In article <[email hidden]>,
Bill Westphal said:don Gabacho <[email hidden]> writes:
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Quoted message said:Quoted message said:Yup: "A hard lesson(s) learned.
Isn't Bush's health care plan wonderful?
Sorry for your wake-up call. You know the crooks charge double if
you don't have insurance, and even the regular insurance charge is
way in excess of what they deserve.
If you don't have insurance you pay the full rate for health care. If
you have insurance, the insurance company has negotiated a discount,
often a very hefty one. The out-of-pocket payor pays the base rate.
Quoted message said:We need to nationalize medical care, and tell the shyster doctors
what we're going to pay them, and fight the AMA lobby to greatly
expand the number of them.
Part of the cost of health care is driven by the shortage of providers,
both doctors and especially nurses. The development over the past 20
years of nurse practitioners as a semi-independent set of professionals
has taken off some of the pressure.
Quoted message said:Do you know the AMA lobby convinces the govt. to pay many teaching
hospitals to forego the lucritive practice of training doctors
(doctors in training are a source of cheap labor).
Training a doctor, from the start of medical school to the point of
being able to practice independently, takes 10 years. Several years ago
I heard a discussion of this on public radio; IIRC it costs nearly
$1,000,000 to prepare a physician for practice, about half of which is
paid for by the government (the other half is paid for by debt incurred
by the medical student; loan payments often exceed income during
residency) It costs nearly $110,000 per year per resident physician
(e.g., "cheap labor"😉 including the cost of the resident's salary and
the cost of on-the-job training and supervision.
The AMA, traditionally fearing a glut of doctors and acting very much
like a guild acting in the interest of the profession rather than the
public, has discouraged the development of public policy that would have
increased the number of physicians trained in the US. As a result we
have to import many doctors from other countries.
http://www.usatoday.com/news/health/2005-03-02-doctor-shortage_x.htm
Quoted message said:I was working at Abbott Labs when Hillary attempted a national health
plan (essentially nationalize the industry) in the 90's, and boy was
she ever demonized by the rank & file there, including people very
low on the management scale, who would have benefited greatly, but
blindly and ignorantly loyal to the "cause".
Hillary didn't really, since as the First Lady she had no real political
role. She was involved in a commission to look at alternative health
care systems. The system proposed, IIRC, was a non-starter due to
immense complexity.
http://www.princeton.edu/~starr/20starr.html
ISTR there were citizen panels convened to consider several competing
plans in 1993. As I recall, the one the panels actually liked was the
Wellstone single-payer proposal, but that never stood a chance and still
would not- even though it would:
* guarantee access to health care for all Americans; would separate
health coverage from employment;
* put US employers on an equal footing with most of the rest of the
world by sharply reducing their cost of health care for employees and
remove one significant impetus for outsourcing jobs;
* eliminate the Byzantine bureaucracies of Medicaid, Medicare and the
Veteran's Administration (but would of course create a single- probably
also Byzantine- bureaucracy to replace them, although that still seems
like progress to me);
* eliminate the many private Byzantine bureaucracies of the insurance
industry;
* reduce the cost of health care coverage by eliminating insurance
company profit margins, which add tens of billions of dollars to the
health care tab in America;
* be able to leverage massive economies of scale to reduce the per
capita cost of health care especially drug costs;
* reduce the total cost of health care by ensuring access to preventive
care and mental health care;
* and streamline the payment system for doctors allowing greater
profitability at lower reimbursement rates.
I am a health care provider (licensed psychologist). My clinic has to
have a business office staff to deal with more twenty different
insurance companies plus Medicare and Medicaid- about 1 business office
person for every 6 providers. By the time all is said and done it costs
nearly $5.00 to send out a bill, and it is not unusual for three to five
bills to have to be sent out for each service. If I could get paid by
sending only one bill out, I could get reimbursed about 10% less and
maintain the same profitability or paid the same and get my first real
raise in over a decade.
BTW, that profitability is a lot less than most people imagine, for
psychologists and for other health care providers. Many doctors,
dentists, psychologists, etc. in private practice are essentially paid
on commission, getting a percentage of collections while the clinic
keeps the rest to pay for overhead. Often we do not get paid benefits
like vacation or sick leave, health insurance, disability insurance,
etc. We may be considered independent contractors and pay all our own
taxes. Private practices that pay a salary rather than commission, and
thus can also offer paid vacation and other benefits, typically have
much greater control over the provider's schedule and set a minimum
number of appointments per day and per week. Smaller clinics are rarely
able to do this, larger clinics affiliated with hospitals often can.
In the case of the clinic where I work, each clinician (there are nearly
80 total, many of whom are part-time) is paying a share of the income
and benefits for the business office staff, the medical records staff,
the receptionists, the administrative staff, plus a share of the office
rent, clinic liability insurance, maintenance services, utilities,
telephone services, office equipment like photocopiers, computers,
remodeling offices, furniture, the out-of-date magazine service, etc. It
costs about $1,250,000 per year for the clinic to have the doors open
six days a week in five locations. Each provider has to pay for
malpractice insurance, too. And a psychology clinic is cheap to operate
compared to a physician or dentist! We don't have to buy medical
equipment like exam tables, X-ray machines, etc. Psychologist's
malpractice insurance is cheap compared to other medical professions-
obstetricians and surgeons can pay more per year in malpractice premiums
than I earn. When you add up the operating costs for medical providers,
the prices that patients pay suddenly start to make some sense.
Provider incomes have been shrinking for years- I make quite a bit less
now, when corrected for inflation, than I did in 1997 (under $40,000
last year); most of the rising costs in health care have been driven not
by doctors making more money but by huge increases in drug costs and an
increase in the use of expensive tests like MRIs.
Quoted message said:Bush supports monopoly control in health care and everything else,
where the ortho doc charges whatever he feels like charging.
Bush would call that a "market solution" and tell you that it's not a
monopoly because you are free to find an orthopedist who charges less
(not, of course, a practical reality but that has never bothered Dubya).
If you saw an orthopedist in a hospital, though the charge was probably
whatever the hospital sets. The ER is far and away the most expensive
place to get health care.
Quoted message said:This has even spread to dentistry (I have been bitten badly there
recently), with a lot of customers receiving construction income and
flooding into their offices, and finally bringing in the half
toothless kids. I guess some of the insurers are footing the bill
for people to have things done in foreign countries. I hope US
doctors get bitten at least 1/10 as bad as I am by the IT outsourcing
exodus.
The exodus in health care is one of "insourcing," bringing health care
providers in from around the world because we don't have enough here. I
have worked with nurses and doctors from all over the world. It seems
like half or more of the professional health care staff I see at most
hospitals locally are not from the US.
