Journalist Margot Sanger-Katz just says Shut-up
It’s not like physicians can’t get a haircut. Doctors recently absorbed a 2 percent pay reduction, their first in a decade, when the sequester kicked in. Industry consultants have seen few major ripple effects. “There are a lot of scare tactics going on,” says Martin Gaynor, a health economist at Carnegie-Mellon University. Gaynor doesn’t endorse the big, all-at-once hit that would ensue if Congress failed to pass a doc fix, but he doesn’t think the sky would fall if it did. “For all the gnashing of teeth and the tearing of clothes and the wearing of sackcloth by the medical profession and their advocates, I don’t think things would be nearly as bad as they say.”
The Medicare Payment Advisory Commission, which analyzes the program for Congress, suggests eliminating the unpopular pay formula but financing it with steep cuts in the rates paid to specialists and freezing payments to doctors in primary care. In 2011, it recommended cuts totaling 18 percent of current fees to be phased in over three years—and did not predict access problems for seniors.
That’s not to say that cutting doctors’ pay would have no effect. Several health economists predict a reshuffling, as some doctors gravitate away from Medicare and others merge with their competitors or local hospitals in an effort to negotiate better commercial payments in compensation. Boomer doctors who are close to retirement might bow out early rather than face a pay cut. All of those changes could prove politically problematic. “The Medicare population can be activated in protest,” says Erik Johnson, a senior vice president at Avalere Health, a consultancy, who recalls a few recent salient examples.
Still, the supply of new doctors would likely remain undimmed in an era of lower compensation. Med-school applications are booming, as are applications from foreign-trained physicians to enter U.S. residency programs. Even current doctors, who enjoy high incomes, say their major career satisfaction is patient relationships, not financial rewards, according to a recent survey from the Physicians Foundation. “It’s an inherently appealing profession,” says Berenson, who adds that lower physician pay might have a “salubrious” affect. “We would have people who wanted to be in the profession for the right reason.”
I look forward to Margot’s column when the Federal Government passes the program to designate and cap the salaries of journalists. After all, there are plenty of people who are willing to write for less than she makes and do it for the [government defined] right reasons.
I can’t wait for the government to start forcing docs to take their cut rate patients. That will be shortly before the time that your third world doctor is going to need an interpreter to talk to you.
“Still, the supply of new doctors would likely remain undimmed…”
And if this turns out to be anything like what happened in the UK, this “undimmed” supply of doctors will come from other countries.
Also, HHS will likely re-define who is a primary care physician so that nurse-practitioners can fill this role (another cute trick for getting enough doctors).
That’s a neat trick by Sanger-Katz, purposely turning this into a class warfare issue – rich doctors vs. needy patients – when the real issues for doctor will be the increased paperwork (e-work, whatever) as well as having their medical judgement supplanted by bureaucratic one-size-fits-all HHS/IPAB guidelines.
Have you noticed that a lot of the drug ads now say something like “So I asked my medical professional…” instead of doctor? They’re already prepping the battlespace…and yes, they’re going to war with you.
This looks really good to me.
Of course, I’ve always thought that all health care workers should be slaves of the state.
This will just give them a little jump on the rest of us, is all.
I think I can channel Mrs. Darth on this one, as she is currently sleeping off a 6pm-3am shift in the ED and we’ve had this discussion several times.
Just about every young person who pursues medicine as a career does so for the “right reason”; i.e. to “help people”. She prepared for medicine from middle school on, working to get the right grades, going into the best pre-med program the family would support, and getting into a good DO program (it’s more holistic, don’tchaknow?). Good enough to succeed in a tough specialty, and landed an excellent and prestigious residency.
Where she learned that medicine is not a “calling”, but a business.
Hospitals, especially non-research for-profit hospitals, are in business. To make money. Evil, filthy, profitous lucre. Guess how businesses make money? By taking care of paying customers. Who get better when they see you or who don’t die when you operate on them. So how do you keep patients from dying on the table or get patients less likely to sue you for malpractice? Attract better doctors, surprisingly with better pay and/or amenable conditions.
So by all means, let’s get doctors who are agenda-driven, narrative-enforcing members of the Ruling Class’s We-Know-What’s-Best-For-You goon squad, rather than folks who know that they’re worth what they’re paid because they have the training and skills to deliver what a customer wants. Because, let’s face it: when you’ve dislocated your elbow while playing paintball, do you want a doc who can reduce it quickly and effectively or a nannystater who blows your ligaments while preaching to you about the dangers of patriarchic heteronormative violence fantasies?
Yeah, I noticed the “medical professional” use in drug commercials, too. Here’s another example of politicians redefining medical care to suit their needs: http://tinyurl.com/oel8eey
“The California Assembly is moving closer to a vote that would widen the pool of those who can perform some first-trimester abortions to include physician assistants, nurse practitioners, and nurse midwives…..The bill redefines the abortion technique as ‘non-surgical’…”
They’ll just keep redefining everything to make sure they can claim this miserable failure, Obamacare, a success, patient safety be d@mned.
Hm, Libby. Wonder if those PAs, NPs and nurse midwives carry malpractice insurance (which ain’t cheap, but most certainly doesn’t impact the cost of medical services, oh no, of course not) to the degree that most docs have to… I think a bunch of ambulance chasers are going to have a whole new playground opened to them if trends like that continue.
Ga. The medical system in the US is so fracked up, I don’t know that it could be saved.
I mean, we can keep dying folks alive for a few more days, or weeks, at $7000+ a day. But no one wants to pay for THAT. You want a few more days to say goodbye to grandma, while she’s hooked up to a dozen machine? Ok, sell your house and it can be done.
If you want to see where all the money is going, go visit a hospital.
And “they” (the hospitals and suppliers, etc) are making money. On a lot of useless crap. Layers and layers of medical bureaucracy. That’s how Michelle made $300,000 (or whatever) for “outreach.”
Because, let’s face it: when you’ve dislocated your elbow while playing paintball, do you want a doc who can reduce it quickly and effectively or a nannystater w –
What “I” want is a doc who can fix it w/o giving me 8 different tests I don’t need, extra drugs I don’t want, physical therapy I won’t use. Who will give me a single bill at the time and let me pay cash, at a reasonable rate.
I don’t want to pay for 8 different doctor fees, nurse fees, hospital fees, lab tech fees, and all the other bullshit.
I want the country doctor back. That’s what I want.
Car in – I can’t defend the entire medical system, but it has fostered the kind of excellent care and treatment innovation that draws people from all over the world. Thanks to this innovation my son received a series of life saving heart surgeries, which didn’t just keep him alive for a few extra days, but made him healthy enough to live a perfectly normal life (OK, he won’t be a triathlete). These surgeries (specifically the Glenn & Fontan) are not performed in other countries such as Canada and the UK because it’s deemed not worth the expense. Here we were able to secure health insurance that covered the costs (and I don’t feel bad about it because I’ve been paying for health insurance since I was 21 with no major costs except the birth of my son). The difference is options – the option to purchase insurance that covers the types of care we need (or choose not to), the option to find doctors and hospitals who will provide this care, and the fact that this spurs the innovation of the kinds of surgeries, medication, etc. that makes the care possible.
Blame the lawyers.
Each day in the ED, Mrs. Darth writes around $500,000 worth of tests she knows flat out she doesn’t need. But *if* one of those patients decides to sue, and she doesn’t have the test done, she’s fallen below an established “standard of care” and is open to having a judgement against her. It’s happened to her before, and if you’re an ED doc that hasn’t been sued, it’s because you haven’t been around long enough.
She’d love to operate like a “country doctor”. In fact she does a little bit of that for the neighbor, but it’s illegal so don’t tell anybody (as I say this on the intartubez). But when she can get sued just because some “I don’t get paid unless you get paid” firm decided to train one of their new grads using one of her patients who couldn’t shop the lawsuit to anybody else, the country doctor days are gone. Sadly.
The lawyers are the ants finding the sugar. I blame the lawmakers who are too afraid to institute tort reform.
Most of the lawmakers ARE lawyers, cranky. Funny, that…
Mrs. Darth sounds like most of the docs I know. Dedicated, hard-working, frustrated, over-worked, burdened by malpractice insurance and stuck with non or semi-compliant patients who may or may not pay for her work. Strangely, uncollected bills at hospitals remain about the same, at 3-7%. Even people who are well-heeled enough to pay don’t always pay up. In fact, about 30% of them don’t. (sourced by either Business Insider or WSJ)
Thanks, leigh. It’s a bit different in the ED; Mrs. Darth’s in particular has a non-payer rate of about 30% which I understand is about normal, but that’s what happens when you don’t refuse anybody. She has a few regulars that are carrying balances approaching a million dollars.
You’re welcome, Darth. I know those people. They abuse the mental health care system, as well.
One of the things that pisses me off whenever Oblather gets up to speechify about his healthcare bill and talks about dorky homeowners falling off ladders and costing “us” big money when they show up at the ED with a compound fracture and no insurance. He fails to mention the absolute fortune we don’t collect for the treat and release (Treat ’em and Street ’em, we used to say) of the gangbangers, drug abusers, alcoholics, bar fights, et cetera.
A simple oversight, I’m sure.
Mrs. Darth has arisen from her slumbers and texted me the following message to relay in response to Ms. Journalist Margot Sanger-Katz:
What “I” want is a doc who can fix it w/o giving me 8 different tests I don’t need
As Darth noted, welcome to the world of “defensive medicine”.
Well said, Mrs. Darth.
I know it’s defensive medicine, and I also know there are some pretty cool examples of expensive medicine / treatments that result in a changed and renewed life.
But visit the ICU. That’s where the $$$ money is. Any many of those folks aren’t going anywhere. Some are. Most aren’t.
My father just passed away on friday, in my home, in hospice. For the last few years, and increasingly at the end of his life, he would get really really sick (multiple issues, none of which curable), and they would put him in ICU, prop him up with drugs for a bit, and send him home.
For a week or so. PTL he finally decided to step off the train and do home hospice (which, don’t get me started on). The type of money which was spend on his care – no one would willingly write that check. Not for his quality of life. But – medicare.
Thanks everyone!
He also had private insurance. BOth paid.
But those young kids had better start working and paying premiums. Elder care is expensive.
Because so much of it is stupid.
Not just extending life until the last breath can be pumped into the body. It’s just everything. You have a hospital which looks at my dad and sees $$$. So they’re more than happy to do anything and everything.
Meanwhile, me and my 5 kids have been w/o health insurance for the last 6 months because we can’t afford the premiums. Good thing we’re healthy. But of course, the complete coverage we’d be forced to pay would mostly go to pay for the sick care. Transfer of wealth.
ANd there is no country doctor.
What do immigrants get for health care?
I’m betting they get a better deal than me and mine.
Condolences, Carin. Even when you see it coming, losing your Dad sucks.
My condolences Carin.
Thanks. He had close to zero quality of life for the last few months, unable to enjoy the things he loved. Just cycled in and out of the ICU.
It was time.
Ditto what Pablo and leigh said, Carin.
What is it about any variant of the word free that causes progressives to go batshit crazy?
Say, how does she feel about senators? As I recall, they, as a class, are a lot richer than doctors.
Sorry for your loss Car in.
Not everyone’s last few days for naught. I have used very little in the way of medical services in my 51 years. I damn well want to cash in when I am older and may need it.
If the bulk of medical dollars are not for are elderly, who the heck is it for? Some a-hole who rides a motorcycle at 100 mph. Some dumb ski bunny on a double black diamond run? A 30 year old hypochondriac?
BTW, I do sympathize Carin, I have had friends in a similar situation as you.
My problem of course is who we allow to make the decisions at the end. I fear that someday I won’t be able to get the care for myself or my wife that my elderly pets are getting today because some bureaucracy has decided it is not in the best interest of society. Selfish I know.
If you are not contributing to society via tax dollars, expect them to let you die. Otherwise they will do a cost-benefit analysis to determine how much in taxes they expect to get out of you for the remainder of your expected life versus how much it will cost to keep you going. If that doesn’t work out in your favor, they will let you die.
Of course, if you know the right people, or have a shitload of personal wealth, you’ll be just fine.
I hope I enjoy my last days more that whatever extra time Nancy Pelosi and Barack Obama are able buy.
Semi-related: I was out visiting my elderly mother (68), who’s been a Type-2 diabetic for at least 20 years, and has considerably fewer extremities than she started out with.
The TV was on — the tv is always on — and some commercial for Stupid People came on, talking about how ObamaCare is the law, and it’s going to help the uninsured get health insurance, and yadda yadda yadda. I grumbled something to the effect of “yeah, thanks – because of ObamaCare I’m this close to dropping my health insurance”. I’m 48, and in the 27 years I’ve been paying for my own insurance (either back when I had a job, or during the last 20 years of self-employment) I have never used one cent of health insurance. Haven’t even seen a doctor. Saw a dentist once in that time, which I paid for out-of-pocket.
She pointed out that she’s paying $200/month for health insurance (some sort of Medicare supplement, presumably), but “thankfully, it covers everything!”
Whereas I’m paying $400/mo. (just for myself) for insurance that covers next to nothing, with a $10K deductible. It was $330/mo. just two years ago, and I’m seeing these horror stories out of CA about insurance rates going up 100% or more. I can’t handle even a 50% increase. They’re going to force me to do the unethical “hey, my leg seems to have been run over by a truck, can I get some health insurance that covers that ‘preexisting condition’?” by pricing me out of the “responsible people” market.
But Mom’s totally cool, at least until the death panels get her, so again, thanks, whomever’s paying for it!
My sister will be 64 in September. If I called her “elderly” I would expect her to smack me, and I would have it coming.
Doctors already save more than enough lives. It’s not like species if dying out or the avg. lifespan is in the toilet or anything. So kiss your rich grandma goodbye and give the government half of her estate you greedy privileged ungrateful reporter piece of shit. Why do you hate this country so much?
It’s not like species if dying out-> is dying out
3rd try: It’s not like the species is dying out…
The species isn’t dying out yet, but it is getting dumber. So we have that going for us.
Meh. Teachers have tought more than enough STEM courses. And we can probably eliminate engineering since engineers could never write something like ‘Hills Like White Elephants’.
Teachers have tought more than enough STEM courses.
We should pay them less, so that we’ll have teachers who teach for the right reasons.
teachers who teach for the right reasons.
Nietzsche noted over a century and a half ago that there would never be enough of those. Universities were springing up everywhere at the time (like mushrooms overnight) and there was just no way to find the few who were fitted by nature and disposition in numbers sufficient to staff the promise implied. The consequent, of course, was to pretend there were enough. And that is in fact what has happened.
You know what makes wage slaves? Wages!
I am not for death panels, etc. But after having viewed a lot of this care way too first hand …
We keep people alive so they can be alone and watch tv, and breath for them, and change their diapers (not their family, mind you, because that’s gross, right?)
If we want to “care” for our elderly – then fricken care for them. Don’t abandon them in a home or a hospital, for them to die a slow death alone in the end, barring the last few breaths.
[please take into consideration that I may have a bit of PTSD right now – the end was very difficult]
Quality of life involves more than just breathing.
My mother passed away at home. It was quite stressful at the end, but it’s what she wanted so that’s what we did.
My sister lives with my father, and I am leaving to take care of him for a month in just a few hours so she can go elsewhere to take care of my other sister for a while. It’s round-robin caregiving. Luckily it’s just cooking dinner and buying food and driving to the doctor and getting meds right now. Plus we take a cab to the bar a few times a week.