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Thursday, January 17, 2013

About that "more access for woman" argument.


  1. According to salary.com, the median income for Ob/Gyn specialists is $256,608.

    So I find it very difficult to feel badly for these physicians, who have made TONS of money from state and federal programs over the years.

    In fact in my opinion it's downright unpatriotic for them to abandon women and children due to dollars.

    I think it's high time for MDs to stop using Medicare/Medicaid and other tax supported programs in order to live luxurious lifestyles.

    Tom Cogburn

  2. Tom,

    Green is such a bad color for you.

    That's probably their gross pay, not their net. Either way we live in a free market economy. You can not force some one to live somewhere or do something for the wage you think is "fair". That is called slavery and it was done away with a few years ago. Possibly you heard about it. It was pretty big news at the time.

    You could try to overturn that constitutional amendment (a pet topic of yours I know) or if the life of an OGBYN is so great you could go back to school and study to become one and live the life you so richly deserve.

  3. Stacey...

    Ouch... I thought you had standards here on your blog.

    I'm hardly envious of OBGYNs. No one is trying to force them to live anywhere.

    However, I believe they have a moral obligation to remain in a community where they very likely prospered. Now that their luxurious lifestyles might be slightly lessened, they cut bait and run. That's a pretty nasty thing to do; especially when you supposedly went into the field to HELP others.

    Don't know how you get that I'm interested in overturning the emancipation proclamation. I believe that's kind of a low-blow even for you...

    Tom Cogburn

  4. Tom,

    If the envy of their money were not an issue for you then why did you bring it up? How much they make is up to them. They have the same right to make as much as they can just like you have the same right to make as much as you can. I don't know what you do but lets say you work at burger king. if your boss walked in and said he was cutting your pay by 20% and you knew you could get the same amount you were getting working at McDonald's doing something similar I doubt you would turn it down because someone else told you that you had an obligation to get the whoppers to the customers and not the Big Mac. If I came in and argued people need to eat and therefore all Whoppers should be 50 cents and you should work for $4.00 an hour to make it so you would laugh me out of the building..

    If I said government is going to subsidise the whopper but you were still going to have to work for less then McDonald's workers to keep the prices down what would you say?

    Now if you want to argue govt should not subsidise them that's fine but then you can not stop them from refusing service when someone can not pay (as the law refuses them that right now)

  5. Here's another one in Rhode Island.

    You could also look into Catron County, NM where they do not deliver babies anywhere in the third largest county in the state. I guess they could no longer afford to deliver the "undocumented" anchor babies "for free".

    Gee, I wonder what other healthcare will disappear once it is "free"...

    "Yes We Can!"

  6. Stacey, I've worked in the medical field as a social worker for over 25 years. And I've seen the tremendous amounts of money funneled through medicine through Medicare and Medicaid.
    I remember riding an elevator with a couple of pediatricians several years back. They worked for Kaiser Permanente (I was in San Francisco at the time). They were both complaining that their $40,000 year-end bonuses were not enough, compared to what other physicians received.
    That money, largely, comes from tax payers (Kaiser has a program called "Senior Advantage", which is a Medicare supported program). The pediatricians, who largely do not get Medicare patients, got smaller bonuses because their money came through the Kaiser-Medi-Cal (Medicaid) program.
    When I first started my work in the social work field, I worked at St. Mary's on Oak Hill, here in Knoxville. There was an ER doctor who routinely referred to Medicaid patients as "trash" and treated them like dogs--talking down to them, insulting them, etc.
    But he never seemed to mind when he walked out of the ER, got into his Land Cruiser and drove out to West Knoxville to his mansion. Again, most of his money came from Medicare and Medicaid. He even benefited from having his student loans forgiven by the feds for working in an economically impoverished area.
    So, I'm hardly envious of them. I just believe that they take an inordinate amount of money from tax payers.
    Sure, what they do is important. But so is trash collecting, road work, and being a police officer.
    I do hold the opinion that it is unpatriotic for the doctors, to which your story referred, to have made fortunes off the system for years and now they're going to abandon the women and children that need them--all due to money.
    They are perfectly within their rights to do so, but I still do not hold a high opinion of them--and CERTAINLY do not have any sympathy for them.
    I've got to say, I'm surprised that you, a fiscally focused conservative, don't back measures that would reign in spending with regards to the obscene amounts of tax payer money paid out to medical providers.
    If the government suddenly decided to decrease their pay-outs to providers, they would simply have to accept it, since the vast majority of MDs patient populations receive benefits through government programs.

  7. Once again you are talking supply and demand. You can't change demand for a necessity by adjusting the price. All you do is is cut supply and drive up price.

  8. Stacey,
    We already set caps on the amount doctors and hospitals are reimbursed. The feds and the state already are the ones who control the purse-strings. It would be fairly easy to lower those pay outs.

    Would MDs, hospitals, pharmaceutical companies throw a fit? Absolutely they would.

    But we are the consumers. We can determine what we are willing to pay. It's not like they're going to find other patients or consumers.

    Again, I don't understand why you support the huge amounts of federal and state dollars that go to pay for health care.

    Seems like we'd be on the same side of this issue...


  9. The goal of lower price may be the same but I disagree with how we get there. You think we can alter the price and it won't have an effect on supply. I think (and this and other examples show) that it will. Doctors just shift what they do and where they do it. Their service is not fixed. It can move around or retire altogether. We are already in a short supply of doctors. The ones we have are getting older. Many are retiring at the same time as the baby boomers. The problem is their are no replacements for them just as we need them the most (the baby boomers are now needing doctors more as they age) so now as we need them to stay in field instead of retire you are cutting their pay and think this will somehow keep them from quitting? Good luck with that.

    Obama's solution for the debt doesnt help things either. you see he is taxing income. not already acquired wealth. Although neither plan is good, taxing income only encourages those who have wealth to stop making it as the incentive is decreased. The Rich doctors and Warren Buffets of the world who have already made their fortune lose nothing other then the incentive to make more. If you cut the pay and increase the taxes on someone who already has made their fortune and they are getting older then why do you think will keep working?

    If we go back to our whopper model, if you are say 70 years old (as many doctors are) you are sitting on a trust fund, enough to retire happily, and the boss comes in and says we are going to cut your pay, increase your taxes on that pay, we are expecting a bus load of people to pull into the parking lot. What do you think is going to happen?

    The 70 year old whopper flipper is going to toss you the apron and say "good luck!" As he walks out the door. If you are lucky he goes to McDonald's where he knows he will get paid instead of staying where the job isn't as easy but in many cases he will just retire.. The problem is, you don't even know how to turn on the grill and 200 people just walked in.

    That is where we are in medicine. Grayling of the profession. Cutting pay, mixed with the ability of the doctors to go into research or less risky fields of medicine where they have a higher likelihood of getting paid by their customers decreases an already limited number of doctors willing to do high risk procedures or work on low income customers.

  10. So many people are claiming that there is a doctor shortage. But this isn't exactly true.

    The actual number of doctor to patient ratio may be decreasing. However, that slack has been taken up by other professionals--primarily nurse practitioners, who make between $68,310 to $86,369 per year and physician assistants, who have a median income of about $86,410.

    Health care groups are actually able to see more patients because of the addition of these other professionals.

    And you say that physicians will simply stop seeing Medicare/Medicaid patients.

    The truth is that they already rely so heavily on these populations that their practices could not survive by providing services only to privately insured patients.

    Sure, they may retire but there are plenty of other physicians, nurse practitioners, and physician assistants who are available and coming down the pike to take their place.

    I believe the days of just opening up our wallets and allowing MDs to set outrageous prices are coming to an end. At least I hope so.

    By the way, when I worked at Stanford University Medical Center in Palo Alto, CA, the price for a regular room in the hospital was $9,000 per day, which included room and board only--no tests, no MD visits, no medicines--just a room and 3 meals. A room in the ICU was $14,000 a day. That was about 6 years ago. Goodness knows what it is now.

    And who do you think footed most of those expenses? Medicare and Medicaid programs were the primary pay sources for Stanford.

    You don't think we can do better than that?

    Health care should not be based on a business model. People should not be able to make 6 and 7 figure salaries through, mostly, government paid health care programs.

    My opinions come from over 25 years of direct observation inside the health care industry.

    Tom Cogburn

  11. Yes, some of those other fields are picking up some of the slack. But not in the areas you need doctors for. Yes they can push pills but they can't do a hip replacement. They can't do the heart valve replacement. That later requires the therapy. . What you are talking about is already the case. Trust me. We are already doing those things (allowing other professions expanded duties) but there are some things you can't just say "well the LPN is going to start doing that." Or "We know you need a disk replaced in your back how about a few visits to a chiropractor and some massage therapy" It's just not the same. Doctors have a profession insome fields that you can't just pick up and do after. 2 years at the community college.

    If it were such an easy way to make a ton of money why doesn't everyone go into it? Why didn't you get into it? Is it your aversion to helping people or your aversion to making money? I suspect neither.

    1. I got into social work instead of medicine because I was terrible at math and couldn't imagine working with "bodily fluids".

      And I've never been averse to making money, per se. I do have a hard time with people who make tremendous amounts of money on what I consider the backs of the sick, poor, elderly, disabled, etc.

      Being a physician isn't so specialized anymore. Goodness, with all of the access to computers and robotics doctors do less today than ever. They carry around most of their knowledge on ipads.

      Don't get me wrong. They are very skilled. They do an important job.

      But as I've pointed out earlier, so do police officers, trash collectors, teachers, etc.

      I don't know how we ever developed a system that so greatly financially rewards physicians.

      It wasn't that way prior to the introduction of insurance. Physicians were paid only what people in the community could afford.


    2. Tom, you said it your self in your reason we have so few doctors.

      The level of expertise has gone way up since say the country doctor of the 1920s when a doctor could carry every tool they would ever need in a little hand bag. People died at a much earlier stage of about anything back then. If you got Cancer,you were done. If you got the flu it was a roll of the dice. If you got a cut,it could lead totem cutting off your leg.

      You also said you didn't want to deal with all the math. Well getin line. Not many do or did. Thus we have few doctors and their services get top dollar because they were wiling to do the work and study what and when you were not. Limited supply create high demand and high cost.

      You also said you didn't want to deal with icky smelly body fluids,well guess what? You aren't alone in that either. Not a lot of people are. Guess what that leads to? Limited supply. Guess what that leads to? High demand. Guess what that leads to? High price.

      You seem to think we can go back to the prices and systems of the 1920s and somehow the level of care will not decrease and the number of people who will go into those highly technical fields will not diminish.

      It isn't realistic.

      Please, look at the average age of the doctors we have. Look at the baby boom bubble we are heading toward. Look at the high level services they will need (not just pills) and tell me how you realistically think all this can be achieved when doctors decide to retire or go into another field or a lower risk practice because their pay was cut.

  12. I know leftist a hate the term but it Truely is leading to death panels. When there is a long list of people that need a critical surgery and their are few doctors willing to do that surgery someone has to get cut from the list. That list will be cut by someone watching the bottom line. For the government supplier it will be a death panel..

    That is the case in Canada. I lived in upstate NY. My sister is an OR head nurse. She would see it all the time. Those with money in Canada would come to the US for surgery. The reason? They could get pills and therapy in Canada but there were not enough doctors willing to do the more risky procedures or procedures on the elderly. They knew they were years away from getting the treatment they Truely needed if it was approved at all.

    1. Look, you are naïve if you believe "death panels" haven't been around for decades.

      I've watched doctors and "panels" with my own eyes refuse to treat or refuse to offer treatment to people who have no insurance.

      These panels are usually made up of nurse case managers, social workers, doctors, and folks from the hospital's business office.

      At least with nationwide coverage, physicians and hospitals will be more likely to accept patients and provide care to people than when then didn't have insurance.


  13. A reduced level of care. That is Canada. You can get meds. I agree. But all the real doctors bolt to where they can get paid for the work they did in school.

  14. And hospitals have to do any and all emergency care procedures that are required to save a life.

  15. Of course hospitals have to do everything they can do to "stabilize" a patient.
    However, if the underlying disease is something chronic--like cancer, hear disease, or kidney failure--the ongoing treatment needed is going to be based on the patient's ability to pay--usually their insurance, or lack thereof.

    Example: A person comes to the ER with uncontrolled internal bleeding. Everything is done to stop the bleeding.
    However, when a work-up discovers that the internal bleeding is related to a cancerous tumor, "the team" will meet to discuss how to proceed.
    There are many ways of proceeding with a cancerous tumor. Everything from recommending surgery to chemo/radiation to palliative care.
    Palliative care is more likely to be recommended for patients who have no insurance coverage. Doctors know that finding an oncologist to take a "self-pay patient"; one who will pursue aggressive treatment, is very unlikely.
    It's also just as unlikely to find an out-patient chemo/radiation therapy center that will see this patient.
    The patient will be stabilized and released.
    Of course the social worker (the role I play in hospitals) will work diligently to link the patient to TennCare. But if that person has no children under the age of 18 living in the home and does not currently have social security/disability in place, it's very difficult to do this.
    In the meantime, their cancer continues to advance without treatment until insurance can be "built".
    On the other hand, if the patient had good insurance (or any insurance), he/she would be offered surgery while in the hospital. Or they would be discharged and immediately begin chemo/radiation therapy.
    There would be no waiting period while insurance is "built".
    That waiting period is when people die. From cancer, heart disease, kidney problems, etc.
    With nationwide coverage, there will be no waiting period.
    Might it be difficult to find a physician willing to follow the patient with "Obamacare"? Perhaps... But their chances of finding someone and getting immediate treatment is greater under Obamacare than with no coverage at all.
    That's the reality of the system.
    Until you've experienced being uninsured and in the midst of a medical crisis, you would not know this.
    But it's what I've done as a career. I know the reality.

    With regards to people coming to this country without insurance, I can only say that it has been my experience that they are treated in the same way. The goal is to stabilize the patient to a point that they can return to their country.
    I've even seen hospitals purchase airline tickets for stabilized patients to return to their country of origin, rather than keeping them here and providing care that might cure them.


  16. Tom,

    I agree they may get some form of health care with Obamacare the issue is what level and when. The results can be seen in how it worked in Canada. Yes, they get meds and low level therapy but not high level treatments. If they did it was years after the problem presented itself and the person was in "great shape" younger, healthier. The older people or more high risk cases were told "sorry, good luck" or see you in 3 years. Of course the goal of doctors making less money was achieved.

    . Until they all moved to the U.S. or changed professions.

    If that's your only goal you will see it but I honestly expect Obamacare to collapse under its own weight. I was talking with some national level economists who have studied it thouroughly who said it was all but a sure thing. The only question was how soon before it is admitted by national democrats.

  17. Stacey...

    I came across this first-hand experience of an uninsured man who cut his hand while installing carpet.

    He went to Miami Valley Hospital, where he received 3 sutures.

    The bill was itemized as:

    $249 for Emergency Room- General
    $600 for Emergency Room- Other ER
    $277 Extended exam
    $39.38 for “Medical surgical supplies and devices- General
    $258 Repair simple S to 2.5 cm

    Total bill: $1,423.38

    Tell me that the health care industry isn't price gouging consumers, insurance companies, and government payers (Medicare/Medicaid).

    Doctors, health care administrators, medical equipment companies, pharmaceutical companies, etc. are taking tax payers for a ride.

    I think Obamacare will force these prices down. I think when everyone has insurance, these insurance companies will be able to dictate to physicians and other health care providers what prices they are willing to pay.

    That's what I see happening...


    1. You can't seem to get past the miss perception that access to insurance is the same thing as access to care. It is not.

      If you think costs are high now, waight till they are "free" who do you think will be paying for it then when people can get all they want and demand to see a specialist for every runny nose?

      Who do you think is going to do complex procedures when pay is cut?

      You seem to also be under the miss perception that you can artificially change the laws of supply,demand and price by legislating down the price without it effecting the other two. Sorry. You can't.

  18. Stacey,

    You just don't seem to get it... For too long the health care system has been dictating to us, the consumers, what amounts they will charge.

    They come up with exorbitant rates (you saw my post about the sutures) and we or the insurance companies are just expected to pay it.

    When everyone has insurance, these insurance companies will be able to say to providers, "Look, we cover 85%-90% of Americans through public or private programs. We're not going to pay you $400 for each suture you put into a person's hand! We agree to pay $100 per suture. And if you don't accept that amount, then you don't get paid at all!"

    See how that works?

    You keep thinking that doctors, hospitals, and pharmaceutical companies have another option. They don't.

    They're the ones who painted themselves into the corner.

    They're the ones who became fat and lazy--charging insurance companies (including Medicare/Medicaid) whatever price they wanted.

    But now the consumers, insurance companies, and the government have an upper hand.

    The only alternative left for health care providers is to go out of business. And I guarantee they will opt to lower their prices before they opt to go out of business altogether.

    Americans are sick and tired of supporting lavish lifestyles for health care providers. And when we act as a unified voice via Obamacare, we will have the upper hand.

    And we've not even started talking about the millions (billions?) of dollars that will be saved in Medicare fraud under Obamacare.


    1. Ummmmm. Did you even read the article that I linked to??? You suffer from the delusion that they can not shift professions or that they will somehow still be able to afford to go out and buyan MRI machines etcetera. .we are not talking about stitches. We are talking about expensive procedures. And again you seem to think there is some hidden pool of doctors out there that are just dieing to do risky procedures at cut rates. There aren't. LOOK AT THE NUMBERS!!!!

      And guess who is going to be forced to pay for all this universal insurance. Those who can't afford it now. How you think those who had not been able to pay before are suddenly going to have the cash to buy any policy in this economy is beyond me.

  19. Another thing... You keep saying that access to insurance isn't access to care.

    I agree. I've seen doctors offices that will not accept any "new" Medicare patients or Medicaid patients.

    But when everyone is covered, these MDs and other health care providers will be fighting for their piece of the pie.

    They are going to have access to people who have never had insurance before.

    They stand to make more money by increasing the number of people they see.

    They may not get paid as much as with other plans, but they will get paid something. And to them that represents a formerly untapped market.

    Imagine providers looking at 30,000,000 previously uninsured people. They see dollar signs.

    You worry about people demanding to see specialists for every runny nose. You must not be familiar with the way insurance companies work.

    You must get "prior approval" before seeing specialists. Nurse case managers (usually), who are supervised by physicians are employed by insurance companies to determine if someone really needs to see a specialist.

    The insurance companies have a huge interest in taking in as much premiums as possible and paying out the least amount for claims. That's how they make their money.

    Insurance companies have auditors who go in regularly and check patient records and billing. They will even take money back from a provider if it turns out that the books were "cooked" to make it look like a patient needed services, but really didn't.

    I personally would like to see a country where there are no insurance companies. The medical industry would be based purely only what the free market dictates.

    For example, Mayfield can't go to the market and charge $50 for a gallon of milk, knowing that a person has "food insurance" that will pay 80% of the cost; leaving the consumer with a $5 co-pay.

    Why should the medical industry be any different?

    But that's another conversation altogether...


  20. Sooooo you want a free market.....but you don't want people to have the freedom to buy or not buy insurance. Are you unfarmilliar with how insurance works? People CHOOSE to buy a level of coverage they think they need. Insurance companies decide on a premium based on the likelihood that you will cost them money.you want to smoke 3 packs of cigs a day? You are going to pay more. You want to weigh 300 pounds and eat ring dings and ho hos you are going to pay more. In exchange for the immediate payment they agree to cover you should big ad things happen. You don't want to buy insurance? Guess what? You run the risk of paying big later.

  21. So what do you think will happen when your idea of a free market runs into someone with no money needing 2 or 3 million dollars of service like say a hemofeleack needing a transplant? Expect that money to magically appear? That doctors will be rushing to sign up to get his $100. Bucks a month?that there will be some magic way for a doctor to buy liability insurance for the 60k a year he is now pulling down? Get real. Who is going to pony up for that new Million dollar MRI machine? Some doc making 60k? The bank will laugh you and any doctor out of the building.

  22. Stacey,

    I simply stated that in my opinion--and maybe I should have specifically said--in an IDEAL world, there would be no insurance. In and ideal world, insurance would never have been developed.

    How did people pay for health care prior to insurance? They paid out of their pockets.

    Hospitals, doctors, and pharmaceutical companies charged only what people could afford to pay out of their pockets.

    And despite the lack of huge reimbursement from insurance companies, doctors treated people, hospitals admitted people, and medical advancements were made.

    Even though I'm about 2 years older than you are, I can remember going to see old Doc. Brown in Mosheim, Tn. He was a "cash only" doctor. You paid $20 for a visit. There were additional charges if you needed an X-Ray or blood work. He even dispensed many of the medicines--antibiotics, pain meds, and similar type drugs.

    His waiting room was full most of the time. He did pretty well for himself.

    It's only been in the past 40 or 50 years that insurance companies have acted as middle-men between health care providers and consumers.

    The way I see it, they helped to drive up health care costs in the first place. It's one of the reasons that Medicare and Medicaid became necessary to begin with.

    But, the genie is already out of the bottle. Health care costs are outrageous. Something has to be done.

    And I think Obamacare will help to get a control of the out of control rise of health care costs.


  23. The cost has gone up because the level of care has gone up.I doubt old doc brown had an MRI machine or did CAT scans. How many joint replacements did he do for 20 bucks? Or heart valve replacements? I bet close to 0. It's not the visit or pushing of pills that costs. It is the expensive, risky, cutting edge procedures that save and extend lives to the level we are at now. I have no doubt old doc brown could push pills with the best of them and his cost to do so were and are minimal. Of course if you send your 65 year old mom to old doc brown and tell him her heart is giving out with20 bucks in her hand what do you think he will say?

  24. I'm sure as a business person, you know a little about economics.

    Prices aren't just set by simple supply and demand. There's a little thing built into the system called profit.

    And a corporation's profit margin is based on a variety of issues.

    One of the primary ways a profit margin is determined is by a company doing studies to see how much the public is willing to pay for a product.

    Apple pays approximately $167.50 to build a 16GB iPhone 5. They retail for over $700.00. That's quite a margin of difference.

    I realize that they spend money on advertising and other overhead, but when you multiply their margin of production cost vs. retail sale cost by the tens of millions of people who will purchase one, you see why Apple is one of the most lucrative companies in the world.

    MRI machines are produced in the same way. Just because it costs $2,000,000 to purchase doesn't mean that it costs $2,000,000 to build.

    It has been my experience in the medical field most medical equipment has a tremendous mark-up.

    When private citizens decide to go out and buy an iPhone with massive mark-up, that's their decision. No one put a gun to their heads.

    But when the federal and state programs pay for the health care of millions, it's not OK for MRI manufacturers and other providers to have such huge mark-ups.

    And I think it's immoral for health care companies to make obscene amounts of money on products people must have in order to live. Don't you?

    Here's a link to an article about how medical companies and providers arrange to have their products remain lucrative, at tax payer expense, for as long as possible.

    Maybe it can explain where I'm coming from a little better than I have.


    And I continue to be surprised that you don't seem to be supportive of reducing health care costs. Rather you seem to be in favor of health care providers and companies raking in cash at the tax-payer's expense.


  25. It all still comes back to supply, demand and price. If you artificially cut the price again you seem to think the companies who make MRI machines will continue to pump money into research and development to produce the next great product to save lives instead of shifting into making I phones. You may wish it to be so but it has seldom to never been proven to be effective.

  26. Stacey,

    Yes, I do believe that companies that make MRI machines will continue to create them. As long as there is a need, someone will make them. If the highly paid companies don't want to make them, then others will rush in to fill the need.

    And I firmly believe that there are still folks out there who do medical research and development for the pleasure of doing what's good for mankind.

    Not everyone is motivated by money.

    The same is true for medical providers. I'm sure there are plenty of physicians out there who do what they do because they truly care about healing sick people.

    Sweden, which ranks much higher in the World Health Organization's Ranking of Health Systems than the U.S., pays its physicians on average about a third of what U.S. physicians receive.

    It would seem that the profit motive isn't what drives everyone. Our country has made the mistake of so closely pairing profit motive and health care.

    But I believe this mind-set can be changed. Color me optimistic.


  27. http://blogs.the-american-interest.com/wrm/2013/01/20/universities-bludgeon-adjuncts-with-obamacare-loophole/

  28. Well it has yet to be proven to be the case. Where are all the competitors then? Where are the long lists of doctors willing to work for less? What we are seeing in the real world is the oposite. Doctors are quitting. They are no longer taking govt patients. They are retiring.. As is so often the case with liberalism, it sounds good in theory but works like crap in actuality.

  29. I guess we'll see...



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