Impeding changes to our Health Care system

[TheMercenary]

Originally Posted by Clodfobble

I have a hard time with this, because on the one hand some doctors are saying they can barely break even with all these Medicare patients, and on the other hand it's widely accepted that doctors in general, and specialists even moreso, make more money in this country than in any other. The few doctors I know personally do make very good money, and work very convenient office hours as well.

Maybe we just know different people but this is hardly my experience. In one private practice clinic where I work 4 doctors make up the practice, any 2 or 3 of them are there every day 5 days a week, plus a Nurse Practitioner and some times a PA. Everyone of them sees 40 to 65 patients every day. And they are specialists. Few specialists have the kind of time they can just sit around and have lazy days on their boats. They all work 7 days a week seeing patients in the hospital on a rotational basis. They take 24 hour call Mon thru Thurs and 72 hour call on a rotational basis. Malpractice is well over $100,000 a year. They have a staff of over 30 in this one office, from RN's to clerks and an office manager. The office is open from 830 am to when ever they are done, usually around 5 pm. How long do you think it takes to get an education to start and run a practice like this? How about the personal and financial costs associated with getting the education? Pick a specialty and I will give you an idea of the time it takes to get that specialty. The idea that most docs live the Life of Reilly is a misnomer in my experience. The hours are long and most people could never keep up.

[Radar]

Originally Posted by jinx

Did you find that part of the constitution that gave the govt the authority to make the louisiana purchase yet? No? Didn't think so.

How about the part of the constitution that gives the govt the authority to mandate health insurance? Or the right to take money from some people but not others to pay for it?

1. It can easily be argued that the United States would be better off if the Louisianan Purchase hadn't happened and the South were another country. The average IQ of America would jump 30 points. Of course, I wouldn't be living in Florida if there were no Louisiana Purchase.


2. I agree that most of what the federal government does is blatantly unconstitutional including health care. But until they stop taking my money to pay for things I don't want, others will have to pay for things they don't want.

I'd prefer not to have any of my money stolen from me, but as long as it is, I'd rather see it spent on hospitals and doctors, than bombs and missiles for unconstitutional wars.

[Clodfobble]

Originally Posted by TheMercenary

Maybe we just know different people but this is hardly my experience. In one private practice clinic where I work 4 doctors make up the practice, any 2 or 3 of them are there every day 5 days a week, plus a Nurse Practitioner and some times a PA. Everyone of them sees 40 to 65 patients every day. And they are specialists. Few specialists have the kind of time they can just sit around and have lazy days on their boats. They all work 7 days a week seeing patients in the hospital on a rotational basis. They take 24 hour call Mon thru Thurs and 72 hour call on a rotational basis. Malpractice is well over $100,000 a year. They have a staff of over 30 in this one office, from RN's to clerks and an office manager. The office is open from 830 am to when ever they are done, usually around 5 pm. How long do you think it takes to get an education to start and run a practice like this? How about the personal and financial costs associated with getting the education? Pick a specialty and I will give you an idea of the time it takes to get that specialty. The idea that most docs live the Life of Reilly is a misnomer in my experience. The hours are long and most people could never keep up.

Aren't most of the specialists you know OB-GYNs? As you note, their malpractice insurance rates are exhorbitant, and far worse than the rest of the industry. I've said before that needs to be curbed.

Why do they need a staff of 30? Is it possible that many, if not most of those employees are hired specifically to deal with chasing down payment from bullshit insurance companies? Wouldn't certain reforms allow them to have a smaller staff and lower operating costs?

And I'm sorry to tell you, but 8:30 AM to 5:00 PM are not excruciating hours. My husband works from about 8:30 AM until 7:30 PM, and usually comes home with more work to do. And his industry does the on-call thing, too, so he's in that rotation as well. Ask Lumberjim what kind of hours he worked this weekend.

My experience is that most private-practice doctors (again, other than OB-GYNs) do not go on call--they have an answering service that will leave a message for an on call nurse, who will call you back to let you know whether your problem can wait until morning, or you should go to the ER.

[DanaC]

From what I've heard on the Cellar, most Americans who work seem to work mad hours. Happens here too, like, but I don't think to the same extent. Though British workers do generally work longer hours than they do in mainland Europe.

[TheMercenary]

Originally Posted by Clodfobble

Aren't most of the specialists you know OB-GYNs? As you note, their malpractice insurance rates are exhorbitant, and far worse than the rest of the industry. I've said before that needs to be curbed.

Yes and Surgeons of all practices. So General Surgery, Plastics, EENT, Vascular, and Ortho.

Why do they need a staff of 30? Is it possible that many, if not most of those employees are hired specifically to deal with chasing down payment from bullshit insurance companies?

I would say that maybe 5 or so work just with insurance, coding, and billing.

Wouldn't certain reforms allow them to have a smaller staff and lower operating costs?

I seriously doubt it.

And I'm sorry to tell you, but 8:30 AM to 5:00 PM are not excruciating hours. My husband works from about 8:30 AM until 7:30 PM, and usually comes home with more work to do. And his industry does the on-call thing, too, so he's in that rotation as well. Ask Lumberjim what kind of hours he worked this weekend.

Those are just the office hours times for the patients. No one goes home or comes in at those times. When I go there, the surgery side we start at 0700 and often do not finish til after 5. Remember they still have to see patients in the hospital after clinic is finished.

My experience is that most private-practice doctors (again, other than OB-GYNs) do not go on call--they have an answering service that will leave a message for an on call nurse, who will call you back to let you know whether your problem can wait until morning, or you should go to the ER.

All surgeons have an on-call service, basically an answering service. They also pay a nurse or PA to be the person on-call for professional stuff over the phone. And one of the 4 is always on-call in-house at the hospital 24/7/356. All of them work the day after call in the clinic, some for just a half a day, one works more. Add up those hours and it would put most peoples work schedule to shame. As a side I work an average of 70 hours a week and often well over 110 hours. The guys I work with will take vacation 2 or 3 times a year for a week at a time, but hey they also work for it. I still say few people would be able to keep up with the average busy doctors work schedule.

[jinx]

Originally Posted by Clodfobble

I have a hard time with this, because on the one hand some doctors are saying they can barely break even with all these Medicare patients, and on the other hand it's widely accepted that doctors in general, and specialists even moreso, make more money in this country than in any other. The few doctors I know personally do make very good money, and work very convenient office hours as well.

If doctors that are doing well under the current system can be influenced by free pens, imagine what will happen if the reforms cut into their bottom line at all.

I don't think adding everyone to an insurance program will result in more consumers--these people already exist, and they will still go to the doctor when they get sick, just like they do now. They'll just be paying into the system instead of holding out and hoping for the best.

Will they? Or will they be added to the insurance system without paying in because they don't have enough money? Do you think most uninsured people can actually afford insurance and just choose not to buy it?

[jinx]

Originally Posted by Kitsune

Well, of course it is just my opinion, just as it is the opinion of many that reform won't work. I would say that most can agree that the current system isn't working and is unsustainable for our future without some kind of correction being made. I think, though, that it is important that current discussions over the way to correct it not get sidetracked and distorted by unrelated issues, including illegal immigrants. ("Lie!", etc.) The current reform plan doesn't concern them. We pay for them through distributed costs now and, if the bill is passed, we will continue to pay for them in the future. No change. Anything affecting that would result from different legislation.

How do you know if you can afford something if you don't know how much it costs? Illegal aliens will cost health care money and will not be paying into the system. A discussion of their numbers and the level of care they will receive is entirely related and relevant - unlike the amount of money that Bush wasted in Iraq.

No good argument can be made for rushing thru reforms that don't get the job done right.

[Flint]

Originally Posted by TheMercenary

...always on-call in-house at the hospital 24/7/356...

Oh yeah? And what about the other nine days of the year, you lazy bastards!

[dar512]

Originally Posted by jinx

How do you know if you can afford something if you don't know how much it costs?

By that argument, government can do nothing. (Yeah. I know. Some people will say that's an improvement.) But the truth is that everything that the government does at that level will cut a wide swath. There's no way you can tally all the downstream costs.

I gotta go with Kitsune on this one. 1) I haven't seen any figures that undocumented immigrants are a significant portion of those getting free treatment. 2) Even if you've got figures to show the above, this is not a med insurance issue. It's a whole other deal. I'd say give 'em all social security cards, let 'em pay taxes like the rest of us and call it a day.

Originally Posted by dar512

By that argument, government can do nothing. (Yeah. I know. Some people will say that's an improvement.) But the truth is that everything that the government does at that level will cut a wide swath. There's no way you can tally all the downstream costs.

I gotta go with Kitsune on this one. 1) I haven't seen any figures that undocumented immigrants are a significant portion of those getting free treatment. 2) Even if you've got figures to show the above, this is not a med insurance issue. It's a whole other deal. I'd say give 'em all social security cards, let 'em pay taxes like the rest of us and call it a day.

Absolutely. This is not an immigration reform bill.

And, the last report I saw, many illegal immigrants pay fica taxes (as a result of having a fake SS card) and are contributing to social security to the tune of $6 billion annually and Medicare to the tune of $1.5 billion annually and wont reap the direct benefits.

[classicman]

Originally Posted by jinx

No good argument can be made for rushing thru reforms that don't get the job done right.

Absolutely correct, again!

[Spexxvet]

Originally Posted by Shawnee123

When my bones were protuding from my arm I don't remember them beating me up for my insurance card: they got me into treatment and the paperwork came later. This isn't, of course, the same as showing up with the sniffles, which is what uninsured people HAVE to do because they have nowhere else to go, under the current system.

When we took my daughter to the ER this summer, nobody asked about payment or insurance until after she was taken care of.

Originally Posted by TheMercenary

Maybe we just know different people but this is hardly my experience. In one private practice clinic where I work 4 doctors make up the practice, any 2 or 3 of them are there every day 5 days a week, plus a Nurse Practitioner and some times a PA. Everyone of them sees 40 to 65 patients every day. And they are specialists. Few specialists have the kind of time they can just sit around and have lazy days on their boats. They all work 7 days a week seeing patients in the hospital on a rotational basis. They take 24 hour call Mon thru Thurs and 72 hour call on a rotational basis. Malpractice is well over $100,000 a year. They have a staff of over 30 in this one office, from RN's to clerks and an office manager. The office is open from 830 am to when ever they are done, usually around 5 pm. How long do you think it takes to get an education to start and run a practice like this? How about the personal and financial costs associated with getting the education? Pick a specialty and I will give you an idea of the time it takes to get that specialty. The idea that most docs live the Life of Reilly is a misnomer in my experience. The hours are long and most people could never keep up.

My workplace has the ophthalmologist, who has been here for about 30 years, a tech, a receptionist, a billing/accounting clerk, an office manager, and me. The doctor work 1/2 days on Mon, Wed, and Thu, full day on Fri, full day on 3 of 4 Tues/month. The rest of us work more than he does, and make less. He drives a Mercedes, owns 4 properties in Haddonfield, a VERY expensive town, flies places on his quarterly (or more) vacations. Tough life.

[classicman]

He's an opthamologist!?!?!?!?! Thats about as cushy a position as a foot doctor!
My brother is one as well, so is his wife - they own two practices and oh - he's in Alaska right now fishing for salmon.

[TheMercenary]

Originally Posted by Spexxvet

My workplace has the ophthalmologist, who has been here for about 30 years, a tech, a receptionist, a billing/accounting clerk, an office manager, and me. The doctor work 1/2 days on Mon, Wed, and Thu, full day on Fri, full day on 3 of 4 Tues/month. The rest of us work more than he does, and make less. He drives a Mercedes, owns 4 properties in Haddonfield, a VERY expensive town, flies places on his quarterly (or more) vacations. Tough life.

I want to be him. Some make better choices than others. I deal with surgeons, few if any lead this type of life. Oh, and they busted ass to get there, a journey few would do or could do. Some are willing to go the distance and make the sacrifice to have a better life, some are not. Those that do should not feel bad or be vilified for hard work and reward.

[lookout123]

Originally Posted by Spexxvet

When we took my daughter to the ER this summer, nobody asked about payment or insurance until after she was taken care of.
.

That amazes me. Not once in my memory have I ever received care before insurance or payment was verified. Even sitting in the ER with a dislocated ankle I had to hand over the debit card and insurance card first.