[Sixstrings]

Want an appointment with kidney specialist Adam Weinstein of Easton, Md.? If you're a senior covered by Medicare, the wait is eight weeks.

How about a checkup from geriatric specialist Michael Trahos? Expect to see him every six months: The Alexandria-based doctor has been limiting most of his Medicare patients to twice yearly rather than the quarterly checkups he considers ideal for the elderly. (snip)

"It's not easy. But you realize you either do this or you don't stay in business," she said.

Doctors across the country describe similar decisions, complaining that they've been forced to shift away from Medicare toward higher-paying, privately insured or self-paying patients in response to years of penny-pinching by Congress. (snip)

On average, primary-care doctors make about $190,000 a year, kidney specialists $300,000, and radiologists close to $500,000, figures that reflect the income doctors receive from both Medicare and non-Medicare patients. The disparity has prompted concern that Medicare is contributing to a growing shortage of primary doctors.

Still, even if primary-care doctors had to rely exclusively on Medicare's lower payment rates their incomes would only drop about 9 percent, according to a recent study co-authored by Berenson, who is also a fellow at the non-partisan Urban Institute.

"The argument that doctors literally can't afford to feed their kids [if they take Medicare's rates] is absurd," said Berenson. "It's just that doctors have gotten used to a certain income and lifestyle."
http://www.washingtonpost.com/wp-dyn/content/article/2010/11/25/AR2010112503638_2.html

Remember the big stink Republicans made about death panels that don't even exist? Well undoubtedly, the new Republican congress will be cutting Medicare more than ever before. If an elderly persona can only get to see a doctor once every six months, isn't that the same thing as a "death panel?"

I'm glad to finally see a hard number that backs up what I've always suspected -- American doctors are rich and GREEDY. According to the study cited in the article above, even if a physician saw ONLY medicare patients then all they'd suffer is a NINE PERCENT cut in pay.

I think in the UK doctors make about HALF as much as US docs. As a society, why is having millionaire doctors so important that elderly patients must go without treatment for no reason other than they can't pay quite as much as young and healthy people?

[Cog]

Maybe this is why:

http://en.wikipedia.org/wiki/Medicare_% ... _States%29

Medicare spending is growing steadily in both absolute terms and as a percentage of the federal budget. Total Medicare spending reached $440 billion for fiscal year 2007 or 16% of all federal spending and grew to $599 billion in 2008 which was 20% of federal spending.[46] The only larger categories of federal spending are Social Security and defense.

[Outcast_Searcher]

It sounds bad on the surface, but just blaming "mean old doctors" won't magically fix the health care problem in this country. (I am not in the health care industry in any way, BTW).

Socialized medicine is a huge budgetary problem for England, for example. Naturally, the English voters want the care but scream when their reps. mention needed tax increases, per The Economist, for example. Canadians tend to like their health care, but they do NOT like their taxes.

In this country, someone has to get a ton of education and therefore borrow a lot of money to become a doctor. Then they have to buy a ton of liability insurance, since the left doesn't want to allow tort reform. (The right does plenty wrong, but the left owns this one).

They have to follow all kinds of rules and regulations, deal with lots of complex insurance issues, and have a big and complex staff to do all the work. I'm sure that is FAR from free.

Some specialist making half a million bucks can probably afford a nine percent cut (but where does it end?) I'm not sure the average (and especially below average) family doctor can or should.

If we want to provide free or cheap medical care for everybody, we should just be honest about it, figure out how much it costs, figure out what else to cut or what taxes to raise, be honest about it, and pay for it. Of course, since politics is basically dishonest, that rarely happens.

[dissident]

There is nothing like a real market for medicine. The corporate and government health care plans mean that pharmaceutical companies and doctors can keep demanding more and more for their products and services. The vast majority of individuals would not be able to afford to pay the prices without the plan subsidy. So while the government and the private sector can afford to pay higher and higher every year to feed the monster, health care inflation will remain over 10% when the CPI is 2%. Clearly this is absurd and not sustainable in the long run.

Since the medical "market" is a distortion to begin with, there needs to be salary caps on doctor's incomes and caps on pharmaceutical prices. I am sure they will squeal like stuck pigs but they deserve no sympathy. Pharmaceutical companies benefit greatly from the use publicly funded research and their biggest expense is advertising. Introducing a slight variation on a previous drug and charging an arm and a leg for it is a fine racket. Their business model is arbitrary and not the only one possible. Also, you cannot trust the government to be a tough negotiator for prices it is willing to pay to corporations and gets taken for a ride most of the time.

[dissident]

Then they have to buy a ton of liability insurance, since the left doesn't want to allow tort reform.

So they take this expense out of their take home pay? I would think they pass it down to the consumer saps like every other business. BTW, "socialized" medicine in Canada and elsewhere is subject to the inflation imposed by private pharmaceutical companies. In Canada a right wing government extended the patent period for drugs, helping those poor starving companies make ends meet by keeping the prices high. I wonder why the price curve for microelectronics is so much steeper than for drugs. It takes billions to build new microchip fabrication plants (AMD for example got out of building its own) and you pretty much need new ones every few years to keep up with microprocessor improvements. New CPUs ain't cheap to design either. But somehow pills which don't take anywhere near as much money to develop are bankrupting medical care.

[Outcast_Searcher]

Dissident, I strongly agree with you on the drug issue. In England, drug companies don't market to end users. Why? Because the NIH refuses to pay for it. It allows them to do it due to free speech issues, but insists it is on the drug companies' own dime. So they don't do it. (I love it).

Once the statistic came out that in the U.S., drug companies pay more for drug maeketing than development, I lost ALL sympathy for them. This is something that could be fixed -- partially by price negotiation. And you're right -- the political class, left and right, has refused to let this happen.

I have to disagree with you though that we can magically make the CPI for medical care the same as for microprocessors, just because they're both high tech, for example. For one thing, the way our medical insurance system is set up so the public bears little out of pocket cost if they have "good" insurance -- they will always opt for the most expensive procedure if they perceive a benefit to them. For another, a lot of medicine is labor intensive. More cost sharing to get folks to think about cost/benefit trade-offs might help -- but of course Americans refuse to save money so that causes problems.

I don't think we can assume that the rip-off that is the drug industry applies across the board. And, high medical inflation is a global problem, not just a US one.

Good medical care is very expensive. We can pay for it. We can limit it somehow. Socialized medicine does some of both.

[Plantagenet]

If an elderly persona can only get to see a doctor once every six months, isn't that the same thing as a "death panel?"

Of course it is. And thats why many people opposed Obamacare.

[Blacksmith]

In Canada a right wing government extended the patent period for drugs, helping those poor starving companies make ends meet by keeping the prices high.

Correction it was a Liberal government and it was done to keep Quebec in confederation.

[Sixstrings]

So far nobody in this thread is addressing the main issue head on. Something has to give here, other than letting gramma go without seeing a doctor.

Either:

a) stop cutting medicare

or

b) doctors need to accept making 9% less

Which is it gonna be?

[Tanada]

So far nobody in this thread is addressing the main issue head on. Something has to give here, other than letting gramma go without seeing a doctor.

Either:

a) stop cutting medicare

or

b) doctors need to accept making 9% less

Which is it gonna be?

You missed the entire point of the article Six, please read it again. PRIMARY care MD's are the ones who would suffer the 9% loss of gross income and they already make the least at $190,000.00 per year. I didn't see anywhere in the article what percentage the specialists mentioned, Geriatric and Nephrologist, take off of their gross pay from Medicare patients. Meanwhile the article bemoans the fact that specialists are reducing their patients ability to access their services.

To have a fair understanding the reporter should have listed much more information, how much less does Medicare pay a nephrologist than private insurance does? I believe it is way more than that 9% that the article implies is all a doctor loses. What about the Geriatric specialist? With just data for one of the three types of Doctor mentioned in the piece it is very misleading in its implications. Geriatric and Nephrologists both deal with patients with low 5 year survival rates, this does amazing things to the cost of malpractice insurance, and the same is true of the Radiologists mentioned in passing, they work mostly with cancer patients.

[Pretorian]

So far nobody in this thread is addressing the main issue head on. Something has to give here, other than letting gramma go without seeing a doctor.

Either:

a) stop cutting medicare

or

b) doctors need to accept making 9% less

Which is it gonna be?

Just let medical schools produce at their full capacity, opening a few more also wont hurt ( In other words, tell AMA to go screw themselves). Problem solved.
Also, malpractice insurance is gotta go obviously. The idea that you should pay your doctor extra $$ so he doesnt have to go to prison when he fucks you up is pretty ridiculous.

PS To everyone who says USA is a free and capitalist country: try opening a private medical school.

[dissident]

Correction it was a Liberal government and it was done to keep Quebec in confederation.

I was thinking of Mulroney's massive extension of the period about which the generic manufacturers were complaining. Probably the Liberals extended it some more since there is basically no difference between them and the neoconized Tories.

[Blacksmith]

Prehaps you in "You-all-land" could fix doctors salaries as we do in Canada. Then we could get some of our doctors back.

[diemos]

Once upon a time, about a hundred years ago, decent upstanding people thought that if someone was sick you should do everything you could to help them.

Of course, a hundred years ago, "everything you could" basically consisted of the ability to give someone an aspirin if they had a fever, the ability to cut off a limb if it became gangrenous and the ability to set a broken bone. Today it would be a trivial expense to provide this level of care to everyone who needed it.

Since that time the human lifespan in the first world has greatly increased due to; universal sanitation, vaccines, antibiotics and the end of harsh physical labor.

Now most "health care" is an attempt to eek out a few more years against the inevitable tide of entropy and decay in old age. It can absorb 100% of our free energy if we let it, and yet everyone will still die, sooner or later, of something or other.

Societies have the ethics they can afford. Eventually we're going to have to decide as a culture where the line gets drawn where we say, "no mas." Otherwise we'll end up in a situation where there are only two classes of people. The people in the hospital beds and the people standing around them.

[Pops]

What diemos said.

--
I don't know how much more greedy doctors are than the average car mechanic but the average car mechanic that makes "mistakes" that "adversely affect" 1 of 4 cars he worked on probably wouldn't be a mechanic for long.

A recent government report found similar results, saying that in October 2008, 13.5 percent of Medicare beneficiaries — 134,000 patients — experienced “adverse events” during hospital stays.
The report said the extra treatment required as a result of the injuries could cost Medicare several billion dollars a year.
And in 1.5 percent of the patients — 15,000 in the month studied — medical mistakes contributed to their deaths.
That report, issued this month by the inspector general of the Department of Health and Human Services, was based on a sample of Medicare records from patients discharged from hospitals...

The researchers found 588 instances in which a patient was harmed by medical care, or 25.1 injuries per 100 admissions.

http://www.msnbc.msn.com/id/40370892/ns ... york_times

[Pretorian]

Once upon a time, about a hundred years ago, decent upstanding people thought that if someone was sick you should do everything you could to help them.

Of course, a hundred years ago, "everything you could" basically consisted of the ability to give someone an aspirin if they had a fever, the ability to cut off a limb if it became gangrenous and the ability to set a broken bone. Today it would be a trivial expense to provide this level of care to everyone who needed it.

Since that time the human lifespan in the first world has greatly increased due to; universal sanitation, vaccines, antibiotics and the end of harsh physical labor.

Now most "health care" is an attempt to eek out a few more years against the inevitable tide of entropy and decay in old age. It can absorb 100% of our free energy if we let it, and yet everyone will still die, sooner or later, of something or other.

Societies have the ethics they can afford. Eventually we're going to have to decide as a culture where the line gets drawn where we say, "no mas." Otherwise we'll end up in a situation where there are only two classes of people. The people in the hospital beds and the people standing around them.

This actually is a great post-- congratulations Diemos, you made it to the peakoil's elite in my eyes.
As a note I remember an article about some babushka in Russia who was always calling an ambulance (daily) about her blood pressure spikes-- and she was in her 90s. So they blocked her phone number and address. By the time that article was written, she was 101, still ignored by the ambulance ( and rightfully so, obviously). My point is that more healthcare is not always better, both in life expectancy and logic. Pretending you can know better than 4-billion years worth of experimenting over trillions of billions of quadrillions of creatures is a bit silly, if you ask me .I remember a note from a 90+ year old I knew that everyone who had ever visited a doctor died early on her record.

[Sixstrings]

Prehaps you in "You-all-land" could fix doctors salaries as we do in Canada. Then we could get some of our doctors back.

So far you've come the closest to directly addressing the issue head on. There are two issues, medicare cuts and exorbitant physician incomes -- they cannot coexist, something has to give.

Huffpost just had an article about the top 10 highest paying jobs in America -- 9 of the 10 are MEDICAL, all physicians except one which is orthodontist. I'm surprised lawyers didn't even make the list. No engineers on the list. No IT workers. Nada -- all doctors, except for CEOs.

The Highest-Paying Jobs In America 2010

10. Pyschiatrists: $163,660
9. Family & General Practitioners: $168,500
8. CEO: $167,280
7. Physicians & Surgeons: $173,860
6. Internists: $183,990
5. Obstetricians and Gynecologists: $204,470
4. Orthodontists: $206,190
3. Oral and Maxillofacial Surgeons: $210,70
2. Anesthesiologists: $211,750
1. Surgeons: $219,770
http://www.huffingtonpost.com/2010/05/15/the-highest-paying-jobs-i_n_577487.html#s90846

This list is regular income, I imagine if you include bonuses and stock options then financial workers would be on the list and CEO's would be higher up. These are also averages, so lots of lower income rural docs skewing the numbers here. Docs in Florida make MUCH more than what's on this list.

Bottom line, our healthcare is seriously out of whack. Healthcare should exist for the patients, not the other way around. IMHO, it should be considered malpractice to only see a sick medicare patient twice a year for no better reason other than maximum profit.

Another problem is that doctors are screwing over medicare by just ordering more tests and doing unnecessary treatment. MRI's don't hurt anyone, but over-treatment can -- unwarranted treatment just so you can bill more should be malpractice.

[Cog]

So far you've come the closest to directly addressing the issue head on. There are two issues, medicare cuts and exorbitant physician incomes -- they cannot coexist, something has to give.

You raise a false dichotomy. Of course the two options can coexist. We can have higher physician incomes and cut medicare. If granny dies a bit earlier then it makes the medicare and social security system solvent for a longer period of time.

[Sixstrings]

You raise a false dichotomy. Of course the two options can coexist. We can have higher physician incomes and cut medicare. If granny dies a bit earlier then it makes the medicare and social security system solvent for a longer period of time.

Well you're right.. I assumed that just letting the old and sick die off for lack of treatment wasn't an option. Although emergency rooms still must provide emergency care, which is more expensive than preventative treatment.

Cog, do you not have any elderly relatives that depend on Medicare? I find that hard to believe. Or do you not care about your family either?

[Pops]

It seems to me the problem lies not in how much docs earn, I have no trouble with a surgeon making lots of money by saving lives but I do have trouble with surgeons making lots of money by doing lots of surgeries.

The 2 aren't the same, the US system pays for procedures not outcomes. I think the GP should be the one to make the big bucks by overseeing the health of the patient and supervising the specialists instead of being a sales rep for specialists and drug companies.