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View Diary: Why healthcare costs so much in the U.S. (181 comments)

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  •  Doctors are driving Ferraris (5+ / 0-)

    Are they really worth 20 times a nurse?

    Slow thinkers - keep right

    by Dave the Wave on Fri May 13, 2011 at 05:39:46 PM PDT

    •  Often, yes (3+ / 0-)

      Nurses can't cut or put in ports or handle complex coding situations and when new, a doctor can identify the correct dosage of many medications which a new nurse cannot.

      Nurses are freaking important, but doctors go to school for a long time for a reason.

      If we don't stop them here, then where? If not now, then when?

      by nightsweat on Fri May 13, 2011 at 05:46:10 PM PDT

      [ Parent ]

      •  All true, but doctors in other countries driving (4+ / 0-)

        Mercedes instead have higher success rates and cover everyone with universal health care.  More capable and therefore more valuable than a nurse, yes.  20 times more? No.

        Would we be so happy to have a military that dwarfs all others combined if it was a line item deduction on our paychecks next to FICA."

        by Back In Blue on Fri May 13, 2011 at 06:08:47 PM PDT

        [ Parent ]

        •  out of curiousity (2+ / 0-)
          Recommended by:
          tardis10, frisco

          How much do you think these doctors should make?

          family doctors
          internists
          pediatricians

          Do you believe they get Ferraris? seriously?

          Beliefs like this drive professionals towards republicans.

          $ to DFA, none to DSCC/DCCC/DNC

          by grrr on Fri May 13, 2011 at 06:53:54 PM PDT

          [ Parent ]

          •  Yeah at a gs station in Pleasanton Cal. He was a (1+ / 0-)
            Recommended by:
            mamamedusa

            psurgin - as per his vanity plate. Brand new Ferrai - Musta cost 200 grand.

            I thinlk that we can pay them as much as they can get but the uppermost tax rate goes above 50% or whatever it takes to provide healt care to everyone who needs it. (of course with reciprocating agreements with other countries)

            I guess what I'm saying that it's more important that people get adequate health care that won't destroy their lives with the cost and that can be done either by paying doctors less or taxing them more. I don't give a shit which way.

            Slow thinkers - keep right

            by Dave the Wave on Fri May 13, 2011 at 07:04:10 PM PDT

            [ Parent ]

            •  asdf (3+ / 0-)
              Recommended by:
              Jojos Mojo, Odysseus, tardis10

              I assume psurgin means plastic surgeon:

              your answer didn't answer my question. Please re-read my question. And check my answer below.

              psurgin - as per his vanity plate. Brand new Ferrai - Musta cost 200 grand.

              For what it's worth, I share your wish for universal health care. I don't think the doctors I've listed make too much.

              Plastic surgeons can wash their hands of insurance companies. Elective plastic surgery is usually not covered by insurance.

              The rest of the docs are on the front lines...including the surgeons.

              $ to DFA, none to DSCC/DCCC/DNC

              by grrr on Fri May 13, 2011 at 07:11:23 PM PDT

              [ Parent ]

              •  True. They pay surgeons much more. (0+ / 0-)

                Medicare can pay a surgeon $3000 for a laminectomy or $30,000 for a spinal fusion. Guess which they do? If a CTL surgeon can perform 3 spinal fusions per week and they do it 40 weeks per year they gross 3.6 million from spinal fusions.

                Slow thinkers - keep right

                by Dave the Wave on Fri May 13, 2011 at 07:28:04 PM PDT

                [ Parent ]

                •  Check your facts (2+ / 0-)
                  Recommended by:
                  grrr, DrFood

                  1) Some spinal surgeons do 2-4 spinal fusions a DAY, several days a week. They are not getting paid $30k per fusion. If they were, they'd be retired. $30k may be part of what the patient is charged, but the surgeon doesn't see anywhere near that amount.
                  2) You saw ONE surgeon with a big enough ego to waste money on a Ferrari and from this you draw the conclusion that ALL physicians are grossly overpaid? This logic does not make your point very persuasive.

          •  by the way (2+ / 0-)
            Recommended by:
            frisco, mamamedusa

            once you've guessed

            here's a link to the answer

            Nurse's salaries range in the US from 45-65K.

            $ to DFA, none to DSCC/DCCC/DNC

            by grrr on Fri May 13, 2011 at 07:04:15 PM PDT

            [ Parent ]

            •  This 20x number (2+ / 0-)
              Recommended by:
              TerryDarc, Odysseus

              Is coming from average salaries- the super-outrageous plastic surgeon/dermatologist salaries drive the number up.  I recently heard a soon-to graduate FM resident discussing his highest job offer at 165K, and this is in an area with very high taxes and cost of living.  Add malpractice insurance and health insurance for you and yours in the open market, and you're probably barely clearing 100K, not even double what a nurse makes.

          •  Average for a family doc (2+ / 0-)
            Recommended by:
            Odysseus, elfling

            straight out of residency is around $120K/year. In some parts of the country that still a helluva lot of money. In others, not so much.

            "Reality divorced the wingnuts after the wingnuts were discovered to be fucking goofy." - DWG

            by Jojos Mojo on Fri May 13, 2011 at 07:56:23 PM PDT

            [ Parent ]

            •  120K/year (1+ / 0-)
              Recommended by:
              grrr

              Would be fine for family/ped/IM docs (as a nationwide average; in some high-COL areas it would need to be higher) if they either went to med school for free or had each year in their practice of those specialties treated as a non-taxable in-kind repayment of their student loans (both undergrad and professional).

              Otherwise, you'd have to consider the fact that someone with the same academic abilities as a med-school graduate could make a whole lot more money by going into a different field with the same academic demands. Going into medicine shouldn't mean making ten times less than your brother who goes into finance (obviously, this means rethinking the extravagant compensation levels found in finance).

              If you Google "headache brain tumor", you will come away convinced that your headache is actually cancer—Seth Mnookin

              by ebohlman on Sat May 14, 2011 at 12:01:26 AM PDT

              [ Parent ]

            •  asdf (0+ / 0-)

              out of the gate, a family doctor who just graduated has the same medicolegal responsiblity as a family doctor practicing for 20 years.

              I might add that the frustration of primary care is overwhelming - fighting with insurance companies with their endless demands of paperwork the companies put in place to prevent payment is exhausting.

              Doctors went to med school to practice their craft, not do endless meaningless paperwork , much of which adds no value to patient care. The hourly rate is not even close to a 40 hour week.

              $ to DFA, none to DSCC/DCCC/DNC

              by grrr on Sat May 14, 2011 at 06:12:14 AM PDT

              [ Parent ]

          •  I already know. I have friends who are doctors, (4+ / 0-)

            nurses, and surgeons. Of course those medical professional you listed don't drive Ferrarris.  The point is that other countries manage to provide better results for their populations than we do and it costs less.  I think the idea in this country that it's not possible to have the best health care in the world if we limit costs or salaries.  it's simply not true.

            I really feel for medical professionals if they are hit hard, but i feel much more for the increasingly huge percentage (and growing) of Americans who can't get medical care at all.  But that's the problem with this country in the first place.  The truly wealthy have captured the American Dream and knocking them down a peg seems counter-intuitive.

            Would we be so happy to have a military that dwarfs all others combined if it was a line item deduction on our paychecks next to FICA."

            by Back In Blue on Fri May 13, 2011 at 08:10:26 PM PDT

            [ Parent ]

            •  asdf (1+ / 0-)
              Recommended by:
              miningcityguy
              The point is that other countries manage to provide better results for their populations than we do and it costs less.

              I agree.

              I think the idea in this country that it's not possible to have the best health care in the world if we limit costs or salaries.  it's simply not true.

              I am going to make the argument that knocking out the middle man of insurance out would do a lot to reduce prices. Even much better insurance regulations would help a lot.  So would efficient electronic medical records to prevent duplication of tests, and to improve communication. So would paying for results instead of visits.

              I don't believe that the salaries of overworked doctors are the issue, though I do think as the middle class is eroded, there will be further drops in the salaries of health care providers, including doctors.

              Doctors' and nurses' salaries depend on the health of a strong middle class. Destroy the middle class, and health care will be poorly funded. There will be boutique practices for the very rich. The rest of us will have mediocre health care.

              Thus, doctors and other health care providers are natural allies of the progressive movement. I believe that attacking them for their salaries is like attacking union members for their benefits.

              $ to DFA, none to DSCC/DCCC/DNC

              by grrr on Sat May 14, 2011 at 06:43:02 AM PDT

              [ Parent ]

              •  asdf (1+ / 0-)
                Recommended by:
                grrr

                all of that will help tremendously.  I would go further and just go single payer and get rid of insurance period.  It does nothing to control costs, just takes money out of the health care system.

                I'm not attacking health professionals in general and don't want to see their salaries reduced. I'm just pointing out that in other universal health-care systems the doctors actually make less and produce better results.  It's something that can't be ignored in the equation.  

                Would we be so happy to have a military that dwarfs all others combined if it was a line item deduction on our paychecks next to FICA."

                by Back In Blue on Sat May 14, 2011 at 09:58:41 PM PDT

                [ Parent ]

                •  agreed (1+ / 0-)
                  Recommended by:
                  Back In Blue
                  I would go further and just go single payer and get rid of insurance period.  It does nothing to control costs, just takes money out of the health care system.

                  I guess politically its been so difficult, that even tighter regulations would make some difference.  I would prefer single payer, as long as there was accountability to the citizens paying for this.

                  $ to DFA, none to DSCC/DCCC/DNC

                  by grrr on Sun May 15, 2011 at 12:15:09 PM PDT

                  [ Parent ]

                •  I also agree with this (1+ / 0-)
                  Recommended by:
                  Back In Blue
                  I'm just pointing out that in other universal health-care systems the doctors actually make less and produce better results.

                  Plenty of doctors would agree -  reward docs for better care, not more care. Just make sure there is an infrastructure - eg Electronic Medical Records, sufficient support staff, etc - to let doctors do what they love...practice medicine!

                  $ to DFA, none to DSCC/DCCC/DNC

                  by grrr on Sun May 15, 2011 at 12:17:04 PM PDT

                  [ Parent ]

          •  On top of paying student debt, it costs a small (4+ / 0-)
            Recommended by:
            PrahaPartizan, grrr, mamamedusa, elfling

            fortune to start a private practice. That's why these days, a lot of new doctors go to work for a corporate medical clinic, often associated with a large hospital corporation. They don't make much money, but they can make their loan payments and don't have to worry much about the business side of a medical practice, insurance, billing, collections, etc., although they may be pressured by the corporate accountants to spend less time with patients, see more patients, and generate more profit for the shareholders.

            Men never do evil so completely and cheerfully as when they do it from a religious conviction. -- Blaise Pascal

            by RJDixon74135 on Fri May 13, 2011 at 10:52:35 PM PDT

            [ Parent ]

      •  IMHO. (10+ / 0-)

        I would just like to say as a nurse, I have asked new doctors about situations and stood there, as they piddled around on their little PDA to figure out what the meds I was talking about and what to do. Having doctors who are specialists ask ME as an RN "How much lidocaine do we put in the potassium runs?" or "What's a 'tylox'?" and "What's a B.N.P." makes me say no, the pay discrepency is not called for. They spend about what, 7 minutes a day with the average hospitalized patient. RNs can be trained to put in PICCs (type of ports), and I have been in several codes well before the doctor ran their tails up from the ER to the ICU where we were.

        Yeah, they go to school a while...They see their first patients in medical school usually, Nurses start day one with patients, most now must be a CNA with experience before being considered for RN programs, and learn medicine too via seeing the treatments and carrying them out first hand, and we learn the alot medicine through that repetition. Typical RN has 3-4 years college, with patient care experiences throughout their programs, NPs and specialists have a Master's degree or higher (6+years, with clinical time). But we approach it all so differently, Doctors are trained to find and treat the disease/disorder and to promote wellness, Nurses are trained to treat the 'human response' to disease/disorder and treatment, and to promote wellness.

        Sure they should get more, even like the graph says above with the UK they make 3X more and that is/would be fine, they have alot of heavy decisions with their choices. Should they be gettin what they are...no. But they shouldn't  be paying high insurance premiums to practice (a big complaint many Doctors have that I talk to), no...insurance is sticking it to them too, especially in light of how much is really going out to malpractice.

        •  Are you talking about doctors or interns? (2+ / 0-)
          Recommended by:
          ekyprogressive, mamamedusa

          Interns - I fully agree.  But post-residency?  If a post residency doctor doesn't know dosages, that's a problem.

          My brother in law is going through nursing school now and he did two years without seeing any patients.  The practical part starts for him next month, so I think we may be at cross terms linguistically here.

          I have a lot of respect for nurses.  My aunt was one (and made a shit-ton of money going up to Anchorage to work for a few years just after the pipeline was completed), but my wife's a specialist (pediatric heme-onc), and I've seen both sides now.

          And you make a good point with the insurance.  If my wife ever wants to change jobs she has to pay (or get the new place to pay) the tail which we figured out will be something like $60K for her.

          If we don't stop them here, then where? If not now, then when?

          by nightsweat on Fri May 13, 2011 at 06:37:35 PM PDT

          [ Parent ]

          •  I am talking about the (2+ / 0-)
            Recommended by:
            Odysseus, mamamedusa

            Interns, which is usually who we have to call with situations regarding the patients first.

            Your brother in law must have started then with the BSN program, which is great for him actually. Most practicing RNs currently have an associates or are from one of the old "Diploma" programs which are now essentially phased out from my understanding (IOM has a good graph here showing nurses by educational level). Starting with an ADN, as most do and as I did, clinicals began the first semester, half way into it, if you didn't have a C in everything, 90% or higher on the dosage exam, and all your preqreqs by midterms, you couldn't touch a patient, but yeah they started us early. Some BSN programs around here start them in the Second year, first semester. Variances happen, not all schools are accredited by the same bodies.

            pediatric heme-onc.... Oh wow, kudos to her, that has to be a tough field. Did three years in peds, but that would be hard to handle.

          •  Correction... (3+ / 0-)
            Recommended by:
            tardis10, mamamedusa, peggy

            It was a urologist who asked me what a BNP was, post-residency. And it was a Ob/GYN who had a patient go really bad and have to come to our ICU that asked about the lidocaine in potassium runs.

            The Gizmo kids are the interns...LOL

          •  all depends (2+ / 0-)
            Recommended by:
            ekyprogressive, Jojos Mojo

            radiologist in a code is like a dermatologist running a code.  I one big one we called for the defibrillator and the radiologist attending grabbed the AED ... right above the crash cart.

            •  Had one... (2+ / 0-)
              Recommended by:
              mamamedusa, peggy

              intern we called about New ST depression on an unconscious ICU patient to "get a U.A." on the patient. Of course we went over their head for the cardiac enzymes (which were positive, imagine that!). My smart-assed buddy was working that night and says "U.A.? ST depression not peaked "P" waves"....

              He walked off...LOL.

      •  Nurses save patients lives every day - just like (3+ / 0-)
        Recommended by:
        ekyprogressive, Matt Z, mamamedusa

        doctors. They constantly have to deal with life or death decisions and if you don't understand that then you don't know what they do.
             Doctors do what nurses can't so of course that makes them more valuable in that regard. Similarly I'd say firemen save more lives than the doctors who treat burn victims. You  understand about an ounce of prevention I assume.
            I'm not advocating that nurses are paid the same as doctors but to say one doctor is worth 20 nurses is ludicrous. In order for patients to pay doctors the exhorbitant prices they charge they should up the tax rate in order to pay for the medical support structure to ensure that the patients can afford the care- Guess what - their ain't no free lunch for doctors either.

        Slow thinkers - keep right

        by Dave the Wave on Fri May 13, 2011 at 06:58:07 PM PDT

        [ Parent ]

    •  Sometimes. n/t (0+ / 0-)

      "George RR Martin is not your bitch" ~~ Neil Gaiman

      by tardis10 on Fri May 13, 2011 at 06:02:55 PM PDT

      [ Parent ]

    •  Not all doctors are rich (4+ / 0-)

      Pay scales between doctors vary widely.  Primary care providers (e.g., GPs, Internists, Family Practitioners) don't make the big bucks.  Not bad, but given the cost of med school, it's not easy money.  Hence a lot of medical grads don't go here where they're needed.  Here in Massachusetts where Romneycare means everyone needs a primary, it's hard to find one taking new patients.  

      Surgeons make a lot.  Surgical fees are outrageous, though the fees cover a lot more than the surgeon. 20 years ago I had a minor procedure and the rate was $1/second.  Now I think it's over $3/second.  Other specialists also do better than primaries.

      Naturally, when insurance companies try to control costs, they push back hardest on primaries...

      •  And it doesn't help (5+ / 0-)

        That the lobbying arms of the AMA of filled with, you guessed it, surgeons, who would be loathe to reduce their own compensation in favor of FMers/GPs/internists

        •  Not To Mention Gender Differences (1+ / 0-)
          Recommended by:
          mamamedusa

          I'm pretty sure that one would also find that substantial gender differences exist between the various specialties in medicine.  Surgical specialties seem to be stuffed with lots of guys.  Family medicine seems to have lots of women.  One must wonder just how those ratios affect just which specialties get protected by the profession's official guild.

          "Love the Truth, defend the Truth, speak the Truth, and hear the Truth" - Jan Hus, d.1415 CE

          by PrahaPartizan on Fri May 13, 2011 at 11:49:15 PM PDT

          [ Parent ]

        •  AMA is a minority of doctors, no? (0+ / 0-)

          IIRC its membership is now something like 16% of the total.  So they're lobbying for a narrow slice.  Doctors who don't like right-wing policies are less likely to join the AMA.

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