Supreme Court: Mandate Stands

[eHombre]

Ok. Diabetes. The diagnosis is not very expensive, but the patient will choose to get insurance once (s)he finds out, because it'll save a lot of money in the long-term.

Sure, but that individual would have been paying $2k a year until that point, at zero actuarial cost to the government since he gets nothing in return, so I fail to see how this is a clever scheme on the individual's part.

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[bruinshockey]

I think employers are going to be more apt to pay the penalty and toss people on the Government coverage. Private healthcare will be expensive but worth it for those that can afford it. People that can will in essence be treated like upper class, cause doctors will want them as patients because they get reimbursed better than medicaid goverment rates.

Eventually it will come to some sort of issue like "gov't insurance discrimination" and "the rich get the good healthcare" give it 10 years, just wait.

 

[Dave89]

Sure, but that individual would have been paying $2k a year until that point, at zero actuarial cost to the government since he gets nothing in return, so I fail to see how this is a clever scheme on the individual's part.

Because he won't be paying for health insurance, which can easily be more expensive.

 

[SurfingDoctor]

"If you don't like something, change it. If you can't change it, change your attitude. Don't complain." -Maya Angelou

"The status quo is not working. Anything is better than sitting on our hands and complaining and not doing anything." -David Platt

 

[eHombre]

Because he won't be paying for health insurance, which can easily be more expensive.

Hm.. Pay $2k and get absolutely nothing in return or pay slightly more for catastrophic health insurance ("Bronze level"). Hmm...

 

[henge]

The objections to the "ACA" are not purely financial. In essence, the SC (Roberts) said the government may do anything it wants, under the guise of "taxation."

The SC found that since people could pay a penalty/tax instead of buying the insurance, the mandate was not really a mandate; i.e., since you have an alternative to doing something, you cannot be under a mandate. Does that mean the government can do "anything it wants"? Plainly not; for example, the same SC decision says the government can't cut MA for states that don't expand coverage, for one thing. The government can force people to pay taxes--nothing new about that--and there is a political party whose primary goal is to prevent taxes, and they have generally been very effective at it (hence federal taxes at their lowest percentage of GDP since the early 1950s). In other words, you have lots of protection through the political system. This time, though the Reps lost. Your reaction is W-A-Y over the top.

How will you feel when the government says you must treat Medicaid/care patients? Oh, it'll be worded as preventing "discrimination against" patients using these programs, but it's coming - already, many, many doctors are refusing such patients.

MA coverage will extend to, what, patients whose income is 133% (whoops, sorry, I forgot you don't believe in percentages) of the poverty level, or about $29,000 per year. The median income is around $50,000, so even if your view is correct, it will be a minority of all patients, and probably a smallish minority once you figure that many patients are on MC. And again, there is political protection.

Yeah, a measly $2000 penalty (errr, tax) is not that big a deal. Cheaper that health insurance, in fact. Which is why many people will ignore it, pay the penalty (errr, tax), and sign up for insurance when disaster strikes. After all, insurance companies may not discriminate based on pre-existing conditions.

The summary I saw said the penalty is capped at the amount of the Bronze policy, which couldl be a lot more than $2000. https://www.bcbsri.com/BCBSRIWeb/pdf/Individual_Mandate_Fact_Sheet.pdf And, as others have pointed out, insurance is not retroactive. Finally, it would be simple enough to put open enrollment period provisions in, if the abuse describe actually came to pass.

But what happens when the government decides to enforce something not to your liking?

They already do; farm subsidies, church subsidies, mineral and grazing subsidies, insurance subsidies for people living on the coast, etc. And before you rage about government in general, there are plenty of things that private sector people do that adversely impact me, without my consent, like air pollution that kills thousands per year, animal factories that breed anti-biotic resistant germs, drivers who endanger my life by jabbering on cell phones while they drive, etc.

Get a grip. Every developed nation in the world has universal health care. The Netherlands (AAA bond rating), Switrzerland (AAA bond rating), Australia (AAA bond rating) and Japan (AA- bond rating) all use a health insurance mandate system, yet they remain democratic, human-rights respecting, overall prosperous, nations with healthy, unenslaved populations.

 

[xf3rn4nd3sx]

This is a medical student forum...

My comment was directed towards your naivety not status.

I have yet to say my actions are better than anyone's. I don't ever think that, nor would I ever say that. I have offered perspective by looking at how much we have to be grateful for.
I wouldn't want my paycheck cut in half either. Yet, I would gladly do it if it meant that poor or uninsured people could gain access to care.

This is my point, you are saying these things because you haven't actually worked in the industry. Many medical and pre-med students act like this. You don't as yet have many financial, familial, or career responsibilities to worry about.

The difference in my philosophy and yours, is that you want to compare yourself to others doing very well while I compare my situation to the average person in the world. You feel like you have rights you're being robbed of, while I'm very grateful for the opportunity to work in a field I enjoy that provides a valuable service.

This is the "holier than thou" attitude I spoke of. None of us are not grateful for being able to practice medicine. The money itself isn't important to most of us. Even if my pay drops to $50k, I will survive. Yes, I would be being robbed. It's not a feeling. It's a fact. My pay goes down, yet my malpractice premiums are still six figures. My pay is cut in half, yet I am working the same amount of hours and have the same amount of risk. I'm was saying that those who are driven solely by money would be better off in other industries.

I think we should focus more on taking care of our patient population than figuring out how large our piece of the pie is. Regardless of what has happened before today, physicians are well paid and are doing just fine.

Again, how much of the pie we receive is not the issue. The issue is that physicians are being targeted when there are more important and significant issues to focus on. Tort reform, pharmaceuticals etc. See my last comment as well

Being in the top 10% or bottom 1/3 of your class doesn't matter in the real world, only in "school world". After medical school + residency, it's all about the person you are and what you bring to the table. He likely makes more money than you because his service produces more income than yours. Does it really matter though? He is better at making money than you and that's that. Richer doesn't mean better life.

Actually, it does matter. It sets you up for the real world. As I said, I interned at Goldman, was good at making money, and could have worked there if I chose. After contributing to the destruction of the economy do you really think that bankers should be enjoying the same or greater pay than before? Being higher up in your class generally suggests better work ethic or higher intelligence. Those are the people you want in medicine. Many do enter medicine. Their contributions to the medical industry have been tremendous (research ,etc.) You do not want to further de-incentivize entering the field.

Lol, it has everything to do with $. The talent is following the money. Medical students, who claim to be altruistic in their personal statements, follow the highest paid fields with great lifestyles. They're no different than Harvard or any other talented group. The talent follows the $.

See above. You want the talent going into medicine. It's better for patient care, research, breakthroughs, etc.

Wrong here. Go back to the first page when someone called a physician greedy for closing shop because of cuts... I said, as I say now, it's not fair to call someone greedy when you don't know their situation. At the same time, I can make a fair analysis and say, physicians as a group are doing very well and if *my* pay being cut means that more uninsured people can gain access to care, I'm willing to do it. I don't believe I'm holier than anyone. I'm probably worse than most.

I don't care that my income is being cut. I care that it is being cut for no reason. If my income is that much of a burden to health care costs, then sure, cut it. But my point was that physician income has been cut without any impact to health care costs. Compensation has decreased, yet costs have continued to balloon. Where is that extra money going? Yes, I am being robbed.

^

 

[eHombre]

the summary i saw said the penalty is capped at the amount of the bronze policy, which couldl be a lot more than $2000. https://www.bcbsri.com/bcbsriweb/pdf/individual_mandate_fact_sheet.pdf and, as others have pointed out, insurance is not retroactive. Finally, it would be simple enough to put open enrollment period provisions in, if the abuse describe actually came to pass.

Get a grip. Every developed nation in the world has universal health care. The netherlands (aaa bond rating), switrzerland (aaa bond rating), australia (aaa bond rating) and japan (aa- bond rating) all use a health insurance mandate system, yet they remain democratic, human-rights respecting, overall prosperous, nations with healthy, unenslaved populations.

+1000

 

[hematosis]

These are the dumb comments that make American politics and discussions worse. You don't need to demonize people who disagree with you.



lol, well I'm optimistic too. As for your, "match EM" strategy, that seems a bit far fetched. I mean, you'll be preparing your application in a few years, do you really believe you'll have an idea of what your practice environment will be over the next 20 years in 2014?



They're in purgatory and very eager to be medical students.

It's a pervasive human quality to take ownership or claim territory. Who knows why. I think it's all over medicine, well beyond the SDN allopathic forum.

No kidding, and you are a prime example of this.

 

[xf3rn4nd3sx]

So are we going to expect to see a salary cut for all physicians? Or certain specialities? And how is that income reduction going to take place? Lower reimbursements? But as many previous posters mentioned, doctors can simply refuse those with medical/medicaid for now. Are we assuming that the govt will force us to to accept medical/medicaid? Sorry my understanding of this is very limited.

First, we are moving towards a system in which all physicians are employed by hospitals (no private practice). Now your questions: Probably a temporary rise in general physician salary and a temporary decline for specialists. The government won't force us to accept medicaid, etc. but this is the fear of a single-payer system. The government could basically say that all specialists make x amount and all general practitioners make x amount. This will decrease supply of physicians, particularly specialists. Supply and demand will eventually come into effect. Hospitals having to compete for physicians will drive up prices. Everything moves in cycles, so don't worry.

More govt intervention in medicine = lower salaries. Govt is much better off cozying up to insurance companies than doctors. So, expect lower reimbursement. And yes, I believe you'll begin to see pressure ("incentives") growing stronger to...persuade...physicians to treat medicare/caid patients.

Yes, exactly. Under the current system, depending on the case, I can actually lose thousands of dollars if I'm treating a medicaid patient.

The financing of medical care must be changed. Insurance should only be used for catastrophes. This will bring all medical costs down.
I agree that med education is ridiculous; no reason for 4-year college and then 4 years med school + residency. Most of college is a waste of time, and can be accomplished by browsing wikipedia.
There is no "1%" - this is an arbitrary number calculated, in true Marxist fashion, to pit people against one another. I love how Occupy Wall Street people like to think they are the "99%" - believe me, 99% of the people can't stand you guys.

Also, the teachers are not the ones who are attacked, it is the public-sector unions, which demand greater benefits than their counterparts in the private sector. Public sector unions have been doing less for more for far too long, and it's time for them to "pay their fair share."

Agreed, and the 1%/99% thing was indeed blown out of proportion.

I think employers are going to be more apt to pay the penalty and toss people on the Government coverage. Private healthcare will be expensive but worth it for those that can afford it. People that can will in essence be treated like upper class, cause doctors will want them as patients because they get reimbursed better than medicaid goverment rates.

Eventually it will come to some sort of issue like "gov't insurance discrimination" and "the rich get the good healthcare" give it 10 years, just wait.

This has already begun with the refusal of some to accept medicare/medicaid.

 

[JackShephard MD]

No kidding, and you are a prime example of this.

Sure.

My comment was directed towards your naivety not status.

This is my point, you are saying these things because you haven't actually worked in the industry. Many medical and pre-med students act like this. You don't as yet have many financial, familial, or career responsibilities to worry about.

Or maybe I'm different from you. Maybe your worries are not mine. That is a possibility.

This is the "holier than thou" attitude I spoke of. None of us are not grateful for being able to practice medicine. The money itself isn't important to most of us. Even if my pay drops to $50k, I will survive. Yes, I would be being robbed. It's not a feeling. It's a fact. My pay goes down, yet my malpractice premiums are still six figures. My pay is cut in half, yet I am working the same amount of hours and have the same amount of risk. I'm was saying that those who are driven solely by money would be better off in other industries.

I don't think it's fair for you to say I feel I'm holier than you. I honestly don't believe my philosophy is better than anyone's. It is my own. I don't look down on people who want to earn $. Re-read my quote, I didn't say you were ungrateful, but that you feel owed something and you do. I don't feel like I'm owed anything and I don't think that makes me better or worse than you, it just is what it is.

Again, how much of the pie we receive is not the issue. The issue is that physicians are being targeted when there are more important and significant issues to focus on. Tort reform, pharmaceuticals etc. See my last comment as well

I agree that there are many opportunities for improvement.

Actually, it does matter. It sets you up for the real world. As I said, I interned at Goldman, was good at making money, and could have worked there if I chose. After contributing to the destruction of the economy do you really think that bankers should be enjoying the same or greater pay than before? Being higher up in your class generally suggests better work ethic or higher intelligence. Those are the people you want in medicine. Many do enter medicine. Their contributions to the medical industry have been tremendous (research ,etc.) You do not want to further de-incentivize entering the field.

This is where we have another difference in philosophy. I look at some of the very smartest people in my class and they are all about themselves. Finding ways to get published, beating people by making the right impressions in front of the right people, there's some surreptitious activity. Why? So they can get that top residency and get into a high paying job / great lifestyle. I understand the situation, but I don't think that high intelligence + talent lead to being great. I think your character matters much more.

The talented and super intelligent group is the future disgruntled group who decides to refuse care to certain patients because they get paid 30% less and it doesn't make financial sense. Isn't it crazy that you can be in the top 1% of earners and refuse care because it's not profitable enough?

One of my friend's dad is an anesthesiologist. He earns around a half million per year. His bought his son a brand new BMW and sends him on regular vacations to tropical destinations around the world. He's pretty well set up at this point and one day he had a call come in for a patient needing his services, he found out who the insurer was and decided to avoid the call to chill at home because they didn't reimburse enough.

See above. You want the talent going into medicine. It's better for patient care, research, breakthroughs, etc.

Again, I don't select people by talent alone. Some of the great physicians in the world aren't #1 in their class or the highest standardized test takers.

I don't care that my income is being cut. I care that it is being cut for no reason. If my income is that much of a burden to health care costs, then sure, cut it. But my point was that physician income has been cut without any impact to health care costs. Compensation has decreased, yet costs have continued to balloon. Where is that extra money going? Yes, I am being robbed.

I don't think you're being robbed. I think you were paid very well (top 1% of the world) and now you're being paid 10-20% less, or whatever. I wish you well and hope no one takes your pay, but in the end what I care about most is the forgotten of society, that they can get care. I know that you and I will always have enough $ to survive, so I'm not really worried about you or I. If that means we need to reform insurance, pharm, whatever, I'm 100% for it. But I'm not going to complain about earning less and surely I don't think it's robbery.

I'm finished with the discussion. We can agree to disagree.

 

[xf3rn4nd3sx]

I'm not going to respond to all of that because I'm getting tired of typing text blocks and have work, but you will change I guarantee. I'd say 70% of my med school class spoke as you do, but now most hold beliefs similar to mine. Second, character is important, but you don't have to have one without the other. You can be driven, intelligent, strive to be the best, and have a great character. Just because you don't come from the top of the class doesn't mean you are going to have a great character either.

Your last comment is alarming and very financially unwise. These days running a practice is essentially running a business. If 10-20% of your revenue suddenly vanishes for no reason, you'd better be concerned and do everything to prevent it from happening again. Only a fool would be indifferent towards such a cut. If you don't draw the line somewhere, then you allow for future cuts and damage, along with demonstrating that you can be walked over. I fear that you will learn this the hard way.

EDIT: Just saw that you were finished with the discussion. My bad, oh well...

 

[wmtxbb]

Yeah, spending more doesn't bring down the cost of things...

Wait, economics 101...

Early computing, starting @ $1 million

Starting @ $1,799

 

[SoundofSilver]

Really great post http://www.reddit.com/r/explainlike..._exactly_is_obamacare_and_what_did_it/c537rqi

Also http://www.ama-assn.org/ama/pub/phy...ality/physician-quality-reporting-system.page

As part of the ACA (or PPACA), patient outcomes will factor into medicare reimbursements. This change in the way doctors are paid begins in 2015. The above post does a good job of explaining what this means and gives some examples of why this is bad (e.g. if your patients are non-compliant which is something beyond your control, patient outcomes will be worse, and you will lose money).

I'm surprised this isn't being discussed more. Seems like it will have major implications.

 

[jonmadden]

I dont know why you think physicians salary will rise in the short term or in general by working for hospitals, that money was chucked out over the market today to the their shareholders. Youre really naive if you think theyll start paying docs more just cause they arent eating as much losses as before, as this only helps patch state or fed budgets.

Medicaid is continually cut, 295 to 200 billion 2004-2008 so hospitals in poor areas will still get screwed.

This isnt some poverty fix in anyway as the people who pay for any benefit are the family, neighbors and people in the same socioeconomic group as the ones who will pay. Directly or through less jobs or lower pay.

Unless you own a hospital that is in a population of uninsured, unemployed healthy 28 year olds who all suddenly start getting sick.

The tax isnt for billion dollar pharm or insurance companies or for anyone rich, its paid by people who work for a living. Capped at the "bronze"level of care and 5k estimated, that doesnt hurt rich people.

Corporations, who drive all these costs, benefit and get to be taxed at the special 15% bracket without paying a dime more than usual. For not doing a single thing that contributes to the health of our country and their policies directly harm patients in the long run. They wont have to fill out an ACO to show that taking their drugs improved care, they get paid no matter what happens post clinical trial. Like a methotrexate induced neoplasm after it was used for a chronic condition.

Or discuss the cost of humera at 25k a year for a person with arthritis. Which has more patent protection than most of these drugs deserve.

 

[crazyozone]

Well, everyone is free to do as they please. Completely cutting off the option to take care of a population because of lower reimbursements probably isn't the best thing to do though. According to the 2010 income survey, the average neurologist made 268k annually (25th% 190k and 90th% 413k). It's not like they are family care physicians, I'm sure if he still took care of all those patients he would still earn more than most FM physicians.

He can take his greed somewhere else. We all know the average neurologist salaries in 2010 and prior and i think they are doing just fine.

It was mentioned above but having a private practice means more than being a doctor, it means running a business. For a small business owner, especially one who takes on a lot of medicare patients, much of the 268k will go to keeping the business afloat. It's not pure profit for the physician; running a small business means paying out of pocket.

http://money.cnn.com/2012/01/05/smallbusiness/doctors_broke/index.htm

I think employers are going to be more apt to pay the penalty and toss people on the Government coverage. Private healthcare will be expensive but worth it for those that can afford it. People that can will in essence be treated like upper class, cause doctors will want them as patients because they get reimbursed better than medicaid goverment rates.

Eventually it will come to some sort of issue like "gov't insurance discrimination" and "the rich get the good healthcare" give it 10 years, just wait.

I agree with you. No, I don't think you can see into the future. I just think you have good critical thinking skills and foresight.

"The status quo is not working. Anything is better than sitting on our hands and complaining and not doing anything." -David Platt

I don't think making something worse is better than the status quo.

 

[BOOYA18]

i just have to reply to the discussion between the attending and drshepard guy. Dr shepard: he is not saying that you ARE holier than thou, rather that you express a holier than thou attitude, which i completely agree with. this has nothing to do with medicine in my opinion, it has to do with general life circumstances. if you make $100 dollars a week (easy for arguments sake), and you have $80 in bills, living expenses etc (whether it be a nice car, a normal car,three houses, a boat, or just enough for food)...then either immediately or throughout a rather quick period of time, you only make $70 dollars a day, but still have $80 in expenses, and actually next week they could go up to $90...THAT SUCKS. the holier than tho naivete that he speaks of is that you cannot see that, regardless of your money vs other professions vs poor people in another country THE FEAR OF NOT PAYING YOUR BILLS SUCKS. in your future life of giving away your money (you claim to be doing lots of charity work in the future), which you can just deem an "expense", and people cut your money...you wont be able to pay YOUR bills or OTHER peoples bills (or whatever you wanna do with your money/do free things, volunteer etc.) and that SUCKS. that is the attendings point, or how i interpreted your dreadful rebuttals of "but we just think different...it shouldnt be about money.."

 

[xf3rn4nd3sx]

i just have to reply to the discussion between the attending and drshepard guy. Dr shepard: he is not saying that you ARE holier than thou, rather that you express a holier than thou attitude, which i completely agree with. this has nothing to do with medicine in my opinion, it has to do with general life circumstances. if you make $100 dollars a week (easy for arguments sake), and you have $80 in bills, living expenses etc (whether it be a nice car, a normal car,three houses, a boat, or just enough for food)...then either immediately or throughout a rather quick period of time, you only make $70 dollars a day, but still have $80 in expenses, and actually next week they could go up to $90...THAT SUCKS. the holier than tho naivete that he speaks of is that you cannot see that, regardless of your money vs other professions vs poor people in another country THE FEAR OF NOT PAYING YOUR BILLS SUCKS. in your future life of giving away your money (you claim to be doing lots of charity work in the future), which you can just deem an "expense", and people cut your money...you wont be able to pay YOUR bills or OTHER peoples bills (or whatever you wanna do with your money/do free things, volunteer etc.) and that SUCKS. that is the attendings point, or how i interpreted your dreadful rebuttals of "but we just think different...it shouldnt be about money.."

Exactly. That is precisely the point I was trying to make.

 

[startoverat40]

(whether it be a nice car, a normal car,three houses, a boat, or just enough for food)...then either immediately or throughout a rather quick period of time, you only make $70 dollars a day, but still have $80 in expenses, and actually next week they could go up to $90...THAT SUCKS.

wait a second, if your expenses are so high then cut back. we don't want a society where people are dying and going into financial ruin from health costs, whereas others don't want to give up the 3rd boat or porche.

p.s. the 1% vs 99% is not blown out of proportion, in fact "It's the inequality stupid" ! meaning the inequality is at the root of most of the ills of our society.

 

[jonmadden]

I think the antitrust laws that prohibited physicians from forming a union with any real power are null and void when nurse midwives are paid 100% of an obgyn for the same job as part of this bill

Elsewhere NPs can be paid not at a mid level rate but a physician and even fill out reimbursement in the same place.

Whether anyone likes it they are practicing medicine as far as the government is concerned and physicians can unionize and strike like they do in other countries. In australia EM docs did and got results as would be expected. $350k they make standard plus 9% towards a PERSONAL social security fund, taxed better, and get this 38 hrs is the max work week and anything over gets time and a half.

In the UK the entire country can officially opt out of working more than 48 hrs a week, online themselves making it impossible for an employer to pressure you to work more

Just allow that and healthcare would stop enough to throw these people out of office. Theyll just ride us into the dirt, and it directly and negatively affects patient care and conflicts with the physicians creed. Maybe we arent the ones causing harm, but letting someone pull the plug while you watch is not a stretch the way this will play out.

Complete idiocy if you think companies will start foregoing profits by not denying someone with cancer insurance, wont happen and theyll take their money and leave the business and in the end the taxable working public pays

They can write it into law all they want, doesnt change how the corporate structure functions. No ones going to force them to stay in business or pay back how much theyve accumulated over these last years when other companies havent recorded nearly as lucrative profits

Suckers

 

[Dave89]

wait a second, if your expenses are so high then cut back. we don't want a society where people are dying and going into financial ruin from health costs, whereas others don't want to give up the 3rd boat or porche.

p.s. the 1% vs 99% is not blown out of proportion, in fact "It's the inequality stupid" ! meaning the inequality is at the root of most of the ills of our society.

Envy and jealousy really are powerful tools, huh?

I've heard it said that socialism could be avoided by following either of 2 of the 10 Commandments: "Thou shalt not covet" and "Thou shalt not steal."

 

[BOOYA18]

My example never had inflated expenses. It was just an arbitrary monetary value. There was no mention of expenses being too high, because they were not too high until their income was reduced 20%. Now I am absolutely for not outliving your means, but the point still stands, regardless on what you decide are your expenses, being unable to afford them, or to living paycheck to paycheck because your income was cut drastically is not enjoyable.

 

[calvnandhobbs68]

I think the antitrust laws that prohibited physicians from forming a union with any real power are null and void when nurse midwives are paid 100% of an obgyn for the same job as part of this bill

Elsewhere NPs can be paid not at a mid level rate but a physician and even fill out reimbursement in the same place.

Whether anyone likes it they are practicing medicine as far as the government is concerned and physicians can unionize and strike like they do in other countries. In australia EM docs did and got results as would be expected. $350k they make standard plus 9% towards a PERSONAL social security fund, taxed better, and get this 38 hrs is the max work week and anything over gets time and a half.

In the UK the entire country can officially opt out of working more than 48 hrs a week, online themselves making it impossible for an employer to pressure you to work more

Just allow that and healthcare would stop enough to throw these people out of office. Theyll just ride us into the dirt, and it directly and negatively affects patient care and conflicts with the physicians creed. Maybe we arent the ones causing harm, but letting someone pull the plug while you watch is not a stretch the way this will play out.

Complete idiocy if you think companies will start foregoing profits by not denying someone with cancer insurance, wont happen and theyll take their money and leave the business and in the end the taxable working public pays

They can write it into law all they want, doesnt change how the corporate structure functions. No ones going to force them to stay in business or pay back how much theyve accumulated over these last years when other companies havent recorded nearly as lucrative profits

Suckers

I can agree with this. Nurses unions have nothing but the interest of the nurses in mind and are willing to run doctors over for it. I'm not willing to cut physician salaries just to watch it go to other providers along the chain who think they're equivalent to physicians. No thanks.

Edit: I'm not really willing to cut physician salaries at all just to make myself clear.

 

[jonmadden]

wait a second, if your expenses are so high then cut back. we don't want a society where people are dying and going into financial ruin from health costs, whereas others don't want to give up the 3rd boat or porche.

p.s. the 1% vs 99% is not blown out of proportion, in fact "It's the inequality stupid" ! meaning the inequality is at the root of most of the ills of our society.

Youre an idiot 6% max physician compensation is of healthcare dollars, 94% is unrelated to physicians and their pay and that 94% is whats risen

Pharm, insurance, devices, long term care facilities, private wall street traded hospitals-their margins and their profits are what has changed and drive this unequivocably

If every physician worked for free it would not matter. They cut medicaid 100 billion from 2004 to 2008 were those magic fixes? Things change those years if you werent sittting in a dirty diaper?

Well physician compensation is 140-150 bill, how much is cutting that going to do? Not a single thing. 2.5 trillion we are talking about and rising


How about we start paying patients our salaries? 300 bill now we are fixing. Still a drop in the bucket and clearly the wrong issue to be looking at

Not to mention it leads to my gpa and i could have done anything and most people in medicine turn off any public sentiment

And physicians obviously couldnt do anything as they are so easily manipulated and too insecure to do more than whine or play into politicians hands by not taking medicaid/medicare.

By the balls anyhow as everyone will have insurance or owe fines equivalent too

 

[BOOYA18]

You also didn't see the point where I said "just enough for food" I was trying to make examples of any expense a person would deem necessary depending on choice and income.

 

[MaraCeles]

I'm fine with the ACA; I think the patient protections were needed. But I do want the doctors to be able to hold their salaries, especially since there should be more patients with ability to pay--we've got to be able to unionize or lobby or SOMETHING in order to hold our own against the insurance industry (and the nurses' union and...)

 

[startoverat40]

Youre an idiot 6% max physician compensation is of healthcare dollars, 94% is unrelated to physicians and their pay and that 94% is whats risen

???

I don't see why you have to be insulting. I'm not arguing for cutting physician salaries. I'm saying that worry over losing income for luxuries shouldn't trump physicians' support for single-payer. I'd much rather see the insurance industry removed from the picture so that we can save all the money wasted on paperwork and them leeching off of the system. If we did that physicians would get to keep most of their money too.

 

[jonmadden]

I can agree with this. Nurses unions have nothing but the interest of the nurses in mind and are willing to run doctors over for it. I'm not willing to cut physician salaries just to watch it go to other providers along the chain who think they're equivalent to physicians. No thanks.

Edit: I'm not really willing to cut physician salaries at all just to make myself clear.

It doesnt go to them either, like in some states after supporting and pushing their autonomy NPs have their reimbursements slashed.

Its just a bait and switch move, they arent going to pay anyone more and wont take NPs for the same price when they can help it.

They have the strongest union so they get some action, theyve had strikes, or they negotiate separately with hospitals to get deals that clearly beat physicians in many aspects. Godforbid a bunch insecure infighting vanity obsessed docs tried maybe getting respect in the one place it matters.

Yea maybe someone should show up to the ER or to scrub, but theres plenty of other ways to be actively resilient without letting people die

Just not taking medicaid/medicare is what they want and wont change the issue which insurance, government, profit or nonprofit as all show to be only concerned with taking peoples money while trying to pay for healthcare

If more than poor people are affected in accessing healthcare than those apes will backtrack.

Better yet start providing politicians with the basic care by law that is provided to all poor people, sit in an inner city ED waiting room for a couple hours everytime they want a checkup or a viagra refill. If Im forced not to see poor patients because it would cause me to go bankrupt then I dont have to see rich politicians with nice insurance if I dont want. "Sorry just switched plans a few minutes ago, 3 hrs outside DC they take that though"

I see no moral objection to refusing a corrupt rich person because of their payment method, when I have to refuse an honest poor person because of theirs. And they took cash out of the equation so you dont have that as some legal BS.

 

[DrAwsome]

I'm fine with the ACA; I think the patient protections were needed. But I do want the doctors to be able to hold their salaries, especially since there should be more patients with ability to pay--we've got to be able to unionize or lobby or SOMETHING in order to hold our own against the insurance industry (and the nurses' union and...)

A medical union, where ALL specialties are united, is essential. How do we make it happen? I agree with someone else that posted that said they are not ok with our salaries going down. This needs to be stopped. If costs need to be cut they should start with staff, including overpaid nurses, PA/NP, CRNAs etc.

 

[MaraCeles]

A medical union, where ALL specialties are united, is essential. How do we make it happen? I agree with someone else that posted that said they are not ok with our salaries going down. This needs to be stopped. If costs need to be cut they should start with staff, including overpaid nurses, PA/NP, CRNAs etc.

A medical union for all specialties is an intriguing idea. Well, as long as the physicians still come out on top. Bwhahah. But in any case, if cutting our salaries doesn't really reduce costs, where should we turn our collective eye? Is it the other staff, or the pharm, the hospitals themselves, the devices, what? That other 94% of costs, that's where our income is going, and that's whom we should start unionizing/lobbying against...(instead of going for each others' throats over ideological differences over a bill that's already been passed by Congress and legitimized by the SCOTUS. We have to deal with the situation as it stands).

 

[Dave89]

A medical union for all specialties is an intriguing idea. Well, as long as the physicians still come out on top. Bwhahah. But in any case, if cutting our salaries doesn't really reduce costs, where should we turn our collective eye? Is it the other staff, or the pharm, the hospitals themselves, the devices, what? That other 94% of costs, that's where our income is going, and that's whom we should start unionizing/lobbying against...(instead of going for each others' throats over ideological differences over a bill that's already been passed by Congress and legitimized by the SCOTUS. We have to deal with the situation as it stands).

How will we unionize? If we strike, people die. Not many docs would take that strike.

Also, we are not helped by those who say "Well, $100,000 is plenty to live on, and you shouldn't go into medicine for the money, yada yada..."

Finally, public opinion is against us. Read any article on CNN, WasPo, etc. about healthcare and the comment thread goes something like this: "those greedy doctors don't care about people, they just want their Porsches!" They just don't know.

 

[MaraCeles]

How will we unionize? If we strike, people die. Not many docs would take that strike.

Also, we are not helped by those who say "Well, $100,000 is plenty to live on, and you shouldn't go into medicine for the money, yada yada..."

Finally, public opinion is against us. Read any article on CNN, WasPo, etc. about healthcare and the comment thread goes something like this: "those greedy doctors don't care about people, they just want their Porsches!" They just don't know.

You bring up excellent points.

What are some ways of negotiating without the extreme of a no-holds-barred strike? They must exist. There are whole industries devoted to that sort of thing, both through lobbies and lawyers, and I think we should begin to utilize them.

And public opinion, yes! I definitely think we should do some work there, if only to get people trusting us again. Hmmmm. If we started thinking of ourselves in terms of a campaign instead of a union...

I mean, physicians have some of the highest incomes in the country, and we should use that to better ourselves just as much as our patients. I don't see a problem in doing that; I think that's just common sense, especially as our salaries aren't the problem here. Let's be honest: With money comes power, so there must be something we can do that we're not doing yet.

 

[jonmadden]

???

I don't see why you have to be insulting. I'm not arguing for cutting physician salaries. I'm saying that worry over losing income for luxuries shouldn't trump physicians' support for single-payer. I'd much rather see the insurance industry removed from the picture so that we can save all the money wasted on paperwork and them leeching off of the system. If we did that physicians would get to keep most of their money too.

Well youre making the point of every US citizen after being bombarded by propaganda and misleading data, this is only the beginning of this crap

He could buy a 100 porches and burn them then charge his patients 1000x times what he does now and it would not change healthcares cost or growth. If he even had the ability to dictate what he is reimbursed.

Learn what youre talking about before you start telling people how to live their lives, I couldnt care less about money as this is people telling me what i have to buy, that I have to work more for less so stockholders can make money as well as corrupt politicians, when I wasnt looking at a lavish lifestyle 300k in the hole.

Also poor people as well as the elderly now will get less money for care, so only a hospital with extra money given by fines can give them worse care than I could without their overhead and corruption eating in. Ill also be paid less and have little control over how I practice medicine with zero recourse.

If they wanted people to be healthier and have better controlled DM and cholesterol they wouldnt allow the worst food for your body to be made so cheap and available, let alone the only food you can get in alot of neighborhoods. Nor do they really care when they have larger stressors that being green or a vegan.

Minimum wage if you can find a job isnt a liveable wage, food stamps and gov aid dont allow a person to be healthy.

They are gonna tell me I dont deserve to get paid for controlling a persons cholesterol, DM, or whatever when they dont have the means or present at advanced stages? Or cant afford a prescription copay? Yea $5 even

when they shouldnt have been letting banks and wall street rob us blind

These people who have caused most of the preventable disease you see in a PCP office?

And they should have stepped in awhile ago, they can step into the economy to give banks 1 trillion dollars and force us to penalties for not buying an item that we dont need or use

I think their stance on capitalism, free market forces and individual freedom speaks better from their actions.

Romney too, theyre all the same. So silly people buy into this democrat vs republican nonsense. Childish, the way they give you 2 idealic choices

Unless you have billions and give them some you might as well not exist. Every meaningful change they make says that going back too long

 

[JackShephard MD]

i just have to reply to the discussion between the attending and drshepard guy. Dr shepard: he is not saying that you ARE holier than thou, rather that you express a holier than thou attitude, which i completely agree with. this has nothing to do with medicine in my opinion, it has to do with general life circumstances. if you make $100 dollars a week (easy for arguments sake), and you have $80 in bills, living expenses etc (whether it be a nice car, a normal car,three houses, a boat, or just enough for food)...then either immediately or throughout a rather quick period of time, you only make $70 dollars a day, but still have $80 in expenses, and actually next week they could go up to $90...THAT SUCKS. the holier than tho naivete that he speaks of is that you cannot see that, regardless of your money vs other professions vs poor people in another country THE FEAR OF NOT PAYING YOUR BILLS SUCKS. in your future life of giving away your money (you claim to be doing lots of charity work in the future), which you can just deem an "expense", and people cut your money...you wont be able to pay YOUR bills or OTHER peoples bills (or whatever you wanna do with your money/do free things, volunteer etc.) and that SUCKS. that is the attendings point, or how i interpreted your dreadful rebuttals of "but we just think different...it shouldnt be about money.."

I don't expect you to agree with my view or my "dreadful rebuttals". My question is this, in a rich country where the average person earns 45k per year. Why does a person earning 220k per year need to have bills that amount to 80% of his income. It's fine, it's their choice but it's not a necessity since obviously many do very well earning 200k less.

I do not fear not paying my bills. I've always been able to and always will. I never said it shouldn't be about money, I said for me it isn't. I think your opinion is probably the opinion of the herd, of the majority.

Instead of saying a person earns $100, let's use real #'s. Here are some figures from the MGMA survey:

Mean salaries:

Anesthesia: 419k
Cardiology: 435k
Dermatology: 437k
Emergency: 280k
Heme/Onc: 430k
Ortho: 524k
Ortho spine: 710k
Ophtho: 376k
Pain: 380k
CT surg: 530k
Rads: 479k

So instead of saying, a guy makes $100, say: A radiologist earns $479,000 and takes home $287,000. His bills are $229,000 per year. His pay is cut and then he only earns $420,000 and his take home is only $220,000. It SUCKS for him to not be able to pay his $229,000 in bills. THE FEAR OF NOT PAYING his $229,000 in obligations SUCKS.

There, that's better.

 

[Go Ducks]

I don't expect you to agree with my view or my "dreadful rebuttals". My question is this, in a rich country where the average person earns 45k per year. Why does a person earning 220k per year need to have bills that amount to 80% of his income. It's fine, it's their choice but it's not a necessity since obviously many do very well earning 200k less.

I do not fear not paying my bills. I've always been able to and always will. I never said it shouldn't be about money, I said for me it isn't. I think your opinion is probably the opinion of the herd, of the majority.

Instead of saying a person earns $100, let's use real #'s. Here are some figures from the MGMA survey:

Mean salaries:

Anesthesia: 419k
Cardiology: 435k
Dermatology: 437k
Emergency: 280k
Heme/Onc: 430k
Ortho: 524k
Ortho spine: 710k
Ophtho: 376k
Pain: 380k
CT surg: 530k
Rads: 479k

So instead of saying, a guy makes $100, say: A radiologist earns $479,000 and takes home $287,000. His bills are $229,000 per year. His pay is cut and then he only earns $420,000 and his take home is only $220,000. It SUCKS for him to not be able to pay his $229,000 in bills.

There, that's better.

It blows my mind when doctors are complaining about how they aren't sure whether they'll be able to pay their bills. If you are a family practice doctor in a rural area or work for a non-profit type clinic in the inner city, then you might have something to worry about. However the sweepingly vast majority of post-residency doctors have six digit incomes. If you can't balance your books and pay off some student loan dept each year making well over $100,000, then I think it's time to do some cutting back.

 

[startoverat40]

Well youre making the point of every US citizen after being bombarded by propaganda and misleading data, this is only the beginning of this crap

He could buy a 100 porches and burn them then charge his patients 1000x times what he does now and it would not change healthcares cost or growth. If he even had the ability to dictate what he is reimbursed.

Learn what youre talking about before you start telling people how to live their lives, I couldnt care less about money as this is people telling me what i have to buy, that I have to work more for less so stockholders can make money as well as corrupt politicians, when I wasnt looking at a lavish lifestyle 300k in the hole.

Also poor people as well as the elderly now will get less money for care, so only a hospital with extra money given by fines can give them worse care than I could without their overhead and corruption eating in. Ill also be paid less and have little control over how I practice medicine with zero recourse.

If they wanted people to be healthier and have better controlled DM and cholesterol they wouldnt allow the worst food for your body to be made so cheap and available, let alone the only food you can get in alot of neighborhoods. Nor do they really care when they have larger stressors that being green or a vegan.

Minimum wage if you can find a job isnt a liveable wage, food stamps and gov aid dont allow a person to be healthy.

They are gonna tell me I dont deserve to get paid for controlling a persons cholesterol, DM, or whatever when they dont have the means or present at advanced stages? Or cant afford a prescription copay? Yea $5 even

when they shouldnt have been letting banks and wall street rob us blind

These people who have caused most of the preventable disease you see in a PCP office?

And they should have stepped in awhile ago, they can step into the economy to give banks 1 trillion dollars and force us to penalties for not buying an item that we dont need or use

I think their stance on capitalism, free market forces and individual freedom speaks better from their actions.

Romney too, theyre all the same. So silly people buy into this democrat vs republican nonsense. Childish, the way they give you 2 idealic choices

Unless you have billions and give them some you might as well not exist. Every meaningful change they make says that going back too long

I'm not sure where or if we have any disagreement. By the way I'm in favor of single payer and also for overturning citizens united to cut the influence of big money on our govt. if people don't trust govt we have to fix the govt, not scrap the whole idea of a democratic govt running public services.

 

[jonmadden]

You dont get this do you. No taking money from nurses doesnt help, nor EMTs, nor anyone that actually directly involved in this 2.5 trillion racket.

The moneys gone first off, and any money the money gives in the form of medicare payments or whatever at this point is money they took from you a year ago in your taxes

They government isnt rich and doesnt earn money or have any, they take ours and it goes to companies that fund their lifestyle.

Trillion dollars bailout, pharmas fees to fda, 200k a year for a nursing home patient fo a long term care facility who spits that money out on earnings day. To other corporations or banks investing firms. That money doesnt come back, even to this country as they have started moving on to the many other areas lf the world they cant make profits off of.

Our country is bankrupt for practical purposes and that money went straight into the pockets of corporations through manipulation of the real estate market as well as any other cent that should be here.

All this is forcing people to make up for money they spent, lost, stole, or gave away.

They dont care who takes care of old people they never met and who should have money they contributed into their Social Security, 7-8% of your pay for life that is supposed to be your retirement money. Or medicare money that isnt there.

Thy dont get to just spend a generations lifetime earnings for times like these and do a switcheroo and say you new workers pay for theirs and when youre old some new young people will pay

Doesnt work because of population shifts, not to mention the money should have not been touched if they cared whether every last american lived or died. What else happens when you take a persons money for when they are too old to work? Its not like a few bucks got lost or embezzled in a strip club.

Do an interesting economic study and look at the wealth of banks vs our bankruptcy timeline. They basically are the government anyway.

The top tax bracket is like 500k, alot of money, but thats like .01% of what the real rich who still have money, as my dad a dentist is bankrupt after 30 years so dont think this has to do with people who work for a living even what normal people think are rich.

So docs fighting with nurses or whoever about salary makes you look like fools

No upslope to this recession here, I bet the whole 2.5 trillion.

They are just seeing how long they can get people to push their free ride that ran out of gas, before they realize their total ****ing idiots

 

[Evil_Abed]

I don't expect you to agree with my view or my "dreadful rebuttals". My question is this, in a rich country where the average person earns 45k per year. Why does a person earning 220k per year need to have bills that amount to 80% of his income. It's fine, it's their choice but it's not a necessity since obviously many do very well earning 200k less.

I do not fear not paying my bills. I've always been able to and always will. I never said it shouldn't be about money, I said for me it isn't. I think your opinion is probably the opinion of the herd, of the majority.

Instead of saying a person earns $100, let's use real #'s. Here are some figures from the MGMA survey:

Mean salaries:

Anesthesia: 419k
Cardiology: 435k
Dermatology: 437k
Emergency: 280k
Heme/Onc: 430k
Ortho: 524k
Ortho spine: 710k
Ophtho: 376k
Pain: 380k
CT surg: 530k
Rads: 479k

So instead of saying, a guy makes $100, say: A radiologist earns $479,000 and takes home $287,000. His bills are $229,000 per year. His pay is cut and then he only earns $420,000 and his take home is only $220,000. It SUCKS for him to not be able to pay his $229,000 in bills. THE FEAR OF NOT PAYING his $229,000 in obligations SUCKS.

There, that's better.

It blows my mind when doctors are complaining about how they aren't sure whether they'll be able to pay their bills. If you are a family practice doctor in a rural area or work for a non-profit type clinic in the inner city, then you might have something to worry about. However the sweepingly vast majority of post-residency doctors have six digit incomes. If you can't balance your books and pay off some student loan dept each year making well over $100,000, then I think it's time to do some cutting back.

I was under the impression that when they're talking about "not being able to pay the bills," they were referring to the costs of maintaining a practice. Hasn't there been a trend of physicians closing practices and moving towards salaried positions because they can't afford overhead costs anymore? From what I understand (based on talking with current residents and attendings), this is a big problem.

 

[crazyozone]

I don't expect you to agree with my view or my "dreadful rebuttals". My question is this, in a rich country where the average person earns 45k per year. Why does a person earning 220k per year need to have bills that amount to 80% of his income. It's fine, it's their choice but it's not a necessity since obviously many do very well earning 200k less.

I do not fear not paying my bills. I've always been able to and always will. I never said it shouldn't be about money, I said for me it isn't. I think your opinion is probably the opinion of the herd, of the majority.

Instead of saying a person earns $100, let's use real #'s. Here are some figures from the MGMA survey:

Mean salaries:

Anesthesia: 419k
Cardiology: 435k
Dermatology: 437k
Emergency: 280k
Heme/Onc: 430k
Ortho: 524k
Ortho spine: 710k
Ophtho: 376k
Pain: 380k
CT surg: 530k
Rads: 479k

So instead of saying, a guy makes $100, say: A radiologist earns $479,000 and takes home $287,000. His bills are $229,000 per year. His pay is cut and then he only earns $420,000 and his take home is only $220,000. It SUCKS for him to not be able to pay his $229,000 in bills. THE FEAR OF NOT PAYING his $229,000 in obligations SUCKS.

There, that's better.

It blows my mind when doctors are complaining about how they aren't sure whether they'll be able to pay their bills. If you are a family practice doctor in a rural area or work for a non-profit type clinic in the inner city, then you might have something to worry about. However the sweepingly vast majority of post-residency doctors have six digit incomes. If you can't balance your books and pay off some student loan dept each year making well over $100,000, then I think it's time to do some cutting back.

I agree when you're talking about a physician making those numbers working for a hospital, but when you're talking about a physician trying to start a business i.e. private practice, things are a lot different. I would disagree in those instances. I put this site up earlier:

http://money.cnn.com/2012/01/05/smallbusiness/doctors_broke/index.htm

 

[jonmadden]

I'm not sure where or if we have any disagreement. By the way I'm in favor of single payer and also for overturning citizens united to cut the influence of big money on our govt. if people don't trust govt we have to fix the govt, not scrap the whole idea of a democratic govt running public services.

Yea we have to scrap the idea cause thats all thats left, an idea that was fake

Democratic? 2 equally worthless choices presented to us as the only ones and 20% vote cause they think it matters? And someone else makes the decision if god forbid it somehow mattered or people voted than predictions

They dont help poor people, federal medicaid is a whole 295 bill in 2004 than 200 bill in 2008 and less now

2.5 trillion is the figure we are cutting down on

There are no free loading immigrants changing this number

If they did the government would have been much more forceful but their exploitation and our need for population growth in the younger demographics doesnt cost them.

They just get more people now citizens to tax, to support older demographics which is when healthcare costs money

Im not sure why you want them to take your money and trust they wont lie and use in for their own gain as they have with life earnings of everyone else to this date.

I'll seriously bet you any amount of money nothing they will do will help anyone

Ask any politician so convinced theyll fix it and they wouldnt come close to that action

Just seriously ask mitt romney or obama if theyll make a wager, you know put something behind personally of things they promise or are so sure about

Live TV that would be the best cause its a politicians worst nightmare, they just bet with house money.

Why the hell should they see my health information or my kids to tax me, when I cant even see where they spend 50 cents out of every dollar I earn?

That too much?

Theyll be privied to info like if your child has autism, the same year they are diagnosed. Maybe incorrectly

Who knows but if they just wanted a tax for $700 or $2k they wouldnt make the eventual fine the cost of healthcare or fine your employer if they dont pay enough till they do and provide your health info

The big payout for them is that health info or else theyd take the tax but the structure shows its your proof and policy number and whos on it and all their identifying info

Sharing info as well frees them from personal info breaches

This is alot weirder than people think

I

 

[jonmadden]

I agree when you're talking about a physician making those numbers working for a hospital, but when you're talking about a physician trying to start a business i.e. private practice, things are a lot different. I would disagree in those instances. I put this site up earlier:

http://money.cnn.com/2012/01/05/smallbusiness/doctors_broke/index.htm

First take biostats or basic math before step 1. Second work a day in your life so you can find out when someone tells you your 45k salary and how much you keep

Then be self employed with employees and see how you thought what was left over after 45k seemed bad.

Cost of employing people, their payroll, yours, state, federal, income taxes then look for yourself how insurance companies perpetually cut reimbursements across the board during this time for no appararent reason.

You also arent paid the same day you see a patient or sometimes at all and are forced to basically be an open credit line for insurance companies, while the housing market which 90% of most peoples life earnings are invested in disappears. If you own your office thats gone too

And everyone else is unemployed and loses insurance so your patient mix becomes heavily medicaid/medicare and reimburses less while everything else about overhead stays the same

You sound like youve seen the world wihout stepping outside, telling people theyve been irresponsible when they are unable-not unwilling to pay their bills because of what was systematic market manipulation.

I think youll call it bad luck, as you probably thing starving children did something to deserve that too

Like you cant comprehend that bad things happen to people that dont deserve it, so your psyche can rest

Those salaries are going down so maybe 100k and 300k of debt and 30k year taxes sounds.

Adjusted for work hours, debt load, and training length as well as practice setting those europeans win on all fronts

Doctors could work for free and there wouldnt be a change, look at the trends, look at the deficit

Like crabs picking at each other

These guys clearly never worked a day in their life or else theyd realize a rich coun

 

[jonmadden]

I agree when you're talking about a physician making those numbers working for a hospital, but when you're talking about a physician trying to start a business i.e. private practice, things are a lot different. I would disagree in those instances. I put this site up earlier:

http://money.cnn.com/2012/01/05/smallbusiness/doctors_broke/index.htm

Those salaries are skewed too high and probably a few years old

Mean, median

Ask for both

 

[xf3rn4nd3sx]

I was under the impression that when they're talking about "not being able to pay the bills," they were referring to the costs of maintaining a practice. Hasn't there been a trend of physicians closing practices and moving towards salaried positions because they can't afford overhead costs anymore? From what I understand (based on talking with current residents and attendings), this is a big problem.

Yes, this is a problem. Hospitals love it, but private practice will soon be nonexistent. We will all be employees.

First take biostats or basic math before step 1. Second work a day in your life so you can find out when someone tells you your 45k salary and how much you keep

Then be self employed with employees and see how you thought what was left over after 45k seemed bad.

Cost of employing people, their payroll, yours, state, federal, income taxes then look for yourself how insurance companies perpetually cut reimbursements across the board during this time for no appararent reason.

You also arent paid the same day you see a patient or sometimes at all and are forced to basically be an open credit line for insurance companies, while the housing market which 90% of most peoples life earnings are invested in disappears. If you own your office thats gone too

And everyone else is unemployed and loses insurance so your patient mix becomes heavily medicaid/medicare and reimburses less while everything else about overhead stays the same

You sound like youve seen the world wihout stepping outside, telling people theyve been irresponsible when they are unable-not unwilling to pay their bills because of what was systematic market manipulation.

I think youll call it bad luck, as you probably thing starving children did something to deserve that too

Like you cant comprehend that bad things happen to people that dont deserve it, so your psyche can rest

Those salaries are going down so maybe 100k and 300k of debt and 30k year taxes sounds.

Adjusted for work hours, debt load, and training length as well as practice setting those europeans win on all fronts

Doctors could work for free and there wouldnt be a change, look at the trends, look at the deficit

Like crabs picking at each other

These guys clearly never worked a day in their life or else theyd realize a rich coun

Completely agree with you. These guys haven't worked a day in their lives. It's easy to sit behind your computer screen and say that physicians shouldn't complain about salary cuts and should be able to adjust their lifestyles.
1. The question is why is our salary being cut. As jonmadden said, physician income has little to nothing to do with health care costs. It's already been cut. We've tried that. Nothing has changed, other than health care costs, which have ballooned. So why further cut income? Physicians are one of the only occupations in which the average income is declining yearly instead of increasing to keep up with inflation.
2. Medicaid/medicare pays me 10% of what is charge 90% of the time. Sometimes they don't pay at all. Other times I have to chase them for months. I have to go through this and administrative/government policy bs every day. Most of us gave up our 20s and early 30s to be in this profession. We went to school for 10+ extra years to earn more than than the $45k average income. We work twice as many hours (80 compared to 40) to earn more than the $45k income. We have infinitely more liability (six figure malpractice premiums) to have higher than the $45k income. It's not the issue of feeling entitled to something. EVERY OTHER industry works like this. High risk, high reward. Look at banking, law, engineering, consulting, etc. The more you put in the more you get out. Out of all of these, medicine is the only industry in which we, as physicians, have business expenses and risks, but are treated as government entities, free to be regulated and slashed as the politicians please.

 

[jonmadden]

Yes, this is a problem. Hospitals love it, but private practice will soon be nonexistent. We will all be employees.



Completely agree with you. These guys haven't worked a day in their lives. It's easy to sit behind your computer screen and say that physicians shouldn't complain about salary cuts and should be able to adjust their lifestyles.
1. The question is why is our salary being cut. As jonmadden said, physician income has little to nothing to do with health care costs. It's already been cut. We've tried that. Nothing has changed, other than health care costs, which have ballooned. So why further cut income? Physicians are one of the only occupations in which the average income is declining yearly instead of increasing to keep up with inflation.
2. Medicaid/medicare pays me 10% of what is charge 90% of the time. Sometimes they don't pay at all. Other times I have to chase them for months. I have to go through this and administrative/government policy bs every day. Most of us gave up our 20s and early 30s to be in this profession. We went to school for 10+ extra years to earn more than than the $45k average income. We work twice as many hours (80 compared to 40) to earn more than the $45k income. We have infinitely more liability (six figure malpractice premiums) to have higher than the $45k income. It's not the issue of feeling entitled to something. EVERY OTHER industry works like this. High risk, high reward. Look at banking, law, engineering, consulting, etc. The more you put in the more you get out. Out of all of these, medicine is the only industry in which we, as physicians, have business expenses and risks, but are treated as government entities, free to be regulated and slashed as the politicians please.

Your malpractice seems high

One fact 94% of the cost is not physicians!!!!!!
Not some biased survey crap they put put, number of physicians 685,000 dividided by the healthcare expenditures, 2.5 trillion. These are the feds own numbers, 6 whopping %

Hey throw in 4 avg years of residency at 50k for 80hrs and that brings down the average income, throw on 300k of debt (10% actually towards education cost) and more hrs worked per week.

I dont know why people actually practicing medicine are being called the ones with their hand caught in the cookie jar.

I just saw some hospital stocks make some lazy jackass, shocking if they had a DC zipcode, a bunch of money for doing nothing. not even because the company actually got more money, just because theres a promise that tax payers will be fined for not having "government approved" health insurance.

Lets make sure that guy gets all the money doctors, nurses, and anyone caring for sick people make

And dont get me wrong theres greedy docs like anyone else, but 99.9% are still professional and hardworking and more capable then this countrys ever going to get. And more likely now cause were broke.

-Wheres the rest lf the money going?

-Why do we allow wall street corporations to make profit margins off the sick and dying that no other country allows?

-whats in it for every joe DC putting OT in for this bill? Its not their salary or the future of healthcare as theyll be out of office

Maybe this is just a fakeout move, romney or congress pulls it and we all feel thankful for something we shouldnt have to. Oldest move, people feel like they got something when they didnt.

I was pissed when i realized they were filling their budget with my loan debt

I mean how does the fed stay well when their tax base lost jobs, lifes earning, house, discretionary income, etc

They are grasping at straws an they cant just shut down some old crap library or sell a few planes at least.

No ones ever going to take over our country if we got rid of every gun in the army. We would be the worst choice, high cost of occupation, populated, debt ridden, poor chance of getting a return like some oil country







What the hell is anyone talking about?

 

[Acoustic]

If anything this thread has ruined the show Lost for me. Man that was a good show, and now this lol

 

[calvnandhobbs68]

I agree when you're talking about a physician making those numbers working for a hospital, but when you're talking about a physician trying to start a business i.e. private practice, things are a lot different. I would disagree in those instances. I put this site up earlier:

http://money.cnn.com/2012/01/05/smallbusiness/doctors_broke/index.htm

Okay I think you have a problem understanding how this private practice thing works since you've said this more than once. Salaries/Benefits are reported AFTER you've paid everything else out when you're a small business owner. You get paid last. Nobody reports a pre-expense salary...that would just be idiotic since you'd be being taxed on that imaginary salary. Not to mention you could never run an office on a couple hundred grand. Try closer to a million or two once you've taken the salaries of a couple secretaries, nurses, the lease, equipment, lighting, heating, cooling, etc, etc into account.

So a physician who is making 0 dollars because overhead from PP is eating everything would report...0 dollars. He would report benefits for this survey but that comes nowhere close to these mean ranges. So yes, that would be taken into account. Whether they actually respond or not is another matter entirely.

 

[startoverat40]

Jonmadden, I want to see Glass Steagal reinstated and even strengthened. I want to see for profit insurance cut out of the picture, or at least restricted to elective nose jobs. And I want to see citizens united overturned and public financing of elections with equal funding for each candidate. Cutting physician salaries is the last thing on my mind if at all.
I don't get what you are saying about medical records.

 

[Wolverines83]

Has anyone given any thought to the negative selection that's going to occur with this? Politics aside, it's a financially unsustainable system.

Since the rates for this insurance are based on an area (ie, NYC, your zip code or whatever), the younger healthier people pay the same rates as the older and/or unhealthy people. The rates are already more than the penalty for young age groups. When they have to pay for the health of less healthy individuals, the rates will only increase. They (the young/healthy) aren't going to pay it. They'll absorb the cheaper "tax." These younger people are the ones under-employed; they aren't going to essentially waste their money if they can purchase insurance once they're diagnosed. Hell, most of them forego insurance even now. This leaves only the sick in the pool...

Anyone who's worked in insurance knows that this is the nightmare scenario for an insurance carrier.

Not to sound dramatic (or political) but this will kill private insurers, forcing more people into the public insurance option and let's face it...the government doesn't exactly run at even money.

 

[eHombre]

It's not as bad as you make it out to be. Insurance carriers participating in the Exchanges will still be able to discriminate on certain factors like age or tobacco use, just not as much as they used to. There would also be a cheap catastrophic plan available for people under 30 who decide to go that route, and this plan likely would not cost much more than the tax penalty.

Summary from Kaiser Foundation:
"Require guarantee issue and renewability and allow rating variation based only on age (limited to 3 to 1 ratio), premium rating area, family composition, and tobacco use (limited to 1.5 to 1 ratio) in the individual and the small group market and the Exchange."

"Catastrophic plan available to those up to age 30 or to those who are exempt from the mandate to purchase coverage and provides catastrophic coverage only with the coverage level set at the HSA current law levels except that prevention benefits and coverage for three primary care visits would be exempt from the deductible. This plan is only available in the individual market."

This link explains the whole law:
www.kff.org/healthreform/upload/8061.pdf

Has anyone given any thought to the negative selection that's going to occur with this? Politics aside, it's a financially unsustainable system.

Since the rates for this insurance are based on an area (ie, NYC, your zip code or whatever), the younger healthier people pay the same rates as the older and/or unhealthy people. The rates are already more than the penalty for young age groups. When they have to pay for the health of less healthy individuals, the rates will only increase. They (the young/healthy) aren't going to pay it. They'll absorb the cheaper "tax." These younger people are the ones under-employed; they aren't going to essentially waste their money if they can purchase insurance once they're diagnosed. Hell, most of them forego insurance even now. This leaves only the sick in the pool...

Anyone who's worked in insurance knows that this is the nightmare scenario for an insurance carrier.

Not to sound dramatic (or political) but this will kill private insurers, forcing more people into the public insurance option and let's face it...the government doesn't exactly run at even money.

 

[Kunu]

This just circles back to our discussion the other day. Medicine is a profession filled with mostly rich kids from well off families. They just want to maintain their lifestyle. I don't think it's everyone obviously, but I think it's possibly >50%.

It's too bad because we can really do good in this profession if we focus on taking care of those who need our help rather than on $.

whoever you are you have no business being in this profession. Wisconsin teachers abandoned their classrooms and protested because a responsible governor stood up to their corrupt union's insistence these people receive standard pay raises irregardless of their performance and blind to the financial bankruptcy the state was facing. They should be grateful they even have a job. Meanwhile CMS just recently froze reimbursements and most compensations have been slashed hard over the years and the public never heard a whisper of dissent from us doctors. I cant even imagine the outrage that would come from nurses if they came in to work one day and were told- oh by the way were cutting your pay 15% and you have no say go screw yourself. We sacrifice personally, professionally, economically, socially in every way from college when we work and study and spend hours and hours in labs while joke majors put a fraction of effort into their degree. We take test after test, go through the gauntlet of interviews and admission, bust our asses day and night in medical school and make minimum wage and take it in the ass hard in residency from clerks, nurses, attendings, janitors, etc etc. When you're finally done you pay thousands of dollars to corrupt boards administrator gatekeepers for the privilege to work 12 hour days putting yourself at risk by scumbag lawyers perched for the slightest opportunity to gain at others expense and rape your well being whether you did or didnt do anything wrong.

So yes. Doctors should be compensated for their work and sacrifices. Doctors in other countries invest much less in their education, work a fraction as hard and bear a sliver of potential financial and professional risk that american doctors do because of our letiginous pro-lawyer climate so they appropriately are more a middle-class like situation. It sounds like you've never had a real job, because making $200,000 on paper considering how long it takes to get to that point, education investment and all the professional burdens that the public is unaware of isnt going to make you "filthy rich".