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  1. groovy's Avatar
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    #1701  
    Quote Originally Posted by palandri View Post
    I wouldn't say he unmasked anyone. Though he tried. And I wouldn't trust Olbermann as an independent journalist/commentator. For example, he derides people who disagree with the President's health care reform plan as hate-mongers and conspiracy theorists but he, himself, has held to conspiracy theories surrounding 9/11. Now he's going to lengths to try to discredit the town hall protests but he says nothing about the Communist and Anarchist plants in many of the "pro-immigrant" rallies in the West. I don't care about him being a political hack; its how he poses as a populist that bugs me.
  2. groovy's Avatar
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    #1702  
    Princeton bioethicist and resident ivory tower crackpot, who happens to be a supporter of health care rationing, has weighed in on the subject.

    Peter Singer Expands On Healthcare Rationing Argument The Nose On Your Face

  3. #1703  
    One possible alternative structure that would do away with the middleman: direct practice, in combination with relatively low cost catastrophic insurance. The insurance industry's worse nightmare.

    Direct practice model
  4. #1704  
    Quote Originally Posted by davidra View Post
    One possible alternative structure that would do away with the middleman: direct practice, in combination with relatively low cost catastrophic insurance. The insurance industry's worse nightmare.

    Direct practice model
    Maybe you could expand on this a little more.

    What I am seeing is it's not for covering the uninsured but rather a lower cost alternative.

    Here's what scares me:

    .... has raised $4 million in venture capital to expand its practice in Washington and to other states around the country.

    The financing was led by Seattle-based Second Avenue Partners, and also included New Atlantic Ventures and Clear Fir Partners. Qliance, founded in 2006, has now raised a total of $7.5 million since it started....
    The venture capital creates the middlemen. If they aren't getting a good return on their money, they will quickly pull their money out of it and invest it elsewhere.
    My Phone & My Wife's Phone Two Unlocked GSM Treo Pro's

  5. #1705  
    As I understand it, the "practice" will still need administration, whether it's owned by the providers or whether the providers are hired by the practice. I admit it's treacherous with private enterprise involved, but my assumption is that the amount of administration will be minimal compared to any insurance company. As long as the overhead stays in single digits, it will be a much better deal than any private insurance company....but 9% of a busy practice with a large number of prepaid "clients", with guaranteed income and no accounts receivable would still be attractive to administrators. I am not supporting this idea, I just think it helps deal with the incredible waste of money that goes for nothing but the support of insurance companies and benefits nobody else.
  6. Micael's Avatar
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       #1706  
    jeez almighty. can we get off of the private insurance companies backs already. they are not the problem. tort reform is where we should be focused.... there and drug costs.
    The Law of Logical Argument: Anything is possible if you don't know what you are talking about.
  7. #1707  
    Michael, if the insurance industry is signing your pay checks, do you think it's unfair for folks to wonder whether you might have a conflict of interst here when you say stuff like your last post? Also politicians who are getting funded by the insurance industry contributions, why shouldn't we consider a conflict of interest there?
  8. #1708  
    Quote Originally Posted by Micael View Post
    jeez almighty. can we get off of the private insurance companies backs already. they are not the problem. tort reform is where we should be focused.... there and drug costs.
    Let's hear a good rationalization of exactly why a consumer's money should go to an intermediary instead of directly for the service they are buying? Why should a quarter of the money paid by the consumer go to support an entity that provides nothing directly? As was noted, you are not exactly an ideal person to make this argument. I wouldn't be either, if I was suggesting that more of the money should go to the providers....but I'm not. I think more of the money should be kept by the consumer....i.e. prices should be lowered.
  9. #1709  
    I agree....the focus should be on reducing the payments to doctors and hospitals. The doctors I see around here in the Charleston, SC area appear to make way too much money. They live in all the fancy prime locations along the harbor and seems like we could save a ton of money in health care if we got doctors down to making a reasonable living at $75,000 to $100,000 per year. Why should doctors be making huge salaries for giving health care? Wouldn't most people be happy with a $75K to $100K salary? Do they really need to live in $2 million plus homes while others who barely can afford health care coverage can't even afford a home?
    PalmPilot, PalmIIIc, Treo 650, Pre, Pre 3, Nokia 1020, Lumia 950

    "It's good to be the King" - Mel Brooks, History of the World, Part 1

    "I would rather have a German division in front of me than a French one behind me." General George S. Patton
  10. #1710  
    Quote Originally Posted by clemgrad85 View Post
    I agree....the focus should be on reducing the payments to doctors and hospitals. The doctors I see around here in the Charleston, SC area appear to make way too much money. They live in all the fancy prime locations along the harbor and seems like we could save a ton of money in health care if we got doctors down to making a reasonable living at $75,000 to $100,000 per year. Why should doctors be making huge salaries for giving health care? Wouldn't most people be happy with a $75K to $100K salary? Do they really need to live in $2 million plus homes while others who barely can afford health care coverage can't even afford a home?
    I agree too. It's silly really for a person to go thru four years of college competing with all of the other premeds, four gruellng years of med school, four or more years of abuse during internship or residency, if all they want to do is to make a lot of money. If the wages were not so rediculous especially for cosmetic procedures there would be a lot less money grubbers in the medical profession and more folks who truely want to help others. if you really can't wait to make as much money as fast you can it's better to major in business during college and then go staright to wall street or get a two year MBA and be an instance executive (lol).
    Last edited by E.LesterBrown; 09/09/2009 at 07:27 AM.
  11. #1711  
    Quote Originally Posted by clemgrad85 View Post
    I agree....the focus should be on reducing the payments to doctors and hospitals. The doctors I see around here in the Charleston, SC area appear to make way too much money. They live in all the fancy prime locations along the harbor and seems like we could save a ton of money in health care if we got doctors down to making a reasonable living at $75,000 to $100,000 per year. Why should doctors be making huge salaries for giving health care? Wouldn't most people be happy with a $75K to $100K salary? Do they really need to live in $2 million plus homes while others who barely can afford health care coverage can't even afford a home?
    The closet model I can think of is Cuba, where the ratio between the highest paid worker and lowest paid worker is 3:1. Heck, the most famous Latin America revolutionary was Che Guevara and he was a doctor. Maybe you are on to something here Clem.
    My Phone & My Wife's Phone Two Unlocked GSM Treo Pro's

  12. #1712  
    Quote Originally Posted by E.LesterBrown View Post
    I agree too. It's silly really for a person to go thru four years of college competing with all of the other premeds, four gruellng years of med school, four or more years of abuse during internship or residency, if all they want to do is to make a lot of money. If the wages were not so rediculous especially for cosmetic procedures there would be a lot less money grubbers in the medical profession and more folks who truely want to help others. if you really can't wait to make as much money as you can it's better to major in business during college and then go staright to wall street or the insurance industry (lol).
    Exactly! Were they forced to go the route of a doctor? No, I'm sure the vast majority took this route because they wanted to help people. Oh sure, there were a few bad apples who only thought of the money, but it's time for that bubble to be popped! Let's get the medical arena back to what it should be, saving lives and not about who can have the fanciest car or largest home with a harbor view. You see Les, you and I can agree on something!
    PalmPilot, PalmIIIc, Treo 650, Pre, Pre 3, Nokia 1020, Lumia 950

    "It's good to be the King" - Mel Brooks, History of the World, Part 1

    "I would rather have a German division in front of me than a French one behind me." General George S. Patton
  13. #1713  
    Quote Originally Posted by palandri View Post
    The closet model I can think of is Cuba, where the ratio between the highest paid worker and lowest paid worker is 3:1. Heck, the most famous Latin America revolutionary was Che Guevara and he was a doctor. Maybe you are on to something here Clem.
    Now look at this!.....even palandri and I are agreeing!
    PalmPilot, PalmIIIc, Treo 650, Pre, Pre 3, Nokia 1020, Lumia 950

    "It's good to be the King" - Mel Brooks, History of the World, Part 1

    "I would rather have a German division in front of me than a French one behind me." General George S. Patton
  14. #1714  
    Quote Originally Posted by clemgrad85 View Post
    I agree....the focus should be on reducing the payments to doctors and hospitals. The doctors I see around here in the Charleston, SC area appear to make way too much money. They live in all the fancy prime locations along the harbor and seems like we could save a ton of money in health care if we got doctors down to making a reasonable living at $75,000 to $100,000 per year. Why should doctors be making huge salaries for giving health care? Wouldn't most people be happy with a $75K to $100K salary? Do they really need to live in $2 million plus homes while others who barely can afford health care coverage can't even afford a home?
    No, the focus should be on stopping any payments to intermediaries who provide no service. Decreasing reimbursements is fine too, but we're just throwing away money by paying a quarter of it to insurance companies.

    And you are largely incorrect. I know a lot of doctors. I also know a lot of rich people, having grown up in Palm Beach County. They don't overlap. While everything is relative, and doctors all do quite well, they are not the uber-rich that have luxury condos and houses at the Amelia Island Plantation or in Palm Beach. I know a developer....a real estate developer....that owns planes, yachts, waterfront property...more than any doctor I know. If you are interested in making a lot of money, med school is not the place to aim. The number of super-highly paid subspecialists is pretty small compared to the total number of doctors. Yes, there are some cosmetic surgeons and aggressive orthopedic surgeons that make millions every year....but that's not most. Primary care docs have starting salaries that are usually in the $120,00-140,00 range. That seems like a lot compared to many people, but the average medical student that graduates from our medical school has a debt of $120,000 to pay back. I'm certainly not arguing for paying doctors more, because I don't believe that should happen. But thinking that all doctors are rich is just another stereotypical view. There isn't a major CEO in the country that makes less than any doctor....unless they are a doctor and are CEO of an insurance plan. As was mentioned, business school at Harvard will pay off much better than going to med school there...unless you're Michael Crichton, and he didn't make his money as a doctor.
  15. KAM1138
    KAM1138's Avatar
    #1715  
    Quote Originally Posted by davidra View Post
    Let's hear a good rationalization of exactly why a consumer's money should go to an intermediary instead of directly for the service they are buying? Why should a quarter of the money paid by the consumer go to support an entity that provides nothing directly? As was noted, you are not exactly an ideal person to make this argument. I wouldn't be either, if I was suggesting that more of the money should go to the providers....but I'm not. I think more of the money should be kept by the consumer....i.e. prices should be lowered.
    I suggested reworking the system to eliminate the intermediaries (government and insurance companies) for all common medical (non-catastrophic) needs, returning this to an interaction between doctors(hospitals, etc) and patients, but your response was that I didn't understand. Funny how you are now advocating the thing I identified as a core element in fixing the medical care system. Glad you've come around and changed your mind.

    KAM
  16. #1716  
    Quote Originally Posted by davidra View Post
    No, the focus should be on stopping any payments to intermediaries who provide no service. Decreasing reimbursements is fine too, but we're just throwing away money by paying a quarter of it to insurance companies...
    Where did you get the 25% from? I've read articles where people pop out with much higher percentages like 33% all the way to 50% when the profit motive is totally eliminated. Since you are in the medical field, you know know much better than I, what numbers are most accurate.
    My Phone & My Wife's Phone Two Unlocked GSM Treo Pro's

  17. #1717  
    Quote Originally Posted by davidra View Post
    No, the focus should be on stopping any payments to intermediaries who provide no service. Decreasing reimbursements is fine too, but we're just throwing away money by paying a quarter of it to insurance companies.

    And you are largely incorrect. I know a lot of doctors. I also know a lot of rich people, having grown up in Palm Beach County. They don't overlap. While everything is relative, and doctors all do quite well, they are not the uber-rich that have luxury condos and houses at the Amelia Island Plantation or in Palm Beach. I know a developer....a real estate developer....that owns planes, yachts, waterfront property...more than any doctor I know. If you are interested in making a lot of money, med school is not the place to aim. The number of super-highly paid subspecialists is pretty small compared to the total number of doctors. Yes, there are some cosmetic surgeons and aggressive orthopedic surgeons that make millions every year....but that's not most. Primary care docs have starting salaries that are usually in the $120,00-140,00 range. That seems like a lot compared to many people, but the average medical student that graduates from our medical school has a debt of $120,000 to pay back. I'm certainly not arguing for paying doctors more, because I don't believe that should happen. But thinking that all doctors are rich is just another stereotypical view. There isn't a major CEO in the country that makes less than any doctor....unless they are a doctor and are CEO of an insurance plan. As was mentioned, business school at Harvard will pay off much better than going to med school there...unless you're Michael Crichton, and he didn't make his money as a doctor.
    Well, you need to move here then. The doctors I know, and I know a few (though obviously not nearly as many as you, since you are a doctor), make high dollars. I'm talking easily $250K to $400K. At first I thought, well why shouldn't they make this type of money? But you've gotten me thinking more that maybe we should take some of the waste out of the health care "business". A doctor should not even think about how much he or she makes. As I said in an earlier post, $75k to $100k should make a good living for most people (especially here in the South) and this can be done, I would think, by doctors willing to take lower fees.

    The local Roper/St Frances Hospital doctors locally got into a battle about 3 months ago with the BC/BS HMO arm on fees. They wanted higher fees and the insurance company was trying to get lower fees. Lower fees is good, right? If the insurance company can get doctors to accept lower fees then that should keep premiums down....it's what we all want. Well, the doctors realized this would hurt their income, and those million dollar homes get a little harder to afford, right? So they fought it and it was announced in the paper that they were coming off the BC/BS network. Well, after the bad publicity and their patients complaining, they went back to the table and suddenly they accepted the lower fees. So good for them for realizing that they should not let their mortgages (plural, gotta have that vacation home to!) and fancy cars stand in the way of health care. But they went kicking and screaming, LOL.

    Anyway, sorry to hear the doctors in your area don't make as much, but they seem to be doing quite well here!
    PalmPilot, PalmIIIc, Treo 650, Pre, Pre 3, Nokia 1020, Lumia 950

    "It's good to be the King" - Mel Brooks, History of the World, Part 1

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  18. #1718  
    Quote Originally Posted by KAM1138 View Post
    I suggested reworking the system to eliminate the intermediaries (government and insurance companies) for all common medical (non-catastrophic) needs, returning this to an interaction between doctors(hospitals, etc) and patients, but your response was that I didn't understand. Funny how you are now advocating the thing I identified as a core element in fixing the medical care system. Glad you've come around and changed your mind.

    KAM
    Sorry. I've been very consistent. Insurance companies price themselves out of the equation, and are unnecessary for routine care. Limiting insurance companies to catastrophic policies would save a lot of money, but how will you provide care to the millions of people who can't afford it? Or are they of any concern at all? There are multiple parts to the equation: no exclusions for pre-existing conditions; no loss of insurance when you get sick; provision of care for those that truly can't afford it; and cost control. You tell me how you will solve those problems without any government involvement, and avoiding for-profit wasteful insurance companies, and I'll be a believer. It's perfectly rational for people to choose a direct care model if that's what they want; and for those who can't afford it, they should be able to have health care, and the best mechanism is by simply expanding Medicare. Easy, simple, and relatively cheap. Do away with fraud and unnecessary procedures, and you'll do just fine financially.
  19. #1719  
    Quote Originally Posted by clemgrad85 View Post
    Well, you need to move here then. The doctors I know, and I know a few (though obviously not nearly as many as you, since you are a doctor), make high dollars. I'm talking easily $250K to $400K. At first I thought, well why shouldn't they make this type of money? But you've gotten me thinking more that maybe we should take some of the waste out of the health care "business". A doctor should not even think about how much he or she makes. As I said in an earlier post, $75k to $100k should make a good living for most people (especially here in the South) and this can be done, I would think, by doctors willing to take lower fees.

    The local Roper/St Frances Hospital doctors locally got into a battle about 3 months ago with the BC/BS HMO arm on fees. They wanted higher fees and the insurance company was trying to get lower fees. Lower fees is good, right? If the insurance company can get doctors to accept lower fees then that should keep premiums down....it's what we all want. Well, the doctors realized this would hurt their income, and those million dollar homes get a little harder to afford, right? So they fought it and it was announced in the paper that they were coming off the BC/BS network. Well, after the bad publicity and their patients complaining, they went back to the table and suddenly they accepted the lower fees. So good for them for realizing that they should not let their mortgages (plural, gotta have that vacation home to!) and fancy cars stand in the way of health care. But they went kicking and screaming, LOL.

    Anyway, sorry to hear the doctors in your area don't make as much, but they seem to be doing quite well here!
    Lke I said, sometimes your observations don't corellate with reality. Anecdotes are not data. Admittedly, it's possible doctors in Charleston make more money that doctors in NY or California...but I doubt it.


    Median salaries for physicians

    Median salary by discipline
  20. #1720  
    Oh...and if you want doctors to work for $75-100K per year, you could start that by not having them be in debt for over $100,000 when they finally start making a good (non-trainee) income at age 31 or 32.

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