The highest paid health care workers aren't...

[JoseCuervo]

Fire protection is an economic good. It takes human effort to produce. The government does not make it exist. So far there is economic motive to becoming a fireman. Although in your case a firetruck will roll to your door when in need, this is not the case for 100% of our nations' population.

Your analog missed the thought experiment by such a distance as to seem to me to be either a deliberate attempt to redirect the debate with a straw man or a closed minded defense showing lack of thought.

So, how does the government "make" doctors or firemen?

Now that I know about the spin zone I feel uncomfortable with this discussion under Medical Topics. I would move it if I could.

I am not sure what the difference is between asking the government to provide fire care and health care. For some reason, we have decided that we like to pay taxes to fund firemen and fire trucks. At least where I live, that is a government function.

Seems like it is a good service for a community to provide, protection of their citizens.

There are other services that make more sense being provided by the government. Police, military, ambulance, prisons, etc. Why not healthcare and fire? (Please keep in mind, there is absolutely NOTHING in the ACA that has the government providing healthcare.)

 

[EppyGA]

My wife as an orthopeadic surgeon has experienced first hand the fiasco of Obama Care. Federal inspectors from DC were VERY concerned that some of the pictures and diplomas in her office were less than 12" from the ceiling. Little care that she spend hours each day trying to enter the correct code for patients instead of seeing patients.

Why am I not surprised by this?

 

[JohnF]

I am not sure what the difference is between asking the government to provide fire care and health care.

Who said there was a difference. The thought experiment didn't mention fire care, you did. The problem that I presented is asking for something deeper and you keep trying to jump ahead.

For some reason, we have decided that we like to pay taxes to fund firemen and fire trucks.

Have we?

At least where I live, that is a government function.

That is not the case everywhere.

Seems like it is a good service for a community to provide, protection of their citizens.

That is a good subject for discussion. In fact, it might even play into the definition of community. But the subject is vast and requires much thought.

There are other services that make more sense being provided by the government. Police, military, ambulance, prisons, etc. Why not healthcare and fire? (Please keep in mind, there is absolutely NOTHING in the ACA that has the government providing healthcare.)

ACA? I never brought up the ACA.

But this is another good subject. What is the purpose of government? You argue that the above make more sense being provided by government, why is that?

 

[Blackhawk]

I am not sure what the difference is between asking the government to provide fire care and health care. For some reason, we have decided that we like to pay taxes to fund firemen and fire trucks. At least where I live, that is a government function.

Seems like it is a good service for a community to provide, protection of their citizens.

There are other services that make more sense being provided by the government. Police, military, ambulance, prisons, etc. Why not healthcare and fire? (Please keep in mind, there is absolutely NOTHING in the ACA that has the government providing healthcare.)

The problem is that health care is not provided well by governments on a large scale. Please cite an example of a government with the population the size of the US where health care has been provided to the populous on an efficient basis.
Health care is no different from any other commodity- food, housing, fuel. Can a government provide it? Sure. Can it do it efficiently? No.

When my wife works with the VA or military facilities it is not unusual for cases to be cancelled because they might run long- can't work past quitting time of course. She has had technicians scrub out in the middle of a procedure to get lunch. Can't work through lunch of course. Fire them you say? Can't be done with a government union.

One need only look at the fiasco going on now with the VA. Does the VA care? Yes, but more about the VA, buildings for the VA, bureaucracy for the VA, art work and booze for the VA. Veterans? Well, if you are not close to DC or one of the elite such as Colin Powell, good luck. As with the IRS no one will be fired.

All I hear from progressives such as yourself is that this time you will be smart and mess it up less.

 

[weilke]

I never said it did, but my point was more to counter the thought of hospital top management making as much as or more than the top doctors.

They should get paid what the market for hospital admins for a hospital of the particular size requires. I am mostly familiar with non-profit hospitals, but the admins get paid based on what the board believes they have to pay to get someone qualified to do the job. As long as there is no collusion with search firms and 'consultants' to drive up the salaries, it is between the board and the candidate.

 

[nddons]

I am not sure anyone ever thought it was supposed to increase the supply of Dr's. If we had a shortage before, we still have a shortage. If we had a surplus before, we still have a surplus. From a Macro standpoint, 100% of this nation's Drs were responsible for providing 100% of the healthcare. That has not changed.





Which was a horrible way to deliver healthcare. Emergency rooms are far more expensive than vaccines, offices, and clinics.















Don't Dr's get more time to see patients and deliver healthcare if they don't have to supervise their collections department?









Prior to this, I had to subsidize every uninsured person's health care when they stiffed the hospital and the dr and didn't pay. That was a "from each according to his ability [to pay] to each according to his need [for health care]." type of model. And terribly inefficient.



Not to mention the amount of my taxes that went to the County to pay for "indigent" healthcare. Are you arguing it is a better system for my tax dollars to go to the County fund?

Where the **** do you think the money comes from for the "subsidies"?

Obama has taken your indirect subsidies and supersized them.

 

[Gary F]

These people were getting it "free". They didn't pay when they went, they left hospital bills and Dr bills to be paid for by the rest of us who had insurance and who paid taxes.

They didn't get elective medical care. Now they can. Unfortunately a lot of elective medical care is not really beneficial but still costs a lot. Providers are going to game the system to maximize profit.

 

[RJM62]

One thing that many people overlook is that most insurance companies are for-profit corporations that aren't ashamed to admit that, whereas most hospitals claim to be non-profit organizations that hold themselves out to be charities and shamelessly beg for contributions from patients whose insurance companies have already paid the hospitals handsomely for services provided.

When I had my gall bladder removed, the hospital was paid roughly $6K / hour for the use of an operating room for about 1.75 hours. There were adhesions that my surgeon (who happened to be a friend of mine) patiently scraped away rather than cutting me open, but which apparently increased the complexity of the surgery -- and the cost-per-minute of the O.R.

That bill was just for the O.R., by the way. It didn't include the absurdly inflated costs for everything else ranging from socks with the rubbery squiggles that they made me wear (something like $40.00 -- for a pair of socks), to the $25.00 Vicodin tablet they gave me to "hold me over" until I could fill the prescription (which cost something like $8.00 for the whole bottle at my local pharmacy). Neither does it count the $400.00 blood tests, the $135.00 pre-op "physical" by an N.P. who barely looked at me, and so forth, and so on.

But whatever. The hospital and the insurance company had their arrangement, and they worked things out accordingly. I was a bit miffed, however, when I started getting solicitations from the hospital to contribute to their various fund-raising drives, which increased exponentially after I made the mistake of sending a contribution in response to the first request. Holy crap, what a mistake that was. Once you make a contribution, they never stop asking. They call you on the phone, send you snail mail, send you email... Hell, they practically climb in the window and pull you out of the bed at night to get you to write them a check.

Now... if the hospital really was a "non-profit" organization in more than name, if they hadn't charged me $40.00 for a pair of socks, if they hadn't marked up a Vicodin tablet by roughly 10,000 percent, if they hadn't charged me $400.00 for the same blood tests that Quest will do for $65.00, then maybe it wouldn't have been so annoying. But they did, and it was.

Now let's add some insult to injury and ponder the fact that the vast majority of former patients at whom these "non-profit" hospitals aim their appeals have incomes that are mere fractions of those of the hospitals' CEOs, Administrators, or whatever else the head honchos at the top call themselves; so not only are the patients being squeezed and guilted for contributions after having charged $25.00 for a $0.25 pill, but they're also being asked to subsidize the incomes of executives who, in some cases, make more in a year than they themselves will in 10 years, or 20, or maybe their entire lives.

Non-profit can be very profitable, indeed.

-Rich

 

[Jim Logajan]

Non-profit can be very profitable, indeed.

Non-profit in the tax regulation sense only. Medicine has always been a service business - I don't think there have been too many times or places where it was ever successful as a selfless noble endeavor. But government has always been around to influence its exercise. Even the Code of Hammurabi had rules regarding payment to physicians:

It is also interesting to note that according to these laws, both the successful surgeon's compensation and the failed surgeon's liability were determined by the status of his patient. Therefore, if a surgeon operated and saved the life of a person of high status, the patient was to pay ten shekels of silver. If the surgeon saved the life of a slave, he only received two shekels. However, if a person of high status died as a result of surgery, the surgeon risked having his hand cut off. While if a slave died from receiving surgical treatment, the surgeon only had to pay to replace the slave. This use of status to evaluate misdeeds does not seem to appear in other, similar "codes" however. [http://www.indiana.edu/~ancmed/meso.HTM]
​

Ancient Egypt had surprisingly good medicine - and even back then specialists were ranked higher in regard and presumably in compensation:

There were professional divisions in ancient Egyptian medicine according to skill and experience. From lowest to highest rank there were:

• Lay physicians
• Supervisors of the lay physicians
• Magic physicians (who treated people through religious rituals)
• Caretakers of the Pharaoh's anus (yes that's right, and it was a high ranking position too!)
• Specialists (like teeth, stomach, etc...)

Doctors worked in the temple as well as having a private practice if they chose. Their wages were paid through barter since there was no monetary system in ancient Egypt. [http://www.experience-ancient-egypt.com/ancient-egyptian-medicine.html]
​

I'd have been satisfied with tweaks to the U.S. laws that would have encouraged medical providers to advertise their prices. (Costs for services are currently hard for the patient customer to compare until after-the-fact, and insurance intermediaries pretty much undermine any possibility of that changing to allow traditional market forces to work properly.) Throw in plenty of publicly accessible customer rating systems and I'd expect the market to start to come into play.

 

[RJM62]

Non-profit in the tax regulation sense only. Medicine has always been a service business - I don't think there have been too many times or places where it was ever successful as a selfless noble endeavor. But government has always been around to influence its exercise. Even the Code of Hammurabi had rules regarding payment to physicians:

It is also interesting to note that according to these laws, both the successful surgeon's compensation and the failed surgeon's liability were determined by the status of his patient. Therefore, if a surgeon operated and saved the life of a person of high status, the patient was to pay ten shekels of silver. If the surgeon saved the life of a slave, he only received two shekels. However, if a person of high status died as a result of surgery, the surgeon risked having his hand cut off. While if a slave died from receiving surgical treatment, the surgeon only had to pay to replace the slave. This use of status to evaluate misdeeds does not seem to appear in other, similar "codes" however. [http://www.indiana.edu/~ancmed/meso.HTM]
​

Ancient Egypt had surprisingly good medicine - and even back then specialists were ranked higher in regard and presumably in compensation:

There were professional divisions in ancient Egyptian medicine according to skill and experience. From lowest to highest rank there were:

• Lay physicians
• Supervisors of the lay physicians
• Magic physicians (who treated people through religious rituals)
• Caretakers of the Pharaoh's anus (yes that's right, and it was a high ranking position too!)
• Specialists (like teeth, stomach, etc...)

Doctors worked in the temple as well as having a private practice if they chose. Their wages were paid through barter since there was no monetary system in ancient Egypt. [http://www.experience-ancient-egypt.com/ancient-egyptian-medicine.html]
​

I'd have been satisfied with tweaks to the U.S. laws that would have encouraged medical providers to advertise their prices. (Costs for services are currently hard for the patient customer to compare until after-the-fact, and insurance intermediaries pretty much undermine any possibility of that changing to allow traditional market forces to work properly.) Throw in plenty of publicly accessible customer rating systems and I'd expect the market to start to come into play.

I've been preaching your last paragraph for years, especially with regard to hospitals, which I consider to a bunch of racketeers worthy of RICO indictments. There's no other business relationship I know of in which the seller can sell a service, without the customer's express consent, without providing a price, without guaranteeing that the service will work, nor even guaranteeing that it's the service that the customer needs; and then legally compel the customer to pay for the service, even if it fails to deliver the desire result. It's absurd.

If I had my way, all hospitals accepting any government-funded payments (which would be all of them) would have to post their prices for, say, the 250 most common procedures on their Web sites. The would also be required to provide price quotes to a conscious patient before providing any services.

-Rich

 

[fnpdoc]

I'm not sure why you think the CEO is "responsible for everything"? This is far from true. They are in no way responsible for care provider. This care may be by physician, NP, PA and on down the chain to nurses. They are all responsible for their care and are liable for it, NOT the CEO.

The guy running the hospital, responsible for everything, shouldn't make as much as one of his doctors?

 

[Bill]

They should get paid what the market for hospital admins for a hospital of the particular size requires. I am mostly familiar with non-profit hospitals, but the admins get paid based on what the board believes they have to pay to get someone qualified to do the job. As long as there is no collusion with search firms and 'consultants' to drive up the salaries, it is between the board and the candidate.

Which that last time I checked (for a decent sized health system, but been a while) seems to run $250k-300k.

 

[EppyGA]

The number of out patient surgeries today makes it much easier to keep your cost down. A year ago when my wife had some arthroscopic work done on here knee we negotiated everything up front as she was self pay at the time. When it was all said and done the total was around $3k.

 

[weilke]

I'd have been satisfied with tweaks to the U.S. laws that would have encouraged medical providers to advertise their prices. (Costs for services are currently hard for the patient customer to compare until after-the-fact, and insurance intermediaries pretty much undermine any possibility of that changing to allow traditional market forces to work properly.) Throw in plenty of publicly accessible customer rating systems and I'd expect the market to start to come into play.

That information is often available for the asking. From my role as administrator I can tell you that very few customers ask. The only ones that ask are the true cash payers, the pakistani carpet merchants that pay the semi-elective surgery for their visiting uncle with cash peeled from a bundle that doesn't seem to get any smaller.
Most customers are not used to asking. As an insured customer with a high deductible plan, your pricing depends on the contract between the insurance and the provider. The process to get pricing for something like a surgery is to ask the provider for the CPT codes for the upcoming surgery and their provider number with the respective insurance or their federal tax ID. With the codes in hand you have to call your insurance co and obtain the pricing. Any difficulty to obtain pricing from the co is between you and your health insurer. There can be substantial differences in contracted rate between your local surgeon and someone who is part of a large hospital owned group (either direction). The same applies to ambulatory surgery centers and hospitals for the (often much larger) technical fees (use of the OR)

 

[weilke]

Which that last time I checked (for a decent sized health system, but been a while) seems to run $250k-300k.

The absolute number varies based on size of the hospital, budget and whether they are part of a larger hospital organization (that may be responsible for some areas like billing or purchasing reducing the portfolio of the local CEO). For someone who typically has several hundred employees under his responsibility, those numbers are imho not excessive. The job comes with risk, if the hospital is in financial trouble or if there is some major business mis-step (e.g. purchases of physician groups that dont work out), the CEO is the first one to get the boot.

 

[Doggtyred]

My wife as an orthopeadic surgeon has experienced first hand the fiasco of Obama Care. Federal inspectors from DC were VERY concerned that some of the pictures and diplomas in her office were less than 12" from the ceiling. Little care that she spend hours each day trying to enter the correct code for patients instead of seeing patients.

Fire code issues associated with CMS and Joint Commission initiatives. They adopt NFPA. Stuff too close to the ceiling might not get covered by the mandated fire protection sprinklers.

Environment of care matters too.

And it was low hanging fruit for the inspector. Congrats.. you gave them a reason to justify their existence.

 

[Doggtyred]

I'm not sure why you think the CEO is "responsible for everything"? This is far from true. They are in no way responsible for care provider. This care may be by physician, NP, PA and on down the chain to nurses. They are all responsible for their care and are liable for it, NOT the CEO.

Oh.. but they are.. Imagine who would be held to task if an uncredentialed or impaired provider continued to practice... Sure the medical staff/contractors would police themselves, but the CEO, he is responsible and accountable for ensuring everything that happens in the hospital on his watch is up to snuff.

At one point, before it was gutted, Sarbanes-Oxley was the driving force behind making EVERY charge nurse on EVERY unit in my hospital personally endorse the census as correct, because if there was a fraud charge over midnight census inaccuracies, the CEO wasn't going down alone. (CEO responsibility was legislated at a Federal level with that one)...