The Medical Cost No One Wants to Talk About

[terrell9584]

Doctors and nurses have a great deal of respect in our society. Given the number of misdiagnoses that are regularly made in the physciatric field (in a desire to push pills) and given that the primary method of treatment from doctors in general is to simply write a prescription it could be very well argued that they don't deserve that respect. No one wants to blame the doctors themselves for the problems in our health care system but they are a huge part of the problem.


In the United States, there are a limited number of physicians. This is because there are a limited number of medical school slots. By limiting the number of doctors two things are accomplished:

1. Pay is higher for those who are fortunate enough to get into medical school and become doctors
2. # 1 justifies medical schools charging far too much for an education due to the belief that they will be able to pay it off.


Now, the practical effect of this is that because there are less doctors the medical industry is able to get away with things that most other service providers never could. Most business could not get away with forcing their customers to have 30-90 minute waiting times. Not to mention the waits that occur when you finally do get into a doctors room. Doctors are also one of the few professions who can economically get away with refusing to see clients. Lawyers, Accountants, Salesman and other professions could never get away with it.


People trust their doctors (misguided trust) and so don't want to hear this truth but the vast majority of American doctors are nothing more than pill pushers who fight to keep well qualified people from being their competition and who, by restricting their own supply, help to drive medical costs up


If doctors had to face the same competition inherent in every other profession they would be paid less, have to compete for customers and this in effect would lower the cost of health care because medical equipment providers, drug companies and all the rest wouldn't be able to keep prices as high as they do.


No one wants to talk about it but if you really want to drive down health care costs now is the time to take on the nations medical schools and demand that they increase the number of slots.

[WhiteTara]

1. medical malpractice insurance can be as high

as $500,000 a year. If we could only regulate the ins. cos. then those costs would go down and the price of medical help would be lessened.

[demodonkey]

3. Under Single Payer, Malpractice Insurance would cost WAY less

If everyone had adequate coverage under the same "carrier" there would be no need to sue to recover medical costs.

Only, perhaps, pain and suffering and lost income etc. but the big threat of more medical bills when malpractice occurs would be gone.

[terrell9584]

4. They can only charge that

Because there are so few doctors in the first place who can afford to pay as much. The same with malpractice suits. Malpractice suits only are able to yield what they do because any doctor right now who is even half decent with his finances can attain millionaire status within 15 years of practice


The insurance companies and equipment providers only get away with what they do because of the limited number of medical school students and graduates. If you quadruple the number of practicing physicians then there will be no choice for all the other components of the medical industry other than reduce costs. If you bring price competition into the industry it will drive prices down.

[Greyhound]

7. Oh, and the other half of the insurance industry scheme,

the no-pay slow-pay game.

Changing treatment decisions to deny payment after treatment has been done or failing that, taking months (in some cases years) to pay off on patient treatments. Having half a mill floating around in an AR won't pay your staff's salaries or your mortgage.

[WhiteTara]

8. community health centers

might be the answer to that.

[SharonAnn]

9. Baloney! Costs didn't go down in states that limit malpratice payouts.

The insurance companies just added to their profit.

The biggest effect would be created by doctors pulling the licenses of bad doctors. The majority of malpractice awards (in number and dollar amount) go to a small percentage of doctors. And the good doctors know who they are, they just won't speak up. Excuses are "How would he make a living? He's got to support his family.", etc.

[WhiteTara]

20. no, they went down in states that limited

the cost of the insurance.

[JoeyT]

22. Bingo.

It's virtually impossible for a doctor to get their ability to practice revoked.
That's why I have little sympathy for the "Cost of malpractice insurance." argument.

[Zoeisright]

16. If doctors better policed each other, cost would go down.

I have seen far too many cases of malpractice where other doctors covered for the perpetrator and allowed him to go on practicing.

[avaistheone1]

2. We do need more docs.

The AMA for years have restricted the number of people who can become docs. It's time that is changed.

[SharonAnn]

10. Absolutely! This has been a problem for many, many years. ARtifically limiting supply.

That's why we see so many foreign doctors here. The need is here so there are opportunities for hem.

[polpilot]

13. Limit plumbers in the same way & it would cost $20,000 to have a toilet installed.

And then throw anybody who installs their own toilet in jail for 20 years. ANY profession could produce millionaires under the AMA monopoly.

[polpilot]

12. This is the #1 reason. DOUBLE or TRIPLE physician output. Crank 'em out.

[Greyhound]

5. Written like someone that has run into the artificial barriers of Medical profession.

You are absolutely right, good post.
:kick: & R

[area51]

6. Pretty damning

Disagree that the vast majority of doctors are nothing more than pill pushers who want to stifle competition. I would hope that most doctors would like to see more people in their profession, especially GPs who are in short supply, in that it would cause them to be less overbooked and allow them more time with their families.

[stopbush]

11. Yep. My wife just got a 2-page letter from her oncologist that was little more than

a "I need to protect my profit margin" screed.

The letter took swipes at the attempts to reform health care and informed my wife that the oncologist was closing one office, consolidating into their other office and - best of all - would not longer accept any insurance! The patient would now have to pay the doctor UP FRONT for any charges and seek reimbursement from their insurance provider. Of course, that means that many patients will have to drop the oncologist because their insurance will not approve of him as an in-network doctor.

This doctor is based in Newport Beach, CA, home of the billionaires, many of whom don't bother carrying insurance because they can afford to pay out of pocket.

The doctor is preserving his right to charge whatever he wants for his services and has decided that the best way to do that is to limit his patients to the rich and gouge them accordingly.

[undeterred]

15. Oncologists are either cold hearted assholes

or absolutely wonderful. Few in-between. I hope your wife finds someone absolutely wonderful.

[treestar]

14. That is a tough sell, because they can always argue that some of

the doctors will be substandard and insurance is high enough.

IMO the main trouble is the specialization of too much. One doctor not knowing the patient went to another and not having all the records. Have the family doc. in on all specialists' actions.

Or have more things assigned to paraprofessionals, where they are simple.

[tonysam]

17. It's all true.

I have felt this way a long time about the medical schools limiting the number of students. This is all about keeping their lifestyles intact by creating an artificial demand by limiting the supply.

It's sort of like what is done in thoroughbred racing by requiring that horses be conceived naturally and not through AI. It creates an artificial demand and more profit for the breeders.

[juno jones]

18. Yes there need to be more slots

and people who are already in dedicated health postitions like nurse practitioners need to be recruited for them.

Many slots are taken by foreign nationals who will not be practicing in the US, we need to make sure that there are adequate numbers of docs coming thru who WILL be practicing here along with adequate GP numbers.




Two things I learned from working with future docs in an IL med program

One, they are human too and can make mistakes just like the rest of us.

Two, there are three types.

The first, about 30%, are good empathetic people who got into medicine to help. They are the best. These are the ones we need to get into med schools with full support. They are meant to be docs.

the second, about 50% or so, are OK, but more attracted to the science, clinician side of things. They are OK docs, but not very empathetic. They are needed as surgeons, etc, but they wouldn't make very good GP's.

The third are the 20% only in it for money, prestige, or family tradition. They really could care less. It's all about them. There is a small subset of these which are so narcissistic as to pose a danger to patients. These are supposed to be culled out during training, but being sociopaths, they generally can manipulate their way thru anyway. I have encountered a couple of these. It was scary to think that they might go on to be docs. We need to get rid of money as medical motivation.

[northernlights]

19. HALF right; half WRONG

Universities would *happily* increase enrollment -- they need a better teacher:student ratio to bring down their costs. What limits the number of slots is *not* the lack of classroom space. It is the lack of *clinical* space in the hospitals. Training in health care includes hands-on, closely supervised, live training that can't be emulated in classrooms and labs.

I'm a Med Lab Tech student right now. The reason we are limited in my state to graduating 30 students per year is because that is about as many as the local hospitals can absorb for 5 months of 40 hour/week clinical training as we rotate through the different lab depts.

Universities could easily increase the size of the lectures, not so easily increase the size of the labs held. But what universities cannot easily change is the number and rate of students area hospitals can train.

This is what makes Bernie Sanders amendment -- to build 1350 Community Health Centers that will also serve as training centers for medical staff -- so important. That will enable more medical providers, including doctors, nurses, technicians, etc., to be trained.

And the other part of his amendment -- to increase grants and student loans to healthcare students -- is equally important.

When there are more healthcare providers available, and they haven't been forced to take on student loans the size of a mortgage, then healthcare costs will start to come down.

[WeCanWorkItOut]

21. We could be more like Italy. More doctors with lower fees. Also more Nurse Practitioners

I'm afraid that one factor making our health care worse is
the physician monopoly on basic tests.
Especially in medically underserved areas that can
lead to people doing without simple means to
prevent heart disease, for example. NPs could help there,
but in many states that's outlawed.

I'm glad that people are talking about the value of patients
having other options, to increase the doctors' commitment
to service. I'm worried that the Medicare Advisory Commission
may go in just the opposite direction, forcing many
into Medical Homes, where the doctors have an incentive
to refuse care.