Back on 2+2 I said (several times) that you’ll be able to see the tipping point in health care when Medicare can negotiate with drug companies. We’re not there yet.
MM MD
Replying to this older post because I just read a nice policy brief about Medicaid work requirements from a health policy center at the University of Washington:
Their “key points”:
- Implementation and administration of Medicaid work requirements are costly and may not save money
- Most beneficiaries targeted by Medicaid work requirements are already working but may lose coverage
- Employment is not likely to increase once Medicaid work requirements are put in place
- People living in rural areas are more likely to be harmed by Medicaid work requirements
If you’re interested you really should read the brief. Their points above are kinda couched in academic speak, but they all add up to the fact that work requirements for Medicaid are really fucked up.
Definitely screwed up. They directly contradict the purpose of Medicaid and I believe a judge or panel of judges recently said as much.
That is why these half measures all suck. Every worst part of the healthcare system is born out of compromise. We need flat M4A.
It is annoying some democratic presidential canidates don’t think that is necessary because they are absolutely wrong.
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Interestingly, that’s basically what my wife did a couple jobs ago from within the industry. She worked for an insurance broker whose clients were mostly smaller companies. Her job was to mostly advocate on behalf of the clients when they had claims issues/questions. She was so good that a) one of the clients blogged about her, and b) when her company was in talks to get bought out by a bigger one, the bigger one said that my wife needed to stay onboard as part of the deal. Clients loved her that much.
She’s still in the industry with a different company, but she’s said that she’d be willing to be out of a job if it meant everyone could get Medicare for All or whatever one would like to call it. She’s unique in that she enjoys being in the health insurance industry because she likes helping people.
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What kind of ridiculous healthcare system requires Patient Advocate as a thing.
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A totally busted broken one ldo.
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When I said the 6% of GDP we’re wasting on healthcare went a lot of places… a simply huge % of it goes directly to doctors. The AMA is the OG healthcare lobby… which is why as long as they have any influence at all there will never ever be a sufficient supply of doctors and the barriers to entry will remain stratospherically high.
Medical school should be free (along with somewhat spartan room and board) and there should be more available seats than there are people capable or willing to fill them. The government should fund it 100%. It would be an incredibly good investment that would be funded directly out of the 12% of GDP we can justify spending on healthcare.
EDIT: Just to be clear a meaningful % of doctors aren’t members of the AMA and some actively advocate against the AMA. There are lots of doctors who are actually good people leading the charge against our cancerous healthcare system. I don’t want it to seem like I’m painting them all with the same brush. At the same time physicians are some of the leading beneficiaries of the healthcare system in the US. Those benefits are nowhere near equitably distributed and some specialties are definitely profiteering way harder than others. They’re kind of like cops in this way, complete with the tribal knee jerk reactions against any criticism of their occupation being extremely common lol.
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That huge percentage is 18-20%, depending on which survey you want to use. Health care costs go up about 4% a year.
So start paying me zero $, and in 5-6 years we’re right back where we are. Except that you have no doctors, of course, because like you I don’t want to work for fuck all
We don’t need more doctors, or at least more primary care doctors, anyway - we need more NP/PA types who can manage general care for people - you can churn them out quicker and cheaper anyway. Make sure they have MD back up when they need it, and we’ll be OK. We’d then have enough spaces in med schools to train the specialist docs we’re running short on. Of course, the real gap is in RESIDENCY slots - which are funded by Medicare and the idiots in Congress have repeatedly refused to increase because taxes or something.
Change to a no fault-system for med mal, allow medicare to negotiate with drug companies like any sane system would and save another chunk of change. This stuff isn’t that hard, really. Do that, and I’ll take a pay cut.
But, yeah - the evil docs are the problem. (And I agree about the med school expenses - our new docs ROUTINELY owe 400-500K when they get out, because they have med school debt stacked on top of their undergrad debt - which is psychotic)
MM MD
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Just do whatever Germany does - with healthcare, with education, with welfare, with social security. We have similar workforces, similar mentalities. There is no universe where our plan is superior to theirs on govt’s role in social safety net.
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I’m sorry man but I think you’re too close to this.
You may be right about residency slots being the bottle neck, but no matter where the bottle neck is you’ll find the AMA’s fingerprints all over it. Who exactly do you think is behind every attemp to stop NP’s and PA’s from practicing primary care medicine?
I’m in total agreement about med mal fwiw.
Still your post is kind of a perfect example of the tribal knee jerk reaction to criticism of the profession even if you end it by admitting that the cost of medical school is crazy (again something that has the AMA’s finger prints all over it) and a major driver of costs. Like the tone and content of your post are totally different. It’s really weird.
The 6% is the difference between what the US spends, 18%, and what the next highest paying developed country pays 12%. Since we get worse results there’s no way to describe this other than waste/rent seeking. If you look at what doctors make in the US vs other places in the world you’ll notice it’s quite a bit more. That’s why so many of the doctors in this country were born and educated in other places. They went where the money was.
Here’s a shock. I think I’m fairly compensated. Maybe even a little bit overcompensated.
But yeah, if you lead with a post telling me we’re wasting a huge amount of dollars by giving it to doctors, yeah, I’m going to be offended.
In terms of residency slots, the AMA isn’t the problem, or at least hasn’t been for a long time. The problem is the feds. Our med school has been trying for over a decade to get a pediatric residency - we have MORE than enough census and clinical staff - but the slots are funded directly thru medicare and they aren’t funding any more slots. The number of residency slots has been frozen since 1996 - and for the last 20 years or so the AMA has advocated increasing them, which hasn’t happened because reasons. The AMA was evil (maybe part evil) when I was in training - but they’ve to some degree evolved over the last 20 years or so for (mostly) the better. I’m not a member, but I can see someone joining. The AMA endorsed the ACA (repeatedly) because it was the best thing around at the time, with a stated goal of achieving some sort of universal health care down the road. I think that was OK.
And this is why I generally steer clear of the Medicare for all stuff around here, because I haven’t seen a single even vaguely coherent statement from ANYONE as to what that means. I look at Bernie’s website - the topic is covered in a single page with a shitton of platitudes and bullshit. The dirty secret is that Medicare allows you BARELY to keep the lights on if you’re a hospital or doctors office. You’re not buying new equipment/hiring new staff/building more hospital beds etc. etc. - you’re JUST getting by. You lose money on every Obamacare/Medicaid patient in most states (It’s very state dependent) - but you make it up on the private insurance patients by cost shifting.
So taxes aren’t going to have to go up, they’re going to have to go WAY up to fund this stuff - but raising taxes is the third rail of politics, yeah? It’s going to have to happen, and I’m not faulting Bernie for his webpage, because (without looking) I’d be willing to bet that everyone else’s looks about the same - he’s trying to get elected. The current system isn’t sustainable - but how we get to the next one is going to be…tricky.
MM MD
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How do dozens of other countries manage?
None of the other people getting paid by the healthcare system think they are overpaid either. You literally can’t all be right. And doctors do make quite a bit more here than in other countries.
I only have a satellite view of what is actually happening on the ground in healthcare so really all I have to go off of is plumes of smoke and the occasional bright flash, but I can see that it’s absolute carnage down there.
You seem like a decent guy and I don’t wish any harm on you, but if your life has to disrupted to fix our healthcare system I think that’s an easy trade off. I say this as someone who has already had his own options in life significantly impacted by crazy amounts of suck from US healthcare.
They manage by having a functional political system which right now we don’t have.
I’m IN FAVOR OF UNIVERSAL HEALTH CARE. I just want to see a honest discussion about what we want to pay for and how we’re going to pay for it (more taxes). Which because we’re politically paralyzed, we’re incapable of doing.
Of course, the NHS, which I suppose is more or less what people think we’d like to get to, is struggling. From a Forbes article earlier this year - " Nearly a quarter of a million British patients ]have been waiting more than six months to receive planned medical treatment from the National Health Service, according to a recent report from the Royal College of Surgeons. More than [36,000 have been in treatment queues] - and one of the drivers that the Brexit weasels used to get people to vote for them was the sham argument that millions of dollars could be pumped into the NHS - so people thought they needed the $$, I suppose.
We’re going to have to pay more in taxes, or accept less services. Or something.
MM MD
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OK - disrupt my life, whatever that means. Cut my pay 20%? That buys you a few (very few) years of “stable” prices - but you’re going to get eaten alive by everything else - drugs/admin costs, mostly. I’m looking for an actual long term fix, not a minimal short term band-aid.
For starters - fix the goddam drug issue. It’s psychotic that medicare isn’t allowed to negotiate prices - that’s billions of $$ a year there. Stop letting the rest of the world free ride on Americans for drug costs - even out the playing field. Churn out a buttload of NP/PA types to manage general health care issues - they can handle 90% of stuff just fine - and free up people like me to take care of actual sick people instead of futzing around with Viral syndromes at 2am because the patient can’t see a primary provider for 3 months AND because I’m mandated by the feds to examine everyone who feels the urge to wander thru the door for nothing. I’m expensive (generally I’m the most expensive piece of equipment in the department) - use me to do the serious stuff.
MANDATE that all EMR’s integrate with each other, so I’m not repeating tests because I can’t access the stuff that the patient had done at 4:55p somewhere else and I need the results at 8pm. I deal with this crap every day, and it’s money flushed down the drain.
Stop letting insurers screw their customers by refusing claims at out-of-network providers, ESPECIALLY if they don’t have a provider in a given area - make them pay the out of network provider the same as they pay the in network, and let them compete on quality/satisfaction.
Go to a no fault med/mal system - help people when they have a bad outcome, not intermittently three years later if they are lucky enough to win a case.
And fifty other things we could do, but won’t because we’re so fucked up.
MM MD
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I’m for all of that and dropping your pay. We have to drop healthcare costs by 6% of GDP. I’m for taking 12% of GDP and saying ‘this is how much we spend on healthcare… make it fit’. Anything that doesn’t fit in the box after doing cost benefit triage gets cut immediately.
I don’t think there’s any way the numbers work doing that without you guys eating a bit of the cost. At the same time I think we probably have to do every single thing you listed as well. There are a lot of people taking money out of the system right now who add very little value. They are the low hanging fruit. Physician pay being a bit high (vs in the rest of the developed world) isn’t that low hanging. Some of these cuts are going to suck though.
If it makes you feel any better about taking a pay cut the pharma reps aren’t even going to have jobs anymore.
Nah - I’m OK with taking a pay cut if -
We get the rest of the system to take a hit too.
I just get tired of the overpaid doctor stuff.
Good luck with the 12% BTW - we’re going no where but up due to the aging population/dementia issue. Unless we’re going to start Old Yeller’in Granny, anyway.
And a LOT of the new (and effective) cancer treatments are going to drive up health costs because they’re basically custom designed immunotherapy for each individual patient - costs will likely come down as the tech improves, but I doubt it will ever be cheap, or anything resembling cheap. We’ll see.
MM MD
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Granny is going to die on a wait list… which is a feature not a bug of the wait list. One of the main drivers of wasteful medical spending is blowing mid six figure sums buying ancient people an extra six months of pain and suffering. It turns out that grieving families aren’t the best decision makers for what constitutes a good use of societies medical resources.
I wanna be really clear here: I would have liked Obamacare way better if it had actually included death panels. At least then someone would have been making a rational decision about which procedures to green light based on the probability that the procedure would make any difference at all in the eventual patient outcome.
Instead we’ve got young healthy people skipping preventative care because they can’t afford it and frequently not showing up in your office until something is really wrong. Something that would have cost a tiny fraction of what it eventually does if handled early… or just dying.