They don’t take Medicare because it does not pay the costs of operating some offices, Medicaid is even worse.
What some doctors do is take a percentage of clients as Medicare, knowing that their private client fees will compensate for the lower reimbursement rate.
Finally, the Medicare payment system can be a disincentive, especially the guilty until proven innocent system of fee penalties.
Doctor’s salaries in the US are approximately the same as in Canada and the UK. What their salary would have to do with unnecessary tests, I can’t even begin to imagine.
The numbers of testing equipment in the US (MRIs, and CT scanners, for example) do seem to be higher than in other nations, which is something of an indication that we do order more tests as a society, but it’s unlikely that this could contribute more than 5-9% spending reduction, when it’s about 50% that we need.
The structure of the UK system differs from that of the U.S., aside from the single payer aspect. In the UK, GPs/PCPs and specialists are essentially divided into 2 domains, with GPs having little connection to hospitals. GPs are paid a fixed salary, rather than billing per procedure, and receive bonuses based on patient outcomes.
In the U.S., all physician income comes from billing codes, so that billing for more and more expensive procedures results in higher payments to physicians. There have been a number of models proffered to remedy this. Aside from the salary + bonus structure, some have suggested increasing reimbursements for cognitive physician tasks, such as diagnosis of disease and interpretation of lab results. Others have proposed paying physicians for an entire course of treatment based on an initial diagnosis, so that more difficult cases pay the same, but unnecessary tests are disincentivized.
Possible. The point remains that the dollar amount that doctors bring in between the US and other countries is similar, and the number of tests performed (while perhaps higher) is still probably not the major cause of American health spending.
This cite says otherwise.
Ahah, I was unable to find a nice chart like that when I looked previously–I had to look up average wages by individual coutnry. GPs seemed to be about the same (using standard monetary conversion rather than some sort of odd GDP per capita conversion), but I presumed that if the GPs were the same, specialists would be about the same as well. It seems I was wrong.
That said, you’ve still not really approached my major point. While some trimming might be done in this arena, we’re not looking at the majority of excess health spending.
Going by Bureau of Labor Statistics data (considering “doctors” as commonly understood to be occupational codes 29-1011 through 29-1069), we’re looking at 1,042,770 people with an average salary of $142,365–somewhat lower than your cite but close enough to seem to be talking about the same group–for a total of $148.5 billion a year. Total health spending is about $1.8 trillion each year. If you can decrease the average salary of a doctor by 1/4th (bringing it to about the same as other nations) you’re looking at about a 6% decrease. We need to save 50%.
The ultimate issue, as stated by the study that your cite referenced (PDF), is that overall, Americans spend more on plain off everything. They’re charged more because either it costs more to do business in the US (which seems unlikely), or because Americans are willing to pay more money. That does seem to be the answer.
The problem is that Americans never see their own health care bill. We only ever pay 15% of our own health bills, and the rest of our health spending is vanished out of our salary before it’s even taxed. Employers offer health insurance packages as a lure to draw select employees, and get tax bonuses for doing so. Americans are proud to be able to point to their hospitals and say that they have the newest and bestest equipment–and hospitals, working closely with American pharmaceutical and medical equipment companies to design new equipment, are also more likely to be aware of and buy the newest stuff.
Ultimately, most excess spending comes back to a single root cause, which is that people are willing to hand over more money than is smart for them, for health in the US. If you decrease that, doctors’ salaries will decrease, the number of tests being run will decrease, the amount of money spent on medical equipment and hospitals will decrease. But that’s a matter of changing buying habits, not mandating a particular optimum for each and every thing that a doctor does. It’s silly to tell a doctor that he can only earn $X thousand a year, that he can only perform Y thousand tests a year, that he can only bill a patient for up to Z hundred dollars.
The much easier solution is to make it so that people don’t get their insurance from their employer, they have to get it themselves. That way they see their money going when they write a check every month. You do that, and spending will decrease on its own.
Idealogically, I agree wholeheartedly. I think individual health care policies would be great. Realistically tho, many to most people can’t afford to pay for their own health insurance, and are incapable of even filling out an EZ1040, much less manage their own health care policy contract. Furthermore, a major point of unionized, socialized and employer-run health care is in the arena of collective bargaining.
an aside, I think this is kind of what Obama was trying to do with the government run health care program idea.
You can’t mandate full coverage and also mandate that people be able to pay for it. There will have to be a minimum level of care for people who have never paid anything in. If they get taken in to the doctor, the doctor can always operate with the knowledge that there is that base minimum regardless of who the carrier is, and let the person sign up with a particular carrier when he’s actually brought in to the ER or whatever.
So what, you’d rather people have to sign up with one of a handful of unions, who then sign up with a particular insurance agency? That seems rather inefficient.
There’s no particular guarantee that a union wouldn’t do the same thing as a business and bargain for -more- coverage rather than -cheaper- coverage.
The problem is so dire that noone wanted to admit it existed.
As bad as it sounds, rationing is in fact the only real answer. We are not limiting how much health care you can get, we are simply limiting how much health care the government will pay for.
Sure we can save some money by taking advantage of medical information technology, making the health insurance market more competitive (or cutting out health insurance companies almost entirely), getting rid of Medicare part C, making medicare avaiable to everyone, etc. but in the end we can’t solve the medicare solvency issue with better efficiency alone.
Sure defensive medicine costs the system some money but according to the CBO, the total savings from national tort reform will save less than 2% including defensive medicine savings (they measured the decrease in defensive medicine in states that have passed tort reform limiting punitive and pain and suffering damages and there was not a significant difference, it turns out your doctor is still likely to order that blood test or X-ray “just to make sure”).
Sure our fee for service system provides some perverse incentives but just saying that we should have some other system is like saying that we can solve our energy problem by using cold fusion and perpetual motion machines. Noone has ever described this mythical system that would get the doctor’s interests aligned with the interests of medicare to save overall health care dollars, simply putting them on salary only accounts for a very small percentage of the actual cost of health care.
Sure we can try to tax our way out of it but it won’t be near enough to close the gap, especially if it is going to be targetted at a cvery small portion of our population. A tax on derivatives is likely to kill the market altogether (and before you start thinking that this might be a good thing, international trade depends on things like interest rate swaps and currency swaps which probably account for most of that ginormous number that was mentioned earlier).
Nope, in the end, we won’t get there with increased efficiencies and reduction of waste or any reasonable increase in taxes, we simply have to stop spenging hundreds of thousands of dollars a month to keep a 95 year old (who hasn’t had a lucid thought in years) in an ICU on life support because noone wants to tell little Tiffany that Grandma is going to die.
Those old farts vote. Those old farts will get medicare moved over to the general budget unless someone stops the insanity.
And why would the Dems listen to a word that the Pubs have to say if all the Pubs want to do is see the Dems fail.
I am getting pretty sick of people who are Republicans first and Americans second.
Suppose it does go bankrupt, for how long? I’ll only be 40 in 2017 and as screwed up as our government is, I have some faith that things will be better before I’m 65. By that point the boomers will mostly be dead, and my generation is far smaller (the smallest since WWII, I think) and the generation after mine is bigger which means there would be more workers to pay in, so things might be significantly improved by the time I need to worry about them. I know, that’s a self-interested way of looking at it, but it beats worrying about how if things do go FUBAR I’d have been paying in for 22 years with nothing to show for it…
It certainly can’t hurt and should be done, although I’m not convinced that doctors pay much of a role in increasing health care costs. Anecdotal evidence, I very seriously considered medical school, but the opportunity cost of both not earning much money for many years and taking on a huge tuition debt negated out a surprisingly wide salary. I think I calculated the “breakeven salary point” at a very low point, somewhere around 50K in 2004, but this was using general physician average salaries, not specialist.
One way to substantially delay the bankrupting of Medicare would be for Congress to pass the Health Care Reform bill: according to the CBO scoring released today, the bill would reduce annual growth in Medicare expenditures by 1.4 percentage points per year and extend Medicare’s solvency by at least 9 years.
Not that that fixes everything, but it gives us 16 years rather than 7 to ‘bend the curve’ of health care costs.
Because cuts like this are politically difficult to make. There are doctors and hospitals and drug manufacturers and medical equipment manufacturers whose bottom line is connected to that money.
Maybe such cuts would have been politically feasible if the GOP had had to find a way to pay for the Medicare prescription drug benefit, but they didn’t; they just had the Treasury borrow every last cent.
There’s also the question of to what extent it’s clear which treatments are the excessive ones. One of the things that the current bill would fund is comparative effectiveness research, so that we can better identify ways where we spend more money to accomplish less in the way of health benefits.
I think Medicare should cut off at age 85. If you get sick after that, then it’s Your Time. The savings would compound.
Keeping elderly people alive to run up bills another day is not an efficient use of society’s resources.
I mean, whatever happened to, “Our children are our future.”?
Hey, let’s put Granny out on an ice floe!
Since when have the Republicans ever cared about the minority party?
You do realize, don’t you, that your post can be more easily summed up as, “Kill the poor”?
Don’t you mean kill the old poor?