Medical Care in the US...Do you see it going downhill?

Parent Cafe
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<p>The folks we saw were participating & preferred with our BC/BS PPO. They were OK but neither I nor our kids were motivated to keep seeing them. They were trying to help our kids deal with the stress of having chronic health conditions, which they had trouble getting docs to treat. None of us found it all that helpful, tho all of the therapists came very highly recommended and all were very nice. We paid our regular $10-15 co-pay. Would have been willing to pay more IF they were helping any of us significantly.</p>

<p>Our insurance is pretty reasonable because H’s employer (the federal government) pays the bulk of the premiums and has a large enough group that it has negotiating power. It also has a lot of healthy young employees & their families covered in the group. If we didn’t have H’s insurance, we’d be in trouble as getting a policy with asthma is difficult & expensive; all 4 of us have asthma.</p>

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<p>alh,</p>

<p>You will not run out of pharma-bashing “studies” and op-eds out on the internet. You could post them all day! It is its own cottage industry – a terrific way to get a first-author paper published by someone trying to get tenure at a college. Too bad that when actually examined with some objectivity and econometrics most of the bashing of pharma becomes pretty lame. It’s a for-profit industry, certainly. Just that status seems to make many people’s blood boil! It’s fine if their dermatologist is bringing home a million a year to treat their kid’s acne though. lol</p>

<p>Anyway – regarding the “cost” of developing a new drug. The main omission your studies have is that they only look at successfully launched drugs – the ones that make it all the way through animal, small human trial, big human trial, then the FDA gauntlet. And even if we only look at those, the studies of the cost that actually have some grounding in reality show that they have been more underestimated, than overestimated. Why? Well, do you really think a drug company wants to tell Wall St that their costs of R&D are gigantic?? What do you think that does to the share price? No, they like to be seen as if they are controlling costs, developing drugs efficiently and operating with a good business model.</p>

<p>But it’s critical to understand that only 1 out of 10 candidate compounds ever makes it to market. Many cost a billion to develop and then never get final FDA approval. Others cost a billion but never get prescribed because by the time they are approved they are already obsolete or face generic competition. If you factor in all the misfires then the actual cost of bringing one successful drug to market is truly mind-boggling.</p>

<p>It’s pretty much like wildcat oil drilling. Massive investments to try to develop a new therapy that has a bout a 1 in 10 chance ever being prescribed.</p>

<p>[Healthcare</a> Economist Cost of drug development: $1 billion](<a href=“http://healthcare-economist.com/2010/02/16/cost-of-drug-development-1-billion/]Healthcare”>Cost of drug development: $1 billion – Healthcare Economist)</p>

<p>Then the stuff on the lobbying. Well, if you want to look at the companies paying lobbyists the most you’re not going to see a lot of pharma –</p>

<p>[Business</a> News, Stock Quotes, Investment Advice - DailyFinance](<a href=“Stock Portfolio & Tracker - Yahoo Finance”>Stock Portfolio & Tracker - Yahoo Finance)</p>

<p>And where it really gets interesting is to look at the top lobbying companies and what they pay in federal taxes –
[30</a> Major U.S. Corporations Paid More to Lobby Congress Than Income Taxes, 2008-2010 - International Business Times](<a href=“http://www.ibtimes.com/articles/264481/20111209/30-major-u-s-corporations-paid-lobby.htm]30”>30 Major U.S. Corporations Paid More to Lobby Congress Than Income Taxes, 2008-2010)</p>

<p>Now if you aggregate all of pharma – including generic companies, btw!!, which of course work against the big bad pharma, you’ll get a big number. But what other industries have government programs (Medicare, Medicaid) as their biggest customers? And what other industries can’t sell a product at all without the govt (FDA) “allowing” them to?</p>

<p>So is it really that outrageous that pharma as an industry would be very engaged in legislation that directly affects (1) whether they can sell a drug, and (2) what price they will be allowed to charge for that drug. </p>

<p>Do you really think that GE has the same valid government engagement as Johnson & Johnson? Of course not. GE is lobbying the government to enact loopholes to enable them to pay no taxes. Johnson & Johnson is lobbying the government to enable Medicare patients with breast cancer to get the newest available therapies. Such villains!!</p>

<p>But hey, keep the pharma-bashing going. It’s fun and you have a lot of company!</p>

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<p>That woman delivered early and, as is always the case with these high risk pregnancies, the closest hospital that had capacity for four neonatal ICU beds is what they needed. The one in Montana was the closest, in either country. There had been several unexpected preemie births in the two days prior to this at the Calgary hospital so there were not four NICU beds available. As you can understand, preemie quads are not that common. </p>

<p>The interesting part of that story is that the Canadian health system paid the full cost of flying the parents and two medical staff to Montana by mercy flight, and then flying them all back again, along with the babies. The difference in cost (not including the flight) was between 3-4 times what it would have cost had the babies been born in Calgary.</p>

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<p>sewhappy, Do you see it as a problem that 50 million Americans are uninsured and thus can’t get decent, regular healthcare? If so, how do you think it should be fixed? Is it entirely a matter of personal irresponsibility?</p>

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<p>[The</a> Medical Cartel: Why are MD Salaries So High?](<a href=“The Medical Cartel: Why are MD Salaries So High? - Wall Street Pit”>The Medical Cartel: Why are MD Salaries So High? - Wall Street Pit)</p>

<p>[High</a> Healthcare Spending On Physicians Due To High Doctors Fees And Not Practice Costs](<a href=“http://www.medicalnewstoday.com/articles/234120.php]High”>High Healthcare Spending On Physicians Due To High Doctors Fees And Not Practice Costs)</p>

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<p>What if we had single payer health insurance, more government funding of medical research, and more medical schools, government funded and tuition free? </p>

<p>How do we eliminate the need for malpractice insurance? I know that is huge.</p>

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<p>After going to school “forever” (not the case in most european countries), incurring huge debt, getting paid 50k for years as a resident and maybe starting to make the “big bucks” when you’re in your 30’s, from a financial standpoint, it is not a lucrative field. Studies have been done that compare the typical doctor’s lifetime salary to a plumber - its not a particularly positive comparison.</p>

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<p>Is it “going downhill”? I don’t know, I’ve never seen it but then the slopes are overcrowded as it is and after a while they just all look the same…maybe it would do better at cross-country…hmm…</p>

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<p>I know a lot of doctors and don’t think any of them make a million dollar salary. Many have difficulty with malpractice insurance payments. </p>

<p>What we are doing just doesn’t work that well in my opinion. </p>

<p><a href=“http://www.nytimes.com/2011/11/25/us/payments-to-doctors-by-pharmaceutical-companies-raise-issues-of-conflicts.html[/url]”>http://www.nytimes.com/2011/11/25/us/payments-to-doctors-by-pharmaceutical-companies-raise-issues-of-conflicts.html&lt;/a&gt;&lt;/p&gt;

<p>"Thousands of Texas doctors, researchers and medical experts — including more than 100 who are employed by the state and are paid with taxpayer dollars — routinely supplement their salaries with income from pharmaceutical companies. "</p>

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<p>I wish my doctors made more money. I want them to make a great deal of money and feel really great about their jobs and not worried about seeing a gazillion patients a day to satisfy their hospital network or insurance employer or whatever.</p>

<p>I’m not a physician. Neither is my spouse. When our son in college told us he wanted to do the premed reqs with his economics degree he seemed to be braced for us to be really disappointed in him – like he was choosing something sort of low. Made us laugh. But not when we saw the cost of medical school! </p>

<p>Let’s put it this way – between an attorney or a banker or an electrical engineer at GE or a doctor, hands down I think the doctor should earn the most.</p>

<p>But they don’t. ( I know a rich dermatologist though - she does the cosmetic stuff.)</p>

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<p>I know docs that are plenty comfortable. They live below their means and invest carefully and wisely. He is a ophthamologist and brilliant, working for a HMO which gives him a good quality of life and pays his malpractice & does all the office overhead. His wife is a dermatologist and works part-time in a group practice (does NOT do much cosmetic stuff but can see a LOT of patients in a very short time, unlike GPs, internists, pediatricians). They both enjoy their jobs and have a considerable amount of money but DO work hard.</p>

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<p>Well, I can tell you that even though I found the doctor’s skills to be very good at this new doc’s office, the office management continues to be horrible. I am trying to get my medical records. So far I have not had any luck, but it has only been 3 business days. Oh, I requested that they fax them! What’s so hard if they have all of my test results? I signed the medical release form (took 2 calls and 1 letter to get that) and they have had that for 3 business days. I had been seen over 2 weeks ago. Additionally the NP or MD was going to call back with answers to my questions. Still waiting for that to happen.
Perhaps I sound whiny and like a pain, but I really am a good, compliant patient. I am just asking for what is reasonable and am not getting it. In order to take care of my health I need access to my records. I’d like answers to about 3 simple questions. They can’t get it done without multiple requests.</p>

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<p>I also want doctors to be paid well. From my standpoint, they deserve the big bucks a lot more than the financial folks who skim off the top moving money from one investment to another and not making anything for the investor.</p>

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<p>I read somewhere that 16% of the ‘evil 1%’ are doctors. That’s fine with me. I certainly don’t want to put my life in the hands of some C student. I want the best and brightest science minds to find the medical profession both rewarding and lucrative.</p>

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<p>There’s a huge difference between the incomes of employed docs and those who are self employed, and also offer technical services. Unfortunately most stats list just the average for a specialty, but a GI doc who runs his own scope room, or a cardiologist who does stress tests and echos, or an orthopod with who has imaging equipment and rehab services can easily make more out of these services than what he bills as his prof fees (hence the >$500K income). </p>

<p>Another unusual fact is that in smaller communities, where a hospital may have difficulty attracting specialists, there are a lot of bones thrown to get these physicians, and they can easily be making much more than an employed specialist at the cutting edge in a tertiary care center. Not uncommon are for a hospital to offer similar services, and for the specialist to refer indigent and (low reimbursement) medicaid patients there while retaining the high paying insurance clients. There are some OB physicians who see no medicaid/self pays in their private office while the hospital maintains an “OB Clinic” for such patients where the OBs are paid by the hour, hence making it lucrative. Also self employed physicians can also hire NP, PA, and non-partner docs (sometimes with the hospital footing a lot of the recruiting and other overhead), and bill for their services and pay them a salary. </p>

<p>A system that would rein in some of these setups so that the facilities that are forced to accept the indigent also get a crack at the high payers would alleviate some of the problems.</p>