I have some thoughts. 19% of the US GDP is spent on health care. It is staggeringly higher than the next highest country. So a logical question is: where does the money go?
https://www.statista.com/statistics/268826/health-expenditure-as-gdp-percentage-in-oecd-countries/#:~:text=Among%20OECD%20member%20countries%2C%20the,U.S.%20with%20distinctly%20smaller%20percentages . The medicare observation was correct. Doctors fought it tooth and nail, but it ended up making a bunch of MDs very wealthy in the 1970s and 80s because they paid well and the private insurers paid asking cost to docs and hospitals. When it became clear that this was unfair and unsustainable, we started to see medicare and insurers start ratcheting payments down. This has put pressure on independent providers in lower paying specialties like primary care. Consolidation among payors means the small docs are at their mercy for getting paid. Literally insurers wl just reject 10% of claims outright and hope that a docs office cannot pay someone to sit on the phone for two hours to sort it out. This and other administrative inefficiencies account for perhaps 15% of every healthcare dollar spent. Rates for doc payment are actually set largely by the AMA. The whole system rewards procedures of various types. This leads to wide disparities in the cost of care; unscrupulous for-profit health systems and docs can bilk the insurance/medicare system by upcoding visits systematically: https://www.google.com/url?sa=t&source=web&rct=j&url=https://www.newyorker.com/magazine/2009/06/01/the-cost-conundrum/amp&ved=2ahUKEwjKsreD5MH5AhWsKkQIHcnxASQQFnoECBAQAQ&usg=AOvVaw2B-tTctc6j_7JCvqiSMUNG But it also drives a lot of the best docs into high paying specialties that do lots of procedures. This is why finding a good primary care doc just gets harder and harder. The US imports foreign medical grads to fill primary care training slots every year, because US grads know their life is going to suck if they practice internal medicine. Your example of the cardiologist married to your internist is a great example; the internist can work part time because the cardiologist makes more than double the salary. Otherwise the internist could not live on that income. Because they cant get paid by insurance companies, literally, unless they are part of a larger network of docs, most internists go into practices that they do not own or manage. This is true in the hospital and for outpatient jobs. So most internists are working for the man. If they built up a big practice, they will get bought by a hospital network who can negotiate better rates with insurers. Hospital owned practices can also charge a lot more for the same services through a payment adjustment designed to compensate hospitals for the cost of caring for uninsured etc. So pracitces are all consolidating due to our frankly corrupt, self serving insurance system taking 20% off the top while denying doctors payment for care provided and denying patients access to needed care at the same time. The concierge model is great if you get a good doc. There are a lot of quacks out there who are financially motivated and practicing sketchy medicine but are accessible to their patients, who dont always know the doc is a quack. There are good concierge docs also. LA is full of them. In any event, the system needs to pay docs to do the right thing. If primary care paid more, more of the smartest people in medicine would do it. GPs in rural Scotland can and do make a killing, for instance, because the system values what they do. Our system tends to reward docs for operating on people and doing coloniscopies and putting in heart valves and stents, so you get smart, materialistic people doing those things and no coherent primary care provider. Until AMA changes the RVUs assigned to primary care, and Medicare pays more for those visits, this will not change. Same with the opioid epidemic; if pain management providers were paid as much for an opioid weaning appointment as they are for an epidural or facet block or radiofrequency ablation, then no one would be strung out on prescription narcotics. You get the idea. Of course hospitals get paid more for procedures also, which is part of the problem. As previously mentioned, insurance companies are a total scam, skimming 20% off every healthcare dollar. They should be limited to 3-5% as they are in Germany. Poof your healthcare just got a lot cheaper.. Medicare should be allowed to negotiate drug prices with drug manufacturers in the same way other countries and our own VA hospitals do. No reason for us to subsidize drug development for the whole world only for drug companies to sell the same drug to Canadians for 1/3 what it costs Americans. Complete graft and unpatriotic. Pigs at the healthcare trough. But we allow it, because Pharma has your congressperson in their pocket. Think about it. We already have socialized medicine. It is called EMTALA and it was brought to you by Ronald Regan: https://www.google.com/url?sa=t&source=web&rct=j&url=https://en.m.wikipedia.org/wiki/Emergency_Medical_Treatment_and_Active_Labor_Act&ved=2ahUKEwjLtoGZ38H5AhW4JEQIHZYsBxoQFnoECAkQAQ&usg=AOvVaw1i-EfrMVFLdFFYNq0o9AHB Basically a pregnant lady was refused evaluation at an ED in texas because she did not have insurance, and either she or the baby died or both. We collectively decided we are not the type of 3rd world country that lets people die on the curb outside the ED with treatable conditions just because they dont have enough cash in their pocket to pay for care they need. I think we can all get behind that. But it costs money. Hospital is required to evaluate all comers. Then either treat acute conditions or transfer to another facility who willl treat, which there arent any because drumroll.... patient has no insurance! Once you have this law, your medicine is pretty socialized. But as you all apparently realize, even though access to healthcare is equal at the ER, ability to choose a primary (or specialist) doc who is smart and answers the phone and takes good care of you is not at all equal and some types of insurance give you that and some do not. We are all equal, but some of us are just a lot more equal than others, as I think Orwell said. Anyway these are just some thoughts. The fact that american healthcare insurance is frequently tied to people's jobs and employment is another unique and not altogether great feature of our healthcare system. It is basically a big tax subsidy to a part of the population that is already better off than most. And it leaves a huge number of people in lower paying jobs completely in the lurch. Basically we don't have a more rational healthcare system because our labor movement does not have a political party. All the countries with more equal healthcare access have strong labor movements with political representation in government. Germany, UK, Australia etc. For more on why we have what we have, read The Social Transformation of American Medicine by Paul Starr: https://www.thriftbooks.com/w/the-social-transformation-of-american-medicine_paul-starr/246472/item/4795668/#idiq=4795668&edition=2402074 Anyway there is no free lunch. Disincentivizing docs performing unnecessary but very expensive and lucrative procedures with a system that rewards health outcomes rather than piecework is a good start, but the healthcare 19% GDP bathtub has many leaks and a lot of that money finds its way back to washington DC to keep things exactly as they are. If you want change, get organized and agitate for it, or donate to candidates who support your agenda. This is America. Money talks. Everybody else can f*&$ right off apparently. https://www.commonwealthfund.org/publications/fund-reports/2021/aug/mirror-mirror-2021-reflecting-poorly Basically illness and death are part of the human condition. The rain falls on the just and the unjust alike; nobody asks to get Type 1 diabetes, PEs or a heart attack or cancer. The country will be a better place when we recognize that fact and invest in programs to promote health for everyone. We can pay for it with money we currently waste on overpriced insurance, overpriced drugs and unnecessary or cost-ineffective care. The wealthy will always be able to pay for more access to more expensive levels of care, the same way they do now. https://www.commonwealthfund.org/publications/fund-reports/2021/aug/mirror-mirror-2021-reflecting-poorly My 0.02 Karl On Wed, Aug 10, 2022, 1:50 PM dan penoff.com via Mercedes < mercedes@okiebenz.com> wrote: > Some good points, Greg, thanks for the insight. > > One of my concerns when it comes to socialized medicine is more a matter > of the ability for everyone to have access to free or inexpensive medical > care. It may not be timely, which seems to be a common thread in these > systems both in Canada and the UK from my experience, but at least it’s > available to every person at little to no cost. > > I see the person serving up my burger or even my oldest son, who still > doesn’t have medical coverage through his employer, and think about how > they’re just one emergency away from bankruptcy. I took my oldest son to a > local walk-in clinic on Monday to be treated for COVID and get Paxlovid, > and the charge for the office visit alone was $135. Had he gone to my > internist’s medical practice it would have been more like $275. > Fortunately, the Paxlovid was free, but still, for someone working for $15 > or even $20 an hour $135 is a HUGE amount of money. Lucky for him he does a > good job saving and budgeting, so he had it, but how many people don’t? And > I’m not talking about people who are indigent, I’m talking about a large > swath of our society. > > There is a large contingent of Canadians that “invade” Florida on a > seasonal basis, and they hit the health care system heavily when they’re > here. My mother in law complains about how tough it is to get a doctor’s > appointment between October and April because of the influx of Canadians in > her area. > > -D > > > On Aug 10, 2022, at 4:26 PM, greg via Mercedes <mercedes@okiebenz.com> > wrote: > > > > I think if that were my dr. I would fire him. > > > > My further thoughts: it's a localized supply/demand issue. I have a > really > > good internist and a super cardiologist. I am sure either one could earn > > much more in NY or BOS. The internist's wife is also an MD and they each > > work 3 days. The cardio is a triathlete and I'm guessing enjoys the > > outdoor opportunities in the PNW. I never have trouble getting my > > appointments or meds. My D-I-L on the coast has all sorts of trouble. > > She's told her scrips are ready then they don't have any when she > arrives. > > > > WRT socialized medicine: I lived in BC for 5 years and paid for (heavily > > subsidized) BC Med. It was fine because I retained my US health insurance > > and could easily use US services if needed. BC med actually pays for > > flights into the US for some emergency services not available there, and > > many Canadians pay in the US so they don't have to wait many months for > > some procedures. I doubt that anyone who lived under socialized medicine > > would want it in the US. > > > > Greg > > > >> What do you think about doctors these days? Are they all idiots? The > >> spouse has been sick for a week, to the point she went to the ER Sunday. > >> Has a virus and very dehydrated. ER basically did nothing. Could not get > >> an IV and just gave up. Today she had a â?owellnessâ? visit with our > >> primary care doctor. She started to discuss the test results etc from > the > >> visit and the huge dehydration problem but he cut her off and said this > >> visit was only to review certain things. Basically just going over the > >> most basic items. So you are in a doctors office and they ignore a > glaring > >> illness and say you would need to make a sick visit rather than this > >> wellness visit? It would seem to this recent issue should be addressed > on > >> any visit including a wellness visit. I use the same doctor and anytime > I > >> want to ask about my neck problems, or anything related to my blood > >> thinners he doesnâ?Tt want to discuss it, only what is on his simpleton > >> agenda for the day. > >> > >> Sent from my iPhone > >> > >> _______________________________________ > >> http://www.okiebenz.com > >> > >> To search list archives http://www.okiebenz.com/archive/ > >> > >> To Unsubscribe or change delivery options go to: > >> http://mail.okiebenz.com/mailman/listinfo/mercedes_okiebenz.com > >> > >> > > > > > > > > _______________________________________ > > http://www.okiebenz.com > > > > To search list archives http://www.okiebenz.com/archive/ > > > > To Unsubscribe or change delivery options go to: > > http://mail.okiebenz.com/mailman/listinfo/mercedes_okiebenz.com > > > > _______________________________________ > http://www.okiebenz.com > > To search list archives http://www.okiebenz.com/archive/ > > To Unsubscribe or change delivery options go to: > http://mail.okiebenz.com/mailman/listinfo/mercedes_okiebenz.com > > _______________________________________ http://www.okiebenz.com To search list archives http://www.okiebenz.com/archive/ To Unsubscribe or change delivery options go to: http://mail.okiebenz.com/mailman/listinfo/mercedes_okiebenz.com
