The Terrifying Stakes Of Repealing Obamacare Without A Clear Replacement

[Tinykong]

Huh? Typically the people who dont qualify for this make more than 55-60k a year (typically the cutoff for most gov programs)

What program are you referring to? A citation would be nice.

Also, this is just another excuse trying to recover from the repeated attacks against your claim that medical care is a free market.

So, it's a "free market" because the people who have no choice can refuse care and die, or they can just take the $20k debt and throw themselves at the mercy of the Federal government's programs for some sort of subsidized relief.

Do people really believe this shit?

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You think a $185,000 salary is what needs to be re-negotiated in a $3,000,000,000,000/year industry? Sort of missing the point of attack the problem.

Work on reducing the exorbitant, crazy healthcare costs which exist because of the amount of money spent on uninsured/non-payers and the amount of money spent on futile treatment and the amount of money spent on preventable medical illness. Salaries are an effect of the market and will equalize when the market has been corrected. The percentage of a medical bill that goes to the doctor's salary... is variable depending on where the encounter takes place, but ultimately a small fraction of the cost.

Some doctors make $400k+ a year. That's extremely excessive for a profession that relies on the misfortunes of others. Their salaries are that high because of the cost of doing business, and would go down (hopefully) if costs went down.

[Tehshocka]

What program are you referring to? A citation would be nice.

Also, this is just another excuse trying to recover from the repeated attacks against your claim that medical care is a free market.

So, it's a "free market" because the people who have no choice can refuse care and die, or they can just take the $20k debt and throw themselves at the mercy of the Federal government's programs for some sort of subsidized relief.

Do people really believe this shit?

Have you been paying attention? I never said healthcare was Free Market LOL. I said single payer would be a FM system. Two totally different things.

You're rambling just to ramble now. You don't even read rebuttals clearly.

[drakensoul]

Some doctors make $400k+ a year. That's extremely excessive for a profession that relies on the misfortunes of others. Their salaries are that high because of the cost of doing business, and would go down (hopefully) if costs went down.

I don't think you're looking at the whole package of healthcare cost correctly.

As above, an appendectomy (and a GS can easily make over $300,000 a year) or a cholecystectomy, laprascopic; the Dr. fee is $1500 compared to a $12,000 procedure. The doctor's fee is 12% of the cost. Is that really where you want to target cost reduction?

[Tehshocka]

What program are you referring to? A citation would be nice.

Also, this is just another excuse trying to recover from the repeated attacks against your claim that medical care is a free market.

So, it's a "free market" because the people who have no choice can refuse care and die, or they can just take the $20k debt and throw themselves at the mercy of the Federal government's programs for some sort of subsidized relief.

Do people really believe this shit?

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Some doctors make $400k+ a year. That's extremely excessive for a profession that relies on the misfortunes of others. Their salaries are that high because of the cost of doing business, and would go down (hopefully) if costs went down.

Can you do brain surgery or have the physical capability of doing such a daunting task? People get paid for their level of services. The only thing up for discussion is how much someone is willing to pay for said service.

[Tinykong]

I don't think you're looking at the whole package of healthcare cost correctly.

As above, an appendectomy (and a GS can easily make over $300,000 a year) or a cholecystectomy, laprascopic; the Dr. fee is $1500 compared to a $12,000 procedure. The doctor's fee is 12% of the cost. Is that really where you want to target cost reduction?

Across all specialties, doctors get paid high salaries because it costs a lot of money to be a practicing doctor. Reducing their salaries by cutting the cost of being a doctor (cheaper schools, cheaper insurances, etc.) is one thing that would help.

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Have you been paying attention? I never said healthcare was Free Market LOL. I said single payer would be a FM system. Two totally different things.

You're rambling just to ramble now. You don't even read rebuttals clearly.

Single payer isn't a "free market," either. Where do you come up with this shit?

Can you do brain surgery or have the physical capability of doing such a daunting task? People get paid for their level of services. The only thing up for discussion is how much someone is willing to pay for said service.

This is a gross over simplification of what makes up a person's compensation in the medical industry. These aren't sales people out peddling paper products.

[drakensoul]

Across all specialties, doctors get paid high salaries because it costs a lot of money to be a practicing doctor. Reducing their salaries by cutting the cost of being a doctor (cheaper schools, cheaper insurances, etc.) is one thing that would help.

Intentionally myopic.

The percentage of the three trillion dollar yearly healthcare expenditure which goes into physician salaries is exceedingly small.
They make money because they bust their asses 80-90 hours a week making life-and-death decisions for peoples' loved ones.

It also takes four years of university, four years of medical school, four years of general surgery residency and typically another year or two of subspecialty training before a surgeon starts making money. For working 90 hours a week and making life-and-death decisions for people.

And the percentage of the healthcare dollar that they take is still exceedingly small. So I think your focus is a bit misplaced.

Fix the market by improving access to healthcare (insurance), improving access to preventative care, and shifting expenditure away from futile end of life care and the market will determine salary.

[Tinykong]

Intentionally myopic.

The percentage of the three trillion dollar yearly healthcare expenditure which goes into physician salaries is exceedingly small.
They make money because they bust their asses 80-90 hours a week making life-and-death decisions for peoples' loved ones.

Maybe you should focus your wage-hatred on people making billions of dollars a year for shifting money around in a few stocks.

Doctors don't work these kind of hours on average. In fact almost no doctors work more than 80 hours a week.

Sounds like someone has a hard on for the medical industry and how they are slaves to society's benefit.

[Narwal]

More a response to "anything is possible," but there are simply some people who exist inside of social circumstances which make unlikely and nearly impossible they will ever escape from it. A 45-year-old unskilled woman whose husband divorces her and leaves her with 4 children in a one bedroom apartment doesn't have the luxury of being bright-eyed and enthusiastic toward the future.

One example in a sector riddled with them. Those people, regardless of their ability to "do anything," should still be able to have a base level of healthcare regardless of ability to pay.

Again, you may disagree. I'm happy to pay a bit higher premium to equilibrate what I consider moral requirements in society. The fact that some people game the system shouldn't be the reasoning by which you decide no one gets a hand.

Certainly there are circumstances where help should be administered. The question isn't should the poor be helped with healthcare, we all (or most of us all) on both sides of Obamacare think they should. The question is how to do it.

I don't think Obamacare did it correctly. It was big, messy and it's hard to understand how some of the plans on there are even considered healthcare insurance (they're unusable when you consider the costs). It's clearly wreaked havoc on our system of private healthcare plans. I would have put in a couple of the rules of obamacare on healthcare plans (children on parents to 26, no pre-conditions, no life-time max, cross state border shopping) and let that playout a little bit in the healthcare sector to see how it affected the plans and the costs. You know, make law the "rights" to have healthcare insurance people are asking for without getting the government involved in the selling of said coverage. Then, if providers can't do this with reasonable costing plans, at least there's a real understanding from the populace why a single payer may be desirable. It will show that private health insurance cannot produce the coverage wanted by the people at a reasonable cost. The simple action of the government getting in the mix of selling healthcare plans, provides a scapegoat to the costs of adding in those new rules.

[drakensoul]

Doctors don't work these kind of hours on average. In fact almost no doctors work more than 80 hours a week.

Sounds like someone has a hard on for the medical industry and how they are slaves to societies benefit.

You're cherry-picking data so you can feel right.

You specifically referred to physicians that make 400,000 a year. The fact that a family practice doc making $120,000 a year (on the high end) works 45 hours a week is meaningless. A general surgeon or an interventional cardiologist who are on call at any hour of the night doesn't make $400,000 for working 40 hours a week selling Avon. Has anyone ever called you at 2am to emergently stick a catheter up someone's groin into their left circumflex artery to put a stent in and abort a heart attack? You'd probably have a hard on for the person who did that for you.

So decide what you're talking about before you make up associations that don't exist.

I'm talking about the overall healthcare expenditure and the percentage of it that doctors salaries comprise.

In fact, if you completely stopped paying physicians in a hypothetical world where they would still work, you would reduce the healthcare expenditure from $3,200,000,000,000 to $2,592,000,000,000.

Bravo? Maybe you're the one with a hard on against doctors? Do you boo.

Meanwhile I'd focus my cost reduction on an area that could actually make a difference. I've already mentioned the three largest.

[Roxaos]

One questions I have for people is whether or not we should stop offering medical assistance for those that need emergency healthcare but are uninsured, or otherwise have no means of paying for it.

[Tinykong]

You're cherry-picking data so you can feel right.

You specifically referred to physicians that make 400,000 a year. The fact that a family practice doc making $120,000 a year (on the high end) works 45 hours a week is meaningless. A general surgeon or an interventional cardiologist who are on call at any hour of the night doesn't make $400,000 for working 40 hours a week selling Avon. Has anyone ever called you at 2am to emergently stick a catheter up someone's groin into their left circumflex artery to put a stent in and abort a heart attack? You'd probably have a hard on for the person who did that for you.

Talk about cherry picking data so you can feel right. LOL

Also, the average salary for a family physician in 2015 was $195k. You misrepresenting this is playing into your "woe is the medical profession" trope nicely, however.

I'm talking about the overall healthcare expenditure and the percentage of it that doctors salaries comprise.

In fact, if you completely stopped paying physicians in a hypothetical world where they would still work, you would reduce the healthcare expenditure from $3,200,000,000,000 to $2,592,000,000,000.

Bravo? Maybe you're the one with a hard on against doctors? Do you boo.

Meanwhile I'd focus my cost reduction on an area that could actually make a difference. I've already mentioned the three largest.

You missed the point entirely. I prefaced my statement by saying I don't have an answer for how to solve the costs of medical care but one area is lowering physicians salaries.

They still treat people in Canada (with a better standard of care, mind you) and get paid half as much in some cases.

[hakujinbakasama]

On topic...

Look at it this way. A single MRI can run over $2,000,000. So let's say it is $2,000,000. Scans, according to google, can range from $500-3000 (making nicer numbers). So we are anywhere from 670-4000 scans needing to be done in order to break even and recoup the cost of that piece of equipment. However, we are ignoring the X number of nurses that have to be trained and qualified to operate the machine and the Y number of doctors that need to be on staff to review and evaluate any results. We aren't factoring in the rent costs either. Now, not all procedures are the same and I'd wager that many things are just spread across the spectrum to a certain extent.

I mean, holy fuck, do you know how much a Life Flight helicopter costs from a capital point of view? Fuck me man, that's a grossly expensive operation even before a damn pilot and crew are factored.

[Roxaos]

On topic...

Look at it this way. A single MRI can run over $2,000,000. So let's say it is $2,000,000. Scans, according to google, can range from $500-3000 (making nicer numbers). So we are anywhere from 670-4000 scans needing to be done in order to break even and recoup the cost of that piece of equipment. However, we are ignoring the X number of nurses that have to be trained and qualified to operate the machine and the Y number of doctors that need to be on staff to review and evaluate any results. We aren't factoring in the rent costs either. Now, not all procedures are the same and I'd wager that many things are just spread across the spectrum to a certain extent.

I mean, holy fuck, do you know how much a Life Flight helicopter costs from a capital point of view? Fuck me man, that's a grossly expensive operation even before a damn pilot and crew are factored.

Doesn't the US vastly outspend every other country in the world in medicinal services despite NOT having universal healthcare?

[Zan15]

Since you I'm assuming are actually trying to understand I'll give you the benefit of the doubt.

A satellite ER is an emergency room that then funnels people that come in to the main hospital (i.e.: JFK Medical Center has two satellite ERs in nearby towns. If Bill goes to JFK ER Boynton and the ER doc decides to admit him, the ambulance company will preferentially transport Bill to JFK Medical Center). It's not an outpatient center, it's an ER. Of course they have to give you a 'choice' to go to any hospital, but if you choose one other than theirs they will require you to pay the transport fee up front. The majority of the time, since the doctor just told Bill "You could die," Bill, who doesn't have $3000 up front, will go to whatever hospital the ambulance company takes him to. Which can be an out of network facility.

And number two is really simple, I'm not sure why you're complicating it. If you start having a heart attack and call 911, they will take you to the nearest hospital. They don't care whether it's in network or not. You might be at a friend's house, at the mall, 20 miles north eating dinner in another town, or maybe you're lucky and are at your house. Believe it or not most people do leave their houses from time to time and do end up in another hospital zone.

And I just have to say... My friend, for someone who so clearly doesn't understand how the system works and thus could very easily end up with an out-of-network bill, you sure like to peg others as "bad consumers." Sometimes people just don't know how things work. You seem to be one of those people.

Do you know the difference between observation and inpatient? Do you know how that affects insurance reimbursement?

Most policies have emergency hold harmless clauses that will pay these out of network providers and ER's at in-network benefits even though they are not part of the insurance companies network when the patient does not have the ability to "choose" at the time of service.

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I'm referring to a generic situation in which a person suffers a medical emergency, and they or someone else dials 911, and an ambulance picks them up and takes them to an ER for emergency medical treatment. They have absolutely no choice in where they are taken, they simply go to the closest facility that is able to treat them, and if they don't have insurance that is accepted at that facility, they will wind up being balance billed in some states for the difference.

My example was just to illustrate that is it possible to be balance billed by a hospital, even when that hospital is in-network, because not all the physicians who are employed by a hospital accept the insurance that the hospital does.

if you are in an in-network facility, and they utilize out of network providers most, if not all, insurance plans/carriers have hold harmless clauses that will pay these providers at your in network level of benefits. i.e the anesthesialogist who comes in while you are being cut open will be paid at your in-network even though almost all fo them in the country are never contracted with insurance companies because they have a de-facto monopoly.

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You're absolutely on crack if you think most insurances pay 80% out of network cost. 80% is what Medicare pays and what other insurances use as a basis for their in-network cost. And you're delusional if you think that patients don't get a bill for the full balance once their insurance rejects the claim. And bringing it back to the earlier discussion, remember the massive number of uninsured who always get a bill for the full amount and almost never pay it?

Do you even know what average hospital bills are? What the GLOS for, say, an admission for acute exacerbation of systolic heart failure is? What the mean LOS is? How much the DRG payment is? How much the bill is?

What about a 5 day stay for a viral syndrome with 5 CBC/BMPs, a CT abd/pelvis with contrast, and a 1u PRBC transfusion. Any idea what the cost would be at an average inner city hospital? So you can then guess at what the cost to the patient would be -- do you know what the average out of pocket maximum is?

Again, the point is that people are charged out of network all the time, and saying it's a failure of 'personal responsibility' shows how little you understand the process. But if you want to shift it to a numbers game, I do it every day.

which points to a huge problem. The difference between the set rates of medicare/medicaid vs what the hospital actually bills insurance and non insured patients.

when a patient walks in with no insurance they are hit with the full bill because a hospital has spent years marking up their charge master to make it look like they are getting pennies on the dollar from medicare, medicaid and private insurance companies. They feel this will further their cause in negotiations and appeals on their rates in the following years. They can't bill medicare 900 dollars for a pill and Joe Mr uninsured 9 dollars, not unless they want a full medicare audit and investigation.

so when that poor fella with no insurance walks in, he is screwed unless he knows he can sit down and either try to negotiate a lower rate post service or get an non profit organization to try to help him reduce his bill.

its a broken system from the top down.

[drakensoul]

You missed the point entirely. I prefaced my statement by saying I don't have an answer for how to solve the costs of medical care but one area is lowering physicians salaries.

Maybe I'm not posting in English? I thought saying "The fact that a family practice doc making $120,000 a year (on the high end) works 45 hours a week is meaningless" pretty obviously included a reduced work schedule, since someone making $200,000 a year isn't working 45 hours a week.



I'll stand by what I said:

You can stop paying physicians entirely and reduce the healthcare expenditure from $3.2T to $2.6T.

Or you can cut physician salaries in half and reduce it from $3.2T to $2.9T.

If you think that's a good way to reduce healthcare costs, I'm glad you're not the one making the decision. Seems to me a better idea to target the three most overspent areas of healthcare: End of life futile care, preventable diseases, and uninsured-related price increases.

But what do I know? Apparently I can't even post in understandable English. Maybe you'd prefer Spanish?

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its a broken system from the top down.

Yes. And one that will take a lot of time and tolerance to change. Unfortunately the administration we've elected appears to want to work backwards.

[Zan15]

The poor have benefited at the price of the middle class. Do you think that the poor who do not pay for healthcare should have access to healthcare before the middle class who are actually paying for it?

The people who lost it, are the people who were paying for it and now can't afford it.

Guess by this logic we should kick the disabled off medicare too.

how dare the disabled get healthcare at the cost of the non disabled. Do you think the disabled who do not pay for healthcare should have access too healthcare.....etc etc


what about widows whom have never worked.....screw them too!!!

hey its the middle class that keeps voting these aholes into office that keep taxing them instead of taxing everyone equal and taxing the rich at all....

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Maybe I'm not posting in English? I thought saying "The fact that a family practice doc making $120,000 a year (on the high end) works 45 hours a week is meaningless" pretty obviously included a reduced work schedule, since someone making $200,000 a year isn't working 45 hours a week.



I'll stand by what I said:

You can stop paying physicians entirely and reduce the healthcare expenditure from $3.2T to $2.6T.

Or you can cut physician salaries in half and reduce it from $3.2T to $2.9T.

If you think that's a good way to reduce healthcare costs, I'm glad you're not the one making the decision. Seems to me a better idea to target the three most overspent areas of healthcare: End of life futile care, preventable diseases, and uninsured-related price increases.

But what do I know? Apparently I can't even post in understandable English. Maybe you'd prefer Spanish?

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Yes. And one that will take a lot of time and tolerance to change.

You keep fighting against cuts to physicians as if a few hundred billion dollars in savings is not worth going after. Every part of the healthcare system is riddled with profit that needs to be cut.


http://fortune.com/2016/06/10/obamac...-from-soaring/

the issue is doctors pay and profit is climbing at a rate much faster then other wages, inflation and most of the healthcare industry.

doctors' pay, a category that accounts for 22% of all U.S. healthcare spending.

savings has to come from the whole system not just parts you don't work in.

On average, family doctors got a $27,000 raise in the past year, from $198,000 to $225,000, for a 13% increase. Doctors in the two other primary care categories, internal medicine and pediatrics, also had great years. Each garnered 15% bumps to $237,000 and $224,000

general surgeons at $378,000 up 12%; dermatologists at $444,000. also up 12%; urologists at $471,000, up 14%; OB/GYNs at $321,000, up 16%; otolaryngologists at $403,000, up 21%; and non-invasive cardiologists at $493,000, which have seen their pay rise more than 30% above what they have been paid on average over the past three years. Orthopedists and invasive cardiologists also got inflation-beating increases of 4% and 5% respectively. On average, both specialties pay well over $500,000 year in salary alone.


and people wonder why their premiums are going up.


do they deserve good pay for what effort they put in. Yes. But at this point its getting out of hand.



three most overspent areas of healthcare[/i]: End of life futile care, preventable diseases, and uninsured-related price increases.

Not even close to the top 3. they are big problems but are dwarfed by:


Personal Health lifestyles
Waste (middleman administrative waste, over utilization of unneeded services-Defensive medicine, inefficient doctors/facilities, etc)
Excessive PROFIT.

[drakensoul]

Posting a bunch of big-sounding numbers is meaningless when you're talking about a sector trading in the trillions. Equivalent to posting graphs which are horribly under-scaled to make things look impressive.

If you correct the underlying systems (with a single-payer system with universal access), salaries will equalize accordingly. Making even a 40% cut to something comprising 22% of healthcare costs is, as I've already shown twice, a relatively low number.

3,200,000,000,000 - 422,000,000,000 (cutting salaries by 40%) = $2,780,000,000,000

So again, if you want to spend your time cutting salaries like it's going to make a big impact in health expenditures, you're going to be disappointed. A 15% reduction by cutting salaries by 40%. And since they're not going to get cut by anywhere near 40%, the reduction by a realistic cut would be even less impressive.

I'm actually fine with salaries going down because I think that will happen organically once the healthcare system itself is corrected, but saying that directly targeting salaries and reducing them will fix anything is bogus.

And yes, those are the three most overspent areas of healthcare. Personal health lifestyles is preventable diseases, by the way. Unless you've got data proving otherwise?

[Zan15]

Posting a bunch of big numbers is meaningless when you're talking about a sector trading in the trillions.

If you correct the underlying systems (with a single-payer system with universal access), salaries will equalize accordingly. Making a 20% cut to something comprising 22% of healthcare costs is, as I've already said twice, a relatively low number.

3,200,000,000,000 - 422,000,000,000 (cutting salaries by 40%) = $2,780,000,000,000

So again, if you want to spend your time cutting salaries like it's going to make a big impact in health expenditures, you're going to be disappointed. A 15% reduction by cutting salaries by 40%.

I'm actually fine with salaries going down because I think that will happen organically once the healthcare system itself is corrected, but saying that directly targetting salaries and reducing them will fix anything is bogus.

And yes, those are the three most overspent areas of healthcare. Unless you've got data proving otherwise?

You keep talking like physicians will be the only cuts that will happen, or the only cuts that people want to happen.


if i cut X by 20%, then cut Y by 20%, then cut Z by 20% then cut AA by 20%....now the whole system just took a 20% cut. that's 600 billion dollars minimum.


.those "meaningless" numbers start to seem meaningful.


The data for overspent/waste in the healthcare industry is everywhere and maybe its just how one classifies what is each category, i am not going to split nails with you on which is the top 3 vs the next 3.

i've been in the industry for over 25 years, top 3 or top 10 there is at least a trillion dollars on the table that could be saved and sorry that includes YOUR salary, and MINE. More so it would have an even bigger impact on my job and salary then yours.

[drakensoul]

These are interconnected systems that will all change--including reductions in physician salaries--as the underlying system changes.

The reduction to the healthcare expenditure by cutting physician salaries by 40% would be less than 15%. It is what it is. If it comes with some loan payback assistance I'm fine with it.

Some say splitting hairs, some say actual data. And I really couldn't care less about how big and rich you are

[Zan15]

These are interconnected systems that will all change--including reductions in physician salaries--as the underlying system changes.

The reduction to the healthcare expenditure by cutting physician salaries by 40% would be less than 15%. It is what it is.

Some say splitting hairs, some say actual data. And I really couldn't care less about how big and rich you are

of course, if we go to single payer type system or a medicare system you will see major cuts in doctors salaries down to the level of medicare/Medicaid reimbursements. Those are not pretty numbers for most specialties in most states.


Bigger impact as far as job loss and salary % cut, i make no where near a doctors salary.....that was not what i was going for.
i am not a doctor or an high paid employee by most standards.