gov't) in other countries and IP laws in other countries keep drug prices significantly lower than they are in the US. Once a drug has come to market, cost of production can be covered with small profit margin by selling at low price in other countries, but not at a price that would incentivize big pharma to develop new drugs. My imperfect understanding is that high prices in U.S. cover R&D of not only successful drugs, but also all the drugs that never make it to market. I also have a sibling who works for one of the big pharma companies, and I believe everything she tells me.

This is the same as saying that the Coach class passenger is subsidized by the First class passenger. It simply isn't the case. The Coach passenger may be below the average cost, but he or she isn't below the low marginal cost. The plane is already built, the drug is already made because it is profitable overall. So on tomorrow's flight to LAX, MXP, NRT, or even DTW, if the airline flies without the Coach passenger, it will be less profitable. There is no subsidy even if the U.S. pays more.

"US is subsidizing rest of world"

We don't subsidize the rest of the world. We subsidize insurance companies and manufacturing companies.

"You may go through 500 drugs to find the "one". Or, 1234, You may, or like AZT and a lot of other drugs, you might find them useful years later. The fact is, product development is expensive.

"It was not until I came out on the other side, at the age of 30, with $310k in debt...."

My brother-in-law came out of medical school with that exact same debt, and got a bonus in the first year that paid it all off.

No need for the sob story about how much doctors are looking out for patients by over-providing and over-prescribing. Because if it were true, and of any benefit to anyone but the doctors, it would show up in our comparative mortality and morbidity rates.

But it does not. It's all a waste of money. That is not necessarily my point of view (though it is) - it is the point of view of the Congressional Research Service and all health economists in the world.

It has nothing to do with patient care. If it did we would have much better mortality and morbidity rates than do other developed countries that spend, on average, half what we do for a better result.

Those are cold, hard, statistical facts. Heartwarming stories are worthless. I've lived in and been a user of the systems in the UK and Spain. They are not deadly, or diabolical. They are efficient, as the VA system is.

The end.

Now go get our coffee!

Obamas wealth transfer is working coffee fetches make Samuel as Drs now

Oh, Brooksie! You're being a silly-billy now!

Stick to topics you don't know anything about.

Oh wait! That would be all of them!

Steve: if one is insured under a "good" plan Stateside, and has $ to pay for out-of-pocket, it's hard to convince that person that a public single-payer alternative is better. I would take UK out of the comparison because of the availability of private doctors and postcode healthcare lottery.

Just take prenatal care as an example. Pregnant women, even in doctor-dense Toronto, do not necessarily get assigned an obstetrician or midwife. If you're out of the metropolitan areas, good luck! Access to specialists depends on availability and connections (yes, there's always currency even if it's not $). Far fewer ultrasounds (maybe a good thing), limited prenatal testing (don't get CVS/amnio if you don't qualify).
In short, if you were pregnant in NYC with a decent private plan + $ for out-of-pocket, being pregnant in Toronto is a clear loser.

As for infant mortality stats, you get less fertility funding (and no private options) in Canada, smaller proportions of ethnicities that have unexplainable but significantly worse infant mortality rates. Lower teen pregnancy rate, lower poverty rate. All these things contribute to lower infant mortality, and not directly attributable to universal healthcare alone.

Yes, longevity stats are better in Canada, which spends less per person but you have to look at those statistics carefully. First, metro city regions (TO, Vancouver, Montreal) have large numbers of adult immigrants. Immigrants generally have better health stats than native-born persons of the same ethnic origin. Add the fact that Canada has much more limited family-based immigration policies, mandatory health exams for prospective immigrants, fewer illegals.

@stevejhx

we are not going to get the UK or Spain system, which is where you are wrong.

insurance protects all of us from the fat-tail risk of the 10,000+ diseases with the best medical care in the world in the U.S.

i agree we are horrible at stopping cardiovascular disease and diabetes, but insurance cannot prevent people from eating 4,000 calories per day. ultimately a good healthcare system should be about more than simply prolonging life, as ultimately it is the 80 yrs of diet and exercise that determines your end-point. it should also be able to protect you from fat-tail risk, which is the point of insurance. as i stated before, wait until you have a debilitating illness at a young age, and then see where you will want to get treated. it won't be spain.

If any of what you were saying were true, 1234, it would show up in the mortality and morbidity rates. It does not.

FYI Canada's infant mortality rate, while comparative high, is still significantly lower than the US's.

http://www.conferenceboard.ca/hcp/details/health/infant-mortality-rate.aspx

In your mind it is the fault of everybody but doctors that our healthcare system is so bad. Thus far you've berated hospital CEO's, unions, malpractice, and now people allegedly "eating 4,000 calories per day."

The facts are the facts: our healthcare system costs twice as much as the next most expensive one, and we are well down on the mortality and morbidity scales, around the level of Costa Rica.

The problem is the way the market is structured. We're only beginning to tackle that issue. The real culprit is fee-for-service, which gives healthcare providers incentives for doing unnecessary work. That is undeniable. Until it is changed - and it will be changed - things will not get better.

OECD has been debunked multiple times:

http://www.aei.org/outlook/health/global-health/us-health-care-a-reality-check-on-cross-country-comparisons/

I already described the difference between capitation with doctors in charge versus bankers in charge.

No, OECD has NOT been 'debunked' other than in right-wing bubbleland fantasies. Other international organzations like WHO and the Commonwealth Club have come to the same conclusions. And countries are not faking life expediencies and infant mortality rates. The fact is the average European, Canadian, Australian, Japanese, Sigaporean, and South Korean gets as good or better results than the U.S. when all is said and done.

The Kaiser and Mayo model is the future. See:

Cleveland Clinic CEO Shares His Incredible Vision For The Future Of Healthcare

Read more: http://www.businessinsider.com/business-innovation-in-healthcare-2012-12#ixzz2ECEGr9pZ

HB - Please tell me you were just being contrarian in your reply to my last post. I can never tell if anyone is kidding on this board; I am just going to assume that you were.

Everyone else - carry on. I am in nyc1234's camp here, but I do see that reasonable minds can differ and there are value judgments at play such that I understand and respect positions taken by stevejhx, jason1006, et al.

Yes, the American Enterprise Institute. That famous institute that said this:

"After 30 years, The New York Times admits Reaganomics worked"

http://www.aei-ideas.org/2012/11/after-30-years-the-new-york-times-admits-reaganomics-worked/

When that was anything but what the NYT said.

And of course this one:

"Math is hard: Why spending, not tax revenue, is the big problem"

http://www.aei-ideas.org/2012/11/math-is-hard-why-spending-not-tax-revenue-is-the-big-problem/

The AEI are truly, truly reliable.

That said, of course the OECD's methodology could be improved - no one questions that, but that does not mean that the results of the study are not valid: such a conclusion drawn would be a fallacy of extrapolation.

No matter how you slice it, our healthcare system costs twice as much as the next cheaper one, and our results are on par with Costa Rica's.

That is the universal conclusion of every study ever undertaken, and a few methodological criticisms - some valid - do not "debunk" it.

Doctors in America are UNDERPAID. The reason why the people think they are overpaid is because people expect the doctors to work for nothing. How many doctors make 1M a year? Bankers, Attorneys, Athelets, and even chefs make more.

Unionized painters, electricians, contractors, etc make well over 6 figures.

Steve,
I am from Canada and I have vast experience in both health industry.
Canada's health care is no way near ours in terms of quality and efficiency.
No choice in treatment plan, longer wait time, low quality of service, and lack of primary physician.

...and yet Canadians, like those in all other OECD nations, have 100% coverage and longer life spans. I will take that over what we have now OR Obamacare. The US is #35 on this list. And because so many stupid racists claim its because of minorities in the US I will point out many OECD nations like the UK and Canada have lots of non-whites, or that the US ranks below the Virgin Islands, Bermuda, Costa Rica, Chile, the UAE, Singapore, South Korea, Hong Kong and Japan.

http://www.nationmaster.com/graph/hea_lif_exp_at_bir_tot_yea-life-expectancy-birth-total-years

http://www.nationmaster.com/graph/hea_lif_exp_hea_yea-health-life-expectancy-healthy-years

And for those who say "its obesity!!!!" STFU. Smoking is worse for you than that, and we are very low in terms of percent who smoke.

"Doctors in America are UNDERPAID. "

Relative to whom? On AVERAGE they make way more than any of the occupations you list. Several times more. For every six figure labouror, I will give you a seven or eight figure specialist. STFU. Doctors in the US make more than there OECD peers, also. There is no reasonable measure by which you can say they make too little.

Oh and the infant mortality rate puts the US at about #146 in the world. Yes, that low. Which is why included "healthy" lifespan as well as overall. Even factoring in that more babies die in the US than elsewhere in the rich world, we spend more of our shorter lifespans being sick. And this despite the fact that we pay not only 17% of GDP on healthcare versus 8-12% for other OECD nations, but in DOLLAR terms we spend more than double the OECD average (since our GDP is higher than most).

Worse, we spend more GOVERNMENT health care by itself per person than most OECD nations spend on TOTAL health care. Even though Medicare, Medicaid, the VA, and government employees combined are only 43% of the population. So The UK or Australia (and the entire rest of the rich world) covers EVERYONE for what we spend to cover 43% of our people. Regardless of whether they have entirely PRIVATE programs (like Switzerland) or mostly private plans (the Netherlands, Australia), hybrid (France, Candada) or mostly government-run (the UK.)

They ALL spend half or less what we do in dollars per person terms and have higher life expediencies.

If the US had the same percentage of HC per GDP as the OECD average for the past 30 years, we would have TRILLIONS of dollars that we could have spent on whatever or given as tax breaks or lowered the deficit/debt or some combo of all. Right now, would have a trillion dollars PER YEAR extra to spend on whatever. If the governments took a third of that, that would be $333B more for Federal and state coffers, and another $2,000 more PER YEAR in each and every man woman and child's pocket. Per year.

STFU.

Well there's nothing I can add to what jason said - he hit the head right on the nail, so to speak.

If all of the platitudes and sad stories and so and and so forth were correct, it would show up in the mortality and morbidity rates.

But it doesn't.

This sort of reminds me of teachers - another group I'm none too fond of - who say that bad education results are the fault of everybody else.

Well, it seems that bad health results are the fault of everybody ... but doctors.

I also know how capitation works, how it works in the UK, too, where doctors have to live by a BUDGET.

That does not mean, however, that that BUDGET means that they don't provide necessary services. They do provide necessary services; just not unnecessary ones.

And with respect to malpractice, and CEO's, and all that malarkey, beyond the Kaiser and Mayo Clinic models, there is the VA model:

http://www.rand.org/pubs/research_briefs/RB9100/index1.html

I suppose the American Enterprise Institute has something to say about this, too. Likely the same garbage.

Full accountability at the VA. As per the study, the difference is that:

* VA patients were more likely to receive recommended care than patients in the national sample.
* Quality of care was better for VA patients on all measures except acute care, on which the two samples were similar.
* The greatest differences between the two samples were in areas where the VA actively measured performance.
* Performance measurement had a positive “spillover effect” on related care.

Simple facts, which get in the way of how the healthcare industry likes to invent its own reality.

@stevejhx

since you make more than most doctors and teachers and know more than all of us combined, why don't you share with all of us why the money you make is fairly earned as opposed to the rest of us. Show us how you provide a service with higher quality, lower cost, and more use for society, per dollar, than a primary care doctor in the boonies?

That is very easy, nyc - I work on a fee-for-service basis.

I guess healthcare really is all about the money in America:

http://www.nytimes.com/2012/12/06/health/interest-groups-push-to-fill-margins-of-health-coverage.html?ref=politics&_r=0

Acupuncture? REALLY?

Health care spending by country. Its. ABSURD that we spend. SO MUCH!!!!

http://www.economist.com/node/21557793

My Swedish friends tell me that their "free" health care is average at best , the waiting times are long , and they all get private insurance to subsidize their hospital stays

But it's not doctors' fault, remember.

Jason,

Canada has more minorities but they are Europeans and mostly Asians. Here we have Hispanic and African AMericans who are notorious for bottom of the barrel kind of health.

Doctors in average earn more than them? Are you HIGH? what the f*ck are you smoking?
Try grouping doctors with nurses, medical assistant, hospital billers, receptionist, etc.
Attorneys and bankers are so vaguely grouped that the salary can range from 25k to 7 figures.
Please name a few doctors who earn 8 figures without running in a corporate setting.

Obesity is rampant in US. It is the number one cause which leads to many other diseases.
If you have no clue of what you are talking about, it's just better to stfu.
Keep throwing those skewed stats, they are meaningless unless you look at the real meaningful numbers.

"Keep throwing those skewed stats, they are meaningless unless you look at the real meaningful numbers."

Well then, post some.

stevejhx

"That is very easy, nyc - I work on a fee-for-service basis"

And we can't work on a FFS basis?
Canada is prohibited on FFS or any privatized care.

jason10006

Health care spending by country. Its. ABSURD that we spend. SO MUCH!!!!

http://www.economist.com/node/21557793

As with our MILITARY SPENDING and WELFARE HANDOUTS. Anything else?

Main News:
Smokers celebrate as Wash. legalizes marijuana

This is the country we live in. The poor shall inherit the world.

In the U.K. a pregnant woman needs to wait to see a doctor for pre-natal care.
So if she doesn't have the money to pay a private doctor, she waits.
My friends in the U.K. have had their babies delivered in a private hospital.
They can afford it.
stevie and jason will never need to wait for pre-natal care anywhere.

ba294: marijuana is not cheap and even legalized pot is pricey.

ba294: This is another discussion but read New York Magazine, "The End of Prohibition", Dec.3,2012.

ba294 - you are of course a gigantic racist. Which is why I noted that Bermuda and the Virgin Islands - places that are overwhelmingly black - rate higher than us. Racist asshole.

And I will note that blacks in Canada and the UK have higher life expediencies than those in the US. WHITES in the bottom 50% have lower life expediencies than almost all OECD countries, plus majority black Bermuda and the VI.

When you break down life expectancy by income level - for ALL races, its actually going DOWN for the bottom 50%, which is dragging down our overall average. Because we only have the "best" HC system if you are in the top 10%. What all these other countries do is make sure that 99% of people have good healthcare. Not a system like ours were 10% have great, 40% have adequate, 30 % have shitty to barely adequate, and then the bottom 20% have adequate government care.

As for specialists making more - that is insane that you would dispute this. Here are incomes by specialty:

http://www.profilesdatabase.com/resources/2011-2012-physician-salary-survey

Yeah, ba, military spending is about 50% too high. Try getting that to change.

"Welfare handouts" - mostly to the Red States.

"And we can't work on a FFS basis?"

The difference between doctors' fee for service and mine is that I am not in a position to decide what fees I charge. That is, unlike doctors, I don't determine what services I provide to my clients; they tell me, and I do it.

Therein lies the problem with FFS in healthcare: I don't have an incentive to charge for unnecessary services because I can't. Doctors do, because they can.

'Life Spans Shrink for Least-Educated Whites in the U.S."

Racist.

http://www.nytimes.com/2012/09/21/us/life-expectancy-for-less-educated-whites-in-us-is-shrinking.html?pagewanted=all

Obviously, jason, the problem with the US healthcare system is:

a) Dumb people
b) Colored people
c) Fat people
d) Hospital CEO's
e) Unions
f) NGO's that use false statistics
g) Pot smokers
h) Trial lawyers
i) Bankers
j) The Mao Clinic - I mean the Mayo Clinic
k) The VA
l) Canada
m) Immigrants to Canada
n) The UK's postcode lottery system
o) Prescription drug margins.

etc., etc.

Notice anybody missing from the list?

Jason,
Are you black? I am not racist and my closest friends are colored.
I am just stating a fact. Hispanics and blacks have health concerns. Most blacks in Canada are educated and are from French islands or Europe.

Millions of illegals with health benefits in this country is another reason why we have higher health cost.

Steve,

You sure sound like Stalin.
Doctors can charge whatever they want if they wish. Free market will drive their fee up or down.
Why should Lebron get paid 18mil a year? Is that fair?

Like nyc1234 had said, You can introduce capitation plan but cannot eliminate ffs (like Canada). Then what stops one from regulating what the sports players make, wall street, electricians, painters, lawyers, including your translational service where I think you deserve $10/hr.

Truth
"In the U.K. a pregnant woman needs to wait to see a doctor for pre-natal care.
So if she doesn't have the money to pay a private doctor, she waits.
My friends in the U.K. have had their babies delivered in a private hospital.
They can afford it.
stevie and jason will never need to wait for pre-natal care anywhere."

I think UK system is fine. If one can afford private care, they should seek aside from capitation plan.
I do have a problem with ALL or nothing plan, like Canada. A good friend of mine is going through pregnancy/delivery soon and they insist on C-section, not natural delivery. I do not want to get into the details of why but she clearly has an alternative tx plan but she is forced to have a c-section.

ba294: marijuana is not cheap and even legalized pot is pricey.

But the poor will give up their basic neccessity to buy pots. Crimes, health issues, etc...another can of worms.

No doctors can't charge anything they want. They can only charge what insurance companies and the government will pay.

So, to get around that, they order procedures and tests that are unnecessary.

It's very well documented.

I can't comment on the rest of your blather, though.

"I am not racist and my closest friends are colored. "

Colored? Racist.

ba: The poor give up the basics to buy bottles of cheap booze , ciggies, lottery tickets (at least they may win some money back).
If they want to give up the necessary basics to buy pots, I think that's O.K. as long as it doesn't lead to them buying pans.

jason buys colored pans.

The way I read this Steve, you don't seem to know much about this topic either and you babbled your way into agreeing with NY1234 which I pointed out all along was more knowledgable about this topic than you. But most post win! So I guess you are rightio again hahahaha hahahaha. Now get NY1234 some coffee .. Know out all haha lmao

Brooks, the retired Air Force fighter pilot wants some coffee!
He's a decorated veteran.

Oops my bad that wad novice ,,,keep posting Steve

"tora, tora, tora!!!".

oops, wrong war.

"THE OIL FIELDS ARE BURNING!!!"
That's the war, still the Brooks bullshit.

Look at Jason the retard flipping out. His racism is ok, but not someone else's.

>Oh and the infant mortality rate puts the US at about #146 in the world. Yes, that low. Which is why included "healthy" lifespan as well as overall.

Outliers.
Who gives a crap?
Parents didn't take care of their babies, and so that's a denunciation of the U.S.?

NYCNovice
2 days ago
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Nyc1234 makes perfect sense to me; agree with each of his/her posts here.
Side note: Brooks2 credibility not destroyed with me.

NYCNovice
2 days ago
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Stevejhx - I respect your points and see consistency in your posts here.

NYCNovice
2 days ago
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Jason - I agree

NYCNovice, you are so politic.