<p>Most docs ARE in the 100-400K range. (Most non-surgeons in the 100-200Ks, most surgeons in the 300-400Ks) Only cardiac surgeons and neurosurgeons average more than that after years of practice. When hospital administrators are making 2 or 3X more than highly trained surgeons–who went into debt and sacrificed many years of their lives for their training. . .that’s just wrong. And what about insurance co. executives?
IMO, insurance companies, medicare, medicaid are part of the problem. We are paying thousands of middle-men and paper pushers/keyboard clickers–mostly to deny claims. If the patient had to be charged TO HIS FACE, they could never get away with these inflated charges. Remember that a high percentage of medical costs go to support all the folks who work for insurance companies and govt. agencies–NOT to the actual doctor/patient services.
Don’t even get me started on documentation/coding–another huge expense in the medical industry that sucks time and $$ away from actual patient care.</p>
<p>Cptofthehouse, I don’t think that people understand that being insured doesn’t mean being insured. </p>
<p>I am sorry you have gone and are going through these issues. I appreciate your posts because I can Learn from your posts.</p>
<p>Atomom, I wonder why a couple of posters objected to that pay when that is the pay for most doctors?</p>
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<p>And, perhaps we should ask ourselves how we got to “have” to pay high school employees, dockworkers, government employees, and firemen those princely sums, Not to mention the ridiculous benefits after very short careers that are bankrupting our country. The answer is none other than decades of caving in to the extortionary practices of unions that wield CBA and the “occasional” bribes with great effect. That and a government that values the term sinecure.</p>
<p>And now think about the direction we seemingly have chosen. If history repeats itself, we will simply pay a LOT more and have a LOT less to show for. At least, if we care to measure the performance of the protected employees. </p>
<p>It will get a lot worse than it is today.</p>
<p>Maybe we can stay on the subject of health care. It is kind of a big issue. </p>
<p>Xiggi, go start a thread on unions. </p>
<p>A friend of mine’ s cancer treatment was 1 million bucks. She had great insurance. She was covered. I wonder how much I would have paid out of pocket?</p>
<p>Absolutely, having insurance is a whole other thing than having enough insurance. In some situations, it’s better to have no insurance. My one son just said he had no insurance for a while when he had some injuries that needed treatment. Also had no money so it was all hospital and medicaid covered. When I stepped in and said, hey, not go, not only were a lot of the charges not covered under insurance though reasonable & customary issues, copays and deductible, not to mention not being a preferred hospital or doctor under the plan, the fact that he had insurance meant he was responsible for it ALL despite the fact that he had no money and was making below poverty level. He was worse off covered than not! </p>
<p>So for those with low/middle incomes to have crappy insurance coverage can mean getting into more trouble than having no insurance at all. I’m looking to get coverage for him because that isn’t always the case and I want him to be covered for catastrophic issues since that could sink us, and I just can’t let him go if that should happen. In my case, I know how it would feel. Been through too much that way already. </p>
<p>When my other son was being treated at a Children’s Hospital, we had Aetna as our provider through DH’s work. For whatever reason the hospital was in a feud with them, so any and all test had to get preapproval before anything had to be done. I remember going with him for an echo cardiogram and the sign on the door saying “ALL with Aetna, have to have pre approval before any treatments or tests can be done”. </p>
<p>The pendulum does swing both ways in all of this. Without a bean counter to check over what the doctors are doing, there are abuses that way too. They will put their mouths to the teat of the insurance company or government and such it dry with all kinds of tests and referrals. I’ve been in that situation too. It comes down to know what to do, to have a doctor in the family or someone in the medical field who is very good to help with the decisions. I’ve had to tell doctors that they were not giving us optimum service and the best choices any number of times in the days before managed care and now.</p>
<p>Cpt… What a mess!! </p>
<p>We just spent 2500 to make sure my wife doesn’t have ovarian cancer. I think she is fine. One of my kids is injured. I don’t know if he is covered. We need referrals and referrals From I guess certain doctors.</p>
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<p>Why dissociate them? Health care is not different from other industries in their desire to protect the service providers over the users of the services. That is the exact mantra used by the unions and similar outfits that just bear a different name. </p>
<p>And that is why governs all public services. The recent changes are nothing than moving from Scylla to Charybdis. We know the ills of the current system and have yet to see how much worse it will get. It will simply be the same but with additional layers of bureaucracy. And plenty more of lazy public sector profiteers.</p>
<p>Xiggi, </p>
<p>Why are u so uncomfortable about the health care issue?</p>
<p>How much do unions add to the health care costs? Out of the extra 800 billion a year in costs Americans pay, how much is because of unions? </p>
<p>There were people in my old town who worked for non profit health insurance companies. They owned multiple Multiple million dollar homes. Made millions a year. I am pretty sure they weren’t part of a union or the public sector.</p>
<p>Who says I am uncomfortable with the heathcare issue. Is it wrong to be worried about the direction “we” have chosen? </p>
<p>Is it wrong to look at the history of services in this country and ask “And, perhaps we should ask ourselves how we got to “have” to pay high school employees, dockworkers, government employees, and firemen those princely sums, Not to mention the ridiculous benefits after very short careers that are bankrupting our country.”</p>
<p>Is it wrong to believe that “we” might have created a monster that will decapitate what made the United States great. Not its government. Not its public services. But the huge middle class loaded with moms and pops operators.</p>
<p>You look at the issue. And I look at what the current solution to the issue might bring us. And if the history of our public services is any indication, my worries will dwarf yours. I look at our public schools, at entities such as the USPS, and at our government. Bloated to the rafters with incompetent and overpaid public servants and utterly inefficient as well … as totally unsustainable. </p>
<p>Aren’t you worried about the unsustainability of the “system?” Aren’t you worried that we end up doing the right thing after exhausting all other alternatives?</p>
<p>Xiggi, you are so off…</p>
<p>You are muddling the health care issue on purpose…</p>
<p>Efficiency and the cost to the public are two different things. People don’t understand that the private sector may be more efficient and the cost to the consumer is still higher.</p>
<p>Forgetting the fact that the private sector may not be more efficient, I have invested in many private sector companies that were not efficient and extremely poorly run, check out
the prices of different procedures in the public and private sectors of health care. </p>
<p>Read the story.</p>
<p>What it comes down to, is that in a country like ours, where the system is capitalism, for most everything, it comes down to the money. I live in a state that actually has generous health care laws for any number of things. However, the very best doctors and best places to go, often are gate kept. Just as London as its Harley Street, NYC has its “Park Avenue” doctors. They don’t take insurance. Heck, they don’t even take patients without referrals, and they only take referrals from certain other doctors. You have to know somebody who can get you to a doctor who can refer you to get to see them. You pay out of pocket and you deal with your insurance yourself. They will give you the payment receipt with the info and codes needed to get reimbursement. </p>
<p>There was an episode on “Sex and the City” where one of the women is diagnosed with breast cancer and wants to see one of these “gods” and she and bunch of others “squat” in the doctors office, hoping for cancellation and fighting with each other and trying to make nice with the receptionist to get favored status and get seen. Would have been funnier, if it weren’t true. I happen to know the doctor that was being parodied. And you can forget “reasonable and customary” when it comes to those guys. </p>
<p>The fact of the matter is that those in the “Bitter Pill” article could not afford to go to Anderson. They needed to go somewhere that would consult with Anderson that was affordable. And having gone to the top centers myself for issues, it’s not that you’ll automatically get the best care for yourself there either. You have to learn to research, ask questions and trouble shoot every bit of the way. WIth the internet boards out there, it’s easier these days to get info. Back when I was down that rabbit hole, those resources were not available so just about anything you read was old news in terms of medical developments and you had no access to a lot of the journals and info that were for MDs only. I spent hours and days in the medical library because a doctor friend gave me access there. Now one can do this with computer or ipad in hand. So there has been some improvement.</p>
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<p>Hmmm, do you consider the American Medical Association to be the physicians’ union? Or the various specialty medical organizations to be unions?</p>
<p>Re: Medicare</p>
<p>I have read on physicians’ blogs and elsewhere that Medicare has low reimbursement rates per procedure compared to most insurance companies, but is less likely than most to contest the necessity of procedures billed. Which creates incentive to overtreat, or bill fraudulently…</p>
<p>Ucb, maybe xiggi will. Did u read the article Ucb?</p>
<p>Cpt… I guess I said this already …love your posts.</p>
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<p>This is most definitely one of the many wonders of the Internet. Information is literally at our finger tips.</p>
<p>Imo, the best approach to health care in America is to keep your weight in the normal range, eat only unprocessed foods in moderation, get one hour of exercise everyday, don’t do drugs or drink too much, and get some sleep. If you are feeling imperfect, wait 2 weeks, because it will probably heal itself. If you must see a doctor, shop around, ask for prices before agreeing to a procedure, do some research.</p>
<p>Sorry about your son, cpt, and I hope he is doing well now.</p>
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<p>However, price shopping by the self-pay patient is often very difficult, with the current situation of lack of price transparency among medical providers (they will probably just quote an inflated list price that exists mainly to be a starting point in negotiations with insurance companies).</p>
<p>Thanks. Dstark. I am no pro in any of this. All just personal experience.</p>
<p>We are finally coming to a point in this country where we are saying that medical treatment is fundamental right. We are at the point where emergency life threatening treatment has to be given. Can’t bounce the dying bum out onto the street, though here in NYC, they do try, by shutting down, privatizing emergency rooms and giving EMS instructions as to where the ambulances should take the injured. Yeah, went through that with son. By pass Columbia Presby which is right down the street to another hospital. But now we are saying certain basic health care needs to be covered and for that to happen, we need health insurance for everyone. Just as we all have to pay for our retirement since we can’t kick you down the stairs when you become a poor starving grandma, we are going to have to pay for health care so that it’s paid for when you need it, since we don’t want to kick you down the stairs when you need non immediately life threatening care. </p>
<p>In the case of the “Bitter Pill”, the featured characters did not wan to go to the local resources but right to MA Anderson. Just like we all want to go to Harvard instead of community college. Even with insurance, is everyone entitled to go to MA Anderson, Memorial Sloan Kettering, Mayo Clinic? </p>
<p>My son needed the maximum lifetime dosage permitted of an anthracycline in his protocol. He had an unusual presentation of leukemia in that it was a lymphomous presentation and was, as result, put on a high risk protocol. The problem with the doses of antrhacycline in those amounts is that it causes permanent weakness of the heart muscles. That can be mitigated somewhat with a continuous infusion rather than just shooting the stuff into you. But Daunomycin, the agent used is not something you can do at home, and a continuous infusion means two days in patient at the hospital. For him that meant every other month just for that one drug. He had, I believe 16 others on the menu as well with other issues, but that one was a big one in terms of permanent side effects. So who pays for the expense of 48 hours infusion vs a 15 minute push? When you have Aetna as your insurance provider, I can tell you their answer. These questions come up all of the time, as optimal care is often very much more expensive than taking care of a situation. Oh, and my son is still getting follow ups as a now adult survivor of childhood cancer, and who is supposed to pay for that? </p>
<p>Which is a part of why despite my DH’s high income, we can’t afford the top college costs for our kids, much as we want to do so. We’ve sought, gotten and have had to pay for top medical choices and still try to do the same. So yeah, AI talk the talk and have walked the walk of making medical care a top priority for our family.</p>
<p>Bay, great advice and my 5 year old was a beautiful sun kissed healthy little felllow the day he was diagnosed and put on a protocol that expected an event free survival rate of about 50% in 5 years. The events being relapse or not reacting to treatment or dying.</p>
<p>Son graduated from college last year and is doing well. Miracles do happen.</p>
<p>I guess the question is, Ucbalumbus, is everyone, anyone who gets a cancer diagnosis entitled to go to MA Anderson for treatment? First of all, that would flood the place so they couldn’t handle all of the cases. You’ll die first trying to get an appointment with some these doctor on their availability without jumping the line somehow. It’s the rare bird who gets to go to one of these centers for treatment, and who should pay for that flock’s care as opposed to through the preferred providers? Now, I’m playing the devil’s advocate here, as I am one who goes right to the top when there is a serious medical problem and the way these insurance gatekeepers try to work is often a joke. </p>
<p>My brother was dxed with a growth on his pancreas that did not look good. Considering that there are only about 125 surgeons in this country or world who can do a Whipple which is what is needed to take out a piece of that organ, it was rather preposterous that his insurance, the infamous Tricare wanted him to see a general surgeon about the matter. We just pushed our way through the process and figured we’d sue the insurance company later for refusing to pay if it came to that, but what do most people do? In dealing with all of this, I’ve lost respect for both the insurance companies, hospital administrators and, yes, the doctors all in the system as there really is no good direction given by any of them. They all have self interest as a primary motive it’s a given one has to deal with when coming up with a game plan. </p>
<p>But I don’t have any solutions as there are not enough resources and time for everyone to get the best. So how do we pick who gets the best? 1) Knowing where to go and what to do–so knowledge is here 2) Who you know to get a referral 3) Money to pay for it all.</p>
<p>Your son is fine now, right?
Edit… Ok. Good.</p>
<p>One of my wife’s best friends was diagnosed terminal cancer
20 years ago. She is cancer free today. She had to pay for her own treatment because the insurance companies wouldn’t cover some of the procedures and she may have gone to md Anderson. Can’t remember. </p>
<p>Took her 8 years to pay her medical bills, but she is alive.</p>
<p>Efficiency and the cost to the public are two different things. People don’t understand that the private sector may be more efficient and the cost to the consumer is still higher."</p>
<p>I ran a million-dollar business in the private sector, and spent two decades in the public sector. In my experience, the public sector was significantly more efficient, delivered more bang for the buck. There weren’t 12 salespeople at my door, all trying to wine and dine me, to sell me exactly the same product. There weren’t people bribing secretaries to get a crack at me. There weren’t 12 different systems of accounting, finance, billing, cost-estimating, bidding, all trying to make a profit. And the public employees, whether unionized or not, tended to be more dependable, and stick around longer. They may not have been exciting. Exciting is not what the public was pyaing for. </p>
<p>One thing the public sector couldn’t do, however, is innovate. That’s because that’s not what the public wants. Boeing can pay 50 engineers to play ping-pong all day for a year, because they know in the long run they will come up with one innovation which will pay for them all, and a lot more back to the shareholders. It’s not very “efficient”. But it can be very innovative.</p>