Why is Medicare for all bad? (1 Viewer)

[Sand]

No it was a US study specifically. However as Scientific American reported the top 20 selling drugs cost 3 times as much in America as they do in the UK for one example.

I was hoping as part of the ACA that a liberal administration would manage to do something here.  Allowing reimportation being the easiest solution (probably along with a grace period so that pharma could recompete those foreign contracts).  It burns that we subsidize the world here.  Sadly the administration caved here and we have what we have.  It's the biggest abject failure in the creation of the ACA IMO.

If we had real markets and the FDA didn’t grant monopolies to pharmaceutical cos. prices would fall dramatically over night. 

The FDA doesn't grant monopolies.  The Patent Office does.  And, typically, by the time a drug gets through trials much less than the 20 year period is left.

 

[NCCommish]

I was hoping as part of the ACA that a liberal administration would manage to do something here.  Allowing reimportation being the easiest solution (probably along with a grace period so that pharma could recompete those foreign contracts).  It burns that we subsidize the world here.  Sadly the administration caved here and we have what we have.  It's the biggest abject failure in the creation of the ACA IMO.

The FDA doesn't grant monopolies.  The Patent Office does.  And, typically, by the time a drug gets through trials much less than the 20 year period is left.

Yeah drug price negotiation was something I was looking for as well. And the average time is 8 years from patent to market.

 

[The Z Machine]

Medicare for All is not bad.  However implementation would have challenges.  Almost all of these challenges are political in nature with voters generally afraid of changes and the accompanying implementation challenges generally preferring to complain about current challenges and gripe that nothing ever changes.

I disagree.  There are huge policy, bureaucratic, and system level burdens to implementation of MCfA across the entire USA.  These are not political challenges.  We have a highly splintered system with a lot of infrastructure in place to do it differently.

That said.  We should still do it.

 

[jonessed]

Medicare is heavily subsidized by private insurers.  If you get rid of the private piece Medicare costs would skyrocket.  The result wouldn’t look like Medicare as we know it.  They would have to find ways to drive costs down.

The fight would be over what Medicare would change to.  It would likely be better for some, worse for others.  Calling it Medicare for all is disingenuous.  It would end up as something entirely new.

 

[CletiusMaximus]

Do people think when they deal with United Healthcare, Aetna or Cigna that it's unicorns and rainbows? It's a time consuming, bureaucratic slog with them too.

It's anecdotal thoughts like these that do a great disservice to progress. Medicare customer satisfaction rates are over 90%. Let the private companies offer Medicare supplemental plans that cover more costs/offer additional benefits, like they already do. 

The ACA was expected to reduce Medicare Advantage Plans' ability to compete and reduce enrollment, but its growth has increased and now over a third of all Medicare beneficiaries go through private Part C plans. More and more insurers are jumping in, creating competition, lower rates, greater benefits. Obviously the population of eligible beneficiaries is increasing, so its a competitive market. I work with Humana and UHC on these plans, and both are expanding their markets significantly. If the beneficiary can work with a somewhat restricted network, they typically get lower rates and broader services than Medicare can provide.

 

[NCCommish]

I think you'd see Medicare payments go up some as part of the deal. Not anything like private insurance but rates would increase.

 

[jonessed]

This is what medicare already does better than any private insurer. It's called "here's how much we'll pay for this, accept it or don't" and the companies do because it's still profitable for them. 

Private companies wouldn't do business with people who are on medicare if it wasn't profitable for them. Yet almost all of them still do. And if it was an even bigger piece of the pie, you can bet they'd continue doing business with people who are on medicare. 

Of course they would.  They use the volume to drive down costs on the aggregate.  They make their margins on the private insurers.  If you put everyone on Medicare their margins would get slashed.  Medicare prices would have to increase, services would have to be cut, or delivery would have to become more efficient.  Probably a combination of all three.

 

[Bottomfeeder Sports]

I disagree.  There are huge policy, bureaucratic, and system level burdens to implementation of MCfA across the entire USA.  These are not political challenges.  We have a highly splintered system with a lot of infrastructure in place to do it differently.

That said.  We should still do it.

The infrastructure challenge is that Medicare outsources much of it's payment of claims to companies (maybe organizations would be a better word) that would otherwise go out of business if they stopped insuring members themselves.  But otherwise the challenge would be what to do with all of those that fill billing offices and sell support services when they are no longer needed.  But that debate is a political challenge.  

 

[Bottomfeeder Sports]

The administrative burden that we would impose on providers-

https://www.ncbi.nlm.nih.gov/pubmed/21813866

We estimated physician practices in Ontario spent $22,205 per physician per year interacting with Canada's single-payer agency--just 27 percent of the $82,975 per physician per year spent in the United States. US nursing staff, including medical assistants, spent 20.6 hours per physician per week interacting with health plans--nearly ten times that of their Ontario counterparts. If US physicians had administrative costs similar to those of Ontario physicians, the total savings would be approximately $27.6 billion per year. 

CONCLUSIONS:

A simplified financing system in the U.S. could result in cost savings exceeding $350 billion annually, nearly 15% of health care spending.

 

[jonessed]

That isn't at all how it works. Nobody loses money on every transaction but makes up for it on volume. That's not how math works. Device companies have a reimbursement schedule with every insurer they work with. They aren't required by law to work with any insurer, and if they decide a particular insurer isn't profitable for them, they simply don't.

I was working in medical device sales when the ACA was being negotiated. We were concerned that the reimbursement rates would change to the point we wouldn't partake in those markets any longer. There is no "well, it's ok if we lose money over here because we're making it in this other place" involved. If any insurer wouldn't reimburse enough for us to profitably operate, we wouldn't work with them. 

I worked primarily with CVA/Dementia patients. Primarily elderly. Medicare was a *substantial* part of what we did. It was profitable, though I was always disappointed, because my commission was a lot lower on Medicare reimbursed devices. 

They aren’t losing money on all transactions.  They are losing money on some of the transactions (Medicare).  How much money and how they are losing it is going to obviously depend on the facility and the location.

We are talking medical facilities here.  They have huge overhead.  If you spread the fixed costs out losing money on the Medicare may not matter.  It’s better than sitting idle.  Those fixed costs aren’t going away.

 

[Tom Skerritt]

My aunt who is a very compassionate person (highly involved in helping the lower income in her community and highly involved with her local church's efforts) and a lifelong Democrat said last Thanksgiving that she is more satisfied with Medicare than she has been with any health insurance she carried while she was employed.  I said we should expand it to everyone, and she surprised me in how adamantly she was against it because it would create longer wait times to get treatment.  It seemed so out of character for her that she was more concerned that her Medicare stay the same than expand it so that everyone has affordable access to basic care.  I'd imagine there are millions more like her in this country.

So your aunt is incredibly selfish?

 

[zoonation]

By the way I was interested in looking at doctor pay in a single payer system. Since the Canadian system seems like the closest to what is being proposed I compared family practioners from both countries.  In America they make slightly less than 190k and it is the lowest paid sector. In Canada family practioners make over 220k. Of course other specialties make more for instance Opthamalogists make over 400k.

This idea that Medicare for All would make doctors paupers seems overblown at a minimum. 

lots of doctors in Canada supplement their income by owning private clinics.  they are not hurting, let's just say that.

we have a two-tiered system in Canada.  health care is free for all.  but you can pay extra for Cadillac care.  I am a member of a private clinic.  If I want an MRI, I get it in days.  If Joe blow wants an MRI, and it is non-emergent, poor Mr. Blow could wait 6-18 months.

Now, that is not true for emergent care.  Everyone gets in asap according to triage score.  And, no bill when you leave!

 

[The Z Machine]

My aunt who is a very compassionate person (highly involved in helping the lower income in her community and highly involved with her local church's efforts) and a lifelong Democrat said last Thanksgiving that she is more satisfied with Medicare than she has been with any health insurance she carried while she was employed.  I said we should expand it to everyone, and she surprised me in how adamantly she was against it because it would create longer wait times to get treatment.  It seemed so out of character for her that she was more concerned that her Medicare stay the same than expand it so that everyone has affordable access to basic care.  I'd imagine there are millions more like her in this country.

I really don't care about them not being happy that quality health care is available to all, even if they are generous and caring in a million other ways.

 

[NCCommish]

lots of doctors in Canada supplement their income by owning private clinics.  they are not hurting, let's just say that.

we have a two-tiered system in Canada.  health care is free for all.  but you can pay extra for Cadillac care.  I am a member of a private clinic.  If I want an MRI, I get it in days.  If Joe blow wants an MRI, and it is non-emergent, poor Mr. Blow could wait 6-18 months.

Now, that is not true for emergent care.  Everyone gets in asap according to triage score.  And, no bill when you leave!

Why does one just want an MRI? I have never just said seems like a good day to get an MRI. Seems like an expensive lark. 

Still in my version of MFA private insurance and hospitals would.exist for those who want them.

 

[jonessed]

Why does one just want an MRI? I have never just said seems like a good day to get an MRI. Seems like an expensive lark. 

Still in my version of MFA private insurance and hospitals would.exist for those who want them.

 

When you have “x” symptoms odds are you have {a b c d}.  If “d” happens to be really bad, but highly unlikely the doctor might want to wait to wait and see how things progress.  Me?  I would prefer to know before then so, if I can afford it, I pay more money.  I get the MRI done early.

 

[NCCommish]

 

When you have “x” symptoms odds are you have {a b c d}.  If “d” happens to be really bad, but highly unlikely the doctor might want to wait to wait and see how things progress.  Me?  I would prefer to know before then so, if I can afford it, I pay more money.  I get the MRI done early.

I'm going to go out on a limb and guess you could rule a,b, and c fairly quickly. I have never presented symptoms and been told let's just wait a while and see what happens . Tests are done.

 

[jonessed]

I'm going to go out on a limb and guess you could rule a,b, and c fairly quickly. I have never presented symptoms and been told let's just wait a while and see what happens . Tests are done.

No, they aren’t.  There’s a big difference between even a Kaiser and a PPO.  Surgeries and tests are delayed.

From a system perspective a lot of the decisions make sense, but from an individual perspective they may not.

 

[roadkill1292]

You know, the Canadian guys don't even come into these threads any more. They probably think we're batpoop crazy to still be having an argument about the superiority of socialized health care.

 

[Grace Under Pressure]

The ACA was expected to reduce Medicare Advantage Plans' ability to compete and reduce enrollment, but its growth has increased and now over a third of all Medicare beneficiaries go through private Part C plans. More and more insurers are jumping in, creating competition, lower rates, greater benefits. Obviously the population of eligible beneficiaries is increasing, so its a competitive market. I work with Humana and UHC on these plans, and both are expanding their markets significantly. If the beneficiary can work with a somewhat restricted network, they typically get lower rates and broader services than Medicare can provide.

Agreed. The Medicare Advantage plans are competitive and beneficiaries are highly satisfied with these plans also, which are offered by private insurers. There is competition within MAPD plans, and competition because beneficiaries can also go with Original Medicare plus a Med Supp plan if they want (also offered through private insurers), and add on a standalone PDP for drug coverage.

But that's the key. Those Medicare beneficiaries can always opt for Original Medicare only as an option. In the world of Employer based coverage 26-64, there is no "public option" that is offering that basic alternative for all Americans, and there should be.

What I advocate is that everyone should be on Medicare to start, and then employers or individuals can choose to add supplemental coverage through a private insurer. Or, through a Medicare Advantage plan, as you mention. But currently, there is no option like that for 26-64 year-olds. In fact, I'm basically advocating making your option above available for everyone.

 

[zoonation]

Why does one just want an MRI? I have never just said seems like a good day to get an MRI. Seems like an expensive lark. 

Still in my version of MFA private insurance and hospitals would.exist for those who want them.

You know, to see if there is underlying damage.  Identify the issue with my chronically sore knee.   Not that I have one, I’m a footballguy.  Obvs 

 

[zoonation]

You know, the Canadian guys don't even come into these threads any more. They probably think we're batpoop crazy to still be having an argument about the superiority of socialized health care.

Pretty much.  I don’t think medicine needs to be CCCP level equality.  But any civilized society should aspire to a basic level where everyone gets quality care when they need it.  That is our collective obligation.  I pay ridic tax.  But I am happy to pay it so I go to bed every night knowing that my countrymen (and women) never have to worry about getting medical care they need.  

I honestly couldn’t imagine sleeping at night where that wasn’t the case.  

Preexisting conditions?  That is for pet insurance.  Good gravy.  

 

[Jackstraw]

lots of doctors in Canada supplement their income by owning private clinics.  they are not hurting, let's just say that.

we have a two-tiered system in Canada.  health care is free for all.  but you can pay extra for Cadillac care.  I am a member of a private clinic.  If I want an MRI, I get it in days.  If Joe blow wants an MRI, and it is non-emergent, poor Mr. Blow could wait 6-18 months.

Now, that is not true for emergent care.  Everyone gets in asap according to triage score.  And, no bill when you leave!

Glad we don't have to ration care in this country. 

 

[IC FBGCav]

Great use of free market here.

https://www.npr.org/sections/health-shots/2018/05/29/614556060/to-lower-your-medicare-drug-costs-ask-your-pharmacist-for-the-cash-price

A pharmacist can only tell you a better deal if you ask.  How American.  Why is it that most regulations try to screw the people out of money?  Shouldn't it look out for the people?

 

[Biff84]

Great use of free market here.

https://www.npr.org/sections/health-shots/2018/05/29/614556060/to-lower-your-medicare-drug-costs-ask-your-pharmacist-for-the-cash-price

A pharmacist can only tell you a better deal if you ask.  How American.  Why is it that most regulations try to screw the people out of money?  Shouldn't it look out for the people?

To be fair, most pharmacist didn’t know about this and the ones that did know, didn’t follow it. I personally never let someone pay the ‘cash price’. But the catch is, it can hurt us in the long run. Many of the available discount cards are just above our costs and actually charge us to bill them, so many of the prescriptions we lose money.

The more scripts we fill using discounts, the more our sales and profits are pushed down. In a chain pharmacy setting that’s how they decide our staffing hours. Help more people out and make your job harder and more dangerous.

 

[IC FBGCav]

How many billions did your industry make last year?  How overpriced is the US market?  Come on man.  

 

[Biff84]

How many billions did your industry make last year?  How overpriced is the US market?  Come on man.  

Are you speaking to me/pharmaceutical market? They made many billions and medications are overpriced. You won’t find me disagreeing at all. If you took my post as defending any of that I’m sorry it sounded that way. I thought it was another example of how broken the system is. I am 100% for ???????? for All.

 

[fatguyinalittlecoat]

You know, the Canadian guys don't even come into these threads any more. They probably think we're batpoop crazy to still be having an argument about the superiority of socialized health care.

No, they're probably just too high to type right now.

 

[NCCommish]

Great use of free market here.

https://www.npr.org/sections/health-shots/2018/05/29/614556060/to-lower-your-medicare-drug-costs-ask-your-pharmacist-for-the-cash-price

A pharmacist can only tell you a better deal if you ask.  How American.  Why is it that most regulations try to screw the people out of money?  Shouldn't it look out for the people?

A lot of businesses do this. If you don't ask for the deal you get charged the most they can. Take pizza. They're aren't supposed to give you the lowest priced deal unless you ask. And if there is another deal that would be cheaper for what than the deal you ask for they aren't supposed to mention that. Yes obviously prescription drugs are somewhat more important than pizza but it's still a for profit business.

 

[ProstheticRGK]

This is what medicare already does better than any private insurer. It's called "here's how much we'll pay for this, accept it or don't" and the companies do because it's still profitable for them. 

Private companies wouldn't do business with people who are on medicare if it wasn't profitable for them. Yet almost all of them still do. And if it was an even bigger piece of the pie, you can bet they'd continue doing business with people who are on medicare. 

Sort of. I know a lot of physicians who refuse Medicare patients, because the reimbursement is poor and because being a Medicare provider comes with extra regulatory restrictions on your practice to stay certified. I know even more physicians who would refuse Medicare patients, if they didn't make up such a significant portion of residents in their area.

you're right that their power is economy of scale and being able to translate that into lower prices. They also negotiate a ton of bureaucratic nonsense, couched as performance standards, into their reimbursement agreements. I imagine the cost-saving benefits have a break even point, beyond which, there's no more room to negotiate lower without crippling the system. The amount of bureaucratic bloat that could result, I see as a potential ravenous Leviathan, with no projected limit on growth.

 

[Tom Skerritt]

Sort of. I know a lot of physicians who refuse Medicare patients, because the reimbursement is poor and because being a Medicare provider comes with extra regulatory restrictions on your practice to stay certified. I know even more physicians who would refuse Medicare patients, if they didn't make up such a significant portion of residents in their area.

you're right that their power is economy of scale and being able to translate that into lower prices. They also negotiate a ton of bureaucratic nonsense, couched as performance standards, into their reimbursement agreements. I imagine the cost-saving benefits have a break even point, beyond which, there's no more room to negotiate lower without crippling the system. The amount of bureaucratic bloat that could result, I see as a potential ravenous Leviathan, with no projected limit on growth.

Physicians and caregivers dislike the medicare system until they become one of their users. It's highly hypocritical.

 

[msommer]

Great use of free market here.

https://www.npr.org/sections/health-shots/2018/05/29/614556060/to-lower-your-medicare-drug-costs-ask-your-pharmacist-for-the-cash-price

A pharmacist can only tell you a better deal if you ask.  How American.  Why is it that most regulations try to screw the people out of money?  Shouldn't it look out for the people?

In Denmark the pharmacist fills your prescription with the cheapest brand automatically. You don't have to do anything other than smile all the way to the bank.

 

[ProstheticRGK]

Physicians and caregivers dislike the medicare system until they become one of their users. It's highly hypocritical.

 If there's a built-in disincentive for a professional to use a product/service/payment form, then it is a flaw with the sytem. Human nature pretty much guarantees people will utilize whatever gives them optimal return for their investment. I don't care how philanthropic somebody is, they're not going to forego making the most amount of money they can for a theoretical sense of "fairness". I don't know what line of work you're in, but imagine somebody suggesting you start using a billing/reimbursement system that makes you jump through a bunch of hoops for lesser pay. But, the real payoff is that you get to claim you support fairness/equity/universal coverage/a great boon to humanity.

it also doesn't strike me as particularly hypocritical that your opinion of Medicare changes once you stop haggling for payment from the system and start receiving coverage that you've paid into. 

 

[Tom Skerritt]

 If there's a built-in disincentive for a professional to use a product/service/payment form, then it is a flaw with the sytem. Human nature pretty much guarantees people will utilize whatever gives them optimal return for their investment. I don't care how philanthropic somebody is, they're not going to forego making the most amount of money they can for a theoretical sense of "fairness". I don't know what line of work you're in, but imagine somebody suggesting you start using a billing/reimbursement system that makes you jump through a bunch of hoops for lesser pay. But, the real payoff is that you get to claim you support fairness/equity/universal coverage/a great boon to humanity.

it also doesn't strike me as particularly hypocritical that your opinion of Medicare changes once you stop haggling for payment from the system and start receiving coverage that you've paid into. 

People complain that "takers" are using the system at their expense. And yet these same people will exploit these "takers" to their own advantage in various forms. That is precisely the definition of hypocritical.

 

[ProstheticRGK]

People complain that "takers" are using the system at their expense. And yet these same people will exploit these "takers" to their own advantage in various forms. That is precisely the definition of hypocritical.

It's a business decision. I never heard any doctors complaining about the "takers". I did hear anesthesiologists complain about being reimbursed at $25/hour for giving a spinal anesthetic to a 79 year old that had spinal stenosis, aortic stenosis, and CHF and then have to monitor their BP like a hawk for 3 hours. It's simply not worth the nail-biting level of anxiety for that money.

you can make it about rich people taking scrooge mcduck baths in their swimming pools of gold dubloons if you want, but that doesn't really advance the conversation, and it doesn't match up very well with my experience.

 

[Tom Skerritt]

It's a business decision. I never heard any doctors complaining about the "takers". I did hear anesthesiologists complain about being reimbursed at $25/hour for giving a spinal anesthetic to a 79 year old that had spinal stenosis, aortic stenosis, and CHF and then have to monitor their BP like a hawk for 3 hours. It's simply not worth the nail-biting level of anxiety for that money.

you can make it about rich people taking scrooge mcduck baths in their swimming pools of gold dubloons if you want, but that doesn't really advance the conversation, and it doesn't match up very well with my experience.

Sorry, but if you choose to go into medicine, you shouldn’t get to choose who and how you care for them based on their ability to pay. Just shouldn’t work that way. You should care for everyone all the same. It all evens out in the end. 

And last time I checked, anesthesiologists are doctors. 

 

[msommer]

Sorry, but if you choose to go into medicine, you shouldn’t get to choose who and how you care for them based on their ability to pay. Just shouldn’t work that way. You should care for everyone all the same. It all evens out in the end. 

And last time I checked, anesthesiologists are doctors. 

Something something hippocratic oath something  

 

[Tom Skerritt]

It's a business decision. I never heard any doctors complaining about the "takers". I did hear anesthesiologists complain about being reimbursed at $25/hour for giving a spinal anesthetic to a 79 year old that had spinal stenosis, aortic stenosis, and CHF and then have to monitor their BP like a hawk for 3 hours. It's simply not worth the nail-biting level of anxiety for that money.

you can make it about rich people taking scrooge mcduck baths in their swimming pools of gold dubloons if you want, but that doesn't really advance the conversation, and it doesn't match up very well with my experience.

And furthermore, if they cannot handle the “nail-biting anxiety” for 3 hours (oh the horror), perhaps they are in the wrong profession. 

 

[The Commish]

Markets work.  Capitalism works.  If we had real markets and the FDA didn’t grant monopolies to pharmaceutical cos. prices would fall dramatically over night.  Same with doctors and licensing regimes.

This is an outdated take given the fact it ignores the global market we now live in.  We aren't self contained any longer.  We are very much impacted by the world market in terms of healthcare now.  So for this to be true, everyone else in the world would have to be on board.  Given the fact that everyone else has rejected this model, there is zero sense in trying to fit our square peg into the round hole of the global market.  It will never work.

 

[Dedfin]

 Capitalism works.

OOOOF

 

[Jackstraw]

To be fair, most pharmacist didn’t know about this and the ones that did know, didn’t follow it. I personally never let someone pay the ‘cash price’. But the catch is, it can hurt us in the long run. Many of the available discount cards are just above our costs and actually charge us to bill them, so many of the prescriptions we lose money.

The more scripts we fill using discounts, the more our sales and profits are pushed down. In a chain pharmacy setting that’s how they decide our staffing hours. Help more people out and make your job harder and more dangerous.

The profit motive and healthcare seem to be mutually exclusive for good health outcomes. 

 

[the moops]

Yes obviously prescription drugs are somewhat more important than pizza

Debatable

 

[ProstheticRGK]

Sorry, but if you choose to go into medicine, you shouldn’t get to choose who and how you care for them based on their ability to pay. Just shouldn’t work that way. You should care for everyone all the same. It all evens out in the end. 

And last time I checked, anesthesiologists are doctors. 

I hope whatever it is you do for a living escapes the "vague moral high horse" clause of public opinion setting your earnings.

And furthermore, if they cannot handle the “nail-biting anxiety” for 3 hours (oh the horror), perhaps they are in the wrong profession. 

For $25/hr? Garbage men make about that much. They may run across an errant fleshlight bow with raccoon gnawings on it, but last I heard, if they aren't on their game for the day, they aren't killing someone. 

 

[Tom Skerritt]

I hope whatever it is you do for a living escapes the "vague moral high horse" clause of public opinion setting your earnings.

For $25/hr? Garbage men make about that much. They may run across an errant fleshlight bow with raccoon gnawings on it, but last I heard, if they aren't on their game for the day, they aren't killing someone. 

So garbage men are pulling in $250k+ now? Got it! Going to apply today.

 

[Dedfin]

 I hope whatever it is you do for a living escapes the "vague moral high horse" clause of public opinion setting your earnings.

For $25/hr? Garbage men make about that much. They may run across an errant fleshlight bow with raccoon gnawings on it, but last I heard, if they aren't on their game for the day, they aren't killing someone. 

I guess if I were an anesthesiologist I could relate. I make more than 25/hr, but I'll never make the crazy 300/hr or whatever those people make. Doing an old man a solid doesn't seem to be so horrible to me. I can see your point though some capitalist tinged glasses though.

 

[ProstheticRGK]

So garbage men are pulling in $250k+ now? Got it! Going to apply today.

Nevermind, you're on a roll.

 

[Tom Skerritt]

Nevermind, you're on a roll.

Well, you're trying to make a point, and you're doing a poor job.

And by the way, these same criminally underpaid anesthesiologists are also hiring illegals, in an effort to pay as little as possible, to help build their mansions and manicure their lawns. As you said, it's a business decision.

 

[ProstheticRGK]

I guess if I were an anesthesiologist I could relate. I make more than 25/hr, but I'll never make the crazy 300/hr or whatever those people make. Doing an old man a solid doesn't seem to be so horrible to me. I can see your point though some capitalist tinged glasses though.

Doing an old man a solid is cool. Having the ability to choose whether to do that old man a solid is even cooler. I've seen a lot of people get their bills waived (anesthesia bills separate from hospitals and other bundled charges) by anesthesia and surgeons both because it was a charitable thing to do.

my argument is just that these are people, just like you and me, not rich guys twiddling their handlebar moustaches, figuring out how to swindle granny out of her house for snake oil. They put a considerable amount of time and money into their training and work long, hard hours with a considerable amount of exposure to liability. They're making business decisions with billing, just like all of us do every day negotiating salaries or billing clients.

People insinuating they should just offer themselves up as sacrificial lambs of goodness to serve the community for low pay just come off as unrealistic, to me. Why would anyone do that? I know I wouldn't. I already made the decision not to become an RN over being an MD because my working career years versus debt load would have made the two choices almost even, and the amount of hours I'd have had to do as an MD made the choice an easy one. If you take away incentive for people to bust their asses to make more money, you're fundamentally breaking the system.

 

[ren hoek]

This is an outdated take given the fact it ignores the global market we now live in.  We aren't self contained any longer.  We are very much impacted by the world market in terms of healthcare now.  So for this to be true, everyone else in the world would have to be on board.  Given the fact that everyone else has rejected this model, there is zero sense in trying to fit our square peg into the round hole of the global market.  It will never work.

That's simply not true.  Canada for example was on board with the US importing drugs across the border.  

https://theintercept.com/2017/01/12/cory-booker-joins-senate-republicans-to-kill-measure-to-import-cheaper-medicine-from-canada/

Artificially closing markets to open competition is not capitalism.  Why are we able to have low cost and efficiency with virtually every other global market in existence except for healthcare?  

 

[ProstheticRGK]

Well, you're trying to make a point, and you're doing a poor job.

And by the way, these same criminally underpaid anesthesiologists are also hiring illegals, in an effort to pay as little as possible, to help build their mansions and manicure their lawns. As you said, it's a business decision.

I'm doing a poor job? You're patently, ridiculously over the rainbow. What do you do for a living, Tom? Whatever it is, you go ahead and spend 11 years in school and training, get yourself $500k in debt and then, when you get out, I'll pay you $25/hr to perform a service that could potentially kill the person for whom you're providing it. Also, I hope your malpractice insurance is paid off, because if things go wrong while you're doing your $25/hr gig, you're getting sued, for millions. In a case that will linger like a stale fart in your life for at least 6 years, until it gets settled even though you didn't do anything wrong and stuff happens sometimes. It's just easier to settle. But only after you've been through hell and carried around the weight of a court case, having to justify your actions and being painted as a soulless, rich doosh who isn't very good at his job and hates old people.

also, I was unaware that anesthesiologists were so active in hiring illegals as to account for all of the hiring. I am interested in your research and would like to subscribe to your newsletter.

 

[Tom Skerritt]

I'm doing a poor job? You're patently, ridiculously over the rainbow. What do you do for a living, Tom? Whatever it is, you go ahead and spend 11 years in school and training, get yourself $500k in debt and then, when you get out, I'll pay you $25/hr to perform a service that could potentially kill the person for whom you're providing it. Also, I hope your malpractice insurance is paid off, because if things go wrong while you're doing your $25/hr gig, you're getting sued, for millions. In a case that will linger like a stale fart in your life for at least 6 years, until it gets settled even though you didn't do anything wrong and stuff happens sometimes. It's just easier to settle. But only after you've been through hell and carried around the weight of a court case, having to justify your actions and being painted as a soulless, rich doosh who isn't very good at his job and hates old people.

also, I was unaware that anesthesiologists were so active in hiring illegals as to account for all of the hiring. I am interested in your research and would like to subscribe to your newsletter.

You poor thing. The daily struggle must be so hard for you.