Impeding changes to our Health Care system

[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?

[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.

[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.

[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!

[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.

[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.

[Radar]

If they brought you in with a gunshot wound, you would have gone right in and they'd have worried about payment later.

[TheMercenary]

Originally Posted by Radar

If they brought you in with a gunshot wound, you would have gone right in and they'd have worried about payment later.

Yea, we call that triage, which is why "The Dude" on the corner who is an illegal gets free care.

Typical exchange:

"How did you get shot?"

"Man I was sitting there minding my own business and up walks this Dude and he just shoots me!"

"Oh really? so one of the famous Dude Brothers shot you?"

"Yea man, I was just minding my own business! And he shot me!"

"Sure."

[Clodfobble]

Originally Posted by lookout123

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.

I think the hospitals in your area are jaded (as well they should be, they get more than their fair share of non-paying customers.) I've never been asked for payment before treatment, and in one case I was desperately trying to give them my insurance information and they said they didn't want it, didn't have time to deal with it, they'd mail me an automated bill and I could deal with it then.

[jinx]

Why did Obama give PhRMA a great deal when even the Dems don't agree with it?

Representative Henry A. Waxman, the California Democrat who heads the Energy and Commerce Committee and helped write the House health care bill, vowed to fight the White House, asserting that it was conceding too much to the powerful drug industry lobby, PhRMA.
“PhRMA would like to see if they can get a bargain,” Mr. Waxman said. “I think that PhRMA should contribute more than PhRMA wants to contribute.”
Under pressure from drug industry lobbyists, the White House for the first time Wednesday clarified its commitment to a behind-the-scenes deal negotiated by the Senate Finance Committee in June. It would limit the drug makers’ share of the cost of a health care overhaul to a total of $80 billion over 10 years without imposing other savings sought by House Democrats, like the government’s negotiation of prices for the drugs it buys under Medicare.

We know we can squeeze more from the system,” Ms. Pelosi told a Washington Post blogger a few weeks ago. “The minute the drug companies settled for $80 billion, we knew it was $160 billion.”
“The president made the agreements he made,” she added. “And maybe we’ll be limited by that. But maybe not!”

Some members of the Finance Committee said Thursday that they, too, were surprised by the explicitness of the promise to the drug makers negotiated by their chairman, Senator Max Baucus, Democrat of Montana, and the White House.



“I think we could do more,” said Senator Olympia J. Snowe, a Maine Republican involved in the panel’s health care talks. “It wasn’t enough.”
“When I read about it, it gave me heartburn,” said Senator Charles E. Schumer, Democrat of New York and a member of the Senate Finance Committee.
Asked about his chances of undoing the deal, Mr. Waxman said, “I don’t do handicapping.”

Profit
Profit
Profit
Dems speak out on drug industry profits
profit

Profit

• Aggressive advertising: Since the federal Food and Drug Administration (FDA) relaxed the rules governing TV ads in 1997, the drug industry has increased its direct-to-consumer spending by roughly 40 percent a year. (Last year, ad spending was up 41 percent, according to Fortune.) As a result, two companies – Merck and Pharmacia – spent $460 million on ads in 2000, which was 20 percent more than Burger King.

• Lower tax rate: A 1999 study by the Congressional Research Service found that thanks to a variety of tax credits, the effective tax rate for drug companies was 16 percent compared to the overall industry average of 27 percent.

• Corporate welfare: According to a study released by the FDA in January 2000, one relatively new government incentive alone accounts for $600 million in additional annual profits. The so-called Pediatric Exclusivity Provision gives companies an extra six-months of monopoly patent protection in exchange for conducting tests on children. But rather than use the incentive to primarily study drugs most important to children – as Congress had hoped – drug companies used it for blockbuster products, such as Claritin, that stood to gain the most from a six-month patent extension. The pediatric provision sunsets at the end of this year and its congressional sponsors, Sens. Mike DeWine (R-Ohio) and Chris Dodd (D-Conn.), are pushing for permanent authorization. The FDA estimates this would cost consumers $14 billion over 20 years, by delaying the market entry of lower-priced generic drugs.

Finally, it's important to note that the drug company's annual reports reveal where their revenues go – and what their priorities really are. The drug industry has long maintained that it needs extraordinary profits to fuel risky and expensive research into new medicines. But the reports show that the companies plow far more into profits and marketing than into research and development (R&D). Consider:

• Fortune 500 drug companies channeled 17 percent of revenue into profits last year and 30 percent into marketing and administration – yet they spent just 12 percent of revenues on R&D. (see Graph 3)

• Eight of the 10 most profitable Fortune 500 drug companies devoted more of their revenue to profits than to R&D. (see Graph 4)

[xoxoxoBruce]

Because it's not an edict, it's a political process that has to get through congress, which is comprised of elected officials that are beholdin', if not owned, by the drug companies. A concerted effort by the drug companies could defeat anything... they could probably get Christmas canceled if they really tried. So you tell them ok, it'll only cost you $80 billion, now back off. That's the reality of politics in this country, who has the money and the power.

Originally Posted by xoxoxoBruce

Because it's not an edict, it's a political process that has to get through congress, which is comprised of elected officials that are beholdin', if not owned, by the drug companies. A concerted effort by the drug companies could defeat anything... they could probably get Christmas canceled if they really tried. So you tell them ok, it'll only cost you $80 billion, now back off. That's the reality of politics in this country, who has the money and the power.

Just wait til you see what happens if the Supreme Court overturns provisions of McCain-Feingold and gives expanded first amendment rights of free speech to corporations. In recent similar cases, the liberals on the court would not give those first amendment rights to corporations; the conservations on the court would.

If overturned, the 2012 campaign will be a corporate feeding frenzy.

[Radar]

Originally Posted by Redux

Just wait til you see what happens if the Supreme Court overturns provisions of McCain-Feingold and gives expanded first amendment rights of free speech to corporations. In recent similar cases, the liberals on the court would not give those first amendment rights to corporations; the conservations on the court would.

If overturned, the 2012 campaign will be a corporate feeding frenzy.

It's insane. As Justice Ginsburg asked, "Is a corporation endowed by the creator with unalienable rights to free speech like a natural human being?"


The answer is absolutely not. A corporation is not a person and it has no rights. A corporation has no right to exist and only does exist because the government allows it to as long as it pays taxes on its profits.

These taxes, were the only taxes on income the founders supported.

People have rights, corporations, unions, or other organizations do not. Money is not speech, regardless of what the Supreme Court says.

All political donations should be limited to $1000 per household, per year, per candidate, and if someone donates their money to a PAC for a candidate, that should be the total of their allowable contributions for that campaign. If a household gives $1000 to a particular candidate's campaign, they should be prevented from giving another $1000 to a political action committee.

Political parties should be prevented from using any contributed money to advertise for or against any candidates, and only be allowed to spend money on issues or ballot propositions.

[sugarpop]

Originally Posted by Redux

Just wait til you see what happens if the Supreme Court overturns provisions of McCain-Feingold and gives expanded first amendment rights of free speech to corporations. In recent similar cases, the liberals on the court would not give those first amendment rights to corporations; the conservations on the court would.

If overturned, the 2012 campaign will be a corporate feeding frenzy.

Yes, it makes me ill to think about it. I literally cannot STAND all the friggin' commercials for drugs. Pot is illegal, but pharmacuetical companies can legally push all the drugs they want to on TV? Sickening.

One more thing about big pharma not mentioned, most of the money going into r&d comes from the government anyway, through the NIH. They fund most of the research in this country, NOT big pharma, although they would have you believe otherwise.

[jinx]

Originally Posted by xoxoxoBruce

Because it's not an edict, it's a political process that has to get through congress, which is comprised of elected officials that are beholdin', if not owned, by the drug companies.

Seems like that needs to be reformed. Makes more sense to start there than worrying about the administrative cost of private insurance companies. Certainly more money to be saved there.

A concerted effort by the drug companies could defeat anything... they could probably get Christmas canceled if they really tried. So you tell them ok, it'll only cost you $80 billion, now back off.

Back off??? They're not fighting it - they are all freaking for it. They're pushing for it. They obviously want to make even more money, and know they will.