September 8, 2009

Do you have health insurance? Would you like to be able to buy cheaper insurance?

OK, go ahead.

Have at it.

I for one enjoy my high-deductible, low-cost, major medical insurance (i.e. you go to the doctor (or the clinics that should be at every Wal-Mart) for a cold, you pay. go to the doctor for cancer or a heart attack, they pay). And if private companies won't offer this out of concern for profits, then the government, on a revenue-neutral basis, should.

What I don't want is a government "takeover" of healthcare. What I don't want is the disaster of the UK - massive taxes for crappy health care.

Government should be in the insurance business, if it's necessary. However they should NOT be in the health care delivery business. And it should not be in the 50% tax bracket business (like the fools in the UK). Never.

Should be another interesting few months, as the American Summer of Rage™ moves on to the American Autumn of Ignorance™


jim said...

All the arguments to the health care things are the same arguments that should be used to privatize the fire and police and military. The only difference is degree.
AS for the argument that it docent work, well, I've been to Europe and Canada, and frankly, they all looked pretty damn healthy to me.

Anonymous said...


You will never know how free something is until the government gets involved


Anonymous said...

I maybe wrong, but didn't the government try somthing similar to this a while back so more people could afford a house?


Bukko_in_Australia said...

We have government health care here, plus private.

The government is like the baseline. If you're too poor to pay for private health insurance, you can go to a public hospital like the one where I work. The quality of the treatment there, and the outcomes for the patients, are as good as all the hospitals where I worked in the U.S.

There are also private hospitals where you go if you have private insurance. I've never worked in one. Nurses who have tell me they're a bit fancier than public hospitals, but they don't take the serious, hard-to-handle cases like the public hospitals do, because there's no profit in that. Hard cases go to the government hospitals.

There are medical clinics all over. I got to a private-practice one street over from my house. You can walk into it for a doctor's visit any time -- no waiting for weeks. Costs $58 for a visit now. I pay from my pocket, even though I have government health care now. People who can't afford to pay for their own doctor visits go to clinics that do "bulk billing" -- i.e. charge the government for that visit. Lots of people go that route. I've never heard any complaints from my hospital patients. They like the system.

Aussies pay a 1.5% income tax for this. Money from the general tax funds also goes to hospitals, public and private. Everybody gets taken care of. Peoples' backs are not broken by taxes. The whole health care hassle is non-existent here. Too bad America can't be like that.

Anonymous said...

like your ideas on this, Keith.

additional ideas:

- Remove mandates for unnecessary procedures like in-vitro.

- Cap punitive damages.

- Forbid insurance companies from discriminating based on preexisting conditions.

- Put Congress on whatever health insurance plan they create for citizens.

- Prior price/rate disclosures wherever possible to increase competition

- No political contributions from entities (e.g., corporations, unions) because they don't vote and they are made up of natural persons who can already contribute as individuals

ContraryRiches said...

My point exactly....Keith, high deductible policies are very difficult to find for most these days. It used to be the norm that you could get these. I work in health care as a provider and know that those with "secure" jobs and better insurance absolutely get better care but utilize health care way more.

A high deductible/major medical plan is the way to go to bring the rolls of the uninsured down.

Anonymous said...

I have Bipolar Disorder.

Nobody will sell me a private policy.

I'd sure love one of those catastrophic policies that you have Keith but no matter what, I can't get ANY health insurance of any kind.

Afterthought said...

Those with good incomes can afford whatever insurance they want.

The problem with the un/underinsured is that all their jobs were shipped overseas.

Had they good incomes, they wouldn't need to turn to government for help.

Lesson: Treat the disease, not the symptom.

Robert said...

I flow through physical thoughts. I stare down the abyss of organic dreams. Dead by 65.

Anonymous said...


Have you been denied by that major medical plan you have yet?

i was just fine with mine also until I got hurt... and the orthopedic bill was triple our premium cost for that year. First time in many years. I'm healthier than a horse and take no drugs at all.

My never before a problem company became a nightmare overnight - sticking me with 50% of the doctor bill, even though they had given a verbal approval. Two company supervisors told me it was a mistake before they suddenly would not talk about it on the phone any more. Would not put anything in writing. After 2 sham 'appeals' (sent to the same pack of assh*oles that denied the claim) and the extensive documentation we had, were told we had no choice but to sue my spouse's employer for the balance. What an option. BTW, this was told to us by the State Insurance Dept. who said the company fell outside of their jurisdiction. No recourse.

The physical therapist was contacted up to 10 - yes TEN - times a day to berate him to bring his fees down, even though they were within their 'usual and customary' amounts. Was told thee bills could not be paid with any time table without doing so. It was done by a consultant to the company so the med insurance co. could claim they were 'not associated with it'. I had to get a med. ins. supervisor on the phone to admit they have a 'business relationship' with the animals.

W fought every BS thing they threw at us - won all of them but the surgeon bill, which like said, would involve suing the one employer we have, so we did not pursue that. Ate the $10G bill. Better than getting fired later.

Oh, and it aint' just the insurance company - the hosiptal also tried to bill us fo the balance of the bill not covered by the insurance, even though they took the plan 100%. Had to make a few calls about that one also. That one was easy. But hey, can't balme the bastards for trying, right?

All of triggered by a young, well person ortho injury. God help me if was cancer.

I may have to go in for follow up procedure - I have no idea if the bill will be paid, they will not promise anything in writing. The employer is no help, the benefit's manager is a friend of the insurance rep. I am considering recording phone conversations with them.

Keith my friend, stay healthy and your company will love you. Like they did me. Need it for that catastrophic care you are paying to be covered for, they will be OK for 1-2 months, tell ya everything is fine and being 'reviewed', then screw you over badly. Or sure will try to. Delayed bill paying, make mistakes in the 'fee schedule' (always to their benefit, BTW), deny procedures. You can fight them. Most folks do not have the strength or will to do so. They count on that.

Sorry for thr rant, but if all this happened to someone who was so 'good' before, it can happen to anyone. Boy did I learn the hard way. Watch where you walk and wash your hands often. Your coverage isn't as strong as you think, i can promise you that.

Is the government option a solution? i don't know, won't go there. But would i consider a govt. option if I thought i would not have to go through that again? Yes. I have nothing to lose, given the nightmare i had already.

And they know that, which is why the ins. co's are fighting it so hard.

Don't know the solution but something has to make those **cks more accountable, there must be relief from their hardball, horrid tactics. Some recourse for the person trying to just be covered for what the company said they would pay for - without having to go on 'News 4 shame on you' on TV.

Again, sorry for my 2 cent rant.

keith said...

Take a look at ehealthinsurance and see if you can get a better policy - maybe even better than the crap you thought was so great at work

For expats, check out hth worldwide

$2,000 or $5,000 deductible, major medical is the way to go - from the government (with nobody denied) or from a non-profit co-op.

And for that stupid cold, go pay $20 to the wal-mart or walgreens nurse

What to do about illegals and uninsured after reform, I'm not sure. I can't see America letting a 3-year old kid die on the steps of a hospital because her parents are illegals and/or uninsured. Any ideas?

TJK said...

Anne Coulter summed it up best when she compared the ObamaCare proposals to renting space in a large apartment building. Obama tells everyone they can live in the penthouse apartment and it won't cost them any more than they are paying for the efficiency down in the basement. Anyone older than 20 knows this is bullshit, and that is why the Dems are seeing so much opposition.

I'm 54, own a small business and have a high-deductible ($10K) policy that covers my family for $950 a month. We also have a health savings account (Ted Kennedy wanted those eliminated) and pay for routine medical care out of that account. Every time I go for treatment, I demand to know the fees up front, because I'm the SOB paying them. It's amazing to see the reactions of the clerks and doctors when they actually have to put down a price in writing for the services! For some of the women it's as though you asked them for a blow job. They actually become indignant and angry! Fortunately, we've never needed care above the deductible (knock on wood), but I imagine it would be ugly to deal with the assholes at the head office. Of course if the federal government takes over that option as health care provider, why would the hassles be any different?

Anonymous said...

A little off topic...
Should have listened to you and bought gold.

Devestment said...

I can't believe the sheeple are falling for this new ponzi scheme.

With socialized health care everyone gets taxed and is FORCED BY LAW to line the wallets of the already filthy rich health care lobby.

Those who object may be eligible for "special mental health care treatments" stripped of their privileges, and labeled Un-American.

This plan is just another deterioration of our freedom motivated by profit and the control of the workforce.

Freedom is about choices and privacy. In a free society, people develop the inteligence to make good choices. In a society where government makes our chioces we end up as fat slugs in Wal-mart looking for a handout.

ContraryRiches said...

regarding your thoughts on illegals and what to do about their insurance/health care needs...there really isn't a good solution to this.

You could force those who come to the ER with a sniffle to go to Walgreens like you posted about. That would certainly help. You could also make a mandatory "no illegals to be treated unless life is threatened." In other words, send them off to community clinics for routine stuff. But in reality, a better economy is the only panacea to this problem.

Ross said...

Tort reform. End of story.

Oh and if you're illegal and you are dying on the steps of a hospital, you get treatment and a one way plane ticket to any other country that will take you.

Anonymous said...

hey bukko,

does australia have a gargantuan defense budget that protects the world too?

Anonymous said...

"What to do about illegals and uninsured after reform, I'm not sure. I can't see America letting a 3-year old kid die on the steps of a hospital because her parents are illegals and/or uninsured. Any ideas?"

amnesty along with absolute control of the borders going's the only way.

i'm all for immigration...i just want them to sing the guest book on their way in...but i also understand there is nothing we can realistically do about the one's that are already here.

casey said...

do not have healthe insurance.Will not support that crooked industry.when I can have insurance that is competitive than I will buy.If it was 50 bucks a month I might consider.I am not going to contribute 1 dollar to those crooks.Like pissing in the wind.

Mike Hunt said...


Listening to Obama is very clear how dangerous and deceiving this guys is.

He talks about insurance not making excessive profits but that they should make a profit and it should be fair. Fair to whom exactly?

And that seniors will get better coverage with less costs. How does this work exactly? Oh yeah, Obama's plan is to force everyone to get a comprehensive (meaning EXPENSIVE) insurance policy so that the young healthy payers will cover the rest of the population. More taxation for people who won't be needing that health coverage for several years.

You say you have high deductible cheaper insurance now? Are you sure that option will be available to you under Obamacare?

There are so many sweeteners in this package that total costs will go way up.

You are taking advice from an administration whos solution to the recession is throwing tons of money and saddling our future, while claiming the US GDP will grow 4% a year? What a load of BS.

And now these same chumps are going to force their agenda for a huge bloated health care package?

The people who listen to Obama need to get their head examined. Follow the actions, don't get sucked into the rhetoric.

Wake up people!


prestonb said...


You just think they will pay if you get cancer, but they have a team that will find an excuse to resend your policy.

You currently don't have insurance, something small - you pay the deductible, something large, they don't pay. Last year, in California they reseeded 20,000 policies. That's about how many people got something serious. Remember, after 65 medicare takes over when lots of people start needing care.

I would much prefer "Government" takeover versus this Wall Street based bull-shit. But wall street can spend million per day to convince you otherwise.

Hope you stall healthy my friend....

Anonymous said...

Good point Keith! Any solution needs to provide care to the poor.

Keith isn’t England’s NHC paid mainly through petrol taxes? I drive a lot and even I would come out way ahead if I paid an extra $4 a gallon for NHC.

Ten years ago I agreed that we had the best system. Health insurance was affordable. Now it’s not affordable, mine has more than tripled in those ten years while service got worse and co-pays tripled as well.

The system was slowly taken over by greed and now it’s chocking on it. It’s simply broken now and we need something new.

We need to pull all those getting fat sucking on the healthcare teat off the teat and start over.

As the system is now I pay through the nose for less care than I got ten years ago. If I go to the hospital there is me and there are people who have no money and can’t/don’t pay.

Even though I have insurance it does not cover everything so I get a BIG bill on top of my $1400 monthly insurance fee. I pay twice for care while others pay nothing. Does this sound fair or sustainable?

If you get sick here in the good ole USA you will be fed upon by a never ending pack of money vultures even if you have expensive insurance.


Anonymous said...

A must read:


Anonymous said...

yes, i have state "family care" (S-chip) - $33.50 a month for my 2 yr old and me to be covered by a Horizon HMO. I had to switch to doctors i've never met before, as my regular doctors do not accept this plan. still, better than nothing, i guess...,

Anonymous said...

Why does a Doctor charge $200 or more an hour and the person working at the warehouse loading the trucks with boxes of medicine to be shipped to all, only charge $7 an hour?

Anonymous said...

I wanted a high deductible plan coupled with an HSA - while our companies' insurance provider would offer us a high deductible plan, the deductible was too high to qualify for the HSA, go figure. So rather than me contributing 1000 - 2000 toward my possible future health needs, it goes into the abyss of the health insurance company.

When I asked why we were not offered a plan with an HSA (they have been out some 5-8 years now), the provider indicated that they did not have time to set one up - along this line, please appreciate that EVERY year when we have open enrollment they allow us a day or so to decide our healthcare for the next year - because, as you know, that is what the law says (the law THEY wrote).

So, essentially, the coworkers all stick with what they have or pay for a high cost plan they really don't need.

Thanks health insurance company!

Oh, and don't get me wrong - I am in no way in support of government health care as I have to work with the federal government everyday - it really is nothing but the DMV on steroids.

Anonymous said...

Those in favor of government healthcare are free to pay for yourselves and, because you are fashioned from such higher moral fiber, you are also free to foot the bill for those that are unable to pay.

As for the rest of us, please count us out.

Anonymous said...

Third party payer drives up prices (and single payer is third party payer). Let's force published prices. Let's give out health stamps (like food stamps) in the form of HSAs. Let's clear away the regulation that is preventing companies from offering high deductible plans. Let's get rid of the employer provided plan deduction so people can get off of that bus. Let's cap liability. Let's negotiate drug prices. Let's review treatment under Medicare so it's not an automatic approval for whatever a doctor wants to fleece the government.

People like the government plans because they don't reject any treatment, but that's why they are going out of business. When that changes, everyone will hate the public plan.

The key thing to avoid is single payer. That will drive down the quality and availability of care.

the Health bet said...

Anon said:
“Why does a Doctor charge $200 or more an hour and the person working at the warehouse loading the trucks with boxes of medicine to be shipped to all, only charge $7 an hour?”

Good question..

The warehouse worker most likely doesn’t spend much more then he/she earns hence doesn’t own to much crap and not much to lose if being sued.

The sophisticated edumecated doctor on the other hand is in debt up to his/ her eyeballs, owes a large mortgage on a Mcmansion, large car payments on an overpriced crappy Mercedes and all the usual crap to impress his / her fellow FBers all this is at risk if he/she gets sued; so now yet another major expense required for malpractice insurance.

Bottom line; the doctor put himself in a very high overhead costly environment and you all need to support it when you need medical help; they are not ‘healers’ who care for you.

Oh, forgot to mention that the schmuck doc overpaid for an education to support FB professors who are in the same boat he’s in.

Mr. Buffet is on the other end of this; the receiving end.
sheeple pay upfront just incase you may need that FB doctor someday, and Mr Buffet buys more assets with your money.

Not a selfish bastard said...

We Can't Afford to Wait

Public Option NOW!

gw said...

The quality of health care would suffer if not sufficient money is paid for health service to attract doctors and nurses or the money is not sufficient to cover the marginal cost of producing a certain drug. This is unlikely - just check the unemployment stats and margins of phama companies despite their huge marketing spend.

Considering the wages of the rest of the population doctors and pharma companies are doing very, very well.

Problem is that wages as an agregate are falling and the people that procure health services are under intense pressure, have limited information, no economies of scale to bargin with and often no time.

No matter what you think the long term solution should be - alone the transition into the recession/depression is now putting a huge number of lifes are risk.

The re-distribution between receipients of health is a ploy to derail the debate. Yes there will be redistribution and possibly to a smaller extent from the older to the younger. But these will be marginal adjustments comparable to the other adjustments that happen every time the rules change.

The big contribution will come from insurance, pharma, pharma marketing and overpaid&overinsured doctors.

Nero said...

You would be wise to follow the words of Granger very closely...he is the best trader in the world and he says Gold will close above $1,033 tomorrow (9/9/09).

Anonymous said...

other ideas:

- only ER care and free voluntary birth control for illegals. reduce financial incentives for illegals to have anchor babies. bill the country of origin (in oil, cash, whatever) whenever possible.

- term limits for Congress (10 years) to remove career politicians and let them live with their legislation

- put Congress and all public workers on Social Security with no additional pensions

- no mandate fines for the uninsured. people don't go uninsured for the fun of it. the last thing they need is a fine because they cannot afford insurance in the first place.

- allow states to determine if they want to legalize weed

Anonymous said...

health insurance is broken. the Democrats' plan sounds horrible from what little we know of the 1000+ page bill they tried to ram through, but Republicans had better start coming up with better ideas (like the ones mentioned on this blog) other than just the medical savings account and tax rebate ideas that don't address costs that far exceed income.

Angry Leprechaun said...

Everyone deserves health care? I am not sure that I am buying that one and sorry if I sound like a cold heart d!ck.

I live on the southern border, looking out my office window at the fence as we speak, and I can tell you I am sick of people driving Chrystler 300s with 22 inch wheels, while they bitch they have no health care and the government is not providing enough.

Those who can't afford it want the government to provide what the government can't afford either. Where is the money going to come from? Oh shit, you want my money and I don't have 22 inch fucking wheels.

Angry Leprechaun said...

Oh and by the way, Obama can take the "what is your answer, what is your solution" comments and shove them up his ass. Is that the only argument he can come up with when he thinks his is the only solution and soes not listen to anyone else.

patrat said...

They've socialized the financial system, why not the health care system? And if the insurance companies complain about being shut out, (waaaa!), well tell 'em to just compete! What's the problem? Isn't that what it's all about?

Anonymous said...






Anonymous said...

Hey schmuck anon at 4:12 am

"does australia have a gargantuan defense budget that protects the world too?"

Protect the world? The USA is the worlds #1 arms dealer and slaughterer of innocent women and children.

Wake upand smell the cordite!

Bukko_in_Australia said...

Anonymous said...

hey bukko,

does australia have a gargantuan defense budget that invades other countries all over the world too?

No. Isn't it great? That's why Australia can afford to protect its own citizens!

Anonymous said...

Insurance is a misleading term when it comes to health and is a lie.

Health Insurance is a cartel concept that is anti-free market and corrupt.

We should use government funds to build hospitals, train docs and nurses, and provide angel capital matching for research. Then let the free market go at it.

evildoc said...

----Why does a Doctor charge $200 or more an hour and the person working at the warehouse loading the trucks with boxes of medicine to be shipped to all, only charge $7 an hour?----

Uhhh... why not?

Do we really wanna weigh what goes into each job description?


Andrea said...

heya mate, i lived in the uk for four years... the health care system there it top-shelf...

Anonymous said...

"Hey schmuck anon at 4:12 am

"does australia have a gargantuan defense budget that protects the world too?"

Protect the world? The USA is the worlds #1 arms dealer and slaughterer of innocent women and children.

Wake upand smell the cordite!"

hey douchebag...i was just trying to point out that we can't afford healhcare because of our oversized defense budget.

whether our military is the most righteous in the world or worst than the Nazi' irrelevant to the debate...we don't have the money...idiot.

Angry Leprechaun said...

Not posting my comments again, can't handle it? Go back into hiding!

thumb twerler said...

evildoc said...
----Why does a Doctor charge $200 or more an hour and the person working at the warehouse loading the trucks with boxes of medicine to be shipped to all, only charge $7 an hour?----
“Uhhh... why not?
Do we really wanna weigh what goes into each job description?”

Evildoc, yeah, please educate us why a lazy ass who partied for 8 years thru college and achieved a Doctors certificate deserves more money then a person who actually works for a living.

Anonymous said...

I'll be honest, I have health insurance through my employer - if I did not and/or they gave me the money instead, I would probably just take the money and save/spend it. I am a pretty health dude so I certainly would not pay 8K a year for it like my employer probably does. Albeit, I would probably purchase a catastrophic/high deductible plan with an HSA for emergencies and to save for my future - as it should be.

preston said...

Angry Leprechaun said...
" Everyone deserves health care? I am not sure that I am buying that one and sorry if I sound like a cold heart d!ck."

Chill out dude, what are you going to do when one of those guys with the 22" wheels smashes the thing against a tree? Just leave him by the side of the road to bleed to death?? It would teach the others a lesson, maybe they would buy some insurance instead of hot wheels but we can't do that.

Chances are the Hospital just has to eat the bill - that raises the costs for everyone.

It's best to just admit that any of us might need care, that no one should really be just left by the side of the road to die even if they are poor and stupid.

Anonymous said...

they may charge 200 An hour but they have to submit bills to the insurer for 1000 an hour?

Vac Quack said...

---thumb twerler said
Evildoc, yeah, please educate us why a lazy ass who partied for 8 years thru college and achieved a Doctors certificate deserves more money then a person who actually works for a living.----

A lazy ass who partied?

Weird, I work with couple hundred fellow evildocs each day, and I have yet to see a walking tushy taking care of anyone. Better yet... I don't see any lazy tushies wandering around taking care of anyone.

I've never seen a tushy paid $7/hr or $200/hr for anything (though we get into dangerous terrain there I s'pose).

Can you explain what tushies with poor work ethics have to do with Physician salary structure?

I mean... I hear your envy, but your question perhaps would best be rephrased.



Vac Quack said...

Another follow up to...

------thumb twerler said
Evildoc, yeah, please educate us why a lazy ass who partied for 8 years thru college and achieved a Doctors certificate deserves more money then a person who actually works for a living.-------

I admit I rather liked my "walking tushy" line, but I could post a serious response, I suppose. Would Keith take a twenty paragraph post and publish it?


evildoc said...

Oops sorry. Blogger default used other handle.



evildoc said...

Part 1. evildoc on "$200/hour Doctor vs $7/hour box packer"

---anonymous said

Why does a Doctor charge $200 or more an hour and the person working at the warehouse loading the trucks with boxes of medicine to be shipped to all, only charge $7 an hour?----

---thumb twerler said
Evildoc, yeah, please educate us why a lazy ass who partied for 8 years thru college and achieved a Doctors certificate deserves more money then a person who actually works for a living.----

Ahhh, where to start.

OK. Before I provide actual content to my answer, let's anticipate and embrace the inevitable populist-ish, hate-the-elite responses this will provoke.

This is just anticipating responses...

First. Yes, I know many here hate "big" anything. Big Oil. Big Finance. Big Pharma. Lawyer monopoly. Doctor monopoly. Military Industrial Complex. Real Estate Industrial Complex. All "Big" and thus no doubt eeeevil. Response: OK. I get it. The world is a challenging place in which to get ahead. Time to move on.

Second. Yes, I know Medicine (let's say, for now, Physicians at least) represents a monopoly with barriers to entry. Only one in three applicants are granted leave to go to medical school, even though (i assert) many of the other two-thirds pool still might have been competent physicians if given the chance to go and even though there is a Doctor shortage. Response: Tough noogies. Most good jobs that require (or even that don't require) advanced skills have barriers to entry. Not everyone gets to be a junior investment banker on Wall Street at age 22. Not everyone gets to be Doctor, Lawyer, Professor. Heck, try to be- what is it- a longshorman where there are unions, if your daddy wasn't one. Suck it up.

Third. Yes, I know while simple supply-demand should rule capitalist free market economic transactions (yeah, where in America is "simple" supply/demand running anything), I know also that the supply-demand equation for physician work is bollixed by the supply limitation of Physicians and by the "bubble" effect of insurance-paid work, rather than physician need to get direct payment (eg. bushels of corn from the local farmer who en masse would not have $2000 angioplasties if they had to pay for it instead of insurance paying). Bubbles bubbles everywhere, I know. So it goes.

Fourth. Yes, I know we are an envious society. Anyone who does well gets, "what's so special about him" from those who don't do so well.

OK. There can be more but that gets a good bit of the venting angry populist rejoinders out of the way.

So... now... why do Docs get "$200/hr" while the warehouse packer gets $7 per hour?


First, let us start not with "merit" or "responsibility" or "risk" or "intellect" or "work ethic" or "paid academic and social dues"

Let's try the supply-demand market.

If the shipping warehouse puts up an ad for the $7 position, he gets 100 qualified applicants within a few days, hours or seconds.

Meanwhile, my work as Hospitalist (hospital based medicine) which pays most of the guys $175/yr for about 2000 hours work ($90-ish per hour, not $200, though I get a big bonus as I have special responsibilities and am probably in the $140/hour zone), is work in which right now in the USA, there are four open positions for every qualified candidate. If i quit my job tomorrow- what with my good qualifications- I likely could have new work within the week at $200-250k (100-125/hr). Supply and Demand. The good ol' American way.

to be continued...

evildoc said...

PART II Evildoc on Physician salary vs box-packer salary

Second, I note as a bit of an aside, that most physicians do not earn $200/hr and furthermore that of the evil unfunded healthcare bubble system, physician salaries are not the dominant cause of cost, though it is not a trivial part.

Here is a link to average physician salaries of late, noting that most physicians are in lower ranked fields (Medicine, Peds, Family Medicine, Pscyhiatry, NOT in subspecialtis at the upper end). Most are in the 150-300k/yr range $75-150/hr.

Third, now embracing the "merit", "responsibility", "risk", "intellect", "work ethic", "paid dues", "hey I'm elitist" column...

Well, I worked hard in high school. Was one in six applicants who got into Princeton. Worked hard and majored in molecular biology with a (non-official) concentration in European history. Ran a campus charity in spare time. Traveled. Had fun. Networked with good people. Scored sky high on standardized tests and for "fun" at time when minimum wage was $3.50 or so, I was one in ten who pulled a job teaching at an SAT course pulling $19/hour, while graduating with like 150 credits (120 the norm) from P-ton. Lazy ass indeed.

Was one-in-three applicants to get into med school and got into a top twenty school. Took a fortune in loans (though far far less than do most folks today) to complete my training at age 26, in debt. Spent next 3-4 years working 90+ hours per week for average $29k salary during residency in job where- no joke- a screw up could kill a fellow human, my patient. For income I moonlighted overnight shifts alone in a rural ER once a week, during my "off" day from the 90-hour week. Kept my lazy ass pretty trim I assure you.

Oh yeah... Internal Medicine Boards, what we take to be Board Certified. Medicine has about the toughest test (highest fail rate... either grandly tough test or boy we are badly trained) with about 55% pass rate. I scored 90th percentile.

Became an Internist eschewing the bigger bucks of subsequent subspecializing. I like seeing variety of illness. Started in 1995 in the ER as an ER Doc (these days ER's mostly do not employ Internists as the model has shifted) coming from medical family and with good sense of medical pay. The $120k pay was grand at the time. Yes. I know that most people have not seen salaries rise the last 15 years, but today working AS an internist (not the more highly paid ER Docs even of today) my salary bubbled up to $300k or so, in part due to supply-demand issues, in part due to the "health bubble", in part as I have a niche position with some unusual perks, in part as I am not "fresh out" where the hospitalist physicians still get $175-200k.

My hospital pays my salary. An admission workup of patient (whether 40 minutes minimum or 90 minutes "usual" maximum effort) bills for the hospital just $180. Plumber at my house gets that or more for 90 minutes work, and I don't begrudge him that. He too is skilled and responsible. Indeed, I often model Doctor on trades like Plumber and Electrician as the processing is similar.

to be continued...

evildoc said...

Part III. Physican vs. Box-Packer salary

Fourth, let's consider "obligation" and "risk" and "responsibility" in more detail

Here is one example of what I do every day. Am I arrogant for considering this a bit more... challenging at least... than packing boxes? Perhaps I am arrogant. But, I am profoundly grateful that life lets me have this responsibility and I try every day to live up to that responsibility, so maybe I am not arrogant.

Last night I took care of a "healthy" military 30 year old who has not been healthy for a year since contracting a weird bug in Iraq, developing a profound life threatening neurological disorder and spending 9 months in military hospitals, released 3 months ago only to have a medical crash yesterday leading to a local hospital admsision that transferred him to me at my tertiary care hospital. This 30 year old man, who has put life on line for our country, had refractory seizures, 105 fever, respiratory failure, possible meningitis.

I made all the medical decisions in attempt to keep him alive. I spent nearly three hours at the bedside with family and patient for the $180 "admission bill" this generates regarding my professional services (no worries, his stay overall likely will be $40k or more). I directed/co-directed spinal tap, intubation, antibiotic choice, anti-seizure-med choice, ventilator management, sedation. I counseled terrified family about outcome. Had the charm to explain I could not promise survival and did so in tactful and caring manner. Laid out options and expected course for subsequent evaluation. Did everything right, but no doubt the patient still might have bad outcome which in the wonderful USA means that I might be sued for $10 million, even though nothing was done "wrong". Bad outcome in a young man can be enough for a jury. But my professional billing was $60/hour for the three hours spent keeping him alive. As I could not do multiple quick admissions during that time (I stayed late at work, unpaid to wrap up) that were pending, my hospital presumably took a loss paying me $150/hour during those three hours, relative to my "billing". So it goes.

That is but one story of what I do in general for mulitple patients each day.

Let's look at the obligations in more general sense.

1) My decisions affect lives.

2) I sign the line making medical decisions. I can be sued for outcome (and outcome often will be bad no matter which branch of a decision tree one takes) even if i do the right thing. Give heparin (blood thinner) for an arterial leg clot and patient bleeds into brain and dies? Lawsuite. Don't use heparin cause worried about brain and leg hasta be cut off? Lawsuit. D*mned if you do or don't.

3) I have exquisitely good training and I am very very good at what I do.

4) I have high level obligations to my "customers".

5) I give devastating news to terrified families I've never before met.

And with all this, my work is in huge demand, with four spots needed nationally for each one of me out there.

I realize none of this rises to the level of packing boxes. ;)

final info in next post...

evildoc said...

Part IV. Physican vs. Box-Packer salary. Final notes

I am grateful for the opportunity life has given me, but this was not simply a passive "happening". I've taken huge steps to do things the right way. Meanwhile unedu"ma"cated mortgage brokers were making $400k/year destroying buyers' futures while banking big bucks and living big expecting it never to end. While, despite my "great" salary I live in a reasonable apartment upstate, happily enjoy my loaded to bear paid off honda 2004 accord couple.

So... you wanna sit there and sneer at docs? Knock yerself out.

You wanna be populist tool yelping "why should Doctor/Lawyer/Scientist/CEO get more money than box filler or custodian" despite my essentially 12 years in school, my loans, my outrageous responsibility with outrageous (indeed, disproportional) risk taken when bad outcome happens, my skill and my commitment? You wanna snark behind your computer about "Lazy Asses".

Knock yerself out.

I am deeply aware that I am fortunate. Life has dealt me a decent hand in letting me have the skills, interest, and perhaps foresight to choose the career I did.

I am, I guess, OK with your disapproval



Angry Leprechaun said...

Sorry Preston,

Still not convinced that I need the governemt to tax me more to pay for the healthcare of someone because someone bought wheels instead of saving money for thier own daman car crash.

Wind Farmer said...

Here's an email making the rounds:

The AMA Weighs In

The American Medical Association has weighed in on National Health Insurance. The Allergists voted to scratch it, but the Dermatologists advised not to make any rash moves. The Gastroenterologists had sort of a gut feeling about it, but the Neurologists thought the Administration had a lot of nerve. The Obstetricians felt they were all laboring under a misconception. Ophthalmologists considered the idea shortsighted. Pathologists yelled, "Over my dead body!" while the Pediatricians said, 'Oh, Grow up!' The Psychiatrists thought the whole idea was madness, while the Radiologists could see right through it. Surgeons decided to wash their hands of the whole thing. The Internists thought it was a bitter pill to swallow, and the Plastic Surgeons said, "This puts a whole new face on the matter." The Podiatrists thought it was a step forward, but the Urologists were pissed off at the whole idea. The Anesthesiologists thought the whole idea was a gas, and the Cardiologists didn't have the heart to say no. In the end, the Proctologists won out, leaving the entire decision up to the assholes in Washington.

Anonymous said...

keith, I lived in England for a decade and can categorically say that I would take their healthcare system (NHS) over the US 'sickcare' system any day. The healthcare that I and my family received was excellent and prompt. People in England don't have to file for bankruptcy because their kid got sick. 67% of bankruptcies in the US are a result of healthcare costs families can't pay.

Anonymous said...

evildoc....I really don't mind that you make a good salary ,especially when you consider what you do and how much education it took. Why do the investment bankers of Wall Street make so much more just churning money and creating ponzi-schemes . You Doc are a social positive and the bankers are a social neg.

Recently I was a victim of the health care industry . I had great insurance coverage ,but the greedy
health care Insurance Company decided they were going to ration my wife . I screamed bloody murder and they tried to undo their bad faith ,but it was to late . My take was that she would of lived 5 to 7 years more ,absent the bad faith and the germs she picked up at the hospital that killed her while the insurance company was dicking around .

I spent weeks at 3 hospitals watching the system for hours and hours . I got a good take on what is wrong and I talked to many a family and nurses and insurance shills and you name it .

One would have to have a medical degree to know when they are being rationed . The power that I saw that the private Insurance Companies had regarding the health care was clear . The influence on the doctors and system is far-reaching .
If we keep going in the same direction a good health care policy will cost a family of 4 30 k a year by 2027 to get coverage .

The system in part is broken because of the 30% profit that insurance companies want to make ,and than there is another 10 to 15 % in waste and paper work . Add to that the high cost of medical mal-practice insurance and this explains about 40% of excessive cost in the system .
Nurses have confessed to me these problems ,while I was spending my life at the hospital for weeks.
So, go ahead and think that your getting your money worth from private insurance until they decide to screw you or cancel you
or refuse to pay for a needed procedure .
I propose single pay system with three plans from A to C . The costs should be set yearly and the three plans would offer standard to higher level care like private room and elective stuff covered ,

The elephant in the room is chronic care ,and that is a major problem . Currently ,those costs end up wiping out a older person usually and represent the final years of life usually . I Don't know how to solve that problem .