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The article implies that Medicare is the correct rate. If anyone has Medicare, or has worked at a clinic that accepts Medicare, or has filled out Medicare pape

The article implies that Medicare is the correct rate. If anyone has Medicare, or has worked at a clinic that accepts Medicare, or has filled out Medicare paperwork- you know Medicare isn't a gold, silver or bronze standard. It's dollar store quality. Things take longer, are often riddled with wrong denials, and him major limitations for patients.

hurryskurry 7y ago
Medicare rate and the reality of using Medicare are separate issues though For me the issue is that if you had something like a hernia it would essentially cost less to fly to Europe, have the surgery, and stay a couple of weeks than to pay out of pocket in the US. And many European healthcare systems tend to rank better than the US. So it seems that the procedure can be done for less, maybe even for less than Medicare costs; the "dollar store quality" doesn't seem to come from the inexpensiveness.
- throwayEngineer 7y ago
  Then your issue is likely with the extraordinary wages of Physicians in the United States. The American Medical Association is the 3rd biggest lobby in the United States. Physicians/surgeons in Europe do not make 300k/year.
  - Gatsky 7y ago
    This isn't really the issue. I live in a country where physicians/surgeons make more than that on average, and we have pretty good free healthcare. As always, singling out some part of a hugely dysfunctional system for criticism is quite unhelpful.
  - hurryskurry 7y ago
    I agree that physicians wages may be part of it. The AMA keeps a tight control on how many physicians are produced to keep fees high, but physician incomes haven't really been increasing. Doctors, I believe, generally make less now adjusting for inflation than they did in the 90s, which I've heard described as like some kind of golden age or something.
  - coredog64 7y ago
    It’s not just doctors though. It’s doctors, nurses, PAs, hospital admins, etc. Everyone in that chain is going to have to take a pay cut* to get prices down to where the rest of the American public feels it’s fair. We’re also going to have to change the way we design hospitals and remodel current ones: US hospitals are built and staffed for private rooms. That’s going to have to give way to wards, with private rooms being reserved for medical necessity. *The staff that manages insurance payments etc. will lose their jobs. I’m not making a value judgment, just stating facts. This is going to be a tough row to hoe once politically attractive groups start mobilizing members to fight the change.
  - conanbatt 7y ago
    This is part of it , but physician salaries are 10% of the spending. This could be fixed by laxing licensing laws, allowing doctor immigration and reducing the cost of education. But only one of many reforms needed.
    - mercutio2 7y ago
      I’m not sure where you got the number 10% from. Perhaps you’re dispatching heavily on the word “salary”, when most doctors and surgeons operate as small businesses, and don’t earn much income directly as salary? Doctor plus nurse compensation dominate every chart I’ve ever seen of US medical spending. People like to imagine it’s all the fault of insurance companies, pharmaceuticals, and malpractice; those are collectively a tiny fraction of US spending. It’s mostly labor costs. The US is rich, health is a good with infinite demand. It’s hard to reduce costs in that context.
      - conanbatt 7y ago
        https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/downloads/highlights.pdf https://www.cms.gov/Research-Statistics-Data-and-Systems/Sta... This one shows 20%, though when you say clinical services you include nurses, mid levels and medical assistants, though it doesnt explain how much of the hospital spending goes to providers, so higher. Also, add that the amount of debt physicians graduate with, does not make it a very healthy career, particularly in primary care (where you could do most of cost control). PCP's have high burnout and suicide rates, work 50+60hour weeks until their 50's , etc. There is nuance to the analysis of provider spending. In any case, i can assure you there are plenty of marginally useless rank-file employees that exist thanks to the current regulatory framework.
erentz 7y ago
> you know Medicare isn't a gold, silver or bronze standard. It's dollar store quality. Source? This doesn’t jive with how popular Medicare is. > Things take longer, are often riddled with wrong denials, and him major limitations for patients Source?
- conanbatt 7y ago
  > Source? This doesn’t jive with how popular Medicare is. One of the great trickeries of using Medicare's "popularity" is that people that have it pay 150$ a month, while the cost is 1000$. If medicare charged its patients what it cost, "popular sentiment" will rapidly change.
sjg007 7y ago
Medicare is standard of care.

hurryskurry 7y ago

Medicare rate and the reality of using Medicare are separate issues though For me the issue is that if you had something like a hernia it would essentially cost less to fly to Europe, have the surgery, and stay a couple of weeks than to pay out of pocket in the US. And many European healthcare systems tend to rank better than the US. So it seems that the procedure can be done for less, maybe even for less than Medicare costs; the "dollar store quality" doesn't seem to come from the inexpensiveness.

throwayEngineer 7y ago
Then your issue is likely with the extraordinary wages of Physicians in the United States. The American Medical Association is the 3rd biggest lobby in the United States. Physicians/surgeons in Europe do not make 300k/year.
- Gatsky 7y ago
  This isn't really the issue. I live in a country where physicians/surgeons make more than that on average, and we have pretty good free healthcare. As always, singling out some part of a hugely dysfunctional system for criticism is quite unhelpful.
- hurryskurry 7y ago
  I agree that physicians wages may be part of it. The AMA keeps a tight control on how many physicians are produced to keep fees high, but physician incomes haven't really been increasing. Doctors, I believe, generally make less now adjusting for inflation than they did in the 90s, which I've heard described as like some kind of golden age or something.
- coredog64 7y ago
  It’s not just doctors though. It’s doctors, nurses, PAs, hospital admins, etc. Everyone in that chain is going to have to take a pay cut* to get prices down to where the rest of the American public feels it’s fair. We’re also going to have to change the way we design hospitals and remodel current ones: US hospitals are built and staffed for private rooms. That’s going to have to give way to wards, with private rooms being reserved for medical necessity. *The staff that manages insurance payments etc. will lose their jobs. I’m not making a value judgment, just stating facts. This is going to be a tough row to hoe once politically attractive groups start mobilizing members to fight the change.
- conanbatt 7y ago
  This is part of it , but physician salaries are 10% of the spending. This could be fixed by laxing licensing laws, allowing doctor immigration and reducing the cost of education. But only one of many reforms needed.
  - mercutio2 7y ago
    I’m not sure where you got the number 10% from. Perhaps you’re dispatching heavily on the word “salary”, when most doctors and surgeons operate as small businesses, and don’t earn much income directly as salary? Doctor plus nurse compensation dominate every chart I’ve ever seen of US medical spending. People like to imagine it’s all the fault of insurance companies, pharmaceuticals, and malpractice; those are collectively a tiny fraction of US spending. It’s mostly labor costs. The US is rich, health is a good with infinite demand. It’s hard to reduce costs in that context.
    - conanbatt 7y ago
      https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/downloads/highlights.pdf https://www.cms.gov/Research-Statistics-Data-and-Systems/Sta... This one shows 20%, though when you say clinical services you include nurses, mid levels and medical assistants, though it doesnt explain how much of the hospital spending goes to providers, so higher. Also, add that the amount of debt physicians graduate with, does not make it a very healthy career, particularly in primary care (where you could do most of cost control). PCP's have high burnout and suicide rates, work 50+60hour weeks until their 50's , etc. There is nuance to the analysis of provider spending. In any case, i can assure you there are plenty of marginally useless rank-file employees that exist thanks to the current regulatory framework.

erentz 7y ago

> you know Medicare isn't a gold, silver or bronze standard. It's dollar store quality. Source? This doesn’t jive with how popular Medicare is. > Things take longer, are often riddled with wrong denials, and him major limitations for patients Source?

conanbatt 7y ago
> Source? This doesn’t jive with how popular Medicare is. One of the great trickeries of using Medicare's "popularity" is that people that have it pay 150$ a month, while the cost is 1000$. If medicare charged its patients what it cost, "popular sentiment" will rapidly change.

sjg007 7y ago

Medicare is standard of care.