The Tyranny of Medical Bills in America

[Alan Klein]

...I also know what's happening with our own medicare and medicaid system in the US. We're losing doctors at a great rate, and there are more and more doctors who refuse to take medicare or medicaid patients since they actually lose money on those patients...

I went on Medicare two years ago.  One of the excellent doctors I used wouldn't take Medicare and a couple of the better doctors I wanted to start using also didn't take Medicare.    If the government passes laws requiring all doctors to take Medicare (and Obamacare) to try to get good doctors to provide service to all, doctors will leave the medical profession in droves.  Smart kids will forgo the medical field for other careers and the overall medical system will become third rate as the second rate students become doctors. 

What's the expression that you get what you pay for?

[Slobodan Blagojevic]

...doctors will leave the medical profession in droves.  Smart kids will forgo the medical field...

No problem...we will just keep exporting jobs to Asia and importing doctors from there.

[Alan Klein]

No problem...we will just keep exporting jobs to Asia and importing doctors from there.

...and importing engineers for Silicon Valley, ...and importing illegal immigrants from Mexico, all of which reduces the number of jobs for Americans at both the top end and bottom ends and/or decreases the money Americans could have made as in the past in many types of occupations.  I hope I'm wrong.  But I don't think this is going to turn out well. 

[Rob C]

I went on Medicare two years ago.  One of the excellent doctors I used wouldn't take Medicare and a couple of the better doctors I wanted to start using also didn't take Medicare.    If the government passes laws requiring all doctors to take Medicare (and Obamacare) to try to get good doctors to provide service to all, doctors will leave the medical profession in droves.  Smart kids will forgo the medical field for other careers and the overall medical system will become third rate as the second rate students become doctors. 

What's the expression that you get what you pay for?

If those smart kids are driven into medicine by money alone, do we really need them in the job?

I had always imagined, and it seems to be the case with my own granddaughter, that it's a vocation as much as anything else. It's having an attraction for how people work, how you can fix things when they go tits ups, and how you can be a bit of a miracle worker in your own, if limited, way.

Perhaps the last quality one wants to see in a doctor is avarice.

Rob C

[DeanChriss]

What happened 25 years ago doesn't represent the current state of affairs.    Government services over time usually decline in efficacy while costs go up.   

We are U.S. citizens and have 2 kids and 2 grand-kids who are Australian citizens since college. One of the grand-kids has serious allergy issues since birth, and obviously having kids (one less than a year ago) created the need for medical care. I can only say that they are lucky to have Australian healthcare. There are very tangible reasons U.S. healthcare is consistently ranked worst among developed countries while being the most expensive in the world.

[Slobodan Blagojevic]

... U.S. healthcare is consistently ranked worst among developed countries...

I assume you meant the health of the population? As far as I know, U.S. healthcare is the best in the world. Meaning the most advanced. Everyone who is anyone flies to the States for the level of advanced treatment not available anywhere else. If thay can afford it, of course.

[Ray]

I assume you meant the health of the population? As far as I know, U.S. healthcare is the best in the world. Meaning the most advanced. Everyone who is anyone flies to the States for the level of advanced treatment not available anywhere else. If thay can afford it, of course.

I think the key point here, Slobodan, is 'if they can afford it'. One can't receive the best health care in the world if one can't afford to have access to it.

The following US opinion article provides some shocking statistics.
http://www.usnews.com/opinion/articles/2014/05/30/no-the-us-doesnt-have-the-best-health-care-system-in-the-world

Here's a couple of extracts.

"According to Commonwealth researchers, 37 percent of Americans do not seek a physician’s help when sick or fail to fill prescriptions due to high cost, compared with 4-6 percent in Britain and Sweden. About 23 percent of Americans had problems paying or did not pay medical bills, compared with only 6 percent or fewer in Britain and Sweden. About 75 percent of Americans said the health care system required fundamental changes; in contrast, 50-63 percent of Europeans were happy with their systems. Americans in fact wait longer than most Europeans to see a primary care doctor: 63-76 percent of Europeans see a doctor within one to two days, compared with 48 percent of Americans; only Canada scores worse (41 percent)."

"First, our system has waste due to excessive bureaucracies. About $750 billion, almost a third of the nation's annual health care spending, was wasted in 2009. One-third of health care dollars are spent on administrative overhead, far higher than other countries."

[michael]

I assume you meant the health of the population? As far as I know, U.S. healthcare is the best in the world. Meaning the most advanced. Everyone who is anyone flies to the States for the level of advanced treatment not available anywhere else. If thay can afford it, of course.

Well, I guess that depends on what you mean by "best".

Does it have some excellent doctors, hospitals and technology? Undoubtedly.

But almost every ranking I can find shows that the US (and Canada) aren't even in the top 10.

Here one link.

And for those wanting some meat on the bones, there's this paper.

Best? No. Try 37th, with Canada not much better.

This is not about chauvinistic chest thumping, this is about meaningful statistics.

Michael

[AlterEgo]

If thay can afford it, of course.

exactly, it is like compare benefits for W2 employees between C-level and rank & file folks... are you seriously using this example about rich as an argument ? they simply pay out of pocket for everything, whatever billing is

[Slobodan Blagojevic]

...chauvinistic chest thumping...

Careful, Michael, this type of name calling can get you in trouble with moderators.

Oh, wait...!? Damn!

[Slobodan Blagojevic]

... are you seriously using this example about rich as an argument ? ...

Yes, seriously, because I was not referring to affordability of healthcare, but its advanced scientific, technological, and educational levels. When money is no object, the rich go for... the best, right? And that was my point. When they need the best, they fly here. I have not heard them saying: "I need this advanced medical treatment, please fly me to Australia."

[RSL]

If those smart kids are driven into medicine by money alone, do we really need them in the job?

I had always imagined, and it seems to be the case with my own granddaughter, that it's a vocation as much as anything else. It's having an attraction for how people work, how you can fix things when they go tits ups, and how you can be a bit of a miracle worker in your own, if limited, way.

Perhaps the last quality one wants to see in a doctor is avarice.

Rob C

I agree with everything you said, Rob (as I usually do), but it's not necessarily avarice. In order to stay in business with his own practice a doctor at least has to break even. In the US, on medicare and medicaid patients a doctor may actually lose money. If he can't pay his nurses and receptionist and can't pay the rent or the taxes he has two choices: he can join a medical group -- hospital or other organization, where his hours, pay, and method of practice are under control of someone else -- an administrator who may be an MBA rather than a medic, or he can give up and either retire or find another line of work.

What's happening in the US as Obamacare proceeds is that the very best practitioners are taking option number two. I had a wonderful primary care doctor who would listen to his patients and, sometimes even more important, to his nurses. I know about the second thing because one of his nurses was one of my daughters-in-law. He was younger than I, but old enough that when he saw Obamacare coming he decided to retire and play golf. I couldn't blame him, but I surely miss him, as do his other former patients.

[amolitor]

People said that doctors would leave the profession in droves in Canada, when they socialized the medical system.

It turns out that "not as lucrative as it used to be" is still pretty lucrative, and driving a bus isn't all that attractive as a new career.

In general, people are completely wrong about what motivates people. As a for instance, people assume that a guaranteed income (a stipend of, say, $15,000 a year given to everyone by the government) will create a nation of TV watching lumps, and this is simply wrong. Experiments have shown that this simply doesn't happen. Given an opportunity to work and improve their lot, most people will. People are motivated in subtle ways by subtle things, and the "obvious" analysis of what will happen is usually wrong.

[RSL]

Unfortunately it's not the "droves" that are the problem. As usual, it's the high-performers you lose. Most high performers are quite capable of leaving one profession and moving to a different one. What's left behind are droves of drones. When you talk about "what motivates people," Andrew, you're biting off a huge chunk of generalization.

I agree that "not as lucrative" isn't the same as "wiped out," but wiped out is exactly what some sole practitioners see facing them in the future. I think Rob's exactly right: the good doctors go into medicine for reasons other than money. But those are the same doctors who aren't comfortable being told how to practice their profession by bean counters.

[Isaac]

It's also a way to lift the gloom and raise your spirits. But to do that you have to have some humor in your bones, Isaac. You might want to look into that.

Apparently the merchants in Dodge first hired a private lawman and when that proved ineffective they turned to government provided troops, and then local government with the appointment of a sheriff.

Your mistaken - "Used to work great when Wyatt was keeping the peace in Dodge, Andrew. But then the government took over." -  is actually an example of failed free enterprise being rescued by government.


Have you used "government-controlled" healthcare?

[RSL]

Isaac, I say again: you ought to look into that. (A sense of humor that is.) It would be worth your time to try to develop one.

[amolitor]

The reality is that Canada, and other nations with government run health care, *are* able to retain doctors. Hypotheticals are one thing, but reality is quite another.

That said, there is a flow of practitioners across the border, north to south. I don't know about the other direction, and suspect that it's smaller. You can make more money in the USA than in Canada.

As for the state of health care in Canada, here's a another little dose of reality: MRI machines and the like are not free. The USA's astronomical health care costs are driven, in a large part, but unnecessary procedures and tests. The fact that there is an MRI machine down every hall sitting idle, does indeed cause a trend of more MRI tests. Canada doesn't have an MRI machine down every hall, that's a fact.

There's a benefit of being able to get an MRI on a moment's notice. That's real. That saves lives.
There's also a cost.

Much as I dislike the idea of placing a dollar value on human life, we have to recognize that our attitude of "no amount is too great" is a big slice of why we're going broke on medical care in this country.

[Alan Klein]

The low payments by Medicare, Medicaid, etc. often force doctors, even the best, to treat patients as another number.  They have to shuffle patients through their office to increase the count so they can pay for running their practice.  They often have assistants do preliminary work and then they spend 5 minutes with you.  How can you get good quality care and advice that way?   You can't.

Also, they become creative in getting money out of the system.  They proscribe tests that really don't have to be done.  The patient doesn;t care because the he's not paying for it directly.  

And let's get something out of the way.  To argue that you want your doctors to be doctors who never think about money for themselves is just unrealistic.    If that was true, the best doctors wouldn't raise their prices for their services.  The truth is they are human,.  Who would have guessed?  They have family's too.  And they want the best for their families and children just like everyone else.  Who here would turn down a raise if it was offered to you by your boss?  Well, doctors also want more money so they can send their children to the best schools and rear them in the best neighborhoods and provide the best clothes, food, and other things.  Wouldn't you?  The idea that doctors check their ego and pride and desire for the good things in life at the medical college door is just silly.  Some may.  Most don't.  (I'm not talking here about doctors who are crooks, who lie to Medicare and bilk the system).   They want to be recognized for their work and paid accordingly.  And that doesn't mean they dopn't care about their patients or the work they do.  

Let me ask you something.  If money were no object, would you go to the specialist who charged $100 for a checkup or one who charged $500?

[Isaac]

Isaac, I say again…

But for some reason you apparently don't wish to say if you have used "government-controlled" healthcare. That is kind-of "funny".

[Otto Phocus]

They have to shuffle patients through their office to increase the count so they can pay for running their practice.  They often have assistants do preliminary work and then they spend 5 minutes with you.  How can you get good quality care and advice that way?   You can't.

That has been my experience even with private health insurance. My doctor does not spend 5 minutes, but usually by the time I see the doctor, I am out of the office in about 15 max.

Let me ask you something.  If money were no object, would you go to the specialist who charged $100 for a checkup or one who charged $500?

That would depend on the doctor.  If money were no object, I would find the doctor that gave me the best care independent of what they charge.

Let's put this in the perspective of photography.  Would you rather pay a photographer $5,000 or $15,000 to shoot your wedding?

The price really has little to do with it.  You would choose the photographer whose work you can see and who you feel you can have a good business relationship with.

Cost does not equate to skill in many cases.  One can't assume that because someone charges more that they are better.