I am sorry for the lengthy note, but tried to be objective with citations:
The problem with medicine today that the population is getting older, the proportion of the population who needs to be supported is getting larger and the portion of the society who is willing to pay tax for this is getting smaller (tax evasion, current politics, fiscal cliff etc).
When your program director says there will be plenty patient to treat in cardiology he/she is right but who will pay for it?
NYT Debt reconking session cited here by David Leonhardt worth to read:
http://www.nytimes.com/interactive/us/politics/debt-reckoning.html?ex=6#sha=fe5cfc1b4
Q: Dont most Americans pay for their Medicare benefits, through payroll taxes over their working lives?
A. No, and it is not even close. Two married 66-year-olds with roughly average earnings over their lives will end up paying about $122,000 in dedicated Medicare taxes through the payroll tax, including the part their employers pay, according to Eugene Steuerle, Stephanie Rennane and Caleb B. Quakenbush of the Urban Institute. That married couple can expect to receive about three times as much $387,000, adjusted for inflation in benefits. The projected gap is even larger for younger people because of growing health care costs.
In short, the single biggest cause of the long-term deficit is that most people receive much more from Medicare than they give to it."
Medicare enacted - life expectancy was about 69 years, now 82-84? about 400% increase in post retirement life expectancy!!! Was there any proportional adjustment made over time in medicare contributions pay by the baby boomer taxpayers?????
In 1949 for 1 retiree there were 49 taxpaying /working citizens now the proportion is 3-4 taxpayer/1 retiree predicted in 15 yrs it will be about 2/1 retiree. So the current generation and the future ones will pay much higher proportion their income to support the nonproductive members of the society.
If you are a politician who needs votes who will he sacrifices for the happiness of the society when you have to provide more healthcare for less $:
1) The retirees
2) Healthcare workers =nurses or doctors?
Your guess which is easier to sell
This is happening these days we are probably at the beginning:
1) British Journal Economist July 18, 2009 about Healthcare reform:
America's hospital industry
Taking a scalpel to costs
Hospital operators brace themselves for health-care reform
EARLIER this month America's hospital bosses gathered in Washington, DC, with vice-president Joseph Biden. To the amazement of many, they vowed to accept a cut of $155 billion in their expected revenues over the next decade as part of a grand bargain on health-care reform. How can they justify giving away such a vast sum?
One of the explicit concessions wrung by the hospital bosses from the White House was a promise to crack down on clinics owned by doctors. These outfits are guilty of anti-competitive self-dealing, since the doctor has a financial motive to refer cases to his own firm, but what hospital bosses were really concerned about was that such clinics are competing hard with them, and siphoning off the most profitable patients.
As this back-room deal illustrates, the strongest motives behind the hospitals' ostensibly generous price cut were self-serving ones: to reduce competition, not boost it, and to head off any increase in government influence over their prices. As health-care reform forges ahead, reformers are desperate to find cost savings and the hospital industry is a juicy target. So its bosses felt they had to cut a deal.
THIS WAS WRITTEN >3 YEARS AGO.
This above means hospital CEOs support Obama care today to make private MDs go bankrupt and get their business happened already:
Many cardiologist group went bankrupt and sold out to the hospital because of the above deal.
Two news post election day 2012:
Election Removes Cloud From Health Law's Future
President Barack Obama's re-election removes the last direct obstacle to his signature health-law overhaul, but doubts remain about whether its intricate new insurance system set to debut in 2014 will be ready in time.
Shares of most of the large health insurers declined more than the broader market Wednesday, while hospital stocks showed big gains. (there are other reasons too why hospital stocks rose).
http://online.wsj.com/article/SB100...4.html?mod=WSJ_hpp_MIDDLENexttoWhatsNewsThird
the other news the same day that the hospital CEOs protest the above, previously accepted 150 billion MEDICARE hospital payment cut to be phased in read on MSNBC, could not relocate webpage.
But it will come
..
And likely more healthcare cuts to come to keep the budget balanced, probably drastic in the form of bundled payment to hospitals only, they will not pay the physician separately, the hospital will give you what they think is fare
Governmental pilot studies showed this can save 2-22% on medicare cost. 86% of those saving were from the savings that the hospital administration negotiated with the physician paying them less
..
So simply the government will get out of the bad guy picture and will leave the protest by MDs against the hospital CEOs
.
There are no private practices, only few patients can afford to pay so you are stuck with your hospital
See your 2nd contract after the initial one...
Is there any significant component in the healthcare reform/cost reductions so far that does not include reduced reimbursement for physician services???
The economist and politicians know that we physicians are professionally enslaved trained for 25-30yrs it is very difficult to change a profession
Nurses technicians, MA not...
If there is an oversupply of MDs the above concept should work
I came from a country where physician who can be independent from the hospital and do fee for device - ophtalmologists, dermatologists, plastic surgeons, dentists - are doing well. The MDs who are employed by the hospital are miserable.
What a patient/person "wants" will pay for it BOTOX, breast augmentation etc.
When the same patient is dying doctor it is your duty to save my life when the bill comes they forget
.
There was a referendum/plebiscite held in my home country where healthcare is socialized Should the citizens pay 1$ copayment (not kidding) for a doctors visit or NO? The governmental payment was so low that even this 1$ copayment would have made a diffenence for MDs. More than 90% of the people voted NO.
People will vote in favor for if they can get something for free probably throughout the world.
I hope the US is not on a similar path
.
It looks like we might not be able to change what is happening in healthcare and politics but we can change ourself.
One senior nurse in the ICU told me when I started my carrier and she saw me rounding day and night I felt a bit strange but realized she tried to help to open my eyes:
Every patients death is hard, but to see a physician dying particularly: doctors realize that time that they had NO life, just worked and studied all their life and that life is about to come to an end.
I am thankful to her opening my eyes
