Why national health care is not the answer for America

[jay santos]

Originally Posted by SoonerCoug

They already have people with "master's degrees" who treat patients, handle easier cases, set broken bones, etc. Those people are called Physician's Assistants. They make less than 6 figures, just like you prefer.

Yeah I'm familiar with PA's. I take my kid into the "doctor", wait an hour, see a PA for 5 minutes, and pay him almost a hundred bucks. That's not what I have in mind.

Nothing personal against doctors. If I had my way, you'd still make triple the national average, you just wouldn't make six times the national average.

I used to work for an HMO. I understand the financial landscape. I think a lot could be done to make things more affordable and serve the consumer better.

[MikeWaters]

Jay, if a plumber charges $100 for an hour of work, I think $500 to treat a broken bone is quite reasonable.

[jay santos]

Originally Posted by SoonerCoug

My first choice for reform would be to eliminate insurance companies altogether and replace them with a government middleman who doesn't make a profit.

Insurance companies make very small margin: 5-10%. They cut costs by managing the docs. With a government middleman, costs would rise way more than the cost insurance companies add.

[SoonerCoug]

Originally Posted by jay santos

Insurance companies make very small margin: 5-10%. They cut costs by managing the docs. With a government middleman, costs would rise way more than the cost insurance companies add.

5-10% is huge, in my opinion. The insurance companies also cut their own costs by denying good claims for bad reasons. I'm going to have to disagree with you on this one. I think a government middleman could be much more reasonable and fair--and not make a profit.

[jay santos]

Originally Posted by MikeWaters

Jay, if a plumber charges $100 for an hour of work, I think $500 to treat a broken bone is quite reasonable.

Your industry is actually a good model to follow. You have LCSW's that are a dime a dozen that insurances can send a lot of patients to for $50 an hour, then you have psychologists that make more, then you have psychiatrists who only end up doing the high value added work. This is also probably why psychiatrists are at the low end as far as avg salaries for doctors.

[SoonerCoug]

Originally Posted by jay santos

Your industry is actually a good model to follow. You have LCSW's that are a dime a dozen that insurances can send a lot of patients to for $50 an hour, then you have psychologists that make more, then you have psychiatrists who only end up doing the high value added work. This is also probably why psychiatrists are at the low end as far as avg salaries for doctors.

Correct me if I'm wrong, Mike, but I think psychiatrists are at the low end because the specialty doesn't have procedures, and generally the doctors who make the most money, do the most procedures. I don't think this is necessarily a fair arrangement either.

[jay santos]

Originally Posted by SoonerCoug

5-10% is huge, in my opinion. The insurance companies also cut their own costs by denying good claims for bad reasons. I'm going to have to disagree with you on this one. I think a government middleman could be much more reasonable and fair--and not make a profit.

A gov middleman would still have the SG&A costs, they just wouldn't require the 5% profit. You save 5% profit but costs balloon because no one is managing them.

It would be good for you in the sense that you're not being told you can't do a surgery when you want to, but it certainly wouldn't cut total health care costs to the consumer.

The reform I'm lookin for is in cutting costs, not in giving more power to docs.

[MikeWaters]

the worst paid psychiatrists are ones that do therapy and ones that do research.

An experienced psychiatrist in town usually charges $150 for an hour of therapy. Usually cash only. But if he can do 4 med checks, 4 x 70 = 280.

So the highest paid guys are the medication mills.

In two states, you don't even have to be a MD to prescribe psychiatric medications. Psychologists with no real experience or supervision are allowed to prescribe. That's how bad things have gotten. It bodes poorly for the profession. Already it's hard to get people to go into psychiatrty. It's' only going to get worse. Watch--you are going to take a relative to see a psychiatrist because he just tried to kill himself. And you will be shocked to find that the psychiatrist in your plan doesn't speak the good english.

[MikeWaters]

Originally Posted by SoonerCoug

Correct me if I'm wrong, Mike, but I think psychiatrists are at the low end because the specialty doesn't have procedures, and generally the doctors who make the most money, do the most procedures. I don't think this is necessarily a fair arrangement either.

that's true. Psychiatrists are in the ballpark of FPs and Internists.

[SoonerCoug]

Originally Posted by jay santos

A gov middleman would still have the SG&A costs, they just wouldn't require the 5% profit. You save 5% profit but costs balloon because no one is managing them.

It would be good for you in the sense that you're not being told you can't do a surgery when you want to, but it certainly wouldn't cut total health care costs to the consumer.

The reform I'm lookin for is in cutting costs, not in giving more power to docs.

Why would you assume that the government wouldn't regulate what doctors could do in various situations? I don't think the government would necessarily give doctors more freedom.

Let me give you an example of how my HMO regulated my claims when I was on the verge of death from Crohn's disease...

HMO: "Your doctor's last name is the same as yours, so we are denying your claim on the basis that he is your relative."

SoonerCoug: "But we aren't related. He's from Kansas, and I'm from Utah."

HMO: "We don't hear you."

Me: "Really. He's not my relative. See! I have my family tree back to the 13th century!"

HMO: "OK, well, we can't pay your claim anyway because it was a pre-existing condition."

...I could go on and on. They do this with the hope that people will eventually give up, and it's a load of crap. I don't call that regulation. I call it crap.