I don’t even try to see my GP if I am sick anymore. I just hit the med clinic. I only have a GP now for my annual and bloodwork. It’s pretty screwed up.
Trump tells House Republicans to find a ‘fair number’ on SALT
- Thread starter crazed_hoosier2
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This is a good source that I just found. Please remember that I came up with the solution on my own thanks to research inspired by others on this board.
There is a sentence in here, @crazed_hoosier2 that makes a claim that is similar to yours. So, kudos to you. After you get done reading it, I will explain why you're both wrong. 😁
Exactly…they have no incentive to see you. It’s a shit system
Strangely, I hear a lot of doctors complain about quotas and not having time to actually spend with patients. I think of course that impacts GP more than specialists, and I think it is GP we have the biggest shortages.
There is also an extensive administrative staff necessary to sort through all the billing, reimbursement and other complexity created by the multi-tier insurance and payor mess.
As to US doctors being 4x those of German, I’d suspect you’d find that to be true of lawyers and other professionally-educated top earners.
And even if you do it’s easier to just run to urgent care down the street. I shared the debacle of minion with his collar bone. Two days worth of bs that urgent care would have handled in an hour for 1/10 the cost
But…It shouldn’t be easier to run to urgent care. The pediatrician should see your kid in office and make diagnosis and proper referral to on call surgeon if needed
Lawyers have giant ranges of incomes. Not so much with Drs who have a pretty high floor.
Got appt with pediatrician. Had to go to hospital for xray. Back to pediatrician to read. Referred to orthopedic. Ortho referred to not in network. Had to find ortho in network. Go to in network ortho. Get a sling.
Stupid
Agreed. In the suburbs, life is exponentially easier than in the cities.
Dr’s have a robust range also. Pediatricians and GPs at the bottom with cardiac surgeons and anesthetists at the top.
Thank you and Thank you!Providers aren't sucking wind. Maybe the hospitals are, but only because they have to pay salaries that have grown exponentially over many decades, due to shortages of actual HC workers.
As I tried to state above, these answers are common sense when viewed through the prism of, what basic materials are driving prices.
If the price of chips, copper wire, plastic, cotton aren't up to a level that explains soaring costs, then it must be something else. Just a rudimentary understanding of health services is needed to get to that conclusion.
Ultimately, it is the Doc lobby, the complete lack of basic economic skills, and the group think that leads to, "this is the way we did last year, and this is the way it was handled under previous administrations, so this is the way we're going to do it."
It is worth noting that the Secretaries and Under-Secretaries can be lobbied. Although, they’re not supposed to accept money from those they have direct responsibility for.
We wouldn't be having this discussion if the problems in FFS pricing were addressed 20-30 years ago. It's the compounding interest that hasn't been addressed that is now eating our collective lunch.
They are the least compensated, because of the system. They don't have a seat on the RUC.
That’s a cluster.
I had a bout of vomiting and couldnt really eat or drink much for 3 days. I worked two of them and on the last day I had a lot of muscle cramps. Call my doctor and see him that afternoon. He refers me to have a CT without contrast. I head to hospital for procedure. In the meantime, he has already contacted on-call surgeon. I have procedure. My physician calls the boss and tells her I am being admitted thru the ER. The on-call surgeon comes in to see me. Diagnosed with small bowel blockage. I was diagnosed, had procedure, admitted within 3 hours. My physician is not a part of any conglomerate. He owns his own practice. Quality care can occur. The physician just has to be invested in your care.
FTR, I don't think we could (or should) approach healthcare finance without third parties. There is pretty obviously going to have to be some risk-pooling with it. Even if prices were normalized by proper market forces as they are for cellphones and air travel, I don't think anybody would ever want to, say, face cancer without some kind of insurance.
So I hope you don't think I'm advocating for a model that puts everything on an OOP payment basis. Because I am not...at all.
Rather, what I do think we should aim for is a situation where most routine healthcare expenditures have the consumer occupying his normal seat at the table -- with the right incentives to play the critical role he usually plays: making choices between a range of options based on what he perceives to be in his own best interest. Consumers can be crafty little devils when they have reasons to be.
Look into Singapore's healthcare paradigm. Put simply, everybody of working age there has an HSA that is funded by withholding. They also have a parallel single payer system -- but only for major costs. Something like 90+% of all healthcare transactions are paid for out of an individual's HSA...consumer to provider. And the consumer has all the normal incentives in place to be frugal. The less they spend on healthcare, the more they have to spend on other things. Very, very important concept. It's the secret sauce to efficiency between prices and service. They're incentivized to live healthy lifestyles, for instance. They're incentivized to find the least expensive means to tending to their normal healthcare situations.
But only when they have a high cost health event does insurance kicks in. In their case, it's single payer. I don't have a strong opinion as to whether SP or private insurance is the best way to approach that. But, to me, that's not even what's most important. What's most important is that Singaporean consumers rarely use insurance to pay for healthcare goods/services.
And doing this, they seem to have found a really good balance between cost, quality, and access -- whereas most systems struggle mightily with at least one of these.
Providers aren't sucking wind. Maybe the hospitals are, but only because they have to pay salaries that have grown exponentially over many decades, due to shortages of actual HC workers.
I sit on a hospital board and have seen the data. They're sucking wind with public insurers. They'd be insolvent if that was their only source of income -- because the privately insured subsidize the publicly insured. Given that, we ought to expect some pretty bad repercussions if CMS just pared back their reimbursement schedules.
If you took what I said to mean that doctors and nurses are waiting in bread lines, then you misread what I was saying.
Also, what you're seeing in this chart is the symptom, not the disease. The disease, if I may distill it all the way down to the nut, is the widely held notion that healthcare is a human right.
It's not. It couldn't be even if we all unanimously agreed that it should be -- it's scarce and demand will always outstrip supply.
The wise words of Thomas Sowell apply here:
Yeah, we will never not have 3rd party payers in healthcare.
However, we would do ourselves a lot of favors if we substantially reduced our reliance on them for healthcare finance -- and substantially grew our use of OOP -- even if we arrange for subsidies for low-income people (as opposed to Medicaid).
I've posted this before. But it's worth posting again. I think it was even in response to you originally. You'd said that the ACA sought to increase OOP with high deductible plans. And I would agree with that. But it hasn't worked out that way. OOP has actually declined since the ACA. Per CMS, OOP only accounts for only about 12.7% of all healthcare payments:
OK, I through it. And I'm not wrong -- but I'll listen to your argument why I am.
As a result, cutting Medicare rates to achieve lower private rates and lower healthcare spending overall could have unintended consequences, as it may reduce Medicare beneficiaries’ access to care.
There's no "could" about it.
There's a reason unintended consequences are unintended. They're the pitfalls we tend to ignore -- or at least downplay. Because they aren't front of mind when we're making plans. What's front of mind is the intended consequences. We want lower costs and universal coverage....and what kind of diabolical person wouldn't want that? After all, the doctors can afford it. They're all raking in millions. What are they going to do...turn down the biggest buyer of their services?
Again, consider Vermont's conundrum. Why are they scratching their heads? Why did they get a poor result....when all the "experts" were telling them that if they got their coverage numbers higher, tightly regulated premiums and costs, they'd finally get that unicorn they've been hunting for: everybody (or nearly everybody) fully covered...with high levels of access and quality and affordable costs.
There's an answer. And it really isn't all that complicated. It's just that nobody wants to hear it.
Even in a Singapore model, we would probably still need some form of Medicaid for the poor who cannot put anything but token amounts in HSAs and Medicare for those who never had a chance to grow an HSA. But I have no issue with going to a mostly Singapore system. The book Nudged also brought up the idea of single-payer catastrophic insurance. It seems it might help some of the problems we see.
But we do need to open med schools up for more kids to become doctors. Or use our increased H1B for doctors and not programmers.
Marv what do you mean open med schools up? Most/many of the good ones are free
You keep bringing universal coverage up. I haven’t mentioned it. Of course universal coverage will shift demand, or anything that increases the number of people covered.
You also omitted some important parts of the quote. So, now explain why you, or they, think demand will shift.
Graduate more people. Expand. Part of the problem I know is residency, there are only so many positions so we'd have to expand that too.
I don’t know how to do that. I know people in their early thirties who make more money renting cars than friends of mine who are my age practicing medicine. Medicine just isn’t appealing. So much school. Horrible hours. Stress. Incredible workload. And the payoff just isn’t worth it.
I sit on a hospital board and have seen the data. They're sucking wind with public insurers. They'd be insolvent if that was their only source of income -- because the privately insured subsidize the publicly insured. Given that, we ought to expect some pretty bad repercussions if CMS just pared back their reimbursement schedules.
If you took what I said to mean that doctors and nurses are waiting in bread lines, then you misread what I was saying.
Also, what you're seeing in this chart is the symptom, not the disease. The disease, if I may distill it all the way down to the nut, is the widely held notion that healthcare is a human right.
It's not. It couldn't be even if we all unanimously agreed that it should be -- it's scarce and demand will always outstrip supply.
The wise words of Thomas Sowell apply here:
Disagree.... I think what we are seeing in that chart is an artificial hard limit on supply. What argument do you have for why there are 2x as many doctors per patient in Germany than in the US?
What are the assumptions with the data? That is the key here. And why you're wrong.
Just to build on this times have changed. There are so many ways to make money today that are so much easier than medicine. And I am around doctors a lot. They constantly bitch about the system, MBAs, bureaucracy, expectations, lack of autonomy, and I think that erodes the appeal of it being a calling.
My BIL is a hospitalist. 7 days on, 7 off. 12 hour shifts
Makes maybe $350k. Not the worst trade off. But left hospital for a rehab type center. Hospital was getting worse and worse as they couldn't get enough staff (Drs).
So if you started Jan 1 this month that’d be 17 days. 204 hours for the month. Not bad not great.
Fwiw that schedule would appeal to me
Yeah, we will never not have 3rd party payers in healthcare.
However, we would do ourselves a lot of favors if we substantially reduced our reliance on them for healthcare finance -- and substantially grew our use of OOP -- even if we arrange for subsidies for low-income people (as opposed to Medicaid).
I've posted this before. But it's worth posting again. I think it was even in response to you originally. You'd said that the ACA sought to increase OOP with high deductible plans. And I would agree with that. But it hasn't worked out that way. OOP has actually declined since the ACA. Per CMS, OOP only accounts for only about 12.7% of all healthcare payments:
That chart mainly just shows the result of Medicaid expansion from the ACA and an aging population (Medicare). I've not seen a health insurance plan in a long time that didn't have OOP cost sharing involved. Even Medicare does
HDHP with HSA has only been a thing for about 20 years. Now something like 53% of employees have one as an option... And about 41% of individuals under 65 are covered by a HDHP
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Why wouldn’t he open his own practice? Be open 4 or 4 and 1/2 days a week. 8-5, maybe 8-12 the other day.
Why wouldn't we just subsidize HSAs? That's what Singapore does, after all. And it seems to have worked.
Again, I'm not familiar with any healthcare system anywhere that has achieved a better balance between cost, access, and quality. Those three things hang in the balance. Everybody wants lost cost, high access, high quality. But here's Sowell again with his whole things about solutions and tradeoffs.
Yes, Singapore is a tiny nation with very different culture, etc. I'm not saying we should or even could just copy it verbatim. But we'd be fools not to at least borrow from it.
Is he not internal medicine or family practice and then decided to do hospital work?
Why not compare to Germany or Netherlands.... Seems at least a closer peer.
According to this ranking system the US scores well on a lot of the metrics.... With the extreme exception being 'fiscal sustainability'
Germany: #3 in the 2024 World Index of Healthcare Innovation - FREOPP
Germany demonstrates one of the best healthcare systems in the world through an array of choices, scientific advancements, and a commitment to fiscal sustainability.
freopp.org
