sycasey;842849311 said:

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Curious: do you have sources on this claim about doctors not making enough money in the U.S.? My understanding is that they are already (as a group) much better-paid than their counterparts overseas.

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The big problem is that those who have been at it for some time, and knew how medicine "was" are choosing whether to stick it out, or retire early. That is a big problem for society. Younger doctors have been brought up in the HMO concept of medicine and are much better with it. It does present problems. So not many are poor per se, but for the years of education they put in they make much less than they should be---and this is especially true of certain specialties---pediatrics, internal med, family practitioners.

To combine Unit2's response with Odonto's response - Unit2 has shown current pay levels and Odonto is pointing out that pay used to be even better and older docs who used to get that higher pay are grumbly about the current situation. It's clear, pediatricians, internal med, family practitioners need to be paid more. Some of the others probably should be paid less.

It's also hard to quantify being paid "less" than you should be. I know lots of people in finance who in younger years made much more than some of these doctors. Now they are struggling to hold jobs as new blood comes in. Doctors have more job stability than other professions so that has to be taken into account as well.

Unit2Sucks;842849313 said:

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This is what Odonto considers "dire financial constraints". From what I've read, about 20% of our healthcare dollars go to physician pay so it's not the only place where we can save money but it's a meaningful expense.

[URL="https://thedoctorweighsin.com/how-much-money-do-us-doctors-make/"][/URL]

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I would say that chart is depressing from Ob/Gyn down for the years of education and training. Heck, compare to your local water district head making $400,000 a year plus. Or an assistant coach at Cal. Yes those numbers are big for the average Joe, no denying, but these peeps start at about age 30+ in their earning lives. And live in the Bay Area with those salaries. You would certainly get by, but I think a doctor deserves more than "get by"

OdontoBear66;842849319 said:

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I would say that chart is depressing from Ob/Gyn down for the years of education and training. Heck, compare to your local water district head making $400,000 a year plus. Or an assistant coach at Cal. Yes those numbers are big for the average Joe, no denying, but these peeps start at about age 30+ in their earning lives. And live in the Bay Area with those salaries. You would certainly get by, but I think a doctor deserves more than "get by"

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Are these salaries just a national average? I'd assume that if so, the salaries in the Bay Area would likely be higher than the national average.

OdontoBear66;842849319 said:

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I would say that chart is depressing from Ob/Gyn down for the years of education and training. Heck, compare to your local water district head making $400,000 a year plus. Or an assistant coach at Cal. Yes those numbers are big for the average Joe, no denying, but these peeps start at about age 30+ in their earning lives. And live in the Bay Area with those salaries. You would certainly get by, but I think a doctor deserves more than "get by"

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Right, so dire financial constraints means top 5% by income? The fact that rich old doctors are retiring is not an argument that doctors are underpaid in this country. I would argue that we are no more near the market clearing price for doctors. There are presently two limits that I'm aware of on the supply of doctors: (i) the number of medical schools in this country, and (ii) immigration restrictions on foreign doctors. There is a ready, willing and able supply of potential med students but the spots are severely limited.

For those, like me, who believe in the free market to allocate resources, the optimum solution would seem to be to unlock supply. I would argue that as part of our infrastructure stimulus we should build new medical school. I would also argue that we should unlock immigration for qualified doctors. There are plenty of doctors overseas who would happily take $150-200k in the US and it would help us reduce entitlement spending. That's a win win right?

sycasey;842849321 said:

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Are these salaries just a national average? I'd assume that if so, the salaries in the Bay Area would likely be higher than the national average.

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Actually it's the opposite. Doctors in rural areas are in such short supply that they tend to get paid more than their urban counterparts. We've discussed moving for that reason but, eff that.

Also, let's be clear about one more thing. Doctor pay has decreased relative to inflation, but patient costs and government costs have gone up. The group that has extracted wealth from all the other players is the insurance industry.

Most of the doctors I know are oblivious to this reality.

For political reasons we have unnecessarily complicated healthcare in this country. This seems to be the policy of the GOP to complicate rather than simplify as their actions speak the loudest.
Medicare needs to be evaluated, but not on the basis of cutting costs but on the basis of increasing effectiveness. Physicians have been pretty vocal on the subject of Medicare payments for their services and many have reacted by not accepting Medicare patients. If you are retired and are age qualified for Medicare, this is a problem as most health plans become a supplement to Medicare when they had been the primary provider before you qualify for Medicare. This is a doughnut in coverage that has been really poorly explained; does your health plan (which has become a Medicare supplement plan) pay only the Supplemental cost for a non-Medicare Provider ( you pay the Medicare portion) based on Medicare payments levels, or are the supplemental costs based on the higher billing from the non-Medicare provider or does your plan pay the billed costs as a preferred provider as it would have before you became Medicare age qualified? My Blue Cross/Blue Shield plan states that it is now a supplement plan to Medicare and is no longer the primary payer to the health care provider.

Bottom line insurance companies have placed Medicare between themselves and health care providers and count on Medicare to protect them by lowering billable amounts and thus the amount of supplemental coverage they provide. Changes in Medicare have a direct impact on retirees access to health care.

AS far as the GOP they are still opposed to legislation prohibiting Medicare from negotiating bulk purchasing discounts from drug companies. The only justification for this is to waste Medicare funds for corporate benefit. Other Federal health care programs negotiate bulk purchase discounts; it the GOP were serious about healthcare they would demand negotiating cheaper prices instead of opposing them.

dajo9;842849297 said:

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I don't understand this thinking. Medicare generally doesn't intrude in the doctor-patient relationship nearly as much as private insurance companies, at least according to my physician wife. The question of trusting doctors vs. politicians seems misguided.

How is your trust level for insurance companies? When they tried to drop my Aunt because she got leukemia my trust level for them went down pretty low.

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One would think a system that is much more expensive than any other system in the world with no better outcomes would be evaluated not even on moral grounds but on a market inefficiency basis.

dajo9;842849328 said:

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Actually it's the opposite. Doctors in rural areas are in such short supply that they tend to get paid more than their urban counterparts. We've discussed moving for that reason but, eff that.

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Yes but that doesn't mean doctors in urban areas are underpaid. The market is massively distorted so doctors make more than enough to live in urban areas and WAY more than enough to live in rural areas. Despite Odonto's pleadings about what doctors "should" make, there is no reason that I can think of why the average dermatologist should make $381k per year to prescribe retin A and tell people to use sunscreen daily.

The fact that he thinks that the head of a municipal water district, whose manages a massive enterprise and whose performance has a tremendous influence on public health and safety, should make less than an average dermatologist is a great example of healthcare provider entitlement. By the way, I just looked up the salary of the the guy who runs San Francisco's water system operations and he makes $230k. A nice salary even in the bay area but that sounds entirely reasonable to me.

dajo9;842849328 said:

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Actually it's the opposite. Doctors in rural areas are in such short supply that they tend to get paid more than their urban counterparts. We've discussed moving for that reason but, eff that.

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Holy crap, I could've written this post. Hell has frozen over.

Unit2Sucks;842849342 said:

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Yes but that doesn't mean doctors in urban areas are underpaid. The market is massively distorted so doctors make more than enough to live in urban areas and WAY more than enough to live in rural areas. Despite Odonto's pleadings about what doctors "should" make, there is no reason that I can think of why the average dermatologist should make $381k per year to prescribe retin A and tell people to use sunscreen daily.

The fact that he thinks that the head of a municipal water district, whose manages a massive enterprise and whose performance has a tremendous influence on public health and safety, should make less than an average dermatologist is a great example of healthcare provider entitlement. By the way, I just looked up the salary of the the guy who runs San Francisco's water system operations and he makes $230k. A nice salary even in the bay area but that sounds entirely reasonable to me.

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Please use WebMD. While you're at it, if you need to build a house or get sued, just Google things.

oski003;842849378 said:

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Please use WebMD. While you're at it, if you need to build a house or get sued, just Google things.

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The head of San Francisco's water system should definitely make more money than the average doctor. That person is managing a lot of above ground capital assets and miles and miles of underground network assets. If something goes wrong from a water quality or water main break standpoint the consequences are severe. There are future growth plans to be developed all looking years into the future. Additionally, that department would have a lot of employees working for him down the chain, both highly educated engineering and finance professionals as well as blue collar field teams.

There is no reason for any doctor to be defensive about things like this.

GB54;842849341 said:

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One would think a system that is much more expensive than any other system in the world with no better outcomes would be evaluated not even on moral grounds but on a market inefficiency basis.

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You would think so but very few have looked at this. Some have looked at the healthcare systems of other countries on a macro level. It is interesting to see countries like Japan who provide good care and do it for less than half of the US. Considering that they have an aging population, it is interesting to see how they do it. Their admin is something like 8% of the cost whereas ours is around 30%. They have regulated costs that appear to satisfy all involved. How they handle the end of life issues is probably more humane and not as much a burden. I'm sure their culture is such that people who abuse the system is looked down upon. They also walk a lot so they are in pretty good shape.

dajo9;842849387 said:

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The head of San Francisco's water system should definitely make more money than the average doctor. That person is managing a lot of above ground capital assets and miles and miles of underground network assets. If something goes wrong from a water quality or water main break standpoint the consequences are severe. There are future growth plans to be developed all looking years into the future. Additionally, that department would have a lot of employees working for him down the chain, both highly educated engineering and finance professionals as well as blue collar field teams.

There is no reason for any doctor to be defensive about things like this.

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I don't base my opinion of doctors salaries by looking at the head of a water district. I do not believe public service positions are a true meritocracy and much pay is in incredible benefits. Perhaps no private job in the US should ever make close to what the California governor makes, given the degree of responsibility, and therefore those salaries should be put in line.

oski - you are right that there is no reason to compare the leader of major public health infrastructure to an individual contributor physician. Some people get really mad when [insert civil servant] makes more than [insert said person's industry] but the validity of the comparison varies of course. If we are talking about private janitors vs public janitors, it is more likely to be a valid comparison.

Of course, it's possible to make irrelevant and misleading comparisons the other way as well. For example, a justice on the supreme court is paid (~$215k) is paid about the same as an average allergy doctor (~$222k).

I don't have anything against doctors by the way. They perform a vital public service and are necessary to a thriving society. I just wish the market dynamics were such that we didn't have an artificially limited supply which unnecessarily drives up costs which is particularly problematic for the people in our society who are most exposed.

Well, the numbers are out. The Senate bill would mean 22 million more people uninsured.

https://www.nytimes.com/2017/06/26/us/politics/senate-health-care-bill-republican.html

dajo9;842849387 said:

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The head of San Francisco's water system should definitely make more money than the average doctor. That person is managing a lot of above ground capital assets and miles and miles of underground network assets. If something goes wrong from a water quality or water main break standpoint the consequences are severe. There are future growth plans to be developed all looking years into the future. Additionally, that department would have a lot of employees working for him down the chain, both highly educated engineering and finance professionals as well as blue collar field teams.

There is no reason for any doctor to be defensive about things like this.

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I certainly realize by comparing to anything, I open to specific criticisms, but I was hoping you would get the point. I have no skin in the medical profession at all except having worked in its realm for years and years. My hopes are not to enrich doctors versus anyone else, but it seems that with any number of comparisons you have doctors underpaid for their education level, their hours worked, and mostly their dedication to the welfare of their patients. I basically care about the future of medicine and its maintainence of quality. I have seen quality, and opposite thereof practiced in all venues, but my experience is that an extremely high percentage of professionals are performing a great service, albeit with exceptions. I personally despise insurance companies having dealt with Delta Dental for most of my practice years, so I am in no conspiracy to protect them or their interests. Back when medicine was fee for service almost entirely it afforded an unbelievable quality care---attention to patients and their needs, relationship between doctors and patients with little to no insurance interference, and a quality product. The latter is still achieved but more difficult to attain. The attention and relationships are diminishing as it has become more business like. I was alarmed that about the time I retired that medicine and dentistry stopped covering its own emergencies after hours (visit docs in a box). That would have been malpractice in my ice age of time. I don't like this erosion, although I see it is upon us in force. In that I like what we had versus where I perceive we are going I will fight it for the good of medicine tooth and nail, not for personal gain---that has long since past. It afforded me a comfortable living that I enhanced with good investment procedures from day one. I suspect we shall agree to disagree, details aside.

GATC;842849389 said:

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You would think so but very few have looked at this. Some have looked at the healthcare systems of other countries on a macro level. It is interesting to see countries like Japan who provide good care and do it for less than half of the US. Considering that they have an aging population, it is interesting to see how they do it. Their admin is something like 8% of the cost whereas ours is around 30%. They have regulated costs that appear to satisfy all involved. How they handle the end of life issues is probably more humane and not as much a burden. I'm sure their culture is such that people who abuse the system is looked down upon. They also walk a lot so they are in pretty good shape.

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That's interesting since Japan is an aging population with little immigration so one would expect that care costs would escalate as the population ages. Of course another factor is that people who have continual care are healthier than those that have none.

The members of the massive Baby Boom Generation that don't have savings are going to be stacked on warehouse shelves in Buttonwillow and watered twice a day.

bearister;842849475 said:

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The members of the massive Baby Boom Generation that don't have savings are going to be stacked on warehouse shelves in Buttonwillow and watered twice a day.

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That is certainly what they are voting for

GB54;842849461 said:

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That's interesting since Japan is an aging population with little immigration so one would expect that care costs would escalate as the population ages. Of course another factor is that people who have continual care are healthier than those that have none.

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It also probably helps that the Japanese don't spend their lives eating massive portions of junk food like Americans do. High obesity contributes a lot to health-care costs.

But the U.K. has nearly as many fat people as America and they still manage a national health care system. Mostly for us it comes down to two factors: (1) after World War 2, America was flush and everyone had jobs with benefits, so there was no great need for the government to enter the system, and (2) our general stubbornness about being rugged individualists. The latter can be a good quality in many ways, but when it comes to creating an efficient health care system for a large country, it's a problem.

sycasey;842849481 said:

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It also probably helps that the Japanese don't spend their lives eating massive portions of junk food like Americans do. High obesity contributes a lot to health-care costs.

But the U.K. has nearly as many fat people as America and they still manage a national health care system. Mostly for us it comes down to two factors: (1) after World War 2, America was flush and everyone had jobs with benefits, so there was no great need for the government to enter the system, and (2) our general stubbornness about being rugged individualists. The latter can be a good quality in many ways, but when it comes to creating an efficient health care system for a large country, it's a problem.

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The other point on fat people is that without a continuum of care and behavior modification many will wind up with diabetes and heart problems. Now, some may do it anyway but prevention can save a lot of money down the road which again is contrary to the sink or swim mentality

sycasey;842849481 said:

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It also probably helps that the Japanese don't spend their lives eating massive portions of junk food like Americans do. High obesity contributes a lot to health-care costs.

But the U.K. has nearly as many fat people as America and they still manage a national health care system. Mostly for us it comes down to two factors: (1) after World War 2, America was flush and everyone had jobs with benefits, so there was no great need for the government to enter the system, and (2) our general stubbornness about being rugged individualists. The latter can be a good quality in many ways, but when it comes to creating an efficient health care system for a large country, it's a problem.

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And how pray tell, would YOU actually design it such that it delivered quality and actually was revenue neutral which was promised after "we read it". How do we get quality at cost, so we can satisfy what you would like, and what I would like? Not easy, is it? We locked in quickly to a failed system with Obamacare. Right now, where it goes I have no clue. But I really do not think it survives. So, change it for the better, or let it die from its own malfeasances. And what is the upside/downside of each? Not easy, is it?

Things sound so good in the abstract. Seattle's minimum wage raise. Whoops. A disaster in the making. Obamacare, I would guess the same. Sounds good. Plays out poorly. Even climate change...I believe absolutely in climate change, but the deal that was struck in Paris was an economic disaster for America, while a boon for China and India. Does that mean I don't believe? Heck no. Stupid negotiating? Heck yeh.

This is to accentuate that the two sides (or maybe more) must come together and negotiate what is best for all. Not your way, not my way, but a negotiated settlement.

OdontoBear66;842849495 said:

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And how pray tell, would YOU actually design it such that it delivered quality and actually was revenue neutral which was promised after "we read it". How do we get quality at cost, so we can satisfy what you would like, and what I would like? Not easy, is it? We locked in quickly to a failed system with Obamacare. Right now, where it goes I have no clue. But I really do not think it survives. So, change it for the better, or let it die from its own malfeasances. And what is the upside/downside of each? Not easy, is it?

Things sound so good in the abstract. Seattle's minimum wage raise. Whoops. A disaster in the making. Obamacare, I would guess the same. Sounds good. Plays out poorly. Even climate change...I believe absolutely in climate change, but the deal that was struck in Paris was an economic disaster for America, while a boon for China and India. Does that mean I don't believe? Heck no. Stupid negotiating? Heck yeh.

This is to accentuate that the two sides (or maybe more) must come together and negotiate what is best for all. Not your way, not my way, but a negotiated settlement.

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Well, you seem to be living in a universe where Obamacare was a disaster. In my world, it was a positive step that did most of what was promised, but was not perfect (for a host of reasons). To me that is an argument to improve it, not blow the whole thing up and return to the bad old days.

Obama roasting Trump at the Correspondence's Dinner (as payback for the birther nonsense) made Trump's testicles retract into his body cavity and led us to where we are today. Trump is like ISIS destroying iconic cultural shrines, he wants to bulldoze Obama's legacy, and then spread salt on the ground so that nothing grows there again.

Well if you mean promised by and to Dems you are certainly right. To most others a giant step backwards with ambiguities galore, and playing out fails in delivery

OdontoBear66;842849521 said:

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Well if you mean promised by and to Dems you are certainly right. To most others a giant step backwards with ambiguities galore, and playing out fails in delivery

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Sorry, but this doesn't make any sense to me. It was promised TO Dems? How's that?

And yes, of course the promises were made by Democrats. They held the Presidency and both houses of Congress, so they were pushing for it. So what? Anyway, the promises were, most broadly, that the bill would:

1. Get more people covered.
2. Stop or at least slow the inflation of costs in the health care system.
3. Not add to the deficit.

Which of these did not happen? If you are about policy, you should be able to provide hard evidence and argumentation beyond vague platitudes like the above.

sycasey;842849534 said:

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Sorry, but this doesn't make any sense to me. It was promised TO Dems? How's that?

And yes, of course the promises were made by Democrats. They held the Presidency and both houses of Congress, so they were pushing for it. So what? Anyway, the promises were, most broadly, that the bill would:

1. Get more people covered.
2. Stop or at least slow the inflation of costs in the health care system.
3. Not add to the deficit.

Which of these did not happen? If you are about policy, you should be able to provide hard evidence and argumentation beyond vague platitudes like the above.

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Guess we just look at it entirely differently. Twould have been nice to do number one on your list without unhinging the system.

Docs penalized with reduced fees (specifically medicaid), insurance companies suffer monster losses such that they drop out of program after program, costs of medical care go up, up, up, and young healthy are penalized if they don't overpay for unneeded medical care to try to balance the books.

Free care is great, but free for one has to come from somewhere. To me it was a quickly crafted disaster in the making and unfolded so. I would love some solutions to be drafted to extend care to more people but again we must be able to afford same. We weren't affordable under this plan except on the recipient end. I do not feel mean spirited and want it to explode or implode on anyone, but a better means of doing this needs to be drafted.

And yes, even make the 1% pay more, but we can't just keep hitting the 1% every time we have Obamacare problems, pension overruns, or want a bullet train to nowhere. There are limits.

OdontoBear66;842849545 said:

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.....but we can't just keep hitting the 1% every time we have Obamacare problems, pension overruns, or want a bullet train to nowhere......

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Why not? I say knock the bastards into the Top 2%. Make them feel real pain.

bearister;842849547 said:

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Why not? I say knock the bastards into the Top 2%. Make them feel real pain.

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And one day the golden goose (excuse me, bastards) died. Wow, take money from those we call bastards. Sign me up (sarcasm) were I even close to the 1%.

OdontoBear66;842849545 said:

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Guess we just look at it entirely differently. Twould have been nice to do number one on your list without unhinging the system.

Docs penalized with reduced fees (specifically medicaid), insurance companies suffer monster losses such that they drop out of program after program, costs of medical care go up, up, up, and young healthy are penalized if they don't overpay for unneeded medical care to try to balance the books.

Free care is great, but free for one has to come from somewhere. To me it was a quickly crafted disaster in the making and unfolded so. I would love some solutions to be drafted to extend care to more people but again we must be able to afford same. We weren't affordable under this plan except on the recipient end. I do not feel mean spirited and want it to explode or implode on anyone, but a better means of doing this needs to be drafted.

And yes, even make the 1% pay more, but we can't just keep hitting the 1% every time we have Obamacare problems, pension overruns, or want a bullet train to nowhere. There are limits.

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You offer no solutions. Obamacare is the compromise and it is working well in places where it has state support (At least it was until Trump stopped the subsidies). If Republicans bring it down Millenials will usher in single payer health insurance. Your generations answer of "I got mine" will not hold in the long run.

OdontoBear66;842849549 said:

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And one day the golden goose (excuse me, bastards) died. Wow, take money from those we call bastards. Sign me up (sarcasm) were I even close to the 1%.

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A few more crumbs tossed from their table could have greatly increased this crew's life expectancy:



This simply is not a sustainable business model:

http://www.vanityfair.com/news/2011/05/top-one-percent-201105

dajo9;842849557 said:

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You offer no solutions. Obamacare is the compromise and it is working well in places where it has state support (At least it was until Trump stopped the subsidies). If Republicans bring it down Millenials will usher in single payer health insurance. Your generations answer of "I got mine" will not hold in the long run.

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I'm not trying to be rude here, but Odonto's last post just seems to carry so many fundamental misunderstandings of how health insurance works, it's no wonder he has no ideas about how to solve the health care crisis. For example, this:

OdontoBear66;842849545 said:

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young healthy are penalized if they don't overpay for unneeded medical care to try to balance the books.

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I mean, really? That's how insurance works. It only works if people pay in when they are young and healthy, so that when they are old and sick there is enough money to cover their treatment. To call this "unneeded" is to basically say, "The problem with insurance is that it's insurance." It's nonsense.

Our system worked reasonably well back in the 50s and 60s when almost everyone had insurance through a large company or a labor union, which have big pools that everyone (young and old) pays into. It doesn't work so well now that we have a more "free agent" economy with people moving around, working multiple jobs without benefits, etc. (Another factor was that hospitals and insurance companies were non-profit back then . . . not by law, but by custom. Things changed when they realized they could make profits.) The answer to this problem is not to wash your hands of it and say, "Maybe it will just work out on its own." Lots of other countries have tried that. They've all wound up with either government-run health coverage or heavily regulated and subsidized coverage.

Times change, the economy changes, people change. The country needs to change with it. If your answer involves 20 million people left without health care, I'm going to say it's the wrong answer.

sycasey;842849578 said:

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I'm not trying to be rude here, but Odonto's last post just seems to carry so many fundamental misunderstandings of how health insurance works, it's no wonder he has no ideas about how to solve the health care crisis. For example, this:



I mean, really? That's how insurance works. It only works if people pay in when they are young and healthy, so that when they are old and sick there is enough money to cover their treatment. To call this "unneeded" is to basically say, "The problem with insurance is that it's insurance." It's nonsense.

Our system worked reasonably well back in the 50s and 60s when almost everyone had insurance through a large company or a labor union, which have big pools that everyone (young and old) pays into. It doesn't work so well now that we have a more "free agent" economy with people moving around, working multiple jobs without benefits, etc. (Another factor was that hospitals and insurance companies were non-profit back then . . . not by law, but by custom. Things changed when they realized they could make profits.) The answer to this problem is not to wash your hands of it and say, "Maybe it will just work out on its own." Lots of other countries have tried that. They've all wound up with either government-run health coverage or heavily regulated and subsidized coverage.

Times change, the economy changes, people change. The country needs to change with it. If your answer involves 20 million people left without health care, I'm going to say it's the wrong answer.

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And the changes are often people's choices, although not always. Forcing people to buy insurance as opposed to choosing to buy insurance?? Doesn't sound like anything I would like. I don't like your 20 million being without healthcare, but the only way it seems to happen is if it is free or subsidized and that caused its collapse. In 2013 there were 45 million uninsured, in 2017 there were 23 million. Easy to figure that one. Back track and work on real solutions, not what has failed.