Price controls coming for health care

Shall I translate into hockey meathead language for you? How about Canadian English?

Ereigel - interesting. Antitrust in healthcare with large ppo and hmos was a hot topic in the early 90s; whenever large market players rig the market against smaller players, those statutes can afford some relief. I haven't done anything in that area in 20 years; your comment prompts me to put on my list another area to look at for recent developments.

>>. I think that if a doctor's goal is to be in the "1%" then he chose the wrong profession.

Top 1% household income starts at $350-400K. Average doctor pay is anywhere from $200-700K depending on specialty. Primary care is around $200K, something like neurosurgery is $700K, more typical specialties around $400-500K.

So a two-doctor household is extremely likely top-1%, and a one-doctor household with specialty is likely top-1%. A one-doctor household without a specialty and no working spouse is relegated to top-5%.

Mind you, these are numbers provided by a profession that employs 1M people. Not just the best / brightest, but all the dull ones too.

What other profession has those sorts of incomes across a classification that covers 1M professionals?

Top 1% is AGI of about $370k. AGI is not the same as salary, by a long shot. 1.35 million people are in the top 1%.

The most accurate figures on physician earnings are here:

http://www.bls.gov/ooh/healthcare/physicians-and-surgeons.htm

http://www.bls.gov/oes/current/oes291069.htm

From the BLS.

Most physicians make around $200k.

>Most physicians make around $200k.

Almost millionaires and billionaires.

From the first link:

>> Wages of physicians and surgeons are among the highest of all occupations. According to the Medical Group Management Association, physicians practicing primary care received total median annual compensation of $202,392, and physicians practicing in medical specialties received total median annual compensation of $356,885 in 2010.

Basically what I said. AGI is usually higher if said doctor has any investments / dividend / interest income. Not sure what you are arguing with on your links vs my statements.

One in six of the top 1% are doctors. That's 0.5% taking 16% of the top-1% slots. They are over-represented in the top 1% by a factor of 30x compared to the average job.

NYCNovice is running for the position of best-liked/most-popular person in her streeteasy community.

She may or may not "generally love reading your perspective because (she) find you to be thoughtful and highly intelligent but this forum is not the right place for (her) to discuss further for a host of reasons."

"To discuss anything offline:
"foolish_renter@hotmail.com" or whatever, she offered up her e-mail address but didn't have any takers.

Be the first in your streeteasy community to e-mail her.

There are no prizes.

It's just some BS. she posted, trying to give the schoolyard bully her lunch money, in advance of actually being bullied.
A preventative, anti-cyber-ass-kicking form of insurance.

Wow, in only 24 hours, both Truth and columbiacounty have been taking down NYCNovice.

NYCNovice, are you getting the point I made a couple weeks back?: you have to pick sides or else you'll be on none. e.g. You can't laugh at Jason the Retard and then two days later say you want him back to hear his point of view.

huntersburg:
I'm not taking NYCNovice down.
She took herself down.

Your comment about how even Bill Clinton had to stop sneaking out in the middle of the night to go from Ron Burkle's house to David Geffen's house was your best of 2012, huntersburg.

Go Nada!
Truth/HB - if I were going for popularity, I certainly wouldn't talk to you two, but I genuinely enjoy your posts. I do not genuinely enjoy or value Jason's posts, but I do not think it is appropriate to call anyone a moron, tempting as that may be. (Come on, you know I made you laugh with my comment about also thinking it is warmer in SF). I have no thoughts on CC and would never have noticed him at all but for the fact that he followed me around like the little boy on the playground in third grade.

PS - IMHO, Geffen was a huge baby in that whole Clinton/Burkle/Geffen nonsense. Clinton never changed his behavior; Geffen just got pouty and Clinton and Burkle continued on their merry way. Geffen's loss.

And HB - I have never asked for Jason's opinion. I do wish he would read my posts because I want him to become a more effective advocate for Democratic Party positions. In his current state, I believe he undermines the positions he takes, and I hate to see anyone give the other side good reason to complain.

huntersburg:
Well, that settles it!
We are both beneath NYCNovice's standards for seeking popularity in her streeteasy community.
However, we are both more enjoyable and valuable than jason.

jason was just spotted in San Francisco wearing a "I'm NEVER going to unignore NYCNovice!" tee shirt.
"WE'RE NEVER EVER EVER GETTING BACK TOGETHER!" is printed on the back of the tee shirt.

PS - Clinton will always be more interested in hanging out with Ron Burkle because that's where his cigar gets lit for him by the hottie babes.

And Truth - Why don't you ask SE how your account got reinstated? I don't like it when anyone is attacked on a thread without provocation. In that last go around, it was apparent you were attacked without provocation, but not by AR. Sorry that I value her posts, but I do and quite a bit. I have no problem with anyone's fighting back if attacked, but I do have a problem with interrupting your nemesis' conversation with a third party for no apparent reason. I don't care if you all are annoyed by my insistence on that basic social convention, but I will take that position every time.

I'm so confused

by the way, I think Burkle and Clinton have been no longer for a few years now.

HB - along the same line, did you follow the netanyahu/adelson/lauder triangle?

NYCNovice: I don't care that you value ar's posts quite a bit.
Value whatever and whomever you want. It's a free cyber-country.

"in that last go around..." I don't care nor do I keep count. The attacks on me and the go arounds have been going around for years before you started posting comments on streeteasy.
If you value her posts, you'll enjoy receiving endless ridiculous e-mails from her.
You seem to have plenty of time to reply to each and every one of them. Just be quick about it.
She gets angry if she's left waiting.

Get over yourself.

I don't need to ask SE how my "account got reinstated". I never noticed that my account changed.
I'm not even interested in what caused my comment to bump up whatever thread discussion huntersburg noticed.

This is a website discussion board. It's not real life. It has no affect on my real life.

I'm not annoyed by your insistence on that or any basic social convention.
Take whatever position you want.

I don't consider any person posting comments on streeteasy as my "nemesis".

Get real.

Brooks and stevie: Come on back here and resume your go arounding.

It's more interesting than the NYCNovice summation.

Truth - I wish you the best; not sure why you are so angry, but I do sincerely hope you are okay and that your lighthearted and amusing posts resurface. Fun Truth is delightful; Bitter Truth is no fun.

NYCNovice: I'm not angry at you. Really.
If you think I'm delightful or bitter, it doesn't matter to me.
Your opinion of me or anybody else on streeteasy doesn't matter to me.
Sincerely.

huntersburg: I think Bill just wants the Burkle action. It was fun while it lasted.

>> I think that if a doctor's goal is to be in the "1%" then he chose the wrong profession.

More fun facts. Steve's link to BLS put number of physicians st 619K. US census bureau puts number of households at 115M, so top 1% is 1.15M, and doctors form 16% of these. So 184K doctors in top 1%, which means that 30% of all doctors are top 1%.

Any other profession where such a large fraction are top 1%?

Lawyers form 8.5% of top 1%. So 98K lawyers in top 1% out of 728K in profession. Hit rate of 13.5% for getting into the top 1%, less than half for doctors.

http://www.nytimes.com/2012/01/15/business/the-1-percent-paint-a-more-nuanced-portrait-of-the-rich.html?pagewanted=all

"doctors are more likely than any other profession to be in the 1 percent — one in five is."

First, inon, I didn't say they weren't in the top 1%. I said if they entered the medical profession TO BE in the 1%, they picked the wrong profession.

Second, how you get "Average doctor pay is anywhere from $200-700K" is the same as "$202,392, and physicians practicing in medical specialties received total median annual compensation of $356,885 in 2010," is beyond me.

Third, your 619k vs. 115M households makes no sense. 2-doctor families (and there are lots of them) are ONE household, but 2 doctors.

But you go on and on and on about something that wasn't even my point - my point was that a reason to become a doctor is NOT to be in the top 1%. It should be to be a doctor.

>First, inon, I didn't say they weren't in the top 1%. I said if they entered the medical profession TO BE in the 1%, they picked the wrong profession.

>my point was that a reason to become a doctor is NOT to be in the top 1%. It should be to be a doctor.

Come on Steve, what puts you in the position to make that demand or value judgment about doctors' objectives?

Ah, yes! The myth of "we need high drug prices to support new product development":

http://www.nytimes.com/2012/12/30/business/questcor-finds-profit-for-acthar-drug-at-28000-a-vial.html?_r=0&hp=&adxnnl=1&adxnnlx=1356875028-+se1X48gmCn/Ev12OWc3WQ

If only it were an isolated story.

Steve - Nada made definitive case for proposition that if one wants to be in top 1%, medecine is best choice of profession. Can you never admit defeat?

And HB makes excellent point re who are you to say what should motivate one to become a physician? Hopefully you can admit that your statement that doctors should be motivated by something other than money is an opinion and not a fact.

>>. Second, how you get "Average doctor pay is anywhere from $200-700K" is the same as "$202,392, and physicians practicing in medical specialties received total median annual compensation of $356,885 in 2010," is beyond me.

My full quote was: "Average doctor pay is anywhere from $200-700K depending on specialty. Primary care is around $200K, something like neurosurgery is $700K, more typical specialties around $400-500K."

Their full quote was: "physicians practicing primary care received total median annual compensation of $202,392, and physicians practicing in medical specialties received total median annual compensation of $356,885 in 2010."

You can fault me for quoting specialties at $400-500K rather than $357K, but that's about it. Their number was 11% below the range I quoted. But still within 3.5% of the top-1% threshold, which was my point.

let's make the experiment simple. comrade steve, please fill in the following incomes (that would make you happy under a capitated system) under your centralized economy:

General Surgeon ______
OB/GYN _________
Internist/FP _______
Nurse Practitioner __________
Nurse ________
Physician Assistant _________
Pharmacist ________
Medical Secretary _________
Healthcare Attorney _________

if u want to decide how much everyone gets paid, go ahead, fill it in for everyone to see, so we can finally put this to rest

>> Third, your 619k vs. 115M households makes no sense. 2-doctor families (and there are lots of them) are ONE household, but 2 doctors.

I came up with an estimate of 30% using the figure of 619K doctors you liked from the BLS. In my original post, I said 1M doctors. That came from the American Medical Association's calculation of 954K doctors:

http://www.ama-assn.org/ama/pub/about-ama/our-people/member-groups-sections/minority-affairs-section/physician-statistics/total-physicians-raceethnicity.page

Using my estimate of 184K top-1% doctors against my original claim of 954K total doctors, you get 19.3% of all doctors being top-1%.

So 20% or 30% from my back-of-the-envelope. Compare that to the NYT quote of "doctors are more likely than any other profession to be in the 1 percent — one in five is."

But never mind all that. You say our numbers make no sense. Please tell us what numbers do make sense, and how you got there, since you seem to have an idea about what would make sense.

On the effect of two-doctor families, had you done even a most cursory search on the topic you would have found this:

http://www.ncbi.nlm.nih.gov/pubmed/21035046

If doctors in general are anything like surgeons, only one in 6 is married to another doctor. I.e., a small effect on my estimates.

Novice, that wasn't my point. Unlike some people, I never deny statistics. It is a response, however, to something that I did not say or mean.

>> my point was that a reason to become a doctor is NOT to be in the top 1%. It should be to be a doctor.

You said "I think that if a doctor's goal is to be in the "1%" then he chose the wrong profession."

In that statement, you did not state that money is not a proper motive for becoming a doctor. You said that if the motive is money, then choosing then becoming a doctor is a poor choice. What other profession should the misguided soul choose if their goal is to be in the top 1%, pray tell?

Or are you now back-pedaling?

Or perhaps the words you chose mis-stated your intent.

You said:

"I think that if a doctor's goal is to be in the "1%" then he chose the wrong profession."

But you meant:

"I think that if a doctor's goal is to be in the "1%" then he chose the profession for the wrong reasons."

Not a common mistake for people whose command of the English language is strong enough to make a successful career as a translator, but perhaps it was the heat of the moment.

feint, bs reference post, feint bs reference post. i like back-pedaling, we may add that into the rotation. feint, bs reference post, back-pedal, repeat.

stevie thinks that doctors should not be motivated by a basic human element. to survive, moreover to survive and thrive. dismisses all that in his gobblygook reference posts. thinks he can solve healthcare when the experts are telling him his pov has significant gaps. now arguing detailed stastical analysis with nada. epic fail on that one.

feint, bs reference post, back-pedal. repeat.

*statistical*

Well, nada, you can make whatever inferences you want from what I said, but how you interpret it is not how I meant it. You can also make fun of my profession, but I make more than a lot of those physicians whose median salary you got wrong.

And I didn't choose my profession to be in the 1%, either - I chose it because I like it.

I agree with Steve on his latter statement. I generally think that people who choose a profession based on money as the primary motivator are misguided. They generally do not end up happy with their careers, and as a result they do not make as much money in the profession as those who do it because they actually like it.

>>Posts: 12337
Member since: Feb 2008
ignore this person
report abuse

Well, nada, you can make whatever inferences you want from what I said, but how you interpret it is not how I meant it.

>> Well, nada, you can make whatever inferences you want from what I said, but how you interpret it is not how I meant it.

If that's not what you intnded, fine. But in your professional capacity, wouldn't you have interpreted your statement in the same way?

>> You can also make fun of my profession, but I make more than a lot of those physicians whose median salary you got wrong.

I was not making fun of your profession.

Nor did I get the income of doctors wrong, if you include all the words written rather than picking-and-choosing.

>> And I didn't choose my profession to be in the 1%, either - I chose it because I like it.

Which is why you make good money doing it, IMO.

BTW, how much are you making these days? I remember you said your best year was $600K+ during pre-crash due to large amounts of CDO documents and whatnot but that things subsequently dropped off. Am I remembering correctly?

nada, i generally agree that individuals should gravitate towards fields that inspire them or motivate them as that should be the first step in mapping at a career. my point was that most will include compensation in that calculation. using at as a sole criteria would be misguided and agree that will likely end in disapointment.

No, you're not remembering correctly. I am not in a position to own CDO's, & never have.

Translating...

steve, he didn't say you owned CDOs, he was suggesting you translated CDO documents and there was a lot of volume of them and so you made good money off the translations.

Any case, found some post where you said $300K. Still that high, or lower due to economy?

Nada - outstanding.
Steve - there is no room for interpretation in your original statement. I have found your interpretation skills curious/creative throughout this thread. If you don't mind my asking, how many employees do you have?

HB - I have provided common ground for truth and cc (and who knows how many others), while steve has provided common ground for you and ino. This is a happy SE moment indeed.

yay!

That's about right, nada. Novice, you can infer whatever you like. I have no employees.

So, not interested in setting salaries?

BTW I was wrong about my end of life statement.

40 percent of Medicare dollars cover care for people in the last month

http://www.thirteen.org/bid/sb-howmuch.html

In essence though all of this doesn't get to the heart of the matter as Steve has pointed out: all american doctors are greedy and that is the only reason for our healthcare failures (and apparently the only reason I went into medical school as well as all my colleagues). Once he sets our salaries, all will be fixed. I have provided an easy form for him to fill out.

Perhaps those of you in other industries can also provide similar forms for Premier Steve so we can finally get this country back on track.

maybe apt23 can help steve with nyc1234's request. Since she's looking for the world to be fair, especially to her late 20s nephew who earns $300-$400K per year but has no closets as a result of private equity carried interest and other tax rules

The problem is that "10 percent of Medicare beneficiaries account for 70 percent of program spending."

The figure that I posted was for the last YEAR of life, not the last month, and it was from the NIH, not Channel 13, but the Channel 13 figures in that link make no sense: it's not possible for "27 to 30 percent of Medicare payments cover the cost of care for people in the last year of life" while at the same time "40 percent of Medicare dollars cover care for people in the last month."

Simply not possible because the last year necessarily includes the last month.

Not all American doctors are greedy - the system is set up in a way that gives them incentives to do things that are not necessary. Once the incentives go away, so will the greed.

The problem with healthcare is that it doesn't work like the market for broccoli: people aren't able to choose what procedures are appropriate for themselves, and doctors don't hang price lists on their walls. So you have a captive demand that is being led by a supply that has incentives to do too much, and that is borne out by all figures everywhere, including the number of MRI's performed in the US, which is twice the OECD average.

The rate that we are spending on healthcare is not sustainable.

Dear huntersburg:
It's so reassuring to now have a streeteasy community organizer, here to right whatever wrongs are selectively
being enforced.

Just reading that common ground has been provided to me with c.c., is so heartwarming.
Yay!

How are things at the streeteasy community center? Still empty?
Maybe the community organizer will provide common ground for a streeteasy community garden.
To be planted by gnomes in the spring.
Hoping that only flowers will blossom there, as too many perishables in the fruit section could cause further delays in vacation packing.

All best to you in this happy moment.

Love,
Truth

I love it. U are unable to post the incomes.

Unfortunately the hospital and government bureaucrats are faced with the same "inconvenince".

Not one person believes spending on US healthcare is under control. You have given significant evidence of this, with hard stats and data.

But even if you are right on the cause - doctors salaries - what is the mathematical centrally planned solution? Are u telling me after 600 posts, you don't have a solution?

U r hiding behind an anonymous forum and still scared to say it ?

Anyone else want to fill it in?

Are you addressing me, 1234, & if so what are you referring to about "the incomes"? "The incomes" of what? I have no clue.

I did NOT say that doctors' salaries are the cause - read, "sole cause" - of what is wrong with the American healthcare system. What I said was the the current structure of the healthcare system pays doctors to do things that are not necessary; that they are not necessary is proved by the fact that our OECD cohorts are not doing them, and they have without exception much better outcomes despite not doing them.

What I also said is that the usual supply and demand structures don't work in healthcare, for the reasons posted above, and also because people are demanding a service that someone else (insurance company) will pay for. I think that you will find that the demand for things that other people pay for is without exception infinite.

There is a huge gap between a "centrally planned solution" and the current perverse incentives for doctors and hospitals and a supply and demand structure that does not (and never will) respond as a competitive market should.

Personally, were I the Premier, as you promoted me to, I would implement a system similar to the UK's NHS, which is a single payer system alongside of supplemental insurance and private practice physicians. In the NHS, patients are assigned to a primary care physician, who has a budget (capitation payment) that he manages. All physicians work for the NHS, but are allowed to offer private services a certain number of hours a week. People can purchase supplemental insurance that covers things such as private and semi-private rooms.

That to me is the most efficient system - capitation payments for most healthcare needs. It can be done through an NHS structure, or through private insurance companies, or some combination of both. It will eliminate fee-for-service and its perverse incentives.

Will it be perfect? No. Somebody will always complain, and instead of healthcare being rationed by income as it now is, it will be rationed by need. And yes, over time, it will cause physician salaries to fall - they're twice as high in the US as they are in any other developed country, as well - because they will effectively be salaried employees who are managing budgets, not entrepreneurs looking for ways to up-code.

Steve - umm, pretty sure I am not the one making inferences; that would be you. BUT, I am happy to report that my psychic powers seem to have improved b/c I was pretty sure you had no employees.

Nyc1234: I'll try re salary setting: I don't care about specific numbers; I just want doctors to earn more than everyone else.

So basically doctors make too much but u r not interested in saying what they should make? That's a good way to weasel out of it.

Earn as much as possible, 1234.

There's at least one doctor traveling with every music Tour, around the country and on world tours.
They make big bucks and they deserve it. They are away from their homes and families usually 10 months each year.

They are at the venues first thing in the morning, for load-in, just in case a crew member gets hurt.
They are there to examine the artists for chest pains, sprains, flu symptoms, headaches, whatever may happen.
If anybody working on the tour has an ache, pain, allergic reaction -- those docs treat them onsite and determine if a hospital visit is needed.

Back at the hotel, they do the same.

Why shouldn't they get paid big bucks for that?

Well I'm glad for your new and improved psychic powers, novice - I was a manager once many years ago, no desire to do it again. I'm very happy working the way I do.

1234, I didn't say doctors made too much money. I said that they make twice as much as their OECD counterparts, and that their incomes would fall if they ceased looking for ways to increase their incomes by performing services that may or may not be necessary.

If you knew anything about economics you would know that incomes are sticky, so it is unlikely that there would ever be a huge reduction in incomes, or that aggregate incomes would fall though unemployment. What most likely would happen is that incomes would stay relatively the same and perhaps fall slowly as doctors started working as employees rather than small businesses.

The offset to that would be that they would probably work many fewer hours in exchange.

And the lines/waiting times would be long indeed for lower quality service . . .

There is ZERO evidence that the service would be of lower quality ... in fact, given international statistics, the service would probably be of a higher quality, and you'd probably get to spend more than 30 seconds with your doctor.

On the other hand, waiting times would increase for some, decrease for others. At present the waiting times for those who don't have insurance is just short of forever.

I do not rule out possibility that you are right re england's system and will go so far as tend to agree, but I am still concerned about innovation and supply of physicians. I am pretty sure my father in law would have died over 10 years ago had we been limited to england's system, but we'll never know.

>Somebody will always complain, and instead of healthcare being rationed by income as it now is, it will be rationed by need.

Free dialysis for all

>On the other hand, waiting times would increase for some, decrease for others. At present the waiting times for those who don't have insurance is just short of forever.

I and my family have insurance, and I work hard for it. In addition, I work hard to pay for others' insurance via my taxes. I have no interest in my wait times going up in order to lower them for others.

Yes we'll never know but urgent care is especially good in England - if it weren't it would show up in the figures, which it doesn't. What you might have to wait a long time for is an artificial hip if you're 97, but then I have serious doubts about giving artificial hips to people that age, anyway.

And though 1234 gets his figures all bass ackwards, he does have a valid point regarding end-of-life care. We do not have a rational system for rationing healthcare - and healthcare, like all goods and services, does need to be rationed, especially end-of-life.

That said, the figures don't lie, and the US does more MRI's, Caesarians, and circumcisions than any other country in the world, by far. Everybody else seems to be living long and prospering without all of these things, so I am reasonably confident that we can, too.

We might even live longer and prosper more, because we'd have more money to spend on other things.

>We might even live longer and prosper more, because we'd have more money to spend on other things.

e.g. more food, more defense weapons, more cable channels

Again, we need to have national health care with the option to buy into higher levels of care via insurance companies or out of pocket. Our patchwork system wherein the uninsured are dumped on the ER, the underinsured (Medicaid) get second rate treatment, and insurance rates are vastly different between large and small businesses is a mess. Entire industries (restaurant workers, the arts) without union representation are essentially excluded from insurance. People make career choices, stay in jobs, don't open up businesses for the sole reason of health insurance. The system as is is falling apart

not according to the novice.

Most doctors like this system.

>not according to the novice.

Is that the best you can do?
You are here to inflame and irritate, create misery where there is none and enhance misery where it is merely latent ... and that's all you got? Pathetic

Yay! Despite the fact that he mischaracterizes my position and is incapable of discourse on my level, I am happy my admirer is still with me. At first I thought his absence from this conversation might have been due to the particularly unfortunate haircut I am sporting at the moment. But then I remembered, this is the Internet, so that couldn't possibly be the reason. Whatever the reason, so nice he has not abandoned me; it is lovely to have someone so drawn to me without having any idea what I look like - this is the validation I have been seeking for song. Thank you CC!

HB - can you explain his infatuation with me? I am torn between being flattered and being creeped out.

>and being creeped out.

eh, what are you worried about? At least your spouse didn't call the police on you falsely accusing you of purchasing an illegal gun in order to menace (or worse) your neighbor.

eh,she also writes on streeteasy that I'm obsessed with having sex with children.
Ding dong.
Only I get the lecture about what I should do for the streeteasy community, though.

As for end-of-life care, I told my trusts and estates attorney that I don't want the end-of-life prolonging hook-up. Just send me home with the best pain-killing meds and let me die in peace.

I signed a Living Will and that's how it will be. Do not resuscitate.
Not everybody gets a deathbed or dies of old age.

stevie: are you signed-up for that?

Until we literally have "blood in the street", nothing major will change. There are enough people who do get good enough healthcare.
Occupy Wall Street and its anti-corporate objectives didn't even make this a major focus. Al Sharpton neither. So who?

http://vitals.nbcnews.com/_news/2012/12/12/15848640-health-insurance-us-paying-more-for-less-report-finds?lite

Everybody's fault but the doctors'.

Watch out what you wish for. The fact that scientific data is not available re physicians opting out of insurance networks and medicare in particular, does not mean it is not happening. Washington knows the opting out is occurring, but has not yet been able to get a handle on it. See, e.g., http://fulltextreports.com/2012/01/27/lack-of-data-regarding-physicians-opting-out-of-medicare/ I cannot imagine a scenario under which Congress ever passes a law requiring physicians to be part of national system in the way I understand physicians are required to in UK, but again, I am not well educated in this area, so I will continue to try to learn more so that I can cast a productive vote if the issue ever becomes ripe.

Most physicians are not in a position (ie in communities with the power to pay out of pocket) to opt out. Manhattan is an anomaly. They (especially the primary care providers) are getting squeezed to a point where many are selling to larger organizations. Losing their autonomy and opening themselves up for big pay cuts or termination when their deals expire.

Even if not forced to be part of the health system by the government, physicians are forced to some extend to participate via call and hospital obligations. Only profession forced to do "pro-bono."

Interesting - I can understand why physicians are not happy and do continue to worry about fewer choosing the path. One of my best friend's fathers was a physician (radiologist in fact), and I recall him advising our little nerdy bunch with the greatest gravity to not choose medecine because of the changing nature of the system. He said, if it is a calling that you feel you must heed, then by all means go for it, but there are many easier ways to make a living. As many, including stevejhx, have pointed out on this thread, that is solid advice for anyone in any profession. I say the same thing to all the youngsters I know considering law. You have to love it. If you love it, the money may follow, but not necessarily, so you should at least love it.

Novice, you need to take a course in economics. For real. There are about 700,000 physicians in the US:

http://www.bls.gov/ooh/healthcare/physicians-and-surgeons.htm

It is impossible for 700,000 people to act in concert.

That's first. Second, there are supply and demand curves, and as currently configured the demand curve is just about vertical - people will continue to demand healthcare services regardless of the cost, because someone else is paying the cost (insurers). Once you take those insurers away - and Medicare is an insurer - the demand curve shifts radically: there is no demand until there is an emergency, which is why poor people wind up in emergency rooms (they have no insurance).

There may be no studies regarding physicians opting out of Medicare, but there are studies about UK physicians emigrating to other countries to practice medicine. The figures are negligible, and are usually related to personal issues, such as a desire to move to a different climate or for family reasons, and not to make more money (though they could).

All the facts remain the same: US healthcare costs twice as much as the next-most-expensive system, doctors are paid twice as much as the next-most-expensive system, and our results are the absolute worst among our OECD cohorts.

It's an industry ripe for a restructuring.

Steve - Really? My degree in econ is more recent than yours and from a university with a significantly higher ranking. I actually started a masters, but abandoned it after trying to find a decent tax application for the entire discipline (my focus was on the wage elasticity of the labor supply curve of married woman). So don't try to pull that BS on me. I am not going to get into a serious econ discussion on a real estate chat board. As I have stated repeatedly, I see your points, but I don't see how you are going to get what you want in the United States without both your taxes going up and your insurance premiums going up, but I am interested in seeing how it all plays out.

stevie can't figure where to buy re, doesn't know where the epicenter of finance is despite his self-professed expertise in this field, his investment prowess is piss poor based on his own statements of asset allocation and now he is lecturing us on healthcare. feint, bs reference post, back pedal, repeat......

stevie is commoditizing healthcare, great first step miscue.

Then if you have such an amazing econ degree you should have recognized the impossibility of what you were suggesting. And my undergraduate thesis was on the respective effects on increases in the minimum wage and inflation on average wages in the food service sector from 1970 to 1980. I got an A+, from a lower-ranked university, alas.

The way to achieve here what others have achieved elsewhere is to do what they are doing. That doesn't seem to be so hard to figure out.

http://www.businessinsider.com/french-healthcare-system-2012-7

Which part of "never going to happen in the United States" is so hard for you to understand? I understand everything you say, but you seem to understand none of what I say. Think about it, and I am sure you will understand my points; if you don't, I suggest printing out the thread and taking it to one of your econ professors, and perhaps they can put it in remedial terms for you.

I don't know which part of "never going to happen in the United States" is so hard for me to understand, because it's the first time that that phrase in quotes appears in this entire thread.

I understand precisely what you're saying - and I think it's nonsense.

I tried to get him to do the same Novice, but he won't. He knows it all. Lmao'

He got an "A+". Really lmfao!!!!

Ah, yes, Brooksie! Positive convexity = negative convexity Brooksie! Banks keep most of their originated mortgages on their books Brooksie! Mortgage bond closing prices Brooksie! Incredible growth in bank MBS holdings Brooksie! Can't use MBS's to hedge duration risk Brooksie! It's out of context Brooksie! Quotes a blog or two as authoritative sources Brooksie!

Brooksie knows it all!

l-m-F-a-o.

I know, Brooksie, an A+. Imagine that, graduating with honors.

So you know, it was impossible to tell whether inflation or an increase in the minimum wage led to the increase in the average wages in that sector in that time frame. But I suppose regression analysis would be difficult for you to understand.

As is so much more.

eriegel makes an interesting point about our view being clouded by sitting in NYC or in Manhattan. If doctors outside of Manhattan and a limited number of other premium markets become excessively squeezed, we may have two very different classes of doctors.

and that could have Manhattan-based implications on real estate, probably upward.

Greensdale gets it.

There's nothing to get, novice. The median household income in NY County from 2007-2011 was $67,204, and the per capita income was $61,290. 17.6% of the population lives below the poverty line.

The median household income in the US as a whole in that period was $52,762; per-capita income $27,915. Percent below the poverty level = 14.3%.

There is NO market for what you are advocating. All 700,000 doctors in the US could opt out of insurance and Medicare and everything, but there would only be a limited demand for their services. Even in places like Manhattan, where the income is distributed exceedingly unequally (which is why the per capita income is so close to the median household income), there simply aren't enough people able to pay the price.

That is why insurance exists.