Medicare for all and physician salaries

[jambro]

Can someone explain why we even need Medicare for all? My HMO is pretty decent, why not just Medicare for those who can't afford insurance?? Or are they the same?

New study finds 45,000 deaths annually linked to lack of health coverage

Medical Bills: The Leading Cause of Bankruptcy in the United States - Apex EDI

https://www.internationalinsurance.com/news/ranking-top-eleven-healthcare-systems-country.php

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[alprazoslam]

If you really want to be depressed, speak to a doctor who works in the UK. Government cuts their salary and increases their hours and patient load on a whim. The public just sees them as greedy and thinks they should work for free, and they can’t strike, so the government and the public craps all over them. It’s a field the smart students avoid. On the plus side, I guess, you can’t really sue them.

Yeah I’d rather live in a lot of places than Harry Potter land UK

 

[Peach Newport]

New study finds 45,000 deaths annually linked to lack of health coverage

Medical Bills: The Leading Cause of Bankruptcy in the United States - Apex EDI

https://www.internationalinsurance.com/news/ranking-top-eleven-healthcare-systems-country.php

...which is a real problem, and is why Obamacare was actually a great compromise. The Individual mandate, state insurance marketplaces, and strong regulatory oversight of insurance companies had (and have) the potential to do some real good... if we had gone all-in and not let it be sabotaged every step.

True, healthcare workers didn’t like the ACA much. It made some changes, not all were good. But it was the compromise we needed.

NOBODY will be happy with single payer system in the USA. Healthcare rationing isn’t just a conservative talking point - it’s a real thing. No one over 65 or so is getting heroic measures or cancer treatment anymore, that’s for sure. People won’t go broke paying for treatment, but they will have to wait 6-8 months to see a doctor, because that’s the inevitable outcome of more patients + fewer doctors.

 

[atomi]

I work in both settings.

The freestanding surgicenter accepts zero no pay patients and everyone goes home by 6. The hospital takes all comers, runs a busy 24/7 ER, level 1 trauma center, blood bank, lab, multiple ICU’s, Cath labs, IR suites, every possible imaging modality, pays call stipends for multiple specialties, etc. They need to cost shift somewhere or else they will go broke.

The ER is required by law to treat anybody if they take govt funds. If you look at outpatient specialty clinics at non profit academic centers, they can be extremely picky about what insurance they accept. Often the only way for a no pay patient to get care at these non profits is via the ED. Yes the hospitals have some more overhead to justify a somewhat higher price. However A lot of this overhead is unneeded bloat and administrators and middlemen skimming. And that slightly higher price is nowhere near the outrageous prices they actually charge.

 

[alprazoslam]

The commonwealth fund is a left biased site. UKs health system is not the best in the world lmao

If we are going to look for places to go with healthcare the U.K. is not the answer esp for doctors. Unless you hate yourself

 

[Lothric]

Why would they cut down on the physician compensation? Doctors are already severely underpaid. You know that when a random actor in their 20s pulls in 50 million bucks from one movie acting 6-10 hours a week for 6 months and can retire after that, or when a 23 year-old peanut-brain baseball player signs a contract of 20 million/year after dropping out of highschool

 

[Gurby]

NOBODY will be happy with single payer system in the USA. Healthcare rationing isn’t just a conservative talking point - it’s a real thing. No one over 65 or so is getting heroic measures or cancer treatment anymore, that’s for sure. People won’t go broke paying for treatment, but they will have to wait 6-8 months to see a doctor, because that’s the inevitable outcome of more patients + fewer doctors.

One of my favorite moments in med school so far:
Respiratory physiology small group, the facilitator is an ICU doc who moved here from the UK. We worked through a case vignette where somebody comes in with a COPD exacerbation. We intubate them, give the drugs, save the day, and they live happily ever after in the answer key.

After we finish the case the facilitator goes, "know what we do for this person in the UK? Give morphine and call hospice". I almost fell out of my chair.

 

[alprazoslam]

Why would they cut down on the physician compensation? Doctors are already severely underpaid. You know that when a random actor in their 20s pulls in 50 million bucks from one movie acting 6-10 hours a week for 6 months and can retire after that, or when a 23 year-old peanut-brain baseball player signs a contract of 20 million/year after dropping out of highschool

Nobody ever attacks the diamond type careers in life and says it’s too expensive. They always go for the oxygen (food, healthcare, electric) and scream free free free.

People enjoy spending money on sports and movies but hate it when they have to dish out for healthcare because it’s not entertainment.

One thing I’ll admit in the US is we spend our money like epicurean *****s

 

[Lothric]

[...] but hate it when they have to dish out for healthcare because it’s not entertainment.

Reading this just pissed me off

 

[alprazoslam]

Reading this just pissed me off

“I don’t want to pay but you can’t not treat me the way I please”


Sigh

 

[jambro]

...which is a real problem, and is why Obamacare was actually a great compromise. The Individual mandate, state insurance marketplaces, and strong regulatory oversight of insurance companies had (and have) the potential to do some real good... if we had gone all-in and not let it be sabotaged every step.

True, healthcare workers didn’t like the ACA much. It made some changes, not all were good. But it was the compromise we needed.

NOBODY will be happy with single payer system in the USA. Healthcare rationing isn’t just a conservative talking point - it’s a real thing. No one over 65 or so is getting heroic measures or cancer treatment anymore, that’s for sure. People won’t go broke paying for treatment, but they will have to wait 6-8 months to see a doctor, because that’s the inevitable outcome of more patients + fewer doctors.

Here are some people who would probably be happy:

1. The 45000 who die every year due to lack of healthcare
2. All those who don't die, but go bankrupt
3. Anyone who has actually had to deal with an insurance company
4. Doctors who are sick of bureaucracy

Furthermore, if you're going to argue that people will be waiting because there would be more patients (and less doctors for some reason), wouldn't that encourage physician salaries to go up, not down? After all, what happens when a hospital knows they are losing money because there are so many new patients that they simply cannot see? Don't you think that would drive physician salaries up?

 

[OrthoTraumaMD]

I read a few posts here about Canadian docs and how they are happy etc. All I know is that in my field, Canadian fellows are literally offering their first born to practice in the US. Under no circumstance do they want to return to Canada—not that there are any jobs for them. We have a bunch of fellows just doing one year additional fellowships in the US in the hopes of finding somewhere here that will take them permanently.

My father’s office regularly gets patients from Canada who cannot wait for proper care, and go to the US to be treated. As an example, In their government system, you cannot “skip” steps— so if you have a spine disc herniation you need to wait 3 months and do therapy before you get to see a specialist and get an injection. Well that’s an arbitrary number (set by the government not doctors), and some people literally can’t get out of bed because of pain, let alone do therapy, and they don’t want to suffer for 3 months.

 

[alprazoslam]

Here are some people who would probably be happy:

1. The 45000 who die every year due to lack of healthcare
2. All those who don't die, but go bankrupt
3. Anyone who has actually had to deal with an insurance company
4. Doctors who are sick of bureaucracy

Furthermore, if you're going to argue that people will be waiting because there would be more patients (and less doctors for some reason), wouldn't that encourage physician salaries to go up, not down? After all, what happens when a hospital knows they are losing money because there are so many new patients that they simply cannot see? Don't you think that would drive physician salaries up?

It’s the govt that makes them wat not the hospital. Do you know how U.K. healthcare works?

 

[dohopeful13]

Healthcare reform is absolutely coming in the near future, but I highly doubt Bernie, Cortez, etc. are going to succeed with literally abolishing private health care anytime soon. Polls show although 56% of Americans support “Medicare for all” that number drops to 37% if it involves removing private insurance or raising taxes. In addition, I think a lot of you guys are underestimating the power of lobbyists. These healthcare giants line the pockets of so many politicians - republicans and democrats, and they wouldn’t die without a fight. I read a story the other day about a Pelosi aide reassuring Blue Cross Blue Shield this won’t happen. Even if a radical dem was president, many in their own party would resist this and Republicans would attack like crazy (Same reason trump doesn’t have his wall despite running on it). Even if they did pass this somehow, it would then be challenged in a conservative Supreme Court.


What’s more likely is we get an expanded public option which could hit salaries but not to the degree single payer would. That said, yeah if all these obstacles were overcome single payer would absolutely **** any of us not rich enough to pay for med school without loans. Trying to pay 300k in loans accruing interest on a 100k salary.(which is probably taxed to hell as well) ...we’d be making the same as a McDonald’s worker after our loan payments. Might as well quit and just live off the govt, which is what the Sanders and Cortez’s of the world want

 

[deleted480308]

Here are some people who would probably be happy:

1. The 45000 who die every year due to lack of healthcare
2. All those who don't die, but go bankrupt
3. Anyone who has actually had to deal with an insurance company
4. Doctors who are sick of bureaucracy

Furthermore, if you're going to argue that people will be waiting because there would be more patients (and less doctors for some reason), wouldn't that encourage physician salaries to go up, not down? After all, what happens when a hospital knows they are losing money because there are so many new patients that they simply cannot see? Don't you think that would drive physician salaries up?

Not if they lose money for each patient

And medicare is not at all free from bureaucracy

 

[OrthoTraumaMD]

One of my favorite moments in med school so far:
Respiratory physiology small group, the facilitator is an ICU doc who moved here from the UK. We worked through a case vignette where somebody comes in with a COPD exacerbation. We intubate them, give the drugs, save the day, and they live happily ever after in the answer key.

After we finish the case the facilitator goes, "know what we do for this person in the UK? Give morphine and call hospice". I almost fell out of my chair.

Yep. That’s how my grandfather died abroad. They wouldn’t give him CHF medication because “there wasn’t enough.”
Socialism at its best. Everyone is equal...ly poor.

 

[alprazoslam]

Not if they lose money for each patient

And medicare is not at all free from bureaucracy

I know right. I can’t believe people think that giving the govt more control will fix 3 and 4 on his list.


Lolllllll

 

[Gurby]

.

 

[alprazoslam]

But hey at least we could just quit and live off the gubmint at that point and just not pay the loans off.

I duno those ATM lines on the first can be brutal

 

[VA Hopeful Dr]

Except that maxing out your 401k isn’t enough, and “no kids” isn’t the norm. So the 1k in “discretionary” income isn’t near enough.

Yes except in my monthly expenses number I do include childcare. That 3K is from my personal finances 2 years ago when both of my kids were in full time daycare.

I'll put this more in perspective:

When our twins were born my wife was making 220k (I was making zero as I had just opened my practice). At that time we had the house I described (2200/month mortgage), my wife was paying 2200/month in loans, we were maxing her 403B and 457, had the kids in daycare, and in that first year replaced the HVAC and water heater, covered the 13k out of pocket for labor/delivery, and still had a week at the beach, a weekend in the mountains, and ate out several times/week.

Now admittedly South Carolina is a pretty low COL state but still. We had a pretty good life on a single PCP-level income. Once I started earning we hired a nanny and replaced my 11 year old car.

 

[321931]

There will be capitalism for another decade or so. I think once the baby boomer generation pass on, the millennial generation will change policies and go for things like "free healthcare for all" "free college."

If that were to happen, then I honestly hope you and I have saved up enough money to survive with paychecks cut in half.

Do I think we need universal healthcare and free college? Yes and no. I'm torn. Why am I torn? Because I paid off all my student loans, worked hard to get what I get, and pay for my health insurance/have savings. It also keeps my job in business...without PPO's my dental practice would sink.

But I'm torn because I don't want my kids to go through 500k of debt to become a Doctor. That sucks to.

But anyways, I do think that once the boomers grow old and get out of power, Gen X and the new millenial politicians like Ocasio-Cortez will push hard for reform.... There will be a "generational shift."

So save up your money and maybe pick up some other life skills. I know how hard physicians work. My cousins are physicians. They work their butt off. The compensation helps go through the tough days...but once that compensation gets cut in half, you see double patients, and still are sued...well you are better off doing healthcare admin, flipping burgers at Mcdonalds, or maybe having a mid life crisis and going into software development.

That's my biggest piece of advice.

 

[Peach Newport]

Here are some people who would probably be happy:

1. The 45000 who die every year due to lack of healthcare
2. All those who don't die, but go bankrupt
3. Anyone who has actually had to deal with an insurance company
4. Doctors who are sick of bureaucracy

Furthermore, if you're going to argue that people will be waiting because there would be more patients (and less doctors for some reason), wouldn't that encourage physician salaries to go up, not down? After all, what happens when a hospital knows they are losing money because there are so many new patients that they simply cannot see? Don't you think that would drive physician salaries up?

I don’t want to get into an argument, but I don’t think you quite understand the issue at hand.

The government is the only payer. That’s what “single payer” means. Hospitals don’t “lose money” anymore than a public school does. It’s all government. The only way to pay doctors more is for the government to get more money. They only way to do that is to raise taxes... or to take the money from other government institutions. Look at the numbers for how much a bare-bones single-payer system would raise taxes already. Then think about the American political scene. We can’t even maintain SOCIAL SECURITY (which by definition pays for itself) in this country without politicians dipping into it.

 

[jambro]

As an example, In their government system, you cannot “skip” steps— so if you have a spine disc herniation you need to wait 3 months and do therapy before you get to see a specialist and get an injection. Well that’s an arbitrary number (set by the government not doctors), and some people literally can’t get out of bed because of pain, let alone do therapy, and they don’t want to suffer for 3 months.

Since you're a physician I'm sure you've had experience with insurance companies doing the same thing, right? So, is it better if an insurance company says that you need to do XYZ before the doc can get paid for a procedure, or the government? Whats the difference? We had a patient who couldn't get an MRI for months because she didn't do ABCDEFGI... according to her great insurance company. Anecdotes aren't useful.

It’s the govt that makes them wat not the hospital. Do you know how U.K. healthcare works?

I'm not saying it's not the government that could make them wait, but we already have the same thing with insurance companies. Furthermore, that is not what the poster was saying. He's saying that it would be bad for patients because so many more would have insurance and would seek care, and we only have so many doctors to help. According to that logic, while it might be bad for patients, supply/demand would lead to physician salaries going up. Especially when you consider that most docs are employed rather than owning their own practice.

Even if a radical dem was president, many in their own party would resist this and Republicans would attack like crazy (Same reason trump doesn’t have his wall despite running on it).


What’s more likely is we get an expanded public option which could hit salaries but not to the degree single payer would. That said, yeah if all these obstacles were overcome single payer would absolutely **** any of us not rich enough to pay for med school without loans. Trying to pay 300k in loans accruing interest on a 100k salary.(which is probably taxed to hell as well) ...we’d be making the same as a McDonald’s worker after our loan payments. Might as well quit and just live off the govt, which is what the Sanders and Cortez’s of the world want

Your politics are showing here and it's not a good look... furthermore, I'd argue a public option would actually be worse for physicians than what we have now, and much worse for physicians than a true single payer system. With a public option, patients are getting a better deal, but physicians wouldn't get any of the bureaucratic advantages that a single payer system relies on.

Not if they lose money for each patient

And medicare is not at all free from bureaucracy

Have you tried to get authorizations from medicare, vs. authorizations from private insurance companies? Medicare requires no auth, each insurance company has different policies and a financial incentive to make things as difficult as possible for physicians to get payment. Furthermore, Obamacare legislated that 80% of healthcare dollars go to actual care for private insurance companies, and Medicare was already operating at around 95%. Medicare is significantly more efficient and much easier for physicians to work with.

Yep. That’s how my grandfather died abroad. They wouldn’t give him CHF medication because “there wasn’t enough.”
Socialism at its best. Everyone is equal...ly poor.

Your Grandpa died? I'm sorry to hear that, but how about the anecdotes of the tens of thousands who die here? And how can you argue our system is overall better when we objectively have some of the worst outcomes in the industrialized world, and especially so for how expensive everything is?

 

[deleted480308]

Have you tried to get authorizations from medicare, vs. authorizations from private insurance companies? Medicare requires no auth, each insurance company has different policies and a financial incentive to make things as difficult as possible for physicians to get payment. Furthermore, Obamacare legislated that 80% of healthcare dollars go to actual care for private insurance companies, and Medicare was already operating at around 95%. Medicare is significantly more efficient and much easier for physicians to work with.

Medicare is not easier. They are the gorrilla that it’s a hassle to get away from because they use govt force to get irrational market power, then make insane demands on documentation that explode administration costs, all while paying inconsistently so low that a TON of doctors refuse to see their patients despite the overwhelming market share they have

Medicare is a crap system

 

[jambro]

I don’t want to get into an argument, but I don’t think you quite understand the issue at hand.

The government is the only payer. That’s what “single payer” means. Hospitals don’t “lose money” anymore than a public school does. It’s all government. The only way to pay doctors more is for the government to get more money. They only way to do that is to raise taxes... or to take the money from other government institutions. Look at the numbers for how much a bare-bones single-payer system would raise taxes already. Then think about the American political scene. We can’t even maintain SOCIAL SECURITY (which by definition pays for itself) in this country without politicians dipping into it.

I absolutely understand that the government is the single payer, that's why the system would be cheaper, there's no profit that needs to be made by the money movers. Furthermore, when I say "lose money", I'm talking about opportunity cost. Let's say a hospital sees X patients and employs Y doctors for Z income. All of a sudden, everyone has health insurance, and now there are 2X patients that can be seen. Well, with only Y doctors, who can only work so much or want to work so much, then can only see a certain number of patients. This would incentivize hospitals, etc. to hire more physicians because they know that without more physicians they are "losing" valuable dollars that could be gotten from that sweet single payer for helping these newly-insured patients.

And no, there are different ways to pay doctors more. When you consider that physicians are becoming employees more and more, thanks to this ridiculously confusing multi-insurance system we have, their salaries are at the whims of administrators. So, if the administrators chose to increase physician salaries, they would go up, because it's not like physicians right now are getting all the cash they bring in. What would make administrators raise salaries or provide more jobs? Well, maybe if they knew they needed more physicians to cash in on these new patients, more jobs opened up, and physicians could better negotiate thanks to their other offers.

Lastly, if you're arguing that a government-controlled system is a poor idea because "take a look at what they've done to social security", I would say that you would need to vote against the people who want to destroy social security, and would likely want to destroy a government-ran system, in the effort to prove that "government things don't work" and therefore need to be privatized so their buddies can make money, just as you're essentially saying here.

Lastly, about taxes, sure taxes go up, but the overwhelming majority of people save money because they no longer have premiums, copays, coinsurance, etc. So essentially the bottom 98% of people would save money, and when you get to the upper echelons more overall is paid, but its around the 5-10k range I believe.

 

[OrthoTraumaMD]

Since you're a physician I'm sure you've had experience with insurance companies doing the same thing, right? So, is it better if an insurance company says that you need to do XYZ before the doc can get paid for a procedure, or the government? Whats the difference? We had a patient who couldn't get an MRI for months because she didn't do ABCDEFGI... according to her great insurance company. Anecdotes aren't useful.


Your Grandpa died? I'm sorry to hear that, but how about the anecdotes of the tens of thousands who die here? And how can you argue our system is overall better when we objectively have some of the worst outcomes in the industrialized world, and especially so for how expensive everything is?

First of all, you can argue with an insurance company. I’ve picked up the phone and reversed their opinion and got my patient what they needed. That doesn’t fly with the government. Try that with Medicare sometime, when the person on the other line is an uneducated shmuck.

Second, l will take the tens of thousands dying here for the MILLIONS that die in countries where the government owns your health and your life. I’ve lived in a country like that. It’s not pretty. You have no idea what that means and how horrific it is. Go live in a socialist country and I’ll see how quickly you run to the US begging to come back.

 

[VA Hopeful Dr]

First of all, you can argue with an insurance company. I’ve picked up the phone and reversed their opinion and got my patient what they needed. That doesn’t fly with the government. Try that with Medicare sometime, when the person on the other line is an uneducated shmuck.

Second, l will take the tens of thousands dying here for the millions that die in countries where the government owns your health and your life. I’ve lived in a country like that. It’s not pretty.

That really is key. With Medicare the rules are the rules, period, no appeals.

Private insurance has to worry about bad outcomes, getting sued, bad press so you can usually find a way to get things done if it really matters.

 

[jambro]

Medicare is not easier. They are the gorrilla that it’s a hassle to get away from because they use govt force to get irrational market power, then make insane demands on documentation that explode administration costs, all while paying inconsistently so low that a TON of doctors refuse to see their patients despite the overwhelming market share they have

Medicare is a crap system

I believe that over 90% of physicians accept medicare... and crap for who? Medicare is the most popular healthcare coverage in America.

First of all, you can argue with an insurance company. I’ve picked up the phone and reversed their opinion and got my patient what they needed. That doesn’t fly with the government. Try that with Medicare sometime, when the person on the other line is an uneducated shmuck.

Second, l will take the tens of thousands dying here for the MILLIONS that die in countries where the government owns your health and your life. I’ve lived in a country like that. It’s not pretty. You have no idea what that means and how horrific it is. Go live in a socialist country and I’ll see how quickly you run to the US begging to come back.

Doesn't medicare not require prior authorization? What decision would you have to reverse? And insurance companies may or may not agree after a peer to peer. Not like they always will.

Also, you're arguing that having a single-payer system here would result in more deaths? Thats a pretty silly opinion. What country are you talking about?

 

[doc05]

Medicare is not easier. They are the gorrilla that it’s a hassle to get away from because they use govt force to get irrational market power, then make insane demands on documentation that explode administration costs, all while paying inconsistently so low that a TON of doctors refuse to see their patients despite the overwhelming market share they have

Medicare is a crap system

Actually, Medicare IS easier. No preauths, and they pay docs and hospitals predicatably and quickly. Which is important when you’re running a business.

And patients love it too. Tons of 64 year olds can’t wait to sign up.

 

[dohopeful13]

Your politics are showing here and it's not a good look... furthermore, I'd argue a public option would actually be worse for physicians than what we have now, and much worse for physicians than a true single payer system. With a public option, patients are getting a better deal, but physicians wouldn't get any of the bureaucratic advantages that a single payer system relies on.

Perhaps my politics are showing, yes. The idea of owing the government half a million dollars while they slash my salary to a third and raise my taxes is rather upsetting.

 

[deleted480308]

I believe that over 90% of physicians accept medicare... and crap for who? Medicare is the most popular healthcare coverage in America.

?

they take it because you have to see those patients if you have any hospital affiliation or get stuck seeing them for free,

medicare is not popular at all, it’s effectively forced on doctors

 

[doc05]

I believe that over 90% of physicians accept medicare... and crap for who? Medicare is the most popular healthcare coverage in America.



Doesn't medicare not require prior authorization? What decision would you have to reverse? And insurance companies may or may not agree after a peer to peer. Not like they always will.

Also, you're arguing that having a single-payer system here would result in more deaths? Thats a pretty silly opinion. What country are you talking about?

You’re not in practice, are you?

No Medicare doesn’t require preauthorizations. So for routine things you’re ok.

But no preauths means you do the surgery, send in the claim, and THEN have it denied. After you’ve done the work.

 

[jambro]

Actually, Medicare IS easier. No preauths, and they pay docs and hospitals predicatably and quickly. Which is important when you’re running a business.

And patients love it too. Tons of 64 year olds can’t wait to sign up.

This is what I came to understand, wanted to make sure I wasn't crazy... compared to private insurance medicare was a pleasure to work with.

You’re not in practice, are you?

No Medicare doesn’t require preauthorizations. So for routine things you’re ok.

But no preauths means you do the surgery, send in the claim, and THEN have it denied. After you’ve done the work.

I'm not, my only experience is getting authorizations and trying to learn as much as I could in a (very poorly run) private practice. I though that medicare paid out, audited everything if you were doing 2+ standard deviations of procedures, and took back all money if they found something was not "necessary." Is that not how it works?

 

[Peach Newport]

I absolutely understand that the government is the single payer, that's why the system would be cheaper, there's no profit that needs to be made by the money movers. Furthermore, when I say "lose money", I'm talking about opportunity cost. Let's say a hospital sees X patients and employs Y doctors for Z income. All of a sudden, everyone has health insurance, and now there are 2X patients that can be seen. Well, with only Y doctors, who can only work so much or want to work so much, then can only see a certain number of patients. This would incentivize hospitals, etc. to hire more physicians because they know that without more physicians they are "losing" valuable dollars that could be gotten from that sweet single payer for helping these newly-insured patients.

Are you imagining a system whereby hospitals somehow operate on a profit by contracting with the government for single-payer dollars?

Oh honey, no...

That would make hospitals a middleman that would quickly and easily be cut out. Why should the government pay more than they need to? It’s a single payer system, they don’t need to compete.

Lastly, if you're arguing that a government-controlled system is a poor idea because "take a look at what they've done to social security", I would say that you would need to vote against the people who want to destroy social security

This is magical thinking

 

[jambro]

Perhaps my politics are showing, yes. The idea of owing the government half a million dollars while they slash my salary to a third and raise my taxes is rather upsetting.

Hey I completely agree, twin that much money with 1/3rd the income would be crazy. The thing is I think you're just throwing those numbers around (1/3rd) without any logic or reason because you're uncomfortable with change, and you want to portray any change as being obviously catastrophic for physicians so that we keep the status quo which is good in some ways for some people.

 

[OrthoTraumaMD]

I believe that over 90% of physicians accept medicare... and crap for who? Medicare is the most popular healthcare coverage in America.



Doesn't medicare not require prior authorization? What decision would you have to reverse? And insurance companies may or may not agree after a peer to peer. Not like they always will.

Also, you're arguing that having a single-payer system here would result in more deaths? Thats a pretty silly opinion. What country are you talking about?

“Silly opinion”.... right.... from someone who’s actually lived it. Nice job, you’re the one that sounds silly. For privacy I won’t say it, but it applies to literally any socialist country. Any place in which the government is responsible for people’s lives instead of the free market is a recipe for disaster and yes, more deaths than would happen otherwise. Newsflash: the government doesn’t give a s**t about you. That’s why people in Canada come down to the United States for cancer treatments. They cannot wait long enough to see a physician in Canada, they will die waiting.

As for what the government would deny, um where do I start? Decision for surgery, hospital stay, injections, etc etc. My patients can’t always get prior authorization because I’m a trauma surgeon. In contrast to that, I’ve had no issues having a private insurance company accept my judgment after a peer to peer. They’ve never denied me. But my father routinely has to talk to Medicare and it is very hit or miss.

 

[doc05]

This is what I came to understand, wanted to make sure I wasn't crazy... compared to private insurance medicare was a pleasure to work with.



I'm not, my only experience is getting authorizations and trying to learn as much as I could in a (very poorly run) private practice. I though that medicare paid out, audited everything if you were doing 2+ standard deviations of procedures, and took back all money if they found something was not "necessary." Is that not how it works?

Yes, they can audit and take back payments. So can private insurers.

 

[deleted480308]

Hey I completely agree, twin that much money with 1/3rd the income would be crazy. The thing is I think you're just throwing those numbers around (1/3rd) without any logic or reason because you're uncomfortable with change, and you want to portray any change as being obviously catastrophic for physicians so that we keep the status quo which is good in some ways for some people.

The market should determine incomes

 

[alprazoslam]

There is this simple solution.

If you want a free market economy stay in America and be happy

If you want the government to hold your hand and tell you not to eat tide pods move to greater Europe.

Don’t be the have not that takes from the haves and tries to change America to get more free stuff.

We won’t miss you and maybe we will even buy your plane ticket.

I’m not a huge fan of trump but honestly it’s more hilarious the pile of liberals that kept saying they would movie to canada or UK if he became prez or America didn’t go their way. As far as I know they are all still here. Sadly .....

 

[dohopeful13]

Hey I completely agree, twin that much money with 1/3rd the income would be crazy. The thing is I think you're just throwing those numbers around (1/3rd) without any logic or reason because you're uncomfortable with change, and you want to portray any change as being obviously catastrophic for physicians so that we keep the status quo which is good in some ways for some people.

I'm just basing my numbers roughly off what I've read other purely single payer countries make, which is around 100k or so if you're lucky. If you take out the free market and let the government and only the government set pricing, they are not going to pay us competitive wages out of the kindness of their hearts. They're going to push those salaries through the floor. It's true I can't predict the exact number we'll get paid, but it's going to be a significant drop.

 

[jambro]

Are you imagining a system whereby hospitals somehow operate on a profit by contracting with the government for single-payer dollars?

Oh honey, no...

That would make hospitals a middleman that would quickly and easily be cut out. Why should the government pay more than they need to? It’s a single payer system, they don’t need to compete.



This is magical thinking

You can have public financing of a private system... that's not unreasonable.

Also, you're saying that voting against people who mess things up is magical thinking? You yourself already said " I think a lot of you guys are underestimating the power of lobbyists. These healthcare giants line the pockets of so many politicians - republicans and democrats, and they wouldn’t die without a fight. I read a story the other day about a Pelosi aide reassuring Blue Cross Blue Shield this won’t happen. Even if a radical dem was president, many in their own party would resist this and Republicans would attack like crazy (Same reason trump doesn’t have his wall despite running on it). Even if they did pass this somehow, it would then be challenged in a conservative Supreme Court." You yourself are engaging in "magical thinking" by worrying about what happens if single payer is passed.

“Silly opinion”.... right.... from someone who’s actually lived it. Nice job, you’re the one that sounds silly. For privacy I won’t say it, but it applies to literally any socialist country. Any place in which the government is responsible for people’s lives instead of the free market is a recipe for disaster and yes, more deaths than would happen otherwise. Newsflash: the government doesn’t give a s**t about you. That’s why people in Canada come down to the United States for cancer treatments. They cannot wait long enough to see a physician in Canada, they will die waiting.

As for what the government would deny, um where do I start? Decision for surgery, hospital stay, injections, etc etc. My patients can’t always get prior authorization because I’m a trauma surgeon. In contrast to that, I’ve had no issues having a private insurance company accept my judgment after a peer to peer. They’ve never denied me. But my father routinely has to talk to Medicare and it is very hit or miss.

Do private insurers give a **** about you? I know that, theoretically, the government is supposed to give a **** about you, but I can unequivocally say that private insurers definitely aren't supposed to give a **** about you. They want to make money. Also you just ignore statistics, we see that outcomes are better in single-payer nations, many of which are socialist. That completely goes against what you're saying.

Also more people leave the United States for care than come to it. That's a bs talking point

Yes, and do you know who makes the decision as to whether something is “necessary?” The government. Not physicians. It’s like having a plumber tell you what you’re doing wrong with your refrigerator. So we work like dogs and then get denied because the government says it wasn’t necessary. You cannot apply a blanket rule to every patient. That patient that the government forces to lay in bed for three months in Canada to do “therapy” for their spine would be much better off with getting an injection immediately and going back to work instead of suffering. The government’s main job is not to help patients with their problems, not to alleviate pain… But to “save” money. They treat their health systems the same way.

One of my biggest confusions with people who rally against a single-payer system in favor of our current one is that they act like the government has an incentive to deny care. No, thats the insurance companies. They literally have a financial incentive to deny care. So my question is, philosophically, why would I be more scared of a government bureaucrat denying care than an insurance company? Again, the insurance company exists to make money, the government does not. And the insurance company makes money by 1. premiums 2. denying care. Philosophically, that is a lot more concerning to me.

 

[alprazoslam]

You can have public financing of a private system... that's not unreasonable.

Also, you're saying that voting against people who mess things up is magical thinking? You yourself already said " I think a lot of you guys are underestimating the power of lobbyists. These healthcare giants line the pockets of so many politicians - republicans and democrats, and they wouldn’t die without a fight. I read a story the other day about a Pelosi aide reassuring Blue Cross Blue Shield this won’t happen. Even if a radical dem was president, many in their own party would resist this and Republicans would attack like crazy (Same reason trump doesn’t have his wall despite running on it). Even if they did pass this somehow, it would then be challenged in a conservative Supreme Court." You yourself are engaging in "magical thinking" by worrying about what happens if single payer is passed.



Do private insurers give a **** about you? I know that, theoretically, the government is supposed to give a **** about you, but I can unequivocally say that private insurers definitely aren't supposed to give a **** about you. They want to make money. Also you just ignore statistics, we see that outcomes are better in single-payer nations, many of which are socialist. That completely goes against what you're saying.

Also more people leave the United States for care than come to it. That's a bs talking point



One of my biggest confusions with people who rally against a single-payer system in favor of our current one is that they act like the government has an incentive to deny care. No, thats the insurance companies. They literally have a financial incentive to deny care. So my question is, philosophically, why would I be more scared of a government bureaucrat denying care than an insurance company? Again, the insurance company exists to make money, the government does not. And the insurance company makes money by 1. premiums 2. denying care. Philosophically, that is a lot more concerning to me.

Did you say the government doesn’t exsist to make money






I think it is time you quit while you are behind. I don’t know many starving politicians

 

[Peach Newport]

You can have public financing of a private system... that's not unreasonable.

Also, you're saying that voting against people who mess things up is magical thinking? You yourself already said " I think a lot of you guys are underestimating the power of lobbyists. These healthcare giants line the pockets of so many politicians - republicans and democrats, and they wouldn’t die without a fight. I read a story the other day about a Pelosi aide reassuring Blue Cross Blue Shield this won’t happen. Even if a radical dem was president, many in their own party would resist this and Republicans would attack like crazy (Same reason trump doesn’t have his wall despite running on it). Even if they did pass this somehow, it would then be challenged in a conservative Supreme Court." You yourself are engaging in "magical thinking" by worrying about what happens if single payer is passed.



Do private insurers give a **** about you? I know that, theoretically, the government is supposed to give a **** about you, but I can unequivocally say that private insurers definitely aren't supposed to give a **** about you. They want to make money. Also you just ignore statistics, we see that outcomes are better in single-payer nations, many of which are socialist. That completely goes against what you're saying.

Also more people leave the United States for care than come to it. That's a bs talking point



One of my biggest confusions with people who rally against a single-payer system in favor of our current one is that they act like the government has an incentive to deny care. No, thats the insurance companies. They literally have a financial incentive to deny care. So my question is, philosophically, why would I be more scared of a government bureaucrat denying care than an insurance company? Again, the insurance company exists to make money, the government does not. And the insurance company makes money by 1. premiums 2. denying care. Philosophically, that is a lot more concerning to me.

“Public financing of a private system”

Are you trolling?

Option A: government spend 100 billion/year to give private hospitals free money

Option B: government opens its own hospitals and spend 75 Billion a year, cutting out the middleman.

If you can tell me why the government would pick A, I will be very impressed.

 

[puahate]

Thoughts on a two tiered system?

 

[dohopeful13]

Maybe all of the docs in support of MFA can just offer free or vastly reduced prices for their services to those that need them. That way they can feel charitable and give up most of their salary without advocating for the destruction of the profession for everyone else.

 

[jambro]

I’m not a huge fan of trump but honestly it’s more hilarious the pile of liberals that kept saying they would movie to canada or UK if he became prez or America didn’t go their way. As far as I know they are all still here. Sadly .....

I think what's even funnier are the right wingers who wanted to move to Canada when Obama was elected.

I'm just basing my numbers roughly off what I've read other purely single payer countries make, which is around 100k or so if you're lucky. If you take out the free market and let the government and only the government set pricing, they are not going to pay us competitive wages out of the kindness of their hearts. They're going to push those salaries through the floor. It's true I can't predict the exact number we'll get paid, but it's going to be a significant drop.

I think its impossible to say if you had this similar system salaries would be the same. There's so many different factors. Malpractice insurance, overhead, student loans, work hours, resident pay, benefits, social security, healthcare, comparison to wages of other workers. I think that if we had an entire system like those in other countries, with all those things included, we'd see that it wasn't as raw a deal as it might initially appear. Plus everyone would have healthcare...

“Public financing of a private system”

Are you trolling?

Option A: government spend 100 billion/year to give private hospitals free money

Option B: government opens its own hospitals and spend 75 Billion a year, cutting out the middleman.

If you can tell me why the government would pick A, I will be very impressed.

Because the people who make those decisions are supposed to be accountable to voters, and voters might decide they didnt want to go full on NHS.

Since you think public financing of a private system is so ridiculous explain this to me:

1. Private military contractors
2. Private prisons
3. Public research that is then privatized by pharmaceutical companies

 

[deleted480308]

You can have public financing of a private system... that's not unreasonable.

Also, you're saying that voting against people who mess things up is magical thinking? You yourself already said " I think a lot of you guys are underestimating the power of lobbyists. These healthcare giants line the pockets of so many politicians - republicans and democrats, and they wouldn’t die without a fight. I read a story the other day about a Pelosi aide reassuring Blue Cross Blue Shield this won’t happen. Even if a radical dem was president, many in their own party would resist this and Republicans would attack like crazy (Same reason trump doesn’t have his wall despite running on it). Even if they did pass this somehow, it would then be challenged in a conservative Supreme Court." You yourself are engaging in "magical thinking" by worrying about what happens if single payer is passed.



Do private insurers give a **** about you? I know that, theoretically, the government is supposed to give a **** about you, but I can unequivocally say that private insurers definitely aren't supposed to give a **** about you. They want to make money. Also you just ignore statistics, we see that outcomes are better in single-payer nations, many of which are socialist. That completely goes against what you're saying.

Also more people leave the United States for care than come to it. That's a bs talking point



One of my biggest confusions with people who rally against a single-payer system in favor of our current one is that they act like the government has an incentive to deny care. No, thats the insurance companies. They literally have a financial incentive to deny care. So my question is, philosophically, why would I be more scared of a government bureaucrat denying care than an insurance company? Again, the insurance company exists to make money, the government does not. And the insurance company makes money by 1. premiums 2. denying care. Philosophically, that is a lot more concerning to me.

An insurance company has incentive to cover enough things easily enough that people and companies want buy and incentive to pay well enough easily enough for me to take their insurance.

Govt has none of that due to their power over everyone

 

[Chibucks15]

I think what's even funnier are the right wingers who wanted to move to Canada when Obama was elected.



I think its impossible to say if you had this similar system salaries would be the same. There's so many different factors. Malpractice insurance, overhead, student loans, work hours, resident pay, benefits, social security, healthcare, comparison to wages of other workers. I think that if we had an entire system like those in other countries, with all those things included, we'd see that it wasn't as raw a deal as it might initially appear. Plus everyone would have healthcare...



Because the people who make those decisions are supposed to be accountable to voters, and voters might decide they didnt want to go full on NHS.

Since you think public financing of a private system is so ridiculous explain this to me:

1. Private military contractors
2. Private prisons
3. Public research that is then privatized by pharmaceutical companies

It will never pass. This utopia doesn't and won't exist, and it will end up in the crapper like every socialist society ever has. Put some law in to hold insurers and big pharma accountable and that will help. I'm usually right in the middle on things, and I'm all for moving forward to a better system, but dumb stuff that will obviously fail isn't the way to go./thread

EDIT: Also, for all the hype this gets out on the coasts, I think NY and Cali severely overestimate how much the middle of the country agrees with most of their extremely progressive ideals.

 

[deleted480308]

Because the people who make those decisions are supposed to be accountable to voters, and voters might decide they didnt want to go full on NHS.

Since you think public financing of a private system is so ridiculous explain this to me:

1. Private military contractors
2. Private prisons
3. Public research that is then privatized by pharmaceutical companies

1. Military action is legitimate role of govt and sometimes subcontractors are efficient
2. See #1
3. Govt shouldn’t be using tax funds on health research at all

Govt should not be engaged in general health care provision at all

 

[Peach Newport]

I think what's even funnier are the right wingers who wanted to move to Canada when Obama was elected.



I think its impossible to say if you had this similar system salaries would be the same. There's so many different factors. Malpractice insurance, overhead, student loans, work hours, resident pay, benefits, social security, healthcare, comparison to wages of other workers. I think that if we had an entire system like those in other countries, with all those things included, we'd see that it wasn't as raw a deal as it might initially appear. Plus everyone would have healthcare...



Because the people who make those decisions are supposed to be accountable to voters, and voters might decide they didnt want to go full on NHS.

Since you think public financing of a private system is so ridiculous explain this to me:

1. Private military contractors
2. Private prisons
3. Public research that is then privatized by pharmaceutical companies

That’s actually not a totally unreasonable point, but it requires too many “ifs” and I don’t like that. You shouldn’t either.

PMCs are a bad example because they’re allowed to do business with other governments, except in certain cases. For instance, our gun manufacterers supply the whole world’s armies. With some exceptions they can theoretically sell to whomever they want. So the US govt needs to pay market rate.

Private Prisons are a very unique example. They save money by abusing a segment of society that no one cares about. That’s why they can do the job cheaper than the govt. try doing that with sick people and see how far you get.