Governement Healthcare...

I know how it works. IMO, getting rid of COBRA would not get rid of the lapse in coverage issue. The "certificate of group coverage" in HIPAA was, I think, intended to help work around problems with pre-existing conditions as well. Maybe that created a problem as well -- that people have to have that certificate -- but I would guess there were more problems with pre-existing exclusions prior. The Medicaid eligibility rules would have to change drastically to allow people between jobs to go on it.

[ladymoreta]

I agree, but it would at least make us come up with a better solution. I think that the lapse in coverage denial should not be allowed, either.

[Deebs]

Also, if we allow that many people into Medicaid, what will happen to our hospitals? In IL, for example, Medicaid is paying less that 40 cents on the dollar. Which means private payers and insured patients have to make up that loss. The hospital ends up taking a loss on the rest. Last year, emergency physicians alone ended up writing off close to $200,000 each in Medicare and Medicaid losses, nationally. I agree that these systems end up being more efficient that most private insurers, but their reimbursements have become so low that it is breaking the system.

Also, when you talk about docs making 1/2 of what they currently make, salaries of specialists are probably what is coming to mind? Primary care docs (think of the pediatrician, FP, internist, emergency doc) will have to leave their specialties in order to afford repayment on student loans. Not all docs are making $300K - many are making less than $100K.

[Sheherezade]

For me, the physician salary discussion brought up in health care reform is always such an eye opener. Honestly, physicians within the same specialty make vastly different amounts of money. My own DH signed up to make lots less than many others in his field do ( like less than half). I assumed it was the academics. Now that the hospital has gone on performance based pay, his salary has increased and others have lost money. It's just weird. Clearly the "average" pay for any one specialty comes form a HUGE distribution. I'm not sure that's "fair" either. How can a doc doing the exact same things as my DH make three times as much seeing the same # of patients? Because they've negotiated a killer deal with the hospital. It's not a clear fee for service. Same service, vastly different fees based on the dynamics of the moment when the contract was signed. This is just one example of how medicine is a complex system. I'd love to get that complexity OUT of the system - but I'm certain it would result in lower pay for a large number of specialties. (Obviously, here, it has. When the hospital went to a strict pay for billing scheme LOTS of people started moving backwards on the pay scale.) For us that is an equalizer. Of course, we also don't like to haggle for cars. Why should one guy get a better deal than the other?

My only other cogent thought to add: I heard the Obama speech today and I was struck by how much of this "hurry hurry" is just the political gamesmanship du jour. Obama mentioned that they wouldn't allow "delay and destroy" tactics. Ah-ha! That explained so much to me. Why is everything so rushed these days -- from healthcare to the stimulus to the bailout (under Bush) to the original war debate for Iraq? Because that's the current strategy designed to defeat the defensive strategy. The "other side" tries to stall and tear it down OR just let it die. The current side tries to ram it through as fast a possible. *sigh* I'm dashing off an email about that today. We need to have a whole congress of serious politicians that stop all this baloney. We DO need to have actual discussions about proposals and solutions with the intent to PASS something. No more BS! Both sides come to the table with a set playbook. I'm so.sick.of.it.

And with that.....back to my chocolate.

[SuzySunshine]

The rumor or whatever you want to call it about how much doctors get paid needs to be the first thing bucked before any sort of reform is going to be practical. We have friends that have gone into academics being paid $150K-$300K right out of training to friends that have gone into private practice being paid $450K-$700K. Some of these are based on cost of living, some are not - some are based on a small base salary with a production based component, some are not.

Here staff all get a salary, there is no incentive to order more tests, etc. The starting salary in all specialties is lower then at most academic institutions but it also comes with a great pension plan.

So I guess my point is comparing across specialties makes no sense to me, even when comparing academic to academic and PP to PP. People in this country will always think that doctors, no matter what they do, are rolling in dough and until there is some way to discredit that it will be what it is.

Until I see a plan that has made it through both parties and looks like it will make it through both branches I don't see a lot of reason to get worked up about it no one seems to know what it will really look like.

[Flynn]

Wow. My head is spinning.

As I read through all of the posts (quickly, sorry) my thoughts really are most in line with DCJenn (no surprise).

There are so many layers to this problem.


A few of my thoughts that are not unique or particularly elightened. Doctors need to get paid or there won't be any qualified docs anymore. Most high level specialists MAKE money for the hospital and get a SMALL fraction of it in pay no matter what their salary is. In many many many hospitals, primary care is a wash (which is a totally different problem). HOSPITALS NEED SPECIALISTS and need to pay them well to keep them AND to stay in the black. Add to this risk and years trained and it makes me ILL to think that a neurosurgeon's pay will possibly get cut by X % or Y %. I think that's just wrong.

Additionally -- DH trained in a big city where there were specialists galore. Where we live now, not so much. We live in the land of primary care and let me tell you, it's been EYE opening. Now before you jump all over me, primary care has a roll. There will never be CT services in parts of Alabama or Eastern Washington for example. It's NOT going to happen. This is a large part of the problem. So, you have primary care docs making specialist decisions and ordering BOAT LOADS of tests that are NOT necessary. DH gets patients who have had 7 - 15 (I KID YOU NOT) tests done BEFORE they get to him that are #1) not necessary #2) expensive and #3) completely worthless when DH needs data to make a diagnosis. It happens ALL THE TIME and DH isn't even busy -- that's why we're looking for other jobs!!! Look at the Mayo -- probably the MODEL for efficient, low cost but high quality care -- run by SPECIALISTS. Docs are a big part of this problem -- but NOT because they are overpaid. I realize a world run by specialists is NOT the answer because it's not realistic but docs contribute to the high costs of health care BIG TIME.

This is so interesting. I think the disparities in care in this country are embarrassing. Those of us lucky enough to have good insurance have access to absolutely top-notch care. But most of us know someone less fortunate -- a friend or relative with a pre-existing condition, or someone who was laid off and can't afford premiums, or maybe even an insured person who was unlucky enough to get a horrible disease and is now going bankrupt from co-pays and deductibles and premium increases. Health care is not a right that I've earned and they haven't. Frankly, I'd be willing to pay more in taxes to be able to know that I live in a society that will look out for the basic health care needs of everyone.

Unfortunately, we can't afford to spend on health care for more people the way we spend on some now. But maybe it's not a zero-sum game? I am hopeful that there are ways to cut costs without sacrificing the quality of care. Following up on Flynn's comment...

Look at the Mayo -- probably the MODEL for efficient, low cost but high quality care -- run by SPECIALISTS. Docs are a big part of this problem -- but NOT because they are overpaid. I realize a world run by specialists is NOT the answer because it's not realistic but docs contribute to the high costs of health care BIG TIME.

... I thought of this Atul Gawande article from the June 1 New Yorker.

http://www.newyorker.com/reporting/2...a_fact_gawande

I highly recommend it if you haven't read it.

[SuzySunshine]

Ok so one of my friends just said that congress is exempt from participating in the government run healthcare as the bill stands now - anyone else find that a HUGE red flag?

[Pollyanna]

Ok so one of my friends just said that congress is exempt from participating in the government run healthcare as the bill stands now - anyone else find that a HUGE red flag?

The unions have some sort of exemption as well...

[Pollyanna]

More information from IBD:

http://www.ibdeditorials.com/IBDArti...32548165656854

[SuzySunshine]

So did anyone watch the press conference? DH and I watched it, or what we could while A was screeching around the living room

He was waiting and waiting for him to say something about the duplication of tests, etc to decrease costs but wasn't thrilled with his answer when he finally did.

I still don't see how the specifics are going to affect us as the public and as a medical family. I guess we'll see.

[GrayMatterWife]

So did anyone watch the press conference? DH and I watched it, or what we could while A was screeching around the living room

He was waiting and waiting for him to say something about the duplication of tests, etc to decrease costs but wasn't thrilled with his answer when he finally did.

I still don't see how the specifics are going to affect us as the public and as a medical family. I guess we'll see.

Are you referring to this afternoon's press conference or the prime-time speech tonight? I caught part of the first; all of the second. The prime-speech was...terrible. I mean, really bad. Weird, almost. Obama gives a great speech. This is the first one I've seen him give where I honestly thought: wow, he wasted that chance. He had zero specifics, all posturing, and was kind of lecturing and condescending. And he is getting, frankly, bossy about it. He keeps saying that we WILL do this and WILL do that. One commentator it was a brilliant speech in its complete denial of reality.

[SuzySunshine]

I didn't know anything about an earlier speech - just this evening's.

One thing that DH and I were curious about was what "largest doctor and nurses group" that he kept saying supports his plan since we know its not the AMA.

[PrincessFiona]

It IS the AMA!

[SuzySunshine]

It IS the AMA!

But hasn't the AMA come out against his plan several times? Never mind I just found an article that says they now back a democratic plan.