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Mr. Nice! posted:These are 'merican ideals, though. I should get to choose my own plan! Why do I, a single white male, need maternity coverage?! Democrats think that you should have more control over your cable TV networks than your healthcare. Just another example of the twisted priorities of these
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May 9, 2017 14:36
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Insurance companies are loving terrible, but I wonder if (in a hypothetical world where we can start reforming poo poo) pharmaceuticals would be a better place to start. For instance, thanks to greedy pharma the cost of insulin pens has skyrocketed to the point where my insurance plans will no longer pay for them. I have to use old school vials and syringes now. For those that aren't aware, insulin pens were a huge step forward for diabetes care because a) once you start using one, you don't need to keep it refrigerated, b) it's more easily portable, and c) it's much, much easier to get precise doses. It blows my mind that I was essentially told to go back in time wrt to my diabetes care. These companies are vile and in a just world the executives and shareholders would have been rounded up and shot for this heinous poo poo.
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May 9, 2017 15:43
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I feel universalized, standardized EMR might be a good thin end of the wedge.
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May 9, 2017 17:57
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Discendo Vox posted:I feel universalized, standardized EMR might be a good thin end of the wedge. Somehow this is one of the only concepts from those 20+ year old at&t "you will" ads that we still haven't mastered yet.
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May 9, 2017 18:02
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Brookings did a study a couple of years ago and came to the conclusion that the higher rate Americans pay for healthcare boils down to three big things. 1) Private insurance 2) Higher compensation for pharmaceutical manufacturers, medical device manufacturers, and medical professionals (especially specialists) 3) Geographic and Lifestyle issues (the US is much less densely populated than every European country, 90% of Canada lives in about 10% of the land mass, high obesity rates, income inequality leads to a small subgroup of people that have tons of health needs that compound costs) Private insurance was responsible for about 18% of the increased costs that Americans pay. Geographic and lifestyle issues were about 20%. Costs for medical professionals, pharma, and medical devices was close to 50%. If the US wants to get per-capita medical spending down to Canadian levels, then they have to accept the fact that doctors are going to be compensated less, some people in the insurance and medical professions will lose their jobs, and that spending money to get the 10% of people that recieve 80% of the US healthcare spending early will save money in the long-run. Those are all politically unpopular things to say and doctors have a very strong lobbying influence and enjoy a very high level of public trust, so it is difficult to get done. The insurance companies promote a ton of waste and perverse incentives, but they are not the primary drivers of cost compared to Canada/Europe. Leon Trotsky 2012 fucked around with this message at 18:24 on May 9, 2017 |
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May 9, 2017 18:22
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Discendo Vox posted:I feel universalized, standardized EMR might be a good thin end of the wedge. That is the intent of HL7 which the ACA was pushing.
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May 9, 2017 18:32
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Xae posted:That is the intent of HL7 which the ACA was pushing. Problem is congress was more interested in accusing vendors of lacking "interoperability" with little basis for the accusations than in actually pushing for hospitals and clinics (who are actually the ones who were refusing to hook up with each other for chart sharing) to set up connections. Literally every vendor worth buying has been able to send charts and data to anyone else since the early 2000s. Medical systems just view their patient data as proprietary and don't want to send it out of their network. It's hosed up.
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May 9, 2017 18:53
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Leon Trotsky 2012 posted:Brookings did a study a couple of years ago and came to the conclusion that the higher rate Americans pay for healthcare boils down to three big things. Man, that one was sneaky. "Medical professions, pharma, and medical devices." "therefore pay doctors less." Let's just wrap the second two parts of the equation up with the first, shall we? You're right that doctors will be paid less, but I am always amazed at how easily pharmaceutical companies price-gouging sneak out of this conversation. I mean, I get it, the only entity that could conceivably negotiate drug prices is the government, both insurers and providers are just short of helpless before them, and neither insurers nor providers really want any more evidence pointing to "the government taking this over is literally the only way to fix this," but man, the facility with which they elude being fingered as part of the problem. The medical device side of things you see more arguments about, because there you have a strong case government ain't helping. The split second medicare okays your new widget, you saturate the old-people advertising networks with "OUR THING GOT OKAYED BY MEDICARE, ASK YOUR DOCTOR ABOUT IT, IT WILL HELP YOU, AND IT'S BASICALLY FREE." quote:Those are all politically unpopular things to say and doctors have a very strong lobbying influence and enjoy a very high level of public trust, so it is difficult to get done. The insurance companies promote a ton of waste and perverse incentives, but they are not the primary drivers of cost compared to Canada/Europe. No, no they're not. Pretending doctors are, though, is only possible when you pull the trick you just pulled.
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May 9, 2017 18:54
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Leon Trotsky 2012 posted:Brookings did a study a couple of years ago and came to the conclusion that the higher rate Americans pay for healthcare boils down to three big things. Do you have a link to the study? Sounds neat
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May 9, 2017 19:04
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Ze Pollack posted:Man, that one was sneaky. "Medical professions, pharma, and medical devices." I wasn't pretending doctors are. But if you break it down, then getting doctor salaries in the US down to the ratio they are in the most efficient European countries would reduce total healthcare costs by about 10%. Doctors would still be making 6-figures in this scenario. It is also highly concentrated in certain fields that make some procedures almost 8x more expensive in the US. That ain't nothing. It has to be a part of the solution. The vast bulk of increased costs to US consumers comes from the excess margin various people in the chain collect. Doctors aren't un-involved. Everyone knows that pharmaceuticals in the US are sold at a crazy markup and it isn't a secret.
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May 9, 2017 19:07
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Leon Trotsky 2012 posted:I wasn't pretending doctors are. But if you break it down, then getting doctor salaries in the US down to the ratio they are in the most efficient European countries would reduce total healthcare costs by about 10%. Doctors would still be making 6-figures in this scenario. It is also highly concentrated in certain fields that make some procedures almost 8x more expensive in the US. Specialists are what you're after, not doctors. Your average GPs in America aren't making vastly more now than what they are anywhere. Specialists are the major source of doctor price gouging.
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May 9, 2017 19:13
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Mr. Nice! posted:Specialists are what you're after, not doctors. Your average GPs in America aren't making vastly more now than what they are anywhere. Specialists are the major source of doctor price gouging. GPs in the US actually do make much more than doctors anywhere else in the world. quote:So do we simply use more expensive technologies? Are doctors murdering our pocketbooks with their tests? In fact, Americans get less MRI scans per person than Japan, and have fewer hip and knee replacements and cardiac catheterizations than many European countries. The distribution of our spending among various sectors—basic medical care, diagnostics, hospitals, pharmaceuticals, and nursing homes—is not actually very different from European countries (we actually spend far less of our healthcare expenditures on nursing homes, at only 6.2% as compared to 20% in Switzerland, and slightly more than European countries on basic care). The highest cost technologies don’t seem to be disproportionately used by us. esquilax posted:Do you have a link to the study? Sounds neat The quote above is the nugget from The Commonwealth Fund that the Brookings used as a guide. The full study is here: http://www.commonwealthfund.org/publications/issue-briefs/2015/oct/us-health-care-from-a-global-perspective I don't have a link to the Brookings study, but it was released in late 2014 or early 2015 and I have a copy at home I can post later. Leon Trotsky 2012 fucked around with this message at 19:17 on May 9, 2017 |
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May 9, 2017 19:15
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Leon Trotsky 2012 posted:GPs in the US actually do make much more than doctors anywhere else in the world. You're right, but it's not much more. Australia is lower than pretty much all of europe. https://journal.practicelink.com/vital-stats/physician-compensation-worldwide/  I suspect that if that was broken down by locality that there are GPs in certain areas of the country that skew the USA's average wage up significantly.
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May 9, 2017 19:18
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Leon Trotsky 2012 posted:I wasn't pretending doctors are. But if you break it down, then getting doctor salaries in the US down to the ratio they are in the most efficient European countries would reduce total healthcare costs by about 10%. Doctors would still be making 6-figures in this scenario. It is also highly concentrated in certain fields that make some procedures almost 8x more expensive in the US. One thing that's not often realized is that doctor salaries have an inverse scale to geography that most professions do. Typically, the salary for a job goes up the more expensive your region is - a programmer/lawyer/whatever in Manhattan gets paid way more than one in Bumblefuck, Texas. That is not actually true of doctors: doctors in Bumblefuck, Texas get paid much more than doctors in Manhattan because you've got to bribe the doctors to go out to the middle of loving nowhere. So you're not actually going to be able to cut doctor pay all the way to where it is in the most efficient European countries because it's an outgrowth of the US's geography problem. There's no need to pay a doctor in Manhattan more than one in London - but you've gotta pay the one in Bumblefuck Texas more.
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May 9, 2017 19:19
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Australia manages to pay their doctors comparable salaries to US doctors for primary care and some specialties. They have similar problems to the US in terms of geographic distribution. Including doctors salaries in with pharma and devices is a huge misdirection. Also, there are many other costs like imaging/labs, support staff, facility fees, etc. that you aren't even mentioning.
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May 9, 2017 19:19
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How do medical school costs in America differ from around the world? A GP taking home a $93,000 salary would have a difficult time paying off $300,000 in student loans at 7% or whatever they are right now.
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May 9, 2017 19:20
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Leon Trotsky 2012 posted:The vast bulk of increased costs to US consumers comes from the excess margin various people in the chain collect. Doctors aren't un-involved. Everyone knows that pharmaceuticals in the US are sold at a crazy markup and it isn't a secret. While this is tangential to the issue of prescription drug prices, I always marvel at how a brand name allergy med like Zyrtec sits next to a basically identical store brand and apparently sells despite being twice the price per pill. There's no information asymmetry and yet people still overpay thanks to the magic of TV advertising.
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May 9, 2017 19:20
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Mr. Nice! posted:You're right, but it's not much more. Australia is lower than pretty much all of europe. https://journal.practicelink.com/vital-stats/physician-compensation-worldwide/ That chart you posted says that the average U.S. GP makes 206% more than the average non-US doctor. How does that jive with the idea that they don't "make much more" than other countries?
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May 9, 2017 19:22
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Mind_Taker posted:How do medical school costs in America differ from around the world? A GP taking home a $93,000 salary would have a difficult time paying off $300,000 in student loans at 7% or whatever they are right now. GP requirements in Australia are different from primary care requirements in the US. A primary care doctor on that chart from the US will have completed 4 years undergrad, 4 years medical school, and an additional 3 years of medical residency, in practice. A GP in Australia can be practicing after as few as 6 years combined undergrad/med school and 1-3 years of medical residency. The US has the longest training for primary care in the world. Doctors don't even sniff close to that salary until age 29 at the earliest if they go straight through without any time off, research, etc. It's really an apples to oranges comparison.
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May 9, 2017 19:34
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Leon Trotsky 2012 posted:That chart you posted says that the average U.S. GP makes 206% more than the average non-US doctor. If you drop the lower-paying countries from the average it drops from 106% to 40-50% depending on your cutoff (42% if you limit it to countries that pay $100k+). That's still significant, of course, but the low end of the sample really isn't comparable in terms of cost of living, education, etc to make a fair comparison.
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May 9, 2017 19:38
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Discussion Quorum posted:If you drop the lower-paying countries from the average it drops from 106% to 40-50% depending on your cutoff (42% if you limit it to countries that pay $100k+). That's still significant, of course, but the low end of the sample really isn't comparable in terms of cost of living, education, etc to make a fair comparison. Also, even if you were to magically subtract $50,000 from every doctor's salary in the USA, that would only result in a cost savings of $40 billion.
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May 9, 2017 19:46
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Lote posted:The US has the longest training for primary care in the world. Doctors don't even sniff close to that salary until age 29 at the earliest if they go straight through without any time off, research, etc. It's really an apples to oranges comparison. The US system doesn't make sense to me. Students should be able to get into US medical schools right out of high school. Having to pay for 4 years of undergraduate school for 1 1/2 years of pre-med education is pretty wasteful.
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May 9, 2017 20:14
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They bang out pre-reqs like bio chem and such during their undergrad. It also makes them more well-rounded individuals supposedly.
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May 9, 2017 20:15
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evilweasel posted:One thing that's not often realized is that doctor salaries have an inverse scale to geography that most professions do. Typically, the salary for a job goes up the more expensive your region is - a programmer/lawyer/whatever in Manhattan gets paid way more than one in Bumblefuck, Texas. That is not actually true of doctors: doctors in Bumblefuck, Texas get paid much more than doctors in Manhattan because you've got to bribe the doctors to go out to the middle of loving nowhere. So you're not actually going to be able to cut doctor pay all the way to where it is in the most efficient European countries because it's an outgrowth of the US's geography problem. There's no need to pay a doctor in Manhattan more than one in London - but you've gotta pay the one in Bumblefuck Texas more. A ludicrous perversion of the labor market caused by the AMA's ability to control the supply at nearly every step of the process. Stop creating artifical shortages (and using tuition cost/length of education to shape the candidate pool), and all of a sudden Bumblefuck will have doctors who will be happy to be employed there (or, indeed, anywhere). I don't begrudge them their cartel, but let's not pretend that they're not driving up medical costs to line their pockets.
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May 9, 2017 20:44
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DrNutt posted:Insurance companies are loving terrible, but I wonder if (in a hypothetical world where we can start reforming poo poo) pharmaceuticals would be a better place to start. Insurance Companies: Damned when they try and ration care to keeps premiums down; damned when they raise premiums. I'm not saying insurance companies always get it right when they try and manage/ration care, but when you've got people selling healthcare for a profit somewhere in the chain between end consumers and manufacturers someone has to determine whether or not the medical care's cost is justified for the improved outcome, and doctors sure as hell aren't doing that right now. Paracaidas posted:A ludicrous perversion of the labor market caused by the AMA's ability to control the supply at nearly every step of the process. Stop creating artifical shortages (and using tuition cost/length of education to shape the candidate pool), and all of a sudden Bumblefuck will have doctors who will be happy to be employed there (or, indeed, anywhere). Non-Physician clinicians like Physician Assistants ans Nurse Practitioners provide better and cheaper care at the family practice level.
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May 9, 2017 20:45
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Paracaidas posted:A ludicrous perversion of the labor market caused by the AMA's ability to control the supply at nearly every step of the process. Stop creating artifical shortages (and using tuition cost/length of education to shape the candidate pool), and all of a sudden Bumblefuck will have doctors who will be happy to be employed there (or, indeed, anywhere). No, I'd rather have a high barrier to entry for doctors than to have doctors desperate to find a job because they're not actually that qualified.
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May 9, 2017 20:46
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evilweasel posted:No, I'd rather have a high barrier to entry for doctors than to have doctors desperate to find a job because they're not actually that qualified. This one time, the truth may actually be in the middle. If we're serious about cutting costs, this is one of the (many) drivers and one that can be adjusted without major structural change or reorientation. This isn't saying throw open the doors (or combine med school/undergrad as was suggested upthread). I am saying that I believe our current supply (of med school spots, of internships, of residencies, of speciality spots) is more motivated by the economic concerns of the AMA and its membership than by concern for public safety.
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May 9, 2017 21:01
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evilweasel posted:No, I'd rather have a high barrier to entry for doctors than to have doctors desperate to find a job because they're not actually that qualified. It is good that the supply of doctors is controlled. Who wants to spend all of that time training to be a doctor only to find at the end of it all that there is no job for you? On the other hand, increasing the supply of doctors would help a lot with lowering the price of medical care, and would allow doctors to actually work more normal hours. Paracaidas posted:This isn't saying throw open the doors (or combine med school/undergrad as was suggested upthread). It's not really an oddball idea. Lots of countries with great healthcare systems do things that way and start medical school after high school. It makes a lot of sense. silence_kit fucked around with this message at 21:17 on May 9, 2017 |
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May 9, 2017 21:01
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We can certainly do more medical schools and lower the barrier to entry with the massive debt, I just don't want something like where law schools are that churn out hundreds of "lawyers" where only half may even pass the bar and those that do, maybe one is a competent lawyer. It should be a high-paying job and we should want a good chunk of our best and brightest going into medicine. We can afford to pay for it as a nation, the costs should just be shared more equally through UHC.
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May 9, 2017 21:08
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evilweasel posted:These are stupid ideas because people are not and should not be expected to be able to determine what medical procedures were needed and then pay for them out of pocket. Being the informed buyer is the job of the insurer and/or UHC org. And really when was the last time someone who got in a bad accident and was full of morphine could be expected to make correct, informed financial decisions?
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May 9, 2017 21:15
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Leon Trotsky 2012 posted:The results of this hefty spending on the same drugs and (perhaps better) doctors doesn’t seem to clearly correlate into better outcomes. Mortality rates in U.S. hospitals after admission for a heart attack, for example, are just average—at 4.3% as compared to just 2.3% in Denmark. Similarly depressing results are available for respiratory diseases, cancers, and surgical or medical mistakes. And overall we have the highest rate of death that would be amenable to healthcare intervention (deaths among people less than 75 years old that are from heart attacks, strokes, diabetes and bacterial infections); the U.S. has 96 such deaths per 100,000 people as compared to France’s 55 deaths. 
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May 9, 2017 22:16
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evilweasel posted:We can certainly do more medical schools and lower the barrier to entry with the massive debt, I just don't want something like where law schools are that churn out hundreds of "lawyers" where only half may even pass the bar and those that do, maybe one is a competent lawyer. It should be a high-paying job and we should want a good chunk of our best and brightest going into medicine. We can afford to pay for it as a nation, the costs should just be shared more equally through UHC. silence_kit posted:It's not really an oddball idea. Lots of countries with great healthcare systems do things that way and start medical school after high school. It makes a lot of sense. xarph posted:And really when was the last time someone who got in a bad accident and was full of morphine could be expected to make correct, informed financial decisions?
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May 9, 2017 22:22
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xarph posted:And really when was the last time someone who got in a bad accident and was full of morphine could be expected to make correct, informed financial decisions? This brings up a really good discussion about consent and whether patients can even be expected to pay, since they are being coerced into decisions. A lot of times they are being asked if they want procedures in the midst of intense pain when they are desperate. Or they are being told they have to have something be done..and why would they argue? The patient is the ignorant one. No one can adequately argue whether care was beneficial or necessary until after it is done.
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May 9, 2017 22:25
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Does that study include residents in the US numbers?
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May 9, 2017 22:32
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Paracaidas posted:Anyone who wants to copy the lawschool model is a damned idiot, so I certainly hope I didn't come across that way. I agree that we can afford to pay for it as a nation, but I'm skeptical we're getting our money's worth at this rate. I suspect that (mildly) weakening the talent pool to increase supply will actually improve outcomes as doctors work fewer hours, but I also recognize that making this change is condemning many nameless, faceless patients to die via errors of doctors who would have otherwise been rejected. Having talked to a bunch of doctors, the hours thing is actually more complicated than people realize. There has not been a meaningful decrease in medical errors as a result of residents being barred from working hours that are too insane, and the problem is patient handoffs. When a patient is handed from one doctor to another, information is lost. The old doctor has a ton of information about everything that's happened with the patient, and they are able to convey only a limited subset of that to the doctor taking over. As a result, the patient now has a better-rested doctor, but also a less informed one. So you might have errors because they don't realize a drug was administered earlier, an allergy was noted or detected, etc, to replace the errors caused by a sleep haze. That's the basic thing that initially led to the crazy hours: because you need continuity of information and that means a doctor needs to be able to stay on duty until that patient is stable. Doctors and hospitals are working on solving that by training people in how to hand off patients better (essentially, training people to convey the information in order of importance, use a checklist, etc) you'll reduce the errors caused by incomplete information. Old doctors whine the new doctors aren't getting as many training hours but that gets less credibility than the patient handoff thing and apparently just comes off as "I had to do it, you should too". There's a limited amount you actually learn in a sleep haze.
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May 9, 2017 22:32
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The handoffs thing should be alarming and something that the profession would want to fix. Instead doctors bitch about EMRs and writing poo poo down.
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May 9, 2017 22:41
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Do doctors in other countries have to pass something like the USMLE Step 1? It's an absolutely brutal exam that requires knowledge in many areas of biological science, to the point where the first two years of medical school have a heavy focus on the subjects covered. A big part of why medical training takes so long is that we require doctors to have a lot of general scientific knowledge that might not be directly applicable to general medical practice. This also puts a lot of pressure on candidates in undergraduate institutions, a lot of wannabe doctors have their dreams crushed by getting a C in Organic Chemistry.
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May 9, 2017 23:04
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This dropped within minutes of that other story we're all paying attention to right now, so in case you missed it: Interesting new Bob Costa/Sean Sullivan WaPo column up identifying that the group of 13 is actually the brainchild of Ted Cruz. https://www.washingtonpost.com/powe...m=.bfc15dcb9e45
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May 10, 2017 00:12
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the AHCA sales tour going well - a town hall in macarthur's district https://twitter.com/daveweigel/status/862438918440058886 https://twitter.com/ddiamond/status/862439092382040064
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May 10, 2017 23:49
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https://twitter.com/daveweigel/status/862440929654865921 lol
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May 10, 2017 23:55
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