Small Business: Doctors going broke

[DaveyF]

Reading this is very disturbing to say the least I just hope here in Australia and Victoria in particular never change to this style of health care. I have had the unfortunate circumstace to use our health system twice in the recent past ( due to near fatal accidents ) and can only say that here the care provided is nothing short of fantastic, I have full private health cover but in reality in the public system you get the same care regardless.

It is sad to see that you are at the mercy of the insurers and purely finacial decisions determine your fate that's just wrong! How did a country like the US allow things to get into such a situation?

Loco57, there are many things in the US that distinguish this country from the rest of the world....One of the main things is that the governing parties have diametric opposition in regards to their positions on every single point.'
The Republicans are DEAD set against a 'public health' care system.....All one has to do is to read any of the news periodicals or see any of the news programs in this country to see the position that they take and are constantly expounding to the public. One might ask as to why said positions are taken and why any civilized society would wish to keep the current health care system that the US 'enjoys'.

It was my impression that one of the reasons that Pres. Obama was voted into power was so that he could 'fix' the health care system....In fact many at the time stated that he had a mandate. Unfortunately, IMO, in the last several years in the US, there is a prevailing undercurrent that seems to want to STOP progress at any cost.......WOW, I'm getting political on a Forum....something i swore to myself to NEVER do.....BUT your post has really triggered one of my hot spots

To say it is Sad is a MAJOR understatement, IMHO

 

[Johnny Vinyl]

To say it is Sad is a MAJOR understatement, IMHO

What makes it even more sad Davey is the fact no country in the world has contributed more to the advancement of good medical care than the U.S. has. To then deny access to its citizens is downright shameful.

 

[Phelonious Ponk]

What makes it even more sad Davey is the fact no country in the world has contributed more to the advancement of good medical care than the U.S. has. To then deny access to its citizens is downright shameful.

Many of the proponents of free market medicine say that the free market, the ability to make lots of money from drugs, procedures, machines, etc, is the reason why we have been responsible for so much medical advancement. There is some truth in that. It is almost certainly the reason why we have invested more in curing erectile dysfunction than ovarian cancer.

What it ignores is the fact that there really is no free market for medicine. Insurance, whether it is employer-paid or public, separates the consumer from the cost and even if it did not, the natural controls of the free market do not apply. When you, your wife, your child, your sibling are seriously hurt or sick, you don't stop to shop the market for price. You don't look around for the Wal Mart Oncologist. You will pay any price. You will sink into financial ruin to save/help a loved one. The "market" breaks down in the face of the nature of the product.

The American health care system is a mess and tens of millions do not have access in one of the world's wealthiest countries because a huge political contingent believes in unfettered free markets that do not exist, and they believe that if they did they would be good for everyone and everything. But almost nothing is ever that simple, and clearly there are some things that do not belong in the markets, even the semi-free ones. There are some things that do not function properly or even meet their objectives when profit is the primary motive. Healthcare is very near the top of the list.

Obama? Obama caved. When he had a majority in both houses he should have been in the offices of every Democratic Congresscritter and Senator who wavered, letting them know that the full power of a very popular president would be standing by a well-chosen primary opponent if they didn't vote for the bill. The real bill. The one with teeth, not the dog's breakfast that passed. It wasn't perfect but it was functional. We could have begun the adjustments from a position of strength instead of a mess on the floor.

Tim

 

[Steve Williams]

Tim

what you say makes sense to us all however the question one must consider is how much this plan will cost the taxpayer, as someone has to pay for it.

John, correct me if I am wrong but IIRC Canada has or did have a soft "cap" on doctor's incomes based on their specialty and place of doing practice. Once that's reached, my colleagues who practice in Toronto used to say they stopped working. Not sure if this is a figment of my imagination because I left in '78 just when the evolution of Socialized medicine took place

OMSIP--->OHSIP--->OHIP

 

[c1ferrari]

Game, Set, Match

Obama? Obama caved. Tim

As it pertains to healthcare

 

[Phelonious Ponk]

Tim

what you say makes sense to us all however the question one must consider is how much this plan will cost the taxpayer, as someone has to pay for it.

I personally wouldn't advocate socialized medicine, but a single-payer set of publicly designed and managed health plans (provided by private insurance companies -- think Medicare drug plan) to choose from like we now choose among plans at work. That would eliminate millions of dollars at the insurance and healthcare level where minions of office workers on both sides spend more time trying to deny payment and secure payment than providers spend taking care of people. I'd also suggest that, unlike the stump-dumb Medicare drug program, that the system be required (as opposed to specifically prohibited from) to negotiate and bid with insurance providers, drug companies, equipment manufacturers, clinics, hospitals, etc. And I would require that the process not be based on price alone, that it look rather deeply into how much is spent on administration vs. care, executive compensation, employee and patient safety, etc, etc. I would also require that the running of the system be isolated from political influence. Give me bureaucrats. Please!

I think American health care throws billions of dollars into the wrong pockets every year. I think health care reform could extend care to every American and save money. I think, instead of finding fault with the Canadian and British systems and projecting that on what has not been created, we should learn from the strengths and weaknesses of every public and public/private system in the world (there are many examples) and create the best system yet. I just don't think we have the political will to pull it off.

Those who think the private sector is the place for everything would say that government is terrible at such things, that it will be slow, inefficient, dysfunctional. And there's probably some truth in that, but seriously, if you have no insurance, or you have very weak insurance - and there are millions of Americans in this position - it can't get much worse. For those who have the money, keep private insurance and private care alive and well and operating in a real market where people know exactly what they're paying for it and have an alternative to turn to.

Tim

 

[Johnny Vinyl]

Tim

what you say makes sense to us all however the question one must consider is how much this plan will cost the taxpayer, as someone has to pay for it.

John, correct me if I am wrong but IIRC Canada has or did have a soft "cap" on doctor's incomes based on their specialty and place of doing practice. Once that's reached, my colleagues who practice in Toronto used to say they stopped working. Not sure if this is a figment of my imagination because I left in '78 just when the evolution of Socialized medicine took place

OMSIP--->OHSIP--->OHIP

Steve,

I wouldn't even consider trying to correct you, because quite honestly I don't even understand what our own healthcare system supplies and what it affords the general populace, and much less how it impacts our practitioners. If I may with respect, it seems to me that our healthcare system places at least some value on the patient...I get the sense that the patient is almost an afterthought in the U.S. with a faceless bureaucracy intent on lining corporate profits .

 

[Phelonious Ponk]

As it pertains to healthcare

I think you can just about say "Obama caved" without qualification. It is, sadly, pretty universally applicable. Really, the only thing that stands a chance of saving him is the weakness of the GOP field.

Tim

 

[DaveyF]

The American health care system is a mess and tens of millions do not have access in one of the world's wealthiest countries because a huge political contingent believes in unfettered free markets that do not exist, and they believe that if they did they would be good for everyone and everything. But almost nothing is ever that simple, and clearly there are some things that do not belong in the markets, even the semi-free ones. There are some things that do not function properly or even meet their objectives when profit is the primary motive. Healthcare is very near the top of the list.

Obama? Obama caved. When he had a majority in both houses he should have been in the offices of every Democratic Congresscritter and Senator who wavered, letting them know that the full power of a very popular president would be standing by a well-chosen primary opponent if they didn't vote for the bill. The real bill. The one with teeth, not the dog's breakfast that passed. It wasn't perfect but it was functional. We could have begun the adjustments from a position of strength instead of a mess on the floor.

Tim

Tim, I do agree that Obama caved....which was a HUGE disappointment to me. Why he did that is anybody's guess, but I suspect that once again the lobbyists got to him. IMO, so long as we have government entities being subject to 'vested' interests in this country, nothing truly positive for the country can occur

Wouldn't it be 'refreshing' for a change, if we could elect a leader who truly puts the countries basic interests ahead of a few 'power players' self absorbed interests. Most likely NOT in our lifetimes

One only has to look at the banking debacle to see what I mean, never mind the health system ( or lack of it) disgrace that we are 'saddled' with.

 

[Gregadd]

Congress never wanted universal health care and thought they could "slow walk it "to death. The real problem is that Medicare is a bully that makes Walmart look fair. The Doctors get squeezed by private and government insurance. The doctors were found liable for anti-trust when they tried to organize and demand a fair price. That means every doctor has to go it alone against the insurance industry pharmaceutical industry and hospital.

 

[Gregadd]

Driving a cab may become a thing of the past. Cities are not satisfied with taxes and Hack license fees. Many are going to a medallion system. Heavy fees and a limited number of medallions. So fat cats will buy the medallions.

 

[MylesBAstor]

Tim, I do agree that Obama caved....which was a HUGE disappointment to me. Why he did that is anybody's guess, but I suspect that once again the lobbyists got to him. IMO, so long as we have government entities being subject to 'vested' interests in this country, nothing truly positive for the country can occur

Wouldn't it be 'refreshing' for a change, if we could elect a leader who truly puts the countries basic interests ahead of a few 'power players' self absorbed interests. Most likely NOT in our lifetimes

One only has to look at the banking debacle to see what I mean, never mind the health system ( or lack of it) disgrace that we are 'saddled' with.

I just think he picked the wrong things to fix

 

[DaveyF]

I just think he picked the wrong things to fix

I don't think so Myles. Problem was and is, that he picked the things that were deeply rooted in larger corporations vested interests. Plus, the spin -meisters were able to convince too many people that fixing these issues was bad for the corporate interest:.
Getting back to health care, IF we look at the systems in numerous other countries, and like Tim said take the best of each system, we could come up with a FAR superior system for the public...Albeit, NOT for the insurance industry.

 

[MylesBAstor]

I don't think so Myles. Problem was and is, that he picked the things that were deeply rooted in larger corporations vested interests. Plus, the spin -meisters were able to convince too many people that fixing these issues was bad for the corporate interest:.
Getting back to health care, IF we look at the systems in numerous other countries, and like Tim said take the best of each system, we could come up with a FAR superior system for the public...Albeit, NOT for the insurance industry.

Well for one, I think Obama should have dealt with medical malpractice problem. Do you know how much that costs the docs? Steve can tell you as the insurance rates for OB/GYNs are among the highest. And you think your insurance rates are out of control? There's no controls on the rates docs pay. And if the docs don't pay, the hospital does.

 

[Johnny Vinyl]

Well for one, I think Obama should have dealt with medical malpractice problem. Do you know how much that costs the docs? Steve can tell you as the insurance rates for OB/GYNs are among the highest. And you think your insurance rates are out of control? There's no controls on the rates docs pay. And if the docs don't pay, the hospital does.

Not a bad idea when their CEO's are being paid millions.

 

[MylesBAstor]

Not a bad idea when their CEO's are being paid millions.

I would like to see a list of CEO's salaries at major hospitals. From what I remember, they were nowhere in that league at Columbia Presbyterian.

 

[Steve Williams]

Not a bad idea when their CEO's are being paid millions.

actually John, it's all about deep pockets. In the 70's when the malpractice situation was a nation wide crisis many doctors went "bare" wherein they refused to purchase high malpractice premiums. Then when law suits came about the deep pockets of the hospital paid the awards until they got wise and mandated all physicians who were to be a member of the medical staff have malpractice insurance

California got luck with tort reform and our rates although sky high weren't like other states. I was paying $55-60K per year just to practice what I was trained to do. In states such as New York and Florida, their OBG malpractice rates are ~$200K/year

It doesn't take much to figure what kind of cash a practice must generate to pay its overhead.

Then to make matters worse many malpractice companies charge a huge "Tail policy" when a physician retires to mitigate any potential law suits after his retirement.

My company was much better. You had to be over age 55 and a member of the company in good standing for 5 years and if so your tail policy was covered at no charge but others are paying many, many hundreds of thousands of dollars for same tail coverage

 

[Phelonious Ponk]

Well for one, I think Obama should have dealt with medical malpractice problem. Do you know how much that costs the docs? Steve can tell you as the insurance rates for OB/GYNs are among the highest. And you think your insurance rates are out of control? There's no controls on the rates docs pay. And if the docs don't pay, the hospital does.

It does cost doctors a lot, depending on the kind of practice and the doc's history. But as a systemic issue it is a pittance. You could eliminate malpractice altogether and it would have a negligible effect on the cost of healthcare in America. Politically, it's a diversion; a red herring. Address it? Maybe. Treat it as a significant piece of "health care reform?" Don't fall for that. They're just getting you to look away from the real problems.

Tim

 

[RBFC]

Tim,

I respectfully disagree. Even the cost of a bandaid in the hospital carries with it the overhead of legal teams, paperwork to show that the bandaid met standards, and paperwork to show that the practitioner that applied it was properly trained (at extra cost) to apply said bandage. There is the followup committee that calculates the infection rate due to improperly applied bandages, and the remedial actions necessary to retrain the personnel or buy different bandages that allow better statistics. Think this is overkill? The lawyers who make their living off this stuff don't.

Lee

 

[Steve Williams]

it's also the lawyers who make their living from medical malpractice and rest assured they aren't going to let the govt take that away from them