4 ms·

Medicare processes and payments have very little basis in reality. The payments are so low that doctors and hospitals often factor in the lost money into non-m

Medicare processes and payments have very little basis in reality. The payments are so low that doctors and hospitals often factor in the lost money into non-medicare bills to make up the difference. So, the real story is that these doctors and hospitals are so committed to providing care, that they're willing to figure out ways to provide it despite medicare.

55555 7y ago
> The mean salary of a doctor in the United States is $294,000/year [Medscape] So, so committed to providing care... they're practically working for free. Maybe they're even losing money. Side note: Google is bizarre. You can tell what words Google thinks are effectively synonyms by typing one word and then seeing which words are bolded in the results; I searched "median earnings of a doctor in the usa" and it bolds "mean" and "average"...
- Mbioguy 7y ago
  Note: if you want a meaningful discussion about physician salaries, you need to be discussing lifetime income after tax and after debt repayment, and compare this metric to other professions. Comparing the yearly salary of a vascular surgeon with 10-15 years of post-high school education, training, and compounding debt interest to the yearly salary of a junior developer ignores the very different lifetime shape of the careers. Any substantial change to the pay structure for physicians needs to address the cost of education and training, and not screw over a large cohort of physicians saddled with debt who see a massive pay cut. They will significantly oppose any attempted changes that don't address these two things. Doctors in Europe are paid a good bit less than here in the US, but their education is paid for (and then some) by the state.
maxxxxx 7y ago
The US health system is full of stories like "Medicare payments are below cost therefore we have to charge other patients more", "International drug prices are too low, therefore we have to charge US prices more", "There are a lot of uninsured patients treated for free therefore we need to charge others more". I tend to call BS on all of them. None of them explains why especially hospitals tend to charge almost random prices for the same thing, make constant billing mistakes and haunt the patient for years with changes that already have been settled with the insurance. It doesn't explain why the medical device my company sells for 30k gets charged 140k by the hospital (happened to my girlfriend). Or why for the same 1 hour surgery one hospital anesthesiologist charges 12k while somewhere else the charge is 3k. The whole system is totally corrupt, opaque and highly profitable for doctors, administrators and middlemen. Each of them blames the other while never providing any real accounting with hard numbers.
- tomohawk 7y ago
  Not disagreeing on the fact that the system is broken. However, if cost is important, why are prices not transparent, and the same for all treatments (hint: medicare is a big reason)? Why do states have laws that prohibit competition? In many states, you can only build a new hospital if existing hospitals OK it. In our state, why is there a shortage of general practitioners? (hint: after paying malpractice insurance and student loans, its almost impossible to make a living). So, GPs are moving to other states. Mis-regulation has created an environment where market forces are prohibited from operating, predatory lawyers make a killing, cronies are comfortable - with predictable results.
  - maxxxxx 7y ago
    You are blaming it on regulation, medicare, malpractice insurance and lawyers. How about also saying that hospital owner, managers and doctors make a killing in this system? They are not victims.
    - tomohawk 7y ago
      What I am saying is that all market forces have been suspended, and replaced with something that is not working. Market forces tend to keep a lid on the kinds of things we are seeing. The mis-regulation has not replaced these market forces with anything that is working. You can't have transparent pricing if medicare comes in and imposed unrealistic pricing. It only works if the advertised price is the same price for everyone. You can't have inexpensive malpractice insurance without the English Rule, and if the tort system is basically a lottery. The health insurance companies are a much bigger problem than the care providers. Things that might be productive instead of pointing fingers: * all medical services and medicines provided by a provider must have a single, public price * prohibit employer provided health insurance, replacing it with insurance purchased by individuals with pre-tax money * enable interstate purchase of health insurance * expand the health care exchange that federal employees have access to to create a single, unified market for purchasing insurance * introduce the English Rule to reign in trial lawyers
deleted 7y ago
[deleted]

55555 7y ago

> The mean salary of a doctor in the United States is $294,000/year [Medscape] So, so committed to providing care... they're practically working for free. Maybe they're even losing money. Side note: Google is bizarre. You can tell what words Google thinks are effectively synonyms by typing one word and then seeing which words are bolded in the results; I searched "median earnings of a doctor in the usa" and it bolds "mean" and "average"...

Mbioguy 7y ago
Note: if you want a meaningful discussion about physician salaries, you need to be discussing lifetime income after tax and after debt repayment, and compare this metric to other professions. Comparing the yearly salary of a vascular surgeon with 10-15 years of post-high school education, training, and compounding debt interest to the yearly salary of a junior developer ignores the very different lifetime shape of the careers. Any substantial change to the pay structure for physicians needs to address the cost of education and training, and not screw over a large cohort of physicians saddled with debt who see a massive pay cut. They will significantly oppose any attempted changes that don't address these two things. Doctors in Europe are paid a good bit less than here in the US, but their education is paid for (and then some) by the state.

maxxxxx 7y ago

The US health system is full of stories like "Medicare payments are below cost therefore we have to charge other patients more", "International drug prices are too low, therefore we have to charge US prices more", "There are a lot of uninsured patients treated for free therefore we need to charge others more". I tend to call BS on all of them. None of them explains why especially hospitals tend to charge almost random prices for the same thing, make constant billing mistakes and haunt the patient for years with changes that already have been settled with the insurance. It doesn't explain why the medical device my company sells for 30k gets charged 140k by the hospital (happened to my girlfriend). Or why for the same 1 hour surgery one hospital anesthesiologist charges 12k while somewhere else the charge is 3k. The whole system is totally corrupt, opaque and highly profitable for doctors, administrators and middlemen. Each of them blames the other while never providing any real accounting with hard numbers.

tomohawk 7y ago
Not disagreeing on the fact that the system is broken. However, if cost is important, why are prices not transparent, and the same for all treatments (hint: medicare is a big reason)? Why do states have laws that prohibit competition? In many states, you can only build a new hospital if existing hospitals OK it. In our state, why is there a shortage of general practitioners? (hint: after paying malpractice insurance and student loans, its almost impossible to make a living). So, GPs are moving to other states. Mis-regulation has created an environment where market forces are prohibited from operating, predatory lawyers make a killing, cronies are comfortable - with predictable results.
- maxxxxx 7y ago
  You are blaming it on regulation, medicare, malpractice insurance and lawyers. How about also saying that hospital owner, managers and doctors make a killing in this system? They are not victims.
  - tomohawk 7y ago
    What I am saying is that all market forces have been suspended, and replaced with something that is not working. Market forces tend to keep a lid on the kinds of things we are seeing. The mis-regulation has not replaced these market forces with anything that is working. You can't have transparent pricing if medicare comes in and imposed unrealistic pricing. It only works if the advertised price is the same price for everyone. You can't have inexpensive malpractice insurance without the English Rule, and if the tort system is basically a lottery. The health insurance companies are a much bigger problem than the care providers. Things that might be productive instead of pointing fingers: * all medical services and medicines provided by a provider must have a single, public price * prohibit employer provided health insurance, replacing it with insurance purchased by individuals with pre-tax money * enable interstate purchase of health insurance * expand the health care exchange that federal employees have access to to create a single, unified market for purchasing insurance * introduce the English Rule to reign in trial lawyers

deleted 7y ago

[deleted]