I'd like Andrew Sullivan to square his stance that simply allowing the SGR-determined cuts on Medicare reimbursement to physicians to stand (due to be about 29% in 2012) with the below graphs. He seems to think that all we have to do is chop physician reimbursement and a big chunk of the spiralling health care deficit can be bridged. Well, you can't squeeze a gin martini from a cold stone, buddy. We surgeons get paid 3% less than what we were paid in the mid-nineties for a laparoscopic cholecystectomy. I have a feeling that your local plumbers or lawn mowing companies aren'tcharging 3% less than what they did ten years ago to plug a leak or mulch your lawn.
We get paid less and our expenses are more. The people who work in our offices get paid significantly more than they did 10-15 years ago. Malpractice insurance is more. Even doctors have to pay the same price for gasoline as everyone else.
Unfortunately, Andrew Sullivan's analysis of medical care crisis has been very poor and very disapointing. The focus of the discussion has been not on returning medical care to the patient, but on top down management of costs. The more I think about Obama's health care bill and the manner in which he managed himself last year, the more I realize Obama is neither a leader nor a visionary, nor was he interested in anything meaningful. Rather, he was interested in doing something which he would be remembered by. He never really laid out what he wanted, waffled about single payor v private insurance, and could not understand the issue- the misalignment of patient cost and interests by third party payers. Instead, he was more than happy to widen that gap, believing that bureaucratic regulated systems could improve what is fundementally a private issue- individual medical care.
The gardener and the plumber rely on the client to pay them not a third party.
Time for Docs to say, sorry, I do not take insurance, I will be happy to sign your insurance claim, I provided you a service I expect you to pay me. If your insurance is as good as you tell me, they will make you whole
You still take Medicare???
Ummm guess someones gotta do it, some guys get turned on by 400lb chicks..
Seriously, is this Russia?
This isn't Russia(yet)although you wouldn't know it in some parts of the Atlanta Suburbs...more bad Russian accents than a Tom Clancy Movie...
and some things get cheaper with time, crack for instance, or Plasma TV's or computers, like the screamingly fast(no pesky modem, CD, DVD) 486SX 33 mhz Computer I paid $2500 for in 1993, and if you wanted more than a wimpy "Beep" when you killed the Nazis in "Wolfenstein 3-D) you had to spring a few hundred for a Soundblaster card...
And anyway, I make ALOT more today than I did in 1993, too bad my wife spends it all...
We need to get some sensibility back in medicine. A patient with end stage metastatic disease, or end stage COPD or end stage heart failure or ends stage pick your organ system is hospitalized yet give the option of being "full code." Yes.....somewhere it says that physicians are not required to provide futile care, yet no one wants to run the risk of "not doing enough" and so all is done -- full court press with ventilators, pressors and ....the patient still dies yet consumes 10's of thousands of collars in those final days. To suggest that we not do everything for everybody is to have "death panels" flung in our face. The reality is that we can't do it all. I can explain that to patients and their families until I am blue in the face, yet they are all going for that "miracle". Since they have no skin in the game (i.e. are not responsible financially for this care) it's an easy decision for them to make. At some stage we need to look at the unreasonable expectations of patients and families (with the underlying malpractice issue) and see how that is a HUGE driver of costs.
you are paid less for a lap chole than you were 10 years ago because it is a lot easier and takes less time to do a lap chole today than it did then.
When lap chole was new, it was harder to do, stressful, and took time the first few times. But as you got better at it and the technology matured, it required less physician work to do it.
In a Resource-Based Relative Value Scale (RBRVS), when the resources needed to do a procedure (including your work) decrease, the fee must be decreased. And so it is.
That's a horrible argument. It isn't cheaper to do a lap chole nowadays, for one thing. OR time is more expensive. And the equipment (fiber optic cameras, newer ports) is significantly more costly. It's just that the relative reimbursement to surgeons has decreased. Why is that? Is your argument that excellence ought to be punished?
Buckeye: I intended my comment as an explanation, not an argument.
When technology is new, it is hard, slow and stressful. Usually as the technology matures, it is quicker and easier to use. In other words, you can do more of the procedure in a given amount of time, and it is easier. This is a productivity gain.
The relative value of a servce is based on the physician work, practice expense and malpractice expense. If the physician work decreases, all else being equal, the relative value is supposed to decrease.
This is, in fact, how the payment system works. I am not endorsing it. I think it is totally screwed up.
Actually anon it is not much of an "explanation" if you really think about. Take a look at any 'service" cost now compared to 10-15 years ago and tell me how many of them are significantly cheaper? Frankly I can't think of one....that is outside of raping doctors of their services. The graphs clearly show MD's salaries going down. Another graph that buckeye did not show is that medicare costs for doctor services have been stagnant for a decade and as you know every year CMS is pushing for a 20%-30% cut. I can assure you how much I pay my staff salaries, expenses, rent, malpractice has not been stagnant. This country has no qualms with pharma charging whatever the market will bear. This country has no problems with a profit-based insurance system that has 25% in overhead (as opposed to a VA system which is 4%). This country has no problems with billions and billions of dollars spent on futile end-of life care. But the health policy wonks think doctor salaries are the problem? Even though total medicare expenses to MD's only amount to around 20% of medicare costs. Thanks for reminding me why I long ago stopped listening to the crap spun by the likes of Sullivan, Maggie Maher, and Ezra Klein. They just don't know what they are talking about. Think about it...these health care policy "experts" have never even spent a day working in the field they are supposed "experts" in. How in any real world scenario does this make sense?
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