83% of u.s. Doctors consider quitting.

[Steve]

Your previous post contains some flat out inaccuracies about how surgeons make more than PCPs (as best I can tell from teh data I looked at, working more hours is not the reason for it) -- I'll post that up later.

But that last quote really sums up the problem. We've (well insurers, doctors, hospitals and the government have) created a system that rewards knee scopes and boob jobs and and lazik and heart/lung transplants over spending an hour with a patient to diagnose and GI problem for example. So naturally the best students are attracted to the specialities and more money (which the studies show, just as with attorneys, doesn't necessarily mean more happiness).

The real question is, why? It wasn't the market that decided to value these services more. For MOST people, a PCP corrently diagnosing a daily ailment if far more valuable than stuffing silicone in their wife's chest.

And that is part of the reason why in our system we pay 30% more per capita on average for poorer or equal overall results than in Oceania or Western Europe. And also why specialists tend to fear Obamacare, and a perceived shifting of the pie away from specialitists to PCPs.

OK, so a surgeon who eats sleeps and breathes medicine for 20+ years knows less about our healthcare system than a non-healthcare attorney. Got it.....

BTW boob jobs, like most cosmetic surgery are cash only and not covered by insurance. They don't really enter into this discussion........but are, nevertheless, a spectacular invention.

 

[Jeff Young]

I don't think he's flung any insults at you at all, that is not his style. You are consistently the one denigrates your fellow posters and does all the insult flinging.

You are just one very nasty individual, and I am certainly not the only one that thinks that on either side of the pond - you have very little support here.

Forum Rule No. 1 Breach! Forum Rule No. 1 Breach!

I've got plenty of PMs about you guys as well. It works both ways and don't think it doesn't.

I did go back and took a look at the Libya thread and got a laugh. This "nasty individual" posted a vid and make a comment that stupid violence was endemic to all societies. That's it. The well-mannered, polite gentlemen on this board responded with "crass fool," "wanker," accused me of being part of "radical organizations" and wanted to report me to my "professional associations." Wow.

So who again are the nasty individuals? That mirror thing might be a useful tool.

In any event, how about we do this. Rather than having you and Pickford continuing to just go into a tizzy over anything I post, why don't you guys, since you aren't mature enough to handle a debate, put me on ignore like Morton. Will save bandwidth and everyone won't have to read your rants.

 

[Jeff Young]

OK, so a surgeon who eats sleeps and breathes medicine for 20+ years knows less about our healthcare system than a non-healthcare attorney. Got it.....

BTW boob jobs, like most cosmetic surgery are cash only and not covered by insurance. They don't really enter into this discussion........but are, nevertheless, a spectacular invention.

Did I ever discount your opinion for lack of knowledge? Absolutely not. You've got a ton of knowledge and experience that I don't. On the flip side, I've got more than you recognize, did a fair amount of CON litigation in the 90s, and a few medmal cases on teh defense side.

More importantly, and I don't mean this in a derogatory way, but you have a micro view of our system. It takes more, in my opinion, than simply practicing medicine to understand the macro side of heatlh care delivery and cost containment. I'm certainly no expert on that, but frankly from some of your assertions about work hours and how compensation, and this takes nothing away from your skills as a surgeon, I don't think you have any specialized knowledge on that either.

 

[DaveM]

Once again the liberal youth brigade has decided there is only X amount of money available.

Can't you guys get over the "if he makes more money, I make less" syndrome?

Before Midicare, an immigrant family without a pot to piss in could afford doctor's visits out of pocket and still buy catastrophic insurance. That all disappeared with the government's medalling with the market.

Bob- were you ever refused health insurance for a pre existing condition? I and many others have. Medicare was instituted because of this. Why have we let the insurance companies set the rules instead of the other way around? Ask seniors if they would give up their Medicare and try to buy private insurance. You'd be hard pressed to find a senior without pre existing conditions.

 

[Bob Fechter]

Bob- were you ever refused health insurance for a pre existing condition? I and many others have. Medicare was instituted because of this. Why have we let the insurance companies set the rules instead of the other way around? Ask seniors if they would give up their Medicare and try to buy private insurance. You'd be hard pressed to find a senior without pre existing conditions.

Of course seniors wont' give up Medicare, its the only game in town. The problem is there's no competition, and we all know the government pays too much for everything they touch.

This "Why have we let the insurance companies set the rules instead of the other way around" mentality shows just how conditioned we are towards private enterprise.

I wish we had some insurers here to tell us how many government laws/paperwork they have to endure and how much just that adds to the bill.

 

[Jeff Young]

Of course seniors wont' give up Medicare, its the only game in town. The problem is there's no competition, and we all know the government pays too much for everything they touch.

Like most cliches you post, wrong. Studies indicate Medicare costs have grown at a slower rate than with private insurers.

Is Medicare Cost Effective?

 

[Bob Fechter]

Like most cliches you post, wrong. Studies indicate Medicare costs have grown at a slower rate than with private insurers.

Is Medicare Cost Effective?

Like most liberals, never trust them with data.

Is Medicare More Efficient Than Private Insurance? – Health Affairs Blog

 

[Jeff Young]

Like most liberals, never trust them with data.

Is Medicare More Efficient Than Private Insurance? – Health Affairs Blog

Nope, still wrong. You posted an opinion piece, not data.

Here's the data. Show us data, not a right wing echo chamber and we may consider it. Otherwise, you are just as wrong as you were with your Port St. Lucie voter fraud nonsense.

The Titanic sails at dawn: Medicare is the most cost-effective health insurance program available in the US, period. No - make that an exclamation mark!

And here:

Fileercapita costs.png - Wikipedia, the free encyclopedia

And here, citing the the New England Journal of Medicine, which is about as respected as it gets on the topic:
Medicare, Medicaid Far More Cost-Efficient Than Private Insurance | FDL News Desk

And so on.

 

[Bob Fechter]

Your sources are two left wing political bloggers and Wikipedia. No opinions there, I'm sure.

 

[Jeff Young]

Wrong. They contain data from the New England Journal of Medicine and the Center on Budget Poilcy and Priorities, and the chart from Wiki comes from a Johns Hopkins study.

And there are many more.

Find me some numbers, not opinion, or this is yet another Disaster at Port St. Lucie for you.

 

[Bob Fechter]

http://www.cahi.org/cahi_contents/resources/pdf/CAHI_Medicare_Admin_Final_Publication.pdf

Medical Progress Report 5 | Comparing Public and Private Health Insurance

Medicare Administrative Costs Are Higher, Not Lower, Than for Private Insurance

5 states top Medicaid fraud list, States recover $1.7B - FierceHealthcare

 

[Steve]

Did I ever discount your opinion for lack of knowledge? Absolutely not. You've got a ton of knowledge and experience that I don't. On the flip side, I've got more than you recognize, did a fair amount of CON litigation in the 90s, and a few medmal cases on teh defense side.

More importantly, and I don't mean this in a derogatory way, but you have a micro view of our system. It takes more, in my opinion, than simply practicing medicine to understand the macro side of heatlh care delivery and cost containment. I'm certainly no expert on that, but frankly from some of your assertions about work hours and how compensation, and this takes nothing away from your skills as a surgeon, I don't think you have any specialized knowledge on that either.

Doing medmal (thanks for defending docs BTW!) and CON litigation can skew your viewpoint as much as mine. That being said, my view is much bigger picture than just Ortho. I do happen to sit on a committee that advises the govt on new CPT codes (the codes we use to describe a procedure. A carpal tunnel release is 64721 for instance.) but I'm dead certain the RVU system was not influenced by surgeons to favor us over PCP's.

We have a fee for service system: you do more, work longer hours, work more efficiently and you make more. The problem is we don't reward good outcomes. Of course, no one agrees on what constitutes a "good outcome". There is also no disincentive to prevent overutization of health services by patients. When the 30million covered by Obamacare come online they're going to place a huge burden on the system as they're going to want a whole body tuneup

 

[Jeff Young]

http://www.cahi.org/cahi_contents/resources/pdf/CAHI_Medicare_Admin_Final_Publication.pdf

Medical Progress Report 5 | Comparing Public and Private Health Insurance

Medicare Administrative Costs Are Higher, Not Lower, Than for Private Insurance

5 states top Medicaid fraud list, States recover $1.7B - FierceHealthcare

Uh, Bob, the first two of those studies take the position that Medicare's admin costs are 6-9% per patient rather than 2-3%, and that private costs are 14% or so rather than 25%. Correct me if I am wrong, but even if your right wing buddies are right 14% is still more than 6-9%.

THe last one is a Heritage Foundation piece by a single doctor claiming that you have to jack up the Medicare side because Medicare patients consume more health care. Or something. It's pretty unclear and contrary to everything else out there.

It's Port St. Lucie all over again there Fechter, and you still owe me a week of "I am a dumbass" posts for that debacle.

 

[Keith]

Forum Rule No. 1 Breach! Forum Rule No. 1 Breach!

I've got plenty of PMs about you guys as well. It works both ways and don't think it doesn't.

I did go back and took a look at the Libya thread and got a laugh.

You got a laugh. I guess that just sums it up.

That, sir, is totally disgraceful.

 

[DaveM]

This "Why have we let the insurance companies set the rules instead of the other way around" mentality shows just how conditioned we are towards private enterprise.

What is that supposed to mean? No regulations at all? Your attitude is people with pre existing conditions are just screwed. Would you be happy if your health insurer cancelled your insurance after you made a claim and you were then uninsurable? More important for the insurance CEO to make $20M/yr. than have people treated fairly?

 

[Randy V]

Reading this thread is like watching a tennis match.
I hate tennis matches unless played by a couple of lovelies..
You guys don't qualify and I've gotten a few PMs and Reports on this thread..

So... Stick a fork in it - it is done.

Let's get back to cars or something with engines for pity's sake...