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Old 01-25-2007, 02:03 AM   #31
Mormon Red Death
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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.
insurance companies make a more than 10%
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Old 01-25-2007, 02:15 AM   #32
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Jay Santos: A lot of med students are in school or training until they are ~34-37 years old. My path is a little longer since I'm doing a PhD plus an MD, but it's not unusual for training to take about this long even without a PhD. During the last 5 years I'll be making ~40,000 a year while working 80 hour weeks. Most med students end up with $100K-200K debt on top of that. If salary is a motivation for career choice, there are much quicker and less painful ways to make six figures. On top of that, many specialists have a very difficult lifestyle throughout their career.

Do you really think doctors don't deserve a 6 figure salary with this kind of lengthy training?

Think about it this way: for many specialties, the period from high school graduation to private practice is longer than the entire period of kindergarten to high school graduation. For me, I'll have been in school and training for 17 years since high school graduation (not counting my mission)...versus the 13 years from kindergarten to high school graduation.
What if the government provided free medical schooling and you did not have to incur such debt? That would ease the burden and drive down the "necessity" of earning a high salary.
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Old 01-25-2007, 02:26 AM   #33
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What if the government provided free medical schooling and you did not have to incur such debt? That would ease the burden and drive down the "necessity" of earning a high salary.
I agree that this would be a good thing.

Actually, the government already does pay for the medical schooling of people who also do a PhD degree (like me), in order to encourage MDs to enter research and academia. You don't have to have a PhD to do academic medicine, but it can be helpful especially for basic science work.

The point is--academic MDs make less money than private practice docs, and so the government funds these MD/PhD programs. In addition, the government will pay 35,000 dollars a year of med school debt for two years of post-graduate research to lessen the debt burden on academic docs.

Here is a question: how much has the free market driven up physician salaries? I mean--if you want to go to an accupuncturist to treat your cancer or heart disease, you could do this, and it'd probably save you money. Would it help with the disease? Not likely, unless you have an interesting placebo effect.

If you want to actually solve the problem, you need to go to someone who has significant expertise. Should there be more of these people in the country in order to drive up supply and thereby also drive down salaries? I think the answer to this question is related to access to physicians. Is there a problem getting access to a doctor? It's supply and demand, right? How difficult is it to get an appointment with a doctor if you're very sick? Compared to other countries, it's pretty darn easy to get an appointment in the states. In Canada, you might have to wait 6 months, and the doctor makes much less money. I think that reasonable access suggests that the supply of doctors is adequate, for most specialties (not for dermatology, though).

My point is: I don't think this is a supply and demand issue. I think it's a question of how valuable is the service that is being provided.

Last edited by SoonerCoug; 01-25-2007 at 02:50 AM.
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Old 01-25-2007, 02:33 AM   #34
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govts already subsidize medical education to the tune of millions of dollars per school.

I paid around 8k per year for my med school. Trust me, the actual cost was much higher than 8k per year.
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Old 01-25-2007, 03:01 AM   #35
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Originally Posted by SoonerCoug View Post
I agree that this would be a good thing.

Actually, the government already does pay for the medical schooling of people who also do a PhD degree (like me), in order to encourage MDs to enter research and academia. You don't have to have a PhD to do academic medicine, but it can be helpful especially for basic science work.

The point is--academic MDs make less money than private practice docs, and so the government funds these MD/PhD programs. In addition, the government will pay 35,000 dollars a year of med school debt for two years of post-graduate research to lessen the debt burden on academic docs.

Here is a question: how much has the free market driven up physician salaries? I mean--if you want to go to an accupuncturist to treat your cancer or heart disease, you could do this, and it'd probably save you money. Would it help with the disease? Not likely, unless you have an interesting placebo effect.

If you want to actually solve the problem, you need to go to someone who has significant expertise. Should there be more of these people in the country in order to drive down demand and thereby also drive down salaries? I think the answer to this question is related to access to physicians. Is there a problem getting access to a doctor? It's supply and demand, right? How difficult is it to get an appointment with a doctor if you're very sick? Compared to other countries, it's pretty darn easy to get an appointment in the states. In Canada, you might have to wait 6 months, and the doctor makes much less money. I think that the demand suggests that the supply of doctors is adequate, for most specialties (not for dermatology, though).

My point is: I don't think this is a supply and demand issue. I think it's a question of how valuable is the service that is being provided.
the reason that I ask is to gauge the feelings of physicians about an even greater governmental subsidy. I had a political science class on governmental policy systems, and I learned that in Germany there is a total subsidy of medical school ( I am uncertain whether this includes living expenses, but I assume that it does). This helps young doctors make it more easily in the early years, but also, it tends to put a ceiling on what doctors earn there, since there is an oversupply.
The German model , in which you have compulsory insurance is worth a look to fix our medical system. I think that we definitely ought look at other health care systems to see what they do that works, in order to drive our health care spending down, and also, to make the system more efficient in providing more preventive access, etc.
i am not with Mormon Red Death in thinking that governmental involvement in an area ALWAYS equals a problem, but I do think that the less intervention is better in almost every area. But Health Care might very well be one of the few areas in which governmental is not only necessary, but smart. The truth is that continuing on the same path is unlikely to produce better results, and health is not an area to be trifled with.
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Old 01-25-2007, 03:23 AM   #36
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Originally Posted by Mormon Red Death View Post
insurance companies make a more than 10%
Good ratios for a health insurance company is a 15% med loss ratio, which is 1 - health care cost/revenue, similar to gross margin.

And then SG&A of 7-10% which equates to 5-8% OI.
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Old 01-25-2007, 03:41 AM   #37
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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.
Those are also important issues. I'm not passionate about those issues, but they are very important.

I'm interested in lowering health care costs. Health care costs have grown at triple inflation for the last 10-15 years. That's a big problem.
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Old 01-25-2007, 03:53 AM   #38
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Those are also important issues. I'm not passionate about those issues, but they are very important.

I'm interested in lowering health care costs. Health care costs have grown at triple inflation for the last 10-15 years. That's a big problem.
So why have health care costs gone up?

Physician salaries have VERY little if anything to do with recent increases in health care costs.

I think the main reasons for increased health care costs result from:
1) New, expensive medications--including biologics (physicians don't get any money for prescribing more expensive medications)
2) Doctors playing defensive medicine (or sometimes lazy medicine)... i.e. doing an MRI either because a patient knows about the high tech stuff and demands it, or because a doctor is afraid of getting sued if he or she doesn't order the MRI, or maybe even the doctor being lazy and sending the patient for an unnecessary procedure. I'd argue that for anything unnecessary, the government could regulate this just as well as an HMO. But this defensive medicine thing doesn't increase physician salaries. I also think HMOs often cut costs by decreasing quality of care or denying a claim unfairly to very ill patients--and that's a very bad thing to do.
3) New, expensive high tech diagnostics (a doctor would only rarely get a cut from these kinds of diagnostics--if theyr'e a part owner of something)

I don't think physician salaries have increased more than inflation....and Medicare and Medicaid compensation have not even kept up with inflation.

Last edited by SoonerCoug; 01-25-2007 at 03:55 AM.
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Old 01-25-2007, 04:00 AM   #39
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I work specifically in the medical recruiting industry. Know the industry very well.

It is wrong to say that Physician salaries are the problem for insurance rates. In fact it's so off it's not even funny.
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