Health care "reform" passes

[AdrianBurton]

I find in coincidental that everyone can find flaws but no one can agree on a solution, so based on what I have read here the best solution is no solution at all.

I have what I need screw everyone else. WOW!!!!!

While I agree that there are a lot of things that can be done, but SOMETHING has/had to be done.

 

[Bill Musarra]

I keep seeing people spouting" some" info about the health care debate/debacle. Some for it some against it. Here is a compendium of information, compiled by someone who has studied the situation, about the health care bill and what you can expect from it. By the way, health care isn't one of them. You might say he is a right winger(he isn't, he is a libertarian)
I will say this, if you disagree with this information, please try to do so with facts and not emotion and opinion. If you can find a section you think he doesn't know what he is talking about, lets hear what you think, excuse me, you know, with facts to back it up. I think you will be hard pressed.
He did leave out one little fact. With the increasing deficits already, added to the amount of debt that will be incurred when the government tries to eliminate the insurance companies, the Democrats will raise a gimmick they tried under Clinton except it will go even further, they will try to take over and administer your 401K (estimates are as high as 13 Trillion $$). Clinton only wanted to have a one time tax. Failing that the U S will lose its bond rating. Foreign countries will stop buying our bonds and some will call in their notes. The government may require you to buy bonds with your 401K. The economy will implode and bankrupt the country. And you thought this recession was tough.

Nealz Nuze on boortz.com

 

[John Milmont]

Having all that money in 401k's really must wet the mouths of those politicians. I have always feared something like that, little did i know that there was ever a proposal for such a devious plan.
Looks Hillary clinton has another hair brained scheme concerning 401k's This is from 2007: Clinton?s 401k proposal - First Read - msnbc.com

 

[Jim Rosenthal]

Ummmm...I don't pretend to know much about finance, but I do know something about medicine; it's been my career since 1982. Before that, my career was getting into medical school..., fortunately a much shorter career than the one afterwards. If you all will permit me a couple of observations:

1) it is hard to comprehend how badly off the American system of medical care is unless you work in it. Even getting sick and getting overpriced and poor quality care doesn't really send it home to you. Working in it, however, is eye-opening and distinctly unpleasant. There isn't a single day of work that I don't wish things were a great deal better. My experiences with my family members, living and dead, have been no better, I regret to say.
2) there are quite a few new medical schools opening up; the issue of a poor supply of doctors may become slightly less of an issue. However, the issue of poor distribution of the doctors that we DO have will not change. The solutions to this problem are not complex and have been well worked out in other countries, but until all the players involved in medical education (the government, the hospitals, the schools, the students- everyone) have the backbone to actually DO something about it, we will continue to have too many specialists, not enough primary care physicians, and uneven distribution of the doctors we do have. We will also have too many of the wrong kind of specialists- for example, too many plastic surgeons, and too few intensivists. What is particularly distressing is that quite a few new grads would go into primary care specialties (FP, IM, Peds, OB/GYN, EM) but the debt load accumulated in medical school discourages people from doing so. Other countries have dealt with this far better than we have- including Mexico and Cuba and Brazil. Embarrassing that countries regarded as third-world are actually better at serving more of their population with medical care than we are here.

3) I am painfully aware that the legislation which is about to pass is flawed and does not address many of the above concerns. In addition, the legislation does not actually address medical care; it addresses the availability of health insurance, which is a different thing altogether, although it is related to medical care. Initatives which help give citizens the financial wherewithal to see a physician are not the same thing as actually providing medical care, although they may be helpful, and we should not confuse the two. But everyone does.
However, the current situation is SO bad (please believe this from someone who has spent his professional life, or most of it, in the current situation) that it is essential to do something that begins to move us out of the mess we are in. It took decades to make this mess, and it will take at least decades to get us out of it. The process will be painful for all the players involved- patients, physicians, hospitals, schools, insurers- have I left anyone out? But it is essential to transform the current dysfunctional and unproductive system into something that more nearly meets our needs and wastes somewhat less of our money, effort and time. Unless you work in this system, you cannot comprehend the degrees of inefficiency and waste with which we all suffer. I may love what I do, but I don't love the situation in which I do it.

Please note that in pointing out the above I have tried very hard to avoid inflammatory rhetoric and fingerpointing. As Pogo said years ago, "we have met the enemy and he is us." We all made this disaster; unless we all participate in fixing it, it will go unfixed.

 

[Al Jones]

Well said,Jim, and from a member of the medical community who has seen this situation develop over the years through the course of many administrations of BOTH parties. And to those doctors out there, I have no problem with what you make for a living. I DO have a problem with an insurance company telling you that you can't do a procedure that both you and the patient want because it will decrease the company's profit margin. Essentially what this bill does is regulate more of what the insurance companies administer, that is,their control over what the medical communties do or do not do. If the insurance industry as a whole had been a bit more flexible toward this restructuring it wouldn't have come to this. Yes, I know there will be someone who will take issue with that too,but the insurance industry isn't in danger of failing tomorrow (not the investment brokerage subsidiaries, but insurance proper),it's one of the most profitable in the western world. Ask yourself how it got there.
Personally, I think that a little more effort,not just time, in ironing out some of the legislation would have resulted in a better bill and less acrimony among party members BUT, something had to be done. Now we need to be VERY careful about how this gets adminstered and to whom.

 

[Al Wohlstrom]

Caterpillar, the biggest heavy equipment builder in the world says that this bill is going to cost them an additional $100 million a year. When they leave the US, think of the jobs and taxes that will be lost, and a lot of big companies will follow.
Has anyone stopped to think why insurance companies don't cover pre-existing health problems? they would go broke. This healthcare is going to be operating in the red so quick it will make your head spin. We don't need the government controling another 14% to 16% of the economy.

 

[Seymour Snerd]

OK I got the motivation, now what's the plan?

... it is essential to do something that begins to move us out of the mess we are in. It took decades to make this mess, and it will take at least decades to get us out of it. The process will be painful for all the players involved- patients, physicians, hospitals, schools, insurers- have I left anyone out? But it is essential to transform the current dysfunctional and unproductive system into something that more nearly meets our needs and wastes somewhat less of our money, effort and time.

Jim -- you had me on the edge of my chair there. i was already to find out from an actual practicing MD what it is exactly we should all do, and..... your post ended. Don't stop.....

 

[Cliff Beer]

Cliff,

Got news for ya...the doctor supply in US has little to do with the number of US graduates. There are ample (a nearly unlimited supply) of foreign medical grads coming to our shores.

You are right about medical schools limiting the number of US grads...there are numerous applicants for every seat in every class of every medical school. As the pay decreases, which it is, you can expect those seats to be filled with students who otherwise would have gone into...say, underwater basketweaving. The sharpest applicants will go elsewhere, where their brainpower and work-ethic will be rewarded more handsomely. Lets face it, anyone with even half a brain will not go into massive debt, study like crazy and take little or no pay for the first 10 years of their carreer (and I'm talking AFTER collage) to make $100-150K/year. You'd have to be a fool to accept that ROI. And, of course, a fool for a physician is exactly what you'd get.

As you might have guessed, medicine is a complicated business, often quite stressful (what with the constant risk of maiming and killing of patients....and the lawsuits that come regardless), and one that requires a high degree of critical thinking and judgement to be any good at. I'd prefer that there be at least some selectivity in the selection process. But, that's just me.

Regardless, unless you've checked lately, you'd be surprised at what physicians make. There are great regional differences, but many/most primary care docs make $100-125K, with specialists making more depending on the specialty (of course that comes at increased expense, and an even longer period of not making enough to pay down your loans, buy a house, start a 401K etc). Very few specialists in my area (including surgeons) make $500K. I don't even come close in the best of times.

As they say, you get what you pay for. Although, I think Obama is trying to convince everyone that you can also get what you don't pay for. Good luck with that.

OK Ron. I'm not as dumb as I look.

Here's some facts upon which I base my opinion. I used to oversee a) the preparation of personal tax returns for many, many doctors, in clinics both large and small, rural and urban, and b) the audit of those same clinics. They were my clients in public accounting. You could say I have a very well informed opinion of what doctors make. My first hand experience is exactly what I stated: GPs make, on average, in the neighborhood of $250K/year with specialists in the neighborhood of $500K/year. That's an average, I'm sure you know what an average means (some more, some less, but overall, that's the number).

That's a very big part of why health care costs so much in the US.

Here's a bit more data that's based upon personal experience and intuition, but not necessarily proven fact:

1. Practice standards don't need to go down just because there are more graduates. Quite the reverse: a larger pool of graduates means more research is done at a lower cost (again, salaries) - the level of care and sophistication is just as likely to go up. In any case, not every doc is performing brain surgery - no need to be Einstein and trained like a NASA astronaut to be a GP. And, if it's something particularly complicated, well, that's what you have specialists for.

2. I have a doctorate degree, and wages are quite modest in that particular area of practice because the profession has decided not to overly restrict the supply of graduates. Previously, (50+ years ago), that wasn't the case, and relative wages were considerably higher then. Practice standards haven't really changed in that time.

3. The AMA has huge influence in DC, as do insurance companies, all designed to maintain the status quo and eliminate threats to pay and profits. To be specific, they have lobbyists by the truck load and hand out money or "other value" in one form or another (campaign contribs, in-kind support, promise of lucrative "consulting" jobs, etc.) by the container load. Who does Joe Average have in DC looking out for his interests? Guess who? Dick All. That's one reason why we have an Executive Branch (in theory at least).

Bottom line is that insurance companies and doctors overplayed their hand and they blew it. The people in the streets want health care reform so they can get reasonable care at reasonable cost. No doubt this Bill falls way short of that, and the end goals won't be achieved, but there's at least some movement away from business as usual and that's a good thing.

That said, I completely respect others have different opinions and that's a healthy thing, the above just happens to be mine.

 

[J. Salmon]

Here's what's broken with US healthcare: medical schools aren't graduating enough docs. The med schools artificially restrict the number of new docs coming into the system for the sole purpose of maintaining and inflating salaries. They say it's to "maintain the highest standards" and such but that's just bs. GP docs should be $100K/year, not $250K/year. Specialist docs should be $150K/year, not $500K. Increasing the number of graduates doesn't mean that standards have to come down....perhaps quite the reverse in fact.

Of course, no politician (or anyone of any importance in the debate for that matter) has the backbone to say that publicly.

Dramatically increase the number of new docs being graduated would cut costs in an equally dramatic fashion. Docs in national health system in the UK, for example, are paid substantially less than here in the US. And, no, liability coverage for docs in the US is not the difference - not even close.

I suspect the above is offensive to a doc or two on this site - no offense intended.

Cliff,
I am sorry, but this just is not accurate.
You are not going to get people to GO to medical school. Why would they? When I started (1993) Not ONE physician told me to go to medical school. Not one. They all said they would never do it again.
Most family docs can barely keep their doors open.
The cardiothoracic surgeons in town make about $250k a year. Do you have any idea how hard they work? How long and hard they trained? How difficult what they do is? There is no way on God's green earth I would do whay they do for that money (OK, I wouldn't work those hours at all). But what are you going to do when you've invested 11-13 years of post graduate training? you are going to do what you can.

There are two places money is going in medicine that is wrong: one, unnecessarily expensive tests and procedures. Two: insurance company profits.

Example one: a Pap smear (one of the most successful tests ever developed in medicine, it took cervical cancer from a leading cause of death of women to a rare event) used to and should still cost about $20. It now costs up to $500, because it has to be a thinprep with DNA analysis for HPV viral type. What's the cost/benefit ratio here? But in the US, you have to have the best, because that's the way it should be.

Example two: Insurance premiums are going up, but reimbursement to (as you say overpaid) physicians has been going down for YEARS. A general surgeon makes now the same thing for a gallbladder removal that they did in the 70s. So where is the money going? We are all paying more for it, but the doctors are getting paid less? Hmmm and insurance companies are some of the most profitable businesses in the US? It doesn't take a brain surgeon to connect the dots.

And lastly, if you think it doesn't take intelligence to be in family practice think again. they have to be the MOST intelligent. They have the least info to go on, they are the least specialized (which means they have to try to know something about everything), and they are the one that has the opportunity to catch something early. If there is anyone you want to be good, it is your GP. In many cases specialization is easier, because you simply get good at what you do.

-J.

 

10 minute away from the village where I live (Mexico), there is a community of 5000 American senior citizens (YOUR contemporaries). When I ask any of them “why are you here?!” The number ONE answer is Health Cost. The Meds are cheap, Hospital stay in private room, major surgery, Doctor visit ,,,,etc is BEYOND cheap. These are Doctors that graduated from Universities in USA! They would make a house call for $10 if you can’t go to them.
If Mexico’s prices or service is NOT good enough for you, you can take a flight to Havana and see doctors that are THE BEST in the world and cheaper! But of course who would want to go to that “despicable Socialist” country??!!!
Socialism and Capitalism are like burp and fart (Democrats and Republicans) both of them stink to high heaven. IM (not so humble)O, you HAVE TO incorporate both to have a system were one does not RAPE the other . Also, one does not bankrupt the other.
P.S I hope Mexico deport all these illegal aliens

 

[Damian]

O.K. so 13 states (and counting) filed suit to stop this bill.

 

[Damian]

Sheik you are dead wrong (not to burst your bubble) but the U.S. has the #1 hospitals in the world period. That's just fact. Now lets get into the whole mexico thing. Lets see; what is the average annual salary over there? A doctor could only charge what the population could realistically pay ( I know mexico is just flooded with cash these days). That is the reason that people go there for. FOR CHEAP DRUGS and nothing else (outside of vacation). Please, they have a more corrupt gov't than we do here in the states. Do you care to argue that medical standards are far far far far greater here in the U.S. than in mexico or any other country for that matter (refer to previous post in relation to people of means comming to the U.S. for live saving surgery). Come on I know you like to have fun on here but that was just WRONG!!!!!!!

 

[Damian]

Oh and I suppose that you spoke to all 5000 seniors when you were forumlating your post? I would bet dollars to donuts that while they may be there for CHEAPER DRUGS the main reason for their presence is that a dollar (why do you guys love to dollar so much and not the pesso) goes much farther there (again what is the economic state of Mexico or what is the average annual salary?) so lets just keep that in mind. You guys are the equivelent of Canada for the southern states and not much more. Don't get me wrong I love the food and the people but lets not confuse dreams with reality.

 

[Damian]

Oh and how about all those pesky cartels that are sturring up MAJOR PROBLEMS (today as a matter of fact). I guess the drug lords who care so much (we all know that they really run MEXICO, not that our gov't don't act like gangsters themselves) for it's people have made it so that Mexico has the greatest medical care around; PLEASE!!!!!!!!!

 

[Chris P.]

Just to make a comment about Neil Boortz - he isn't exactly centrist. I have always felt that libertarians are just rebranded republicans and Mr. Boortz is a good example of that. Just look at his daily columns - look at the archives. He is extremely critical of the left and almost silent in the same regards with the right. I see just as many problems with both, personally.

And the thing about facts - here's a fact: honesty is the underlying ideal that comes to my mind. Honesty depends upon facts, but honesty requires providing ALL the facts, not leaving out the ones that counter your viewpoint. You can spout all day long about facts (like so many do - think O'Reilly), but as soon as you leave out facts from the other side of the argument, you're just another partisan blabber. I personally am sick of this and wish I was in the kind of position to host my own show - one that purposefully takes no sides and points out the good and bad about not only both sides of the isle, but the more important meat - the more rational middle. This is where our problem is - everything we talk about, every solution we are supposedly trying to work on comes down to left or right as if it's between right or wrong. This is so wrong and counterproductive I am now numb to ANYTHING that happens in our government. It's all just hot air blowing around, back and forth with nothing actually happening.

I know that the real changes don't come from government every four years, they are generational and happen every 20 years. That's why it took so long for racial issues to settle down, environmental issues to get cleaned up. They can't be discussed and decided upon by individuals. This healthcare problem didn't happen because people sat down and wrote legislation to make the way it is, it morphed into it over time. Just the same, don't expect people to be able to sit down and write legislation to fix it; it's going to take time. For all we know, in 20 years, with today's signing as a spark, maybe healthcare will be so much better. At least we're trying. I really believe it's the best our government can do.

 

Sheik you are dead wrong (not to burst your bubble) but the U.S. has the #1 hospitals in the world period. That's just fact. Now lets get into the whole mexico thing. Lets see; what is the average annual salary over there? A doctor could only charge what the population could realistically pay ( I know mexico is just flooded with cash these days). That is the reason that people go there for. FOR CHEAP DRUGS and nothing else (outside of vacation). Please, they have a more corrupt gov't than we do here in the states. Do you care to argue that medical standards are far far far far greater here in the U.S. than in mexico or any other country for that matter (refer to previous post in relation to people of means comming to the U.S. for live saving surgery). Come on I know you like to have fun on here but that was just WRONG!!!!!!!

Damien my brother,
Why does it have to be that YOURS or MY point of view is WRONG??! There are fantastic doctors and facilities in US and Mexico. There are Awful doctors and facilities in US and Mexico. Same thing with corruption, every American thinks Mexico is more corrupt than US,,,WRONG, they are both as corrupt ,,soo WHAT???????!!!!!
The issue here is Healthcare cost,,,and who pays for it. The Sheik’s remedy is to lower the profit margin of every American citizen, YES EVERYONE. If that is going to lower the standard of living,,THEN GOOD, welcome to the rest of the planet earth.
I have lived (not vacationed) in Middle East, USA, and Mexico. Most of the OLD WHITE people that I have met in Mexico, would have had NEVER come there had it not been for the healthcare cost. WHY do they come there??? ARE THEY MORONS (They are the same age as most of YOU here)?? Ramble all you want, IT IS COST that brings them there.

And no Damien, I did not talk to all 5000 of them, but let me ask you when was the last time you lived (not vacationed) outside or talked to anyone who is living outside of USA??!

The comment about the Mexican Cartels also makes me laugh,,,,I grew up in Oakland California. THE MOST dangerous place, I have EVER lived in my life was/is not Middle East, or Mexico,,,,you guessed it,,,US of A. And that is a FACT, JACK

A personal note, the Sheik gets his teeth/fangs cleaned for $12, extractions are $25, root canals are around $100 and pearly white crowns are $150. This is a Dental facility that is BETTER than the ones I have been to in California. And this is a personal FACT.

On a disturbing note the cost of teeth cleaning has now jumped in my area to $15, because the despicable gringos pay without bargaining!! I tell you every where the whitey goes he F%^*$ things up

 

[Dave Wood]

Just to make a comment about Neil Boortz - he isn't exactly centrist. I have always felt that libertarians are just rebranded republicans and Mr. Boortz is a good example of that.

As a lifetime Libertarian( well, adulthood in 1969), I resent the generalization. I don't consider ALL Rep.'s as being represented by Rush nor all Dem.'s as being represented by the Clintons. I feel that both sides are greedy self serving SOBs. ALL they are interested in is RE-ELECTION. The discussion about this bill re-emphasized that to the fullest extent. The question/debate was never centered around the constitutionality of it, but how it was going to effect them in the next election cycle. Why do they have their own "cadillac plans" that the taxpayers already pay for?? There was no provision in this monstrosity for them to give up their plans and enroll in what they feel is the best for everyone else. It is passed time for Americans to wake UP, the politicians are just that POLITICIANs...on both sides. They only represent THEIR interests. IF, which I will not hold my breath for, they stop exempting themselves from every piece of $hit law they pass...we may be at a turning point. Until then they will just continue bleeding the working people of the US. IF they think Canada or Europe's medical insurance is so great, I encourage them to become citizens of whatever country they presume to be the best...just get out of my business/face/life. Let someone that is more motivated by following the Constitution, than someone that is interested in following the money, take their place. The same people that took campaign contributions from Wall Street are the same ones that bellowed the most when things went awry. They can't manage to spend more money than they take in, yet think they can run the auto industry. For all practical purposes the US is bankrupt, if a private citizen operated a business the way they run the govt. they would have been closed decades ago.
Both sides represent the worst hypocrisy and greed imaginable, yet they wonder why the country is the same way. I understand their concerns, but you are what you represent.
Since 1969, I have only voted for 1 of the 2 main party candidates...that was a Democrat. Unfortunately I was picked to be the precinct representative, which I served for one whole meeting. They had no interest in knowing WHAT the people wanted or thought( this was during the ever so popular 55MPH BS), they wanted the precinct persons to follow in lock step. I think the same thing can easily be applied to the Republican's. It's time to not elect either one and vote independent. If in the next election cycle the incumbent in your area disparages any other candidate because they don't have the connections they have...vote for the one with no connections. If that had any importance, we wouldn't be about belly up. No country falls, just their corrupt leaders. Germany is still germany even after Hitler.That can be traced back through recorded history, Egypt may not have the Pharoahs, but it is still Egypt. Using just those 2 examples a case could be made that they actually caused the countries to fade from prominence and innovation.
Libertarian..YES...but "rebranded Replublican"..far from it.

 

[Ron R.]

Cliff,

There are regional differences, but I seriously doubt you've done the taxes of any GP that is currently making $250K. If so, they are not running a normal practice, perhaps they own a clinic in which other docs work.

Not to split hairs, because I'm assuming by "GP" you mean any primary care doc. GPs typically only have one year of post medical school training, and are not boarded in anything. An internist (adult care) and pediatrician (child medicine) each have 3-4 years or residency training, and are boarded. Family Practicianers do a little of both, do a residency, and are also boarded. All are considered primary care docs.

My wife is an internest. She trained at a top 5 medical school, and has never seen a job advertised for anything close to what you are claiming. Half that would be exceptional in our area.

My mother-in-law is a CPA, and does the finances of a number of MDs, DDSs, and orthodontists. Wanna guess who makes the most money...by far.....the orthodontists. And just think, no call, no life or death decisions (I make them daily), little risk of law suit, and nobody else telling you how much you are allowed to make. BTW, training is a total of 4 years, and is WAY cheaper than med school/residency.

As I said, there are regional differences, and in our part of california, reimbursement is particularly poor. I did a quick search of all specialties and subspecialties, and found a report on line "2009 Physician Compensation Survey, By the American Medical Group Association (AMGA)" Only three specialists make an average of $500K or more; Cardiothorasic Surgery, Neurological Surgery, and Ortholopedic Surgery. Only the Neurosurgeons made significantly more than $500k, with the other two hovering right around that number. All of the primary care docs averaged about $200k nationally.

Finally, the last comprehensive survey I saw stated that physician pay comprised only about 17% of healthcare costs. Eliminate it completely, and you are still not even close to solving the problem.

 

[Ron R.]

"You are not going to get people to GO to medical school. Why would they? When I started (1993) Not ONE physician told me to go to medical school. Not one. They all said they would never do it again."

My experience exactly. And I strongly caution all youngsters asking me about going into medicine.

Sunday afternoon I was talking to an older cardiothorasic surgeon friend about the current state of medicine. He said that he could see where medicine was going (considered a "right"...and run by the government), and that is exactly what prompted his retirement. Otherwise, he would have kept working.

His partner at the time, can now barely make ends meet.

 

[Dave Wood]

Has anyone stopped to think why insurance companies don't cover pre-existing health problems?

I have found this term extremely annoying. Sure it sounds so nice, but would you wreck your car and then get full coverage after the fact and expect them to repair it?? Hell no, and I'd like to be there when they laughed at you for suggesting it. Insurance is INSURANCE...it's not a winning lottery ticket. I feel that is the biggest part of the problem, I saw it with vehicle insurance claims and find it hard to believe that these same people don't also try the same thing with health insurance. Just for the record, I have NO health insurance. The best health insurance is to take care of YOURSELF and not expect someone else to pay for it when you don't. I pay for my dental, when I can, if I can't I do without. I also pay for my medical when I need it. I'm 59 and when my physical was done at 50, I had the same basic data as I had when I had it done at 27. I think Health Insurance itself is the biggest contributor to rising costs. Physicians have to do a battery of tests for virtually anything, that in itself raises costs to those that pay their way. Add into that those that bleed the system because it's free ( that would include public aid and politicians) and the costs will never subside. The bill they passed is longer than most health insurance contracts.....hmmmm.