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Disclaimer: I am a physician. There are greedy physicians. There are bad physicians. These physicians can drive up health costs. I do not find, however, much e

by logjam 17y ago

Disclaimer: I am a physician. There are greedy physicians. There are bad physicians. These physicians can drive up health costs. I do not find, however, much evidence to support the idea that physician reimbursement has anything to do with our high national health costs. Most I know are neither bad nor greedy. Generally, my colleagues are the best, most compassionate, smartest humans I know. The physicians I know have worked 60-80 hours a week for their entire professional lives, went into enormous debt to finance their professional educations and make between $140-200K annually before paying for their own expenses, health care insurance, sick time, vacations, etc. I understand what you are saying about taking your health destiny into your own hands. Most physicians, including myself, want you to do just that, and will work with you to encourage you to efficiently and cheaply monitor and care for your own conditions. Most of us feel that has to be the future. Most of us believe strongly in preventive medicine, and feel caring for chronic disease is like trying to put the toothpaste back in the tube. I'm with you, notwithstanding your hyperbole about the illegality of caring for your own health in a free nation. But I think you might agree that when your 9 month old starts wheezing one February day in the midst of a common respiratory syncytial virus outbreak, despite all the self-learning you did on the Internet, you're probably best advised to seek counsel, evaluation, and treatment from someone who has seen a few cases of RSV, seen a few more cases of how fast children can go down with something so seemingly simple, and can treat it effectively.

bokonist 17y ago
The problem is not with physicians, rather its a structural problem with the American political system. I have no doubt that you and many of your colleagues are compassionate and well intentioned. But you also pay dues to an organization that has a political lobbying arm. This is of course, entirely understandable. Washington has a ton of power, power which can be used to steam roll you. Thus you support an organization that has a goal of looking out for your interests in Washington. It does so quite well. Too well, in fact. As a result of AMA lobbying, America has far fewer doctors than most other developed countries. The result is higher prices for consumers, and no evidence of better care. See: http://blogs.law.harvard.edu/philg/2009/04/05/the-futility-of-trying-to-control-health-care-costs-in-a-country-short-of-doctors/ http://blogs.law.harvard.edu/philg/2009/04/05/the-futility-o... Again, I don't blame the doctors, I blame the design of the political system that creates constant factional fighting over the resources of the country, with some factions getting screwed and others doing the screwing. ( Oh Madison, how wrong you were ... ) Part of the way the restrictions of new doctors work is by restricting medical schools. This of course drives up the price of medical schools, sending doctors into massive debt. Frankly, there is no reason that doctors need four years of college on top of four years of college on top of four years of high school. I'm sure the whole thing could be compressed into eight years, as other countries have done. For new doctors, loosening the barriers to entry would be a Pareto optimum improvement. Salaries would fall, but so would the costs of schooling. Overall the public would benefit without harming new doctors. But existing doctors would get screwed, as you point out. To be fair, any reducing of the barriers to entry should include compensation for current doctors.
- netsp 17y ago
  Often, when laws are changed, some people lose out. Easier entry/certification. Changing trade laws can put whole industries out of business. Zoning laws can make your property double of half in value quite easily. Emission controls can make your car worthless. Every time a politician sneezes someone get screwed. You can't compensate everyone.
deleted 17y ago
[deleted]
gnaritas 17y ago
It's not that people don't want to go to a doctor, but after a while people get to know their own issues pretty well, especially if they're recurring. There are many common things that happen to people that they can easily self diagnose from experience. They shouldn't need a doctor to go to the pharmacy and get medicine. It's not at all uncommon to go to the doc knowing exactly what he's going to do, exactly what he's going to say, and exactly what prescription he'll give you, why waste all that fucking time and money just so the guy in the white coat can tell me what I already know? I want to go to a doctor when I don't know what's wrong with me, not when I do.
- Retric 17y ago
  Assuming you know what's wrong you need to go to the doctor for: 1. Access to prescription drugs which are not safe. 2. Access to specialized equipment. 3. Access to highly skilled people to do something you can't do safely. If you break your leg you can make your own cast, but it's probably a bad idea. So it's mostly a question of prescription drugs and I think having gatekeepers for them is a good idea. PS: If it's really safe for you and society then you can buy it over the counter. Do you really think it's a good idea to change this?
  - yummyfajitas 17y ago
    Various other countries do allow you to purchase various prescription drugs which are considered by the US to be unsafe. It doesn't cause any serious harm. For example, Iran does not have an epidemic of dying women due to OTC birth control.
    - Retric 17y ago
      There are a lot of prescription drugs and a lot of edge cases. I think the Pill is a prescription drug in the US because it can be used to have a chemical abortion which is a seperate issue. You can probably find a fairly large number of drugs that could become over the counter and every year many make that jump. However, antibiotics sould not fall into this category.
  - 17y ago
Radix 17y ago
I'm curious, what is your specialty? To be clear, I agree with you and believe it would be a bad thing if mothers and fathers could buy antibiotics for every gash and flu. But, I can't go discuss a problem with my pharmacist then buy a generic. And, I would be surprised to hear I can go directly to a specialist, even if I pay cash instead going through insurance. Just saying, it's difficult.
- Zak 17y ago
  To be clear, I agree with you and believe it would be a bad thing if mothers and fathers could buy antibiotics for every gash and flu. They can, actually. All of the more common antibiotics are marketed for use in fish tanks and can be bought with no prescription from aquarium stores or ordered from Amazon. Looking up the markings on the pills shows them to be exactly the same pills you'd get from a pharmacy with a prescription. Of course, you should have a pretty good idea of what sort of bacterium you're infected with before you take antibiotics. If you live with two people who are diagnosed with strep throat, and your tonsils swell up a day later, you probably don't need a culture to tell what you have. Don't abuse antibiotics.
deleted 17y ago
[deleted]
cma 17y ago
> I do not find, however, much evidence to support the idea that physician reimbursement has anything to do with our high national health costs. Really? I have read that the increases in the mean wage of doctors have outpaced or at least tracked medical inflation at least since Bush took office. Given that doctor salaries are a major component of health care costs, there aren't too many ways that that can not have anything to do with our national health costs. In general, doctors in the US make close to twice as much as doctors in other rich countries, while enduring similar costs of living. Doctor salaries definitely aren't the whole picture--we also spend almost twice as much per patient on prescription drugs along with twice as much on bureaucratic overhead. Drug costs: The NSF funds a near majority of the drug research that is done in the US (and this doesn't include much of their basic biology research even when it later proves crucial for drugs), and meanwhile drug companies spend close to 50% of their budgets on sales and marketing. Of the research that they do carry out, a large portion of it is on developing clone drugs to get around other drug companies' patents. Some portion of their research budgets also go into things which in a sane world I could have categorized under marketing and sales without drawing comment: stuff like cures for baldness. Overhead: I don't know a lot of details about why the bureaucratic overhead is so much higher; I've heard some handwaving on lawyer costs involved in eeking out payments from estates during medical bankruptcy, the costs of dealing with multiple insurers, etc., but I haven't seen any hard numbers itemizing these things. I do know that malpractice isn't a significant part of it: around the time Bush came into office touting his catch-all solution to the problem of rising health care costs--malpractice reform--the ratio of malpractice judgments in dollars to national health care spending was around 0.60%. I don't know if that included settlements, but there is a pretty decent upper bound on what settlements/judgments could have been in total: the ratio of the amount spent by doctors on malpractice insurance premiums vs. national healthcare spending was 1%.

by logjam 17y ago

bokonist 17y ago

The problem is not with physicians, rather its a structural problem with the American political system. I have no doubt that you and many of your colleagues are compassionate and well intentioned. But you also pay dues to an organization that has a political lobbying arm. This is of course, entirely understandable. Washington has a ton of power, power which can be used to steam roll you. Thus you support an organization that has a goal of looking out for your interests in Washington. It does so quite well. Too well, in fact. As a result of AMA lobbying, America has far fewer doctors than most other developed countries. The result is higher prices for consumers, and no evidence of better care. See: http://blogs.law.harvard.edu/philg/2009/04/05/the-futility-of-trying-to-control-health-care-costs-in-a-country-short-of-doctors/ http://blogs.law.harvard.edu/philg/2009/04/05/the-futility-o... Again, I don't blame the doctors, I blame the design of the political system that creates constant factional fighting over the resources of the country, with some factions getting screwed and others doing the screwing. ( Oh Madison, how wrong you were ... ) Part of the way the restrictions of new doctors work is by restricting medical schools. This of course drives up the price of medical schools, sending doctors into massive debt. Frankly, there is no reason that doctors need four years of college on top of four years of college on top of four years of high school. I'm sure the whole thing could be compressed into eight years, as other countries have done. For new doctors, loosening the barriers to entry would be a Pareto optimum improvement. Salaries would fall, but so would the costs of schooling. Overall the public would benefit without harming new doctors. But existing doctors would get screwed, as you point out. To be fair, any reducing of the barriers to entry should include compensation for current doctors.

netsp 17y ago
Often, when laws are changed, some people lose out. Easier entry/certification. Changing trade laws can put whole industries out of business. Zoning laws can make your property double of half in value quite easily. Emission controls can make your car worthless. Every time a politician sneezes someone get screwed. You can't compensate everyone.

deleted 17y ago

[deleted]

gnaritas 17y ago

It's not that people don't want to go to a doctor, but after a while people get to know their own issues pretty well, especially if they're recurring. There are many common things that happen to people that they can easily self diagnose from experience. They shouldn't need a doctor to go to the pharmacy and get medicine. It's not at all uncommon to go to the doc knowing exactly what he's going to do, exactly what he's going to say, and exactly what prescription he'll give you, why waste all that fucking time and money just so the guy in the white coat can tell me what I already know? I want to go to a doctor when I don't know what's wrong with me, not when I do.

Retric 17y ago
Assuming you know what's wrong you need to go to the doctor for: 1. Access to prescription drugs which are not safe. 2. Access to specialized equipment. 3. Access to highly skilled people to do something you can't do safely. If you break your leg you can make your own cast, but it's probably a bad idea. So it's mostly a question of prescription drugs and I think having gatekeepers for them is a good idea. PS: If it's really safe for you and society then you can buy it over the counter. Do you really think it's a good idea to change this?
- yummyfajitas 17y ago
  Various other countries do allow you to purchase various prescription drugs which are considered by the US to be unsafe. It doesn't cause any serious harm. For example, Iran does not have an epidemic of dying women due to OTC birth control.
  - Retric 17y ago
    There are a lot of prescription drugs and a lot of edge cases. I think the Pill is a prescription drug in the US because it can be used to have a chemical abortion which is a seperate issue. You can probably find a fairly large number of drugs that could become over the counter and every year many make that jump. However, antibiotics sould not fall into this category.
- 17y ago

Radix 17y ago

I'm curious, what is your specialty? To be clear, I agree with you and believe it would be a bad thing if mothers and fathers could buy antibiotics for every gash and flu. But, I can't go discuss a problem with my pharmacist then buy a generic. And, I would be surprised to hear I can go directly to a specialist, even if I pay cash instead going through insurance. Just saying, it's difficult.

Zak 17y ago
To be clear, I agree with you and believe it would be a bad thing if mothers and fathers could buy antibiotics for every gash and flu. They can, actually. All of the more common antibiotics are marketed for use in fish tanks and can be bought with no prescription from aquarium stores or ordered from Amazon. Looking up the markings on the pills shows them to be exactly the same pills you'd get from a pharmacy with a prescription. Of course, you should have a pretty good idea of what sort of bacterium you're infected with before you take antibiotics. If you live with two people who are diagnosed with strep throat, and your tonsils swell up a day later, you probably don't need a culture to tell what you have. Don't abuse antibiotics.

deleted 17y ago

[deleted]

cma 17y ago

> I do not find, however, much evidence to support the idea that physician reimbursement has anything to do with our high national health costs. Really? I have read that the increases in the mean wage of doctors have outpaced or at least tracked medical inflation at least since Bush took office. Given that doctor salaries are a major component of health care costs, there aren't too many ways that that can not have anything to do with our national health costs. In general, doctors in the US make close to twice as much as doctors in other rich countries, while enduring similar costs of living. Doctor salaries definitely aren't the whole picture--we also spend almost twice as much per patient on prescription drugs along with twice as much on bureaucratic overhead. Drug costs: The NSF funds a near majority of the drug research that is done in the US (and this doesn't include much of their basic biology research even when it later proves crucial for drugs), and meanwhile drug companies spend close to 50% of their budgets on sales and marketing. Of the research that they do carry out, a large portion of it is on developing clone drugs to get around other drug companies' patents. Some portion of their research budgets also go into things which in a sane world I could have categorized under marketing and sales without drawing comment: stuff like cures for baldness. Overhead: I don't know a lot of details about why the bureaucratic overhead is so much higher; I've heard some handwaving on lawyer costs involved in eeking out payments from estates during medical bankruptcy, the costs of dealing with multiple insurers, etc., but I haven't seen any hard numbers itemizing these things. I do know that malpractice isn't a significant part of it: around the time Bush came into office touting his catch-all solution to the problem of rising health care costs--malpractice reform--the ratio of malpractice judgments in dollars to national health care spending was around 0.60%. I don't know if that included settlements, but there is a pretty decent upper bound on what settlements/judgments could have been in total: the ratio of the amount spent by doctors on malpractice insurance premiums vs. national healthcare spending was 1%.