<p>Mini, that’s a great post. </p>
<p>I have tax loss carry forwards because of the efficiency of the private sector. Lol</p>
<p>Why did u leave the private sector?</p>
<p>I agree, Mini. But when you or a loved one gets dxed with a life threatening conditions with complex treatment options, you want some innovation in there. You don’t want the more efficient 15 minute push of the Red Devil because it is more cost effective and efficient than the 48 hour continual infusion in the hospital. Most of the time you get the push because it is far more efficient and the math say it’s just as effective. Looking the next layer down, you see that it isn’t.</p>
<p>My kids and I have had a very difficult time getting medical care and treatment because our health conditions are atypical. We are fortunate that we have “good insurance” and therefore were able to go without being referred, even though we had to pay our own travel expenses (which we were able to do).</p>
<p>I have gone line by line to argue over some of the expenses on medical bills. When D was hospitalized, she was charged $5 PER ASPIRIN & took LOTS and LOTS of aspirin when she was in the hospital. After some arguing (even though insurer didn’t flinch about the bill that THEY paid), they agreed it was actually $5 for the entire bottle of aspirin.</p>
<p>Also got a bill 2 years after D was born for her birth. I questioned it and asked for an itemization because the only thing we paid for when S was born 2 years before D was the sterile “dad’s coverall” that H was supposed to have worn to participate in S’s birth. He forgot to take it out & we used it for D’s birth instead. They said they had no itemization because it was too long ago and told us to just disregard the bill.</p>
<p>Billing is CRAZY. We are routinely billed about $800 for a test that my docs order for me periodically. Insurance pays about $200 or less of it & the rest is written off. We can perform similar testing out in the community for about 10% of the cost, including having it read/interpreted by a specialist. Medical centers and professionals take as much as they can from whomever they can so that care for others is subsidized (e.g. Medicare, Medicaid and insured).</p>
<p>Many of the healthcare providers I see refuse to take patients unless they are referred by other docs, etc. </p>
<p>One problem that is seldom discussed or even mentioned is that under ADA, the MDs have to hire their OWN interpreters for patients who need them. This is NOT compensated in any way and can cost MUCH more than whatever the MD/healthcare provider stands to earn or even gross for services. This is a huge issue in our state, where there are so many languages spoken. The interpreter has to be hired EACH time the patient is seen–at initial visit and at all subsequent visits, including any procedures. It is VERY expensive.</p>
<p>Thanks for posting the link to the article–have printed & will read it and try some of the lniks it has when I have more time.</p>
<p>The first rule of medical costs is nobody pays the list price. I don’t even know why they bother except it starts the negotiations with the insurers. If you can pay cash (no insurence) you usually can negotiate a 25-40% discount. Most insurers pay about 40-60% of the sticker price. Medicaid pays about 10-20% and most providers lose money on them. Yes the $5 aspirin sounds crazy but somebody has to get it, give it to you, chart it and bill it. At $40/hr for nurses you eat through $5 very quickly.</p>
<p>I also don’t think we would have enough doctors at $100k or even $200k for specialists. And the costs of those tests usually relate to the cost of the equipment which is very high for numerous reasons. Most providers are trying to cut costs but it’s harder than it looks. When your number comes up most people want the very best. Just the way Americans are.</p>
<p>“Why did u leave the private sector?”</p>
<p>I was too “successful”/ I wanted to have time for my kids, I wanted to write (rather than be a publisher), and I HATED managing people.</p>
<p>My wife works as a unionized employee of a large, Catholic, “non-profit” health system that is always going around talking about their dead nun. Without the union, when they could get away with it, they’d offer no health insurance at all. The union DEFINITELY adds to the cost of health insurance. (thank God!)</p>
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<p>All good advice; won’t help at all if you get hit by a car.</p>
<p>One of my friends, 46 years old, did all the above and was training for a marathon when she was suddenly diagnosed with a brain tumor and needed immediate surgery, then two more surgeries when the tumor grew back. Luckily she lives in the UK so the surgeries, chemo, radiation, PT, a month in a rehab facility etc. etc. are all covered.</p>
<p>People will pay the list price if they don’t negotiate–preferably BEFORE treatment. Generally, you CAN ask for a cash discount and sometimes you can get an installment plan from some providers. Some will also allow you to use your charge card.</p>
<p>We clearly need more docs, but only a certain number of docs can be trained with the current system, which is why med school admisssions are so crazily competitve in the US and elsewhere. All med school applicants I know have had to have at least two interviews to get accepted–the person(s) interviewing glean what they can that isn’t already in the applications in these interviews. Fluency in Spanish is more important in some areas of the country than others. For example, in HI, Spanish is a not nearly as common a primary language as some other tongues.</p>
<p>You can do everything right and STILL need fairly intensive and sometimes expensive medical care. My kids & H & I are living examples. The care we needed was not available locally, even though we tried repeatedly to use care we could get here, we have had to travel. We are stlll at the lower end of “normal” for BMI, and still have chronic health issues that fortunately are under pretty decent control. Medical systems need to be able to provide adequate care for most folks because “life happens,” no matter how careful we are.</p>
<p>“As far as the efficiency thingie, point me in the direction of a government entity that is both efficient and cheaper?”</p>
<p>Oh, that one is easy - our state mental health services. Every two years our Legislature studies privatizing the system, and every two years the study comes back that the state system is both more efficient and cheaper. That was also true of our State Printer (but they privatized it anyway.) It was also true of our state travel agency. We’ve also just privatized alcohol sales in the state, and prices have gone up 10-15%. (All of these, by the way, were or are unionized). They’ve studied the prisons too - more expensive in the private sector. </p>
<p>I retired after 20 1/2 years of state service. My pension is tied to 2% per year for each year (not the highest year), reduced by the number of years I retired before age 65. Before taxes. Take any salary you like and figure it out. I’m not getting rich, and had I worked in the private sector, I would have gotten 30-35% more per year in salary. (I know that - there are such things as headhunters…) Yup, let’s factor it in…</p>
<p>A good friend was diagnosed with cancer of the liver. He was a VERY healthy 40 year old. He consulted numerous local specialists and was told to get his affairs in order. He and his mom decided that wasn’t the answer, so he and she went to Sloan Kettering, where they treated him at considerable cost which was NOT covered by insurance. A few years later, it recurred. He was again told by all the local specialists to get his affairs in order and went again to Sloan Kettering in NY. He had extensive AND expensive treatment and is still alive now 10 years later.</p>
<p>What do you do when the local specialists won’t do anything for you? That was his experience and mine for an unrelated serious chronic condition. I was told I’d be seen again in 6-12 months or in the ER and nothing more could be done.</p>
<p>Just finished that article. Very, very scary.</p>
<p>The author documented the extreme markup on almost each item used (or even not used but billed) by each patient. Incredible.
What I think is just as important is the need to contain the over utilization of those lab tests, pharmaceuticals, radiology scans, etc. Does every patient admitted need a chest Xray, CBC with diff, UA, liver profile, etc X several each day?
Can we go back in time just a little bit and have physicians be allowed and encouraged to diagnose without ordering tests to cover themselves ‘in case’?</p>
<p>Can Antibiotic Stewardship programs help with cost containment as well as at least slowing the emergence of more resistant ‘superbugs’?</p>
<p>"“Why did u leave the private sector?”</p>
<p>I was too “successful”/ I wanted to have time for my kids, I wanted to write (rather than be a publisher), and I HATED managing people."</p>
<p>I understand. Thanks for sharing. </p>
<p>“What do you do when the local specialists won’t do anything for you? That was his experience and mine for an unrelated serious chronic condition. I was told I’d be seen again in 6-12 months or in the ER and nothing more could be done.”</p>
<p>That is a good question.</p>
<p>In many instances, those inexpensive doctors (100k) are usually family medicine physicians who do not have the knowledge to determine treatment for anything beyond colds etc. and refer you to specialists who command higher salaries. Flattening the salaries may increase the number of family practitioners but will reduce the number of specialists who are necessary for serious illnesses. Why would they waste time going for more medical training?</p>
<p>Yes, I still remember when mom was hospitalized because of a fractured sternum because the airbag hit her when she was rear-ended. My MD brother was mad that they didn’t have any monitors on her but insisted in keeping her overnight for observation. They did run a few tests on her, including some imaging but not much else and I believe had even removed the IV. They probably kept her because she was 82 and they didn’t want to discharge her and then have anything bad happen. They were amazed that all 7 of her kids and her H, plus a few in-laws were crowding around her bed in the ER and later the room they released her to. She fully recovered without incident and only one follow up exam at the hospital for a CT scan and one follow up with her internist, after he checked and found that she had healed well some weeks later.</p>
<p>I do think there is a lot of defensive medicine being practiced and this greatly drives up the cost of medical care. Penalties for having patients being readmitted will also add another wrench to treatment in the hospital.</p>
<p>I must say that doctors are NOT being over- payed and are NOT the source of the financial health care mess. Physicians salaries are approximately 15% of the total cost of health care ( not nearly enough to change the mess even if you payed the doctors nothing at all)! Obviously the problem with health care is that it’s is FOR PROFIT and there is a lot to be made by insurances companies and “middle men” The problem with insurance is that there IS insurance! Forget the smoke and mirrors that government tries to emotionally convey regarding the 30 million uninsured!!! If we got rid of private medical insurance and tax companies what they would pay in health care premiums to insure the Americans that are insured, there would be enough left over to insure all ( remember no fat profits for the insurance companies) and also provide coverage for the Americans not currently insured! It’s simple economics but lobbying ( which should be illegal IMHO) prevents this sort of intervention! After all why are insurance companies providing coverage? Is it the goodness of there greedy little hearts or to make a profit! This healthcare financial mess could be rectified in a week if there was real motivation to do so! Yes there are problems with greedy doctors like in any other profession but that’s not the heart of the problem ! The politicians and insurance companies are in bed together and until lobbying and special interest groups are eliminated there will NEVER BE A SOLUTION!!</p>
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<p>Billing for medical care is like redistribution of income. You are subsidizing the costs for those who use medical care without paying, especially ER services.</p>
<p>Well doct, .the doctors who specialize would still make more than 100,000.</p>
<p>I was listening in on a conversation today which is why I brought this doctor pay up.</p>
<p>Musicmom’s reference to the mark ups of procedures is a bigger issue.</p>
<p>Procedures that are marked up 400 percent. What are we selling here? Jewelry?</p>
<p>We had to fly from our state to get treatment. My friend had to fly to NYC, where fortunately he had some relatives. I had to fly to Denver. I did try and saw 3 of the top specialists in our state, none of whom were able to help. It’s easy to say, you can use what is available locally, but it isn’t always enough.</p>
<p>For our kids, we had to fly to get them evaluated in Denver and on a separate trip to NY, and now D is trying to get treatment in LA. The local docs have been stumped, and only one has been willing to keep trying to help them. The answers can be quite complicated, and fortunately for us, there is no language/translation issue which would further complicate matters.</p>
<p>One of the docs they want D to see has a 4 year waiting list! She has added her name to it, but who knows if and when she will actually be seen there!?!?! Possibly, the specialist she is now being seen by (after a lot of begging on my part) will be able to help her find someone else to work with her underlying condition since the specialist she is seeing only wants to treat the symptoms (which is of course an important PART of the issue).</p>
<p>Just a comment about salaries- my SIL is a CPA and works for a firm that specializes in medical practices. She claims that most of the doctors wealth is earned from being partners in the firms that do the various tests. She says their salaries averaging $100-200k are pocket change. The business income is in the millions for many doctors.
I realize this is only anecdotal but I am not sure we should just look at salaries but we need to measure total compensation medical professionals earn.</p>
<p>Tom1944, that’s true.</p>