mac said:
Thats quite a plan Loki, how long have you been holding on to that? You make a good point with the 5 dollar co-pay, it really is outrageous to pay that little. I'm really not sure you could implement your idea, one of the problems today seems to be that the costs have inflated so much. You're a med student so you know how a insurance company will agree to pay the doc a third of what he's entitled or else they stop refering him patients.
I conceived of such a plan about a year ago, after reflecting on the pertinent issues and trying to figure out the most equitable and just way to do things. I'm sure I'm not the first to think of or propose such a plan, because it's not exactly rocket science.
As for rising costs:
The bulk of our nation's rising expenditures on health care stem from two unrelated issues: defensive medicine and the attempt to recoup costs (I alluded to this in my prior post). First off, defensive medicine-- which has become the protocol due to the outrageous tort system in this country-- exacts an
enormous price from consumers. Briefly, "defensive medicine" is the term for a mindset whereby a physician does
everything possible in the diagnosis and/or treatment of an ailment,
even if their training and expertise does not indicate that such tests or procedures are medically necessary. The litigious climate of our nation has forced doctors into a siege mentality, where they have to cover all
possible scenarios in order to elude the ever-looming specter of a lawsuit which could ruin the career they've spent decades building at great cost to themselves. I'm not a medical student (yet
), so I'm not sure about the specifics, but you can find stories about such cases all over various physician forums on the web. So, let's say you come in with a specific complaint and the doctor-- due to his training and experience-- believes it to be ailment "A" (and, in 99.9% of cases it
would be ailment "A"); instead of acting upon that educated belief, however, he orders a battery of expensive diagnostic tests to be done on you (CT scans, ECG's MRI's etc.)
just in case your situation happens to fall within that .1% spoken of earlier. The physician does this to cover his ass, basically, because rapacious medical "malpractice" attorneys have no qualms about bringing spurious claims to court (independent arbitration panels composed of physicians, judges, and attorneys found that upwards of 85% of all lawsuits brought are not meritorious; i.e., they have no sound basis in medical or scientific fact and exhibit no negligence-- in addition, 85% of cases that go to court are found in favor of the physician/hospital; this should tell you something about the state of our legal system vis-a-vis "malpractice", but I digress...)
In any event, just do the math-- an MRI typically runs anywhere from $700-1000 (some of that is cost inflation due to the next issue I deal with below). Multiply such scenarios by thousands upon thousands of patients, and you can easily see where our dollars are going. If you actually speak to physicians (obviously a group with vested interests in this instance, but that doesn't make everything they say untrue), they'll uniformly assert that the costs of defensive medicine in this nation have been astronomical, and they will
continue to be until physicians are allowed to do their job to the best of their abilities in good faith with their patients, and not have to worry about losing their livelihoods for honest (and usually non-negligent, see my 85% statistic) errors or, worse, merely "bad outcomes". People nowadays tend to think that if something bad happens, it must be the doctor's fault. Well, sometimes (< 15% of the time), sure...but most times not. Bad result != bad doctor. But anyway, the point has been made about the costs associated with defensive medicine.
And that isn't even the half of it. Allow me to share with you an anecdote:
I volunteered in a hospital this summer, and the first day, the clerk was running me through some routine clerical stuff; so she hands me this huge binder with literally
hundreds of pages in it divided into various sections. So I inquired, "are these the files for all the patients in the unit (one of the geriatric wings; 30-40 patients)? She said, "no, those are for Mrs. Miller". That unwieldy monstrosity was for
a single patient! Reams and reams of pages of lab reports, progress evaluations by doctors and nurses, vital stat indices-- all updated twice daily or more, all needing to be printed, sorted, and appropriately filed. I was flabbergasted. So one day when I was speaking to the nurse manager (a 25 year veteran), I remarked about how stunned I was about the level of documentation they had for each patient, and she said to me, "you know why, right? Lawsuits." She said that this "paper explosion" occurred within the last 10-15 years, unsurprisingly right around the time when huge insurance companies started to hold increasing sway among the populace and at hospitals, and also when the current malpractice demon was birthed. Obviously, the medical staff needs to be apprised of all information relevant to the care of their patients, but trust me when I tell you that when you see it in person, you'll know that something is horribly, horribly wrong.
As you can see, the costs of defensive medicine manifest themselves in myriad ways, both visible and hidden.
The other primary issue related to soaring expenditures is the issue of physicians and hospitals trying to recoup costs by any means possible. In order to fully understand this, we must examine several facets of the issue...
First among these is the role that insurance companies play in this whole fiasco. Declining reimbursements (unjustified, mind you) from the major insurers in this country (Medicare/caid, Blue Cross etc.) have compelled healthcare providers to increase their billing so as to stay solvent. In a perfect world, that $1000 MRI may cost only $600-- the only reason they charge $1000 to your insurance carrier, as seen on your statement, is because they know full-well that they're only going to be reimbursed a cool $300-450. For private physicians, as opposed to labs, the situation is even more dire; doctors are often reimbursed only
20-40% of what they charge for office visits (for a truly disturbing-- if a bit hyperbolic-- read, see
this page, written by an actual physician).
As a result of declining payouts, physicians have resorted to "rapid-fire" medicine, churning out patients in private practice at sometimes alarming rates-- it's no coincidence that the level of "customer satisfaction" with our medical system is at an all-time low, and it's not because doctors are any worse, or less caring, than they used to be. Think about when you go to your family physician-- you'd like, at the minimum, 15 minutes with him or her, would you not? That would seem to me like the bare minimum needed to assess, diagnose, and discuss treatment options with the patient, as well as tend to the necessary (and ever-increasing) documentation. So say your doctor sees 4 patients per hour (and that's moving very briskly, mind you); he gets $30 or so from each of them (less under many coverage plans, and next to nil from medicaid)-- well, he just made $120/hour. "That's great!", you say....well, not so fast. Plumbers, carpenters, and electricians all make upwards of $100/hour, and your mechanic can easily make that much per hour on any given day. But still, let's look past the
flagrant injustice of a situation where a plumber or electrician is making anywhere
near what a physician is making, and assume that it's a reasonable amount (which, everything else being ideal, it would be-- but here's where the snags come in). Now, what about fixed costs such as renting the office, hiring and paying staff, utilities, purchasing supplies such as syringes etc., as well as the average physicians' typical $160K-200K in med school loans that they have to repay. Oh yeah, whoops-- I almost forgot to mention the malpractice insurance physicians are required to carry, which ranges from $30K-$140K+ per year for some specialties. Pretty nuts, huh? The plumber, electrician, or mechanic have none of these (with the exception of the garage for the mechanic).
Now who's coming out on top? This is not to argue that physicians should make the most money out of ANY occupation, but such an unjust state of affairs as described above-- which is
increasingly common in primary care especially-- cannot in any way, shape or form be defended imo.
But this is becoming somewhat unfocused, so allow me to bring it back to the original aim, which was to elucidate the reasons for rising costs:
In clinical settings of all sorts-- private offices, hospitals etc.-- practitioners and institutions attempt to recoup the costs incurred by both patients with insurance policies with cruddy reimbursement rates as well as patients (such as who come to the ER especially) who simply DO NOT pay regardless of what their bills are (and this is legal, as I explained in my first post to MAF). If they see a cash-paying customer, it's like blood in the water, and this is an unfortunate byproduct of an incredibly flawed system. Hey, we all have horror stories of horrid overbilling-- my aunt stayed in a hospital room for
4 nights, with no TV or anything, and the bill (just for the ROOM, not for tests, procedures etc.) came out to
$25K. Now, I can stay at the finest hotels in the world for much less than $6250 per night, I'll tell you that much; so what's going on, you say? Well, all I can ask is that you read this post thoroughly, and think a bit on these things.
This is not to imply that some physicians or hospitals are not greedy-- either now or in the past-- because there are certainly bad apples in every group. But realize this: despite supposedly "soaring expenditures",
physicians' salaries have remained relatively stagnant (look it up), and in some cases (mostly primary care such as FP's and pediatricians) have actually
declined precipitously when adjusted for inflation. Hospitals are closing left and right, despite the fact that more money is circulating through the system now than at any point in our history. Where is the money going, you ask? Well, besides the obvious answers of "the insurance companies and the lawyers", realize that since the managed care explosion in the early-mid '90s,
administrative costs have increased over 500%-- this includes added paperwork as well as hiring additional staff and managers who do nothing but deal with the monstrous bureaucracy that medicine has become, both in private practice and in hospitals. I don't know about you, but if money is being sucked out of my pocket into the system, I'd like it to go to the people who, you know,
actually provide the care-- the doctors and nurses. Not to some lawyer, or some MBA grad insurance company rep., or to some hospital "administrator" making $250K/year. But maybe that's just me. People always have this illusion of "rich doctors", and obviously most are not starving and a great many make an excellent living by anyone's standards; I would argue, however, that they are currently not being paid commensurate with their training and expertise and the realities of their profession which they have to deal with on a day-to-day basis. Before anyone crucifies me by pulling up the average physician salaries relative to the national median, allow me to ask where everyone's ire is for attorneys, accountants, successful electricians or plumbers (many of whom earn upwards of $170K here in NY, believe it or not), or investment bankers, hedge fund managers and other speculators, or CEO's-- all of whom make livings
grossly disproportionate to the amount of schooling and training they've endured and who, on top of all that, largely engage in ignoble, soulless, and unproductive endeavors which do not benefit society and people's lives in any meaningful way (yes, I'm generalizing and embellishing a bit, but I feel that it holds in general-- indulge me a bit
). Why is everyone quick to pick on physicians? I feel that it's an untenable opinion, personally. And, just so you know, doctors aren't the only profession that I feel is getting a bum rap, compensation-wise-- I feel that MANY professions (Ph.D's in any field, for one) and jobs (see: cops, teachers-- the good ones, at least) deserve the benefit of more adequate remuneration. Please don't look upon my remarks and see them in some vacuum, or, worse, as some binary "physicians vs. the world" thing. I'm
far from that way as a person.
Well, I've veered off on several tangents, and I haven't spoken fully on all the points I was hoping to get to, but I start classes tomorrow, so it'll have to wait.
How do we fix all this? Well, I feel that a great place to start would be to implement a plan similar to the one I proposed above. In addition, the broken tort system in the US needs to be reined in, preferably by independent review panels comprised of physicians, judges, and attorneys who would serve as a filter against frivolous claims-- this would still allow victims of legitimate negligence to have their day in court and seek damages; the insurance demon also needs to be slain, though I didn't have the time to delve too deeply into the injustices they inflict upon healthcare providers (and worse, upon their own subscribers via refusal of payment for necessary treatments at inopportune times etc.) More than anything, however, I feel that people need to be educated as to the present realities of the system and what can be done to ameliorate the situation. And before anyone points out that I intend on going to medical school, and that I therefore have a vested interest, allow me to state-- in all honesty-- that I've felt this way and had these exact same thoughts for
many years before I even had an inkling that I wanted to endeavor to become a doctor (which I first realized about 2 years ago). So my thoughts and opinions are not as biased in that regard as you may care to believe, though I can only offer my word as to this much.
PS: Dice, I'm not defending anything your doctor may have done to you, because it sounds like it was a blatant money-grab, from the side of it you presented (your doctor might obviously have a different take on things, though). But please try to see past the bad actions of the few and understand what realities may have led them to do such things, given your status (i.e., uninsured)-- particularly in light of what I've explained above about recouping costs. Most physicians aren't out to "screw you", and I'm sure you know that. All we can do as consumers is educate ourselves about the relevant issues and try to effect change in whatever measure we can; to that end, I hope this post helped you see some things that maybe you didn't realize before.
PPS: Sorry about the length, but it would have been about twice as long if I didn't have class at 8 AM tomorrow. You lucky bastards, you.
