Home Forums Discussions General Discussion The War on Physicians...

It has begun, and you Docs better find a way to make your voices heard. As discussion of healthcare reforms heat up, the Insurers are out to make the Docs and patients the "bad guys" by saying:
1) patients are unhealthy
2) Docs order too many tests.

I recently wrote the following to the AppealDemocrat

"The ripoff in Health Insurance is with the Insurance companies. The average cost of a healthcare plan for a family of 4 is $1200.00. Health Maintenance Organizations usually pay the physician/provider $15 - $25 per month to provide care for the patient. The fraud is evident when you see that the former CEO of United Health Care, Bill McGuire who took with cash-and-stock paydays that have topped $100 million in recent years -- and he's still sitting atop stock options valued at $1.6 billion. For 1.6 billion, Mr. McGuire alone can afford to pay for the health insurance for 110,000 families of 4 for one entire year. That is 440,000 people!!! For this compensation, Mr. McGuire does not perform brain surgeries, nor does he perform open heart surgeries. Instead his organization provides a pittance in payment to the physician, while doing everything it can to deny benefits to the customers.

Until the insurance companies GET OUT of the medical business we will not see a reduction in health care costs.

I am willing to bet, an analysis of the executive compensation of insurance company CEOs you would find that there is more than enough waste for people who provide absolutely NOTHING to the healthcare system. Like Wall Street and Detroit, these people have found a way to game the system, providing a bad product, blaming the physician and the patient, and laughing all the way to the bank."

Very well written as the other letter is as well.

How True!!

OK, so what do we do about it? What should our war strategy be? We have pleaded for years to Congress and our professional associations for change. Now that the Messiah of Change (sorry, couldn't resist) will be coming in January, can we expect things to improve? I am gloomily pessimistic. So, instead of trying to wage a World War, I just keep plodding along waging my little battles on the home front. Unfortunately, too many physicians refuse to fight at all and just wave the white flags and surrender. Until we somehow rile up the locals (patients) nothing will change. We somehow need to get the Rosie The Riveters behind us. And, if it takes us as their physicians to exert some pressures by refusing to bend and refusing to abide by their insurance company's so called "rules" then so be it. Losing their nylons 60 years ago was enough to move the masses then. Surely we have more persuasive measures now. (Sorry for all the metaphores....couldn't resist again).

Leslie

Well I don't know about you, but I would first move for SINGLE PAYER. There are those who believe in the free market. It has failed medicine miserably: there are now a plethora or "insurance providers" all extracting "their cut" for their administrative services while reducing the payment to the WORKERS/PHYSICIANS.

From what I have seen, Medicare sets the standard for payment rates, and all other insurers follow that, so what does it really matter WHERE YOUR PAYMENT is coming from if the amount paid is THE SAME minus the administrative overhead for dealing with 20 different insurance companies.

I'm not sure about "RILING" up the patients; because most of them will be out of work and on some form of government assistance for health care.

I will try to keep the politics out of it but the reality is that those of us from the 3rd world have ALWAYS known about the devastating effect "capitalism" has had on our countries. Unfortunately, Americans, myself now included, are now seeing it first hand. Globalization would be fine if everyone had to meet the same standards, but it doesn't work that way...so the American worker is expected to compete for same wages as a worker in Mexico and yet maintain his standard of living.

Soon, very soon, our healthcare will come from India and China via telemedicine.

G,
I agree completely in that the 3rd party payer system has destroyed U.S. healthcare, made millions for just a few people (the CEO's), raped and plundered the landscape of medicine.

I further agree that single payer is the way to go, PLUS medical malpractice tort reform. One will not happen without the other. I believe the single payer needs to be the patient. Until the patient has full responsibility for what gets ordered for tests and what doesn't (and the doctor has the threat of lawsuit removed from daily life), the healthcare costs could dramatically go down.

I fear that U.S. governement involvement will only drive these costs up, reduce our incomes, and create more redtape and administrative overhead.

If this were a 3rd world country where the governement could just fix the system by redesign, we might all fare better. I've never lived outside the U.S., but it's clear that we had all get used to living at a lower standard because our economy will no longer support more people on disability and Medicare retirement than are paying into it.

Here in Maine, we officially have more people that DO NOT WORK than people who do. The unofficial Maine status slogan: "Maine, the way life should be," ahhh it might have been true 20 years ago....

Adam,

Perhaps physicians need to unionize and have collective bargaining. Medicare does what it does at 3.5% above the cost of services. If there is only ONE PAYER there is only one person to bargain with. No one has the time to bargain with 25 different payers.

I am sorry, but your believe is not borne out my current experience. We have found Medicare to be MORE EFFICIENT BY FAR, than any of the OTHER PAYERS.

For example, we began the "registration process" on July 15 for a practice that was to Open Oct 1. Medicare was the only payer who processed the our agreement on time. The others CIGNA, United, Aetna, BCBS for some strange reason were not able to make the changes before Nov 1. This means that we now have to APPEAL all the claims we submitted in October, EVEN THOUGH THE DELAY was THEIR FAULT. How difficult can it be to change the tax id of a physician, especially for one who has been a provider in your system for 20 years?

I am not convinced that MedMal is part of the reason costs are high. The average cost of MedMal for an internist is $17,500.00. The problem I believe lies in the reimbursement.

Single quasi-private payor should be the only way to go. It should be out of the government but regulated. Blue Cross of the US, perhaps of every state, but the government is to fraught with possibilities for corruption (anyone need a senate seat??? (sorry, I'm from Illinois.))

It's illegal to have collective bargaining for physicians. It's OK that the private companies have private rates that are suprisingly similar but then with their own rules to confuse both providers and patients.

However, if we went to single payor, it would probably cause a full scale depression with displacement of about 500,000 jobs. Talk about a works project.

DoctorWAW apparently you refuse to acknowledge that ONE MAN took a compensation of 1.6 billion dollars from United Health Care. You cannot possibly acknowledge that FACT and still maintain that going to single payer would cause a depression.

So now DOCTORS should feel responsible for loss of jobs in the insurance industry? OK I don't want a more efficient system because the vampires who are sucking my blood have to live too.

If we went to single payer it would probably cause a depression? Please explain.

Oh yes DoctorWAW, the government is fraught with corruption. That is why THE GOVERNMENT just had to pony up 700 Billion dollars to save the financial system from collapse. At least politicians get jail time, what do the tycoons of Wall Street get.

I'm sorry, but you will never convince me that FOR PROFIT health insurance will EVER benefit the workers(physicians) and the patients. It will always benefit the profiteers.

Adam, I agree with you--the single payor should be the patient, at least in primary care. We have seen what a 3rd party single payor system in the US would look like (See: Medicare & Medicaid) and this would be pretty bad for physicians. And alot of patients won't like that either--unless they can pay for extra services. But usually when you have a single system run by the gov't, they refuse to allow competition so you HAVE to take it. I will never advocate such a system in the US unless doctors also have the right to directly charge the patient for the "gap" between their fee and the reimbursement (at least or primary care).

Single payor sounds good unless that payor doesn't pay you for 3-6 months due to rule changes, computer errors, address issues. I have had medicare not pay for 3-6 months at a time twice in the last 4 years - once my post office returned mail with my street address since they only accept box numbers (bear in mind medicare would not take PO Box numbers and my town is small enough that Dr. _____ would get it to me normally) and the other when medicare changed the rule on what to put in BOX 34 or something and then changed it again after we rebilled 1 1/2 months of bills.

I don't know about the rest of you but if they were the great single payor I would be hurting if all my bills were denied... I do not believe there is a great solution for this. The issue of socialized medicine and what they do in other countries is always brought up but americans want everything and don't want to pay the tax rate to get it... something for nothing doesn't work.

SFHill 90% of the patients we see are on medicare. We bill medicare electronically and we get paid every 14 days. The payments ALSO are made electronically EVERY TUESDAY AND FRIDAY!

It is a canard for you to suggest people want "something for nothing" when one person is taking 1,600,000,000 out of the system and putting it in his pocket.

Single payor=monopoly. If we did this, we'd be at the mercy of policy changes like reduced reimbursement due to arbitrary budget formulas or restrictions on balance billing (we should never forget these wonderful "gifts" from medicare)

There would have to be strong checks/balances in the payment power of any single payor to make that work. A start would be (1) allowing balance billing and (2) establishing realistic market based rates by CPT codes. The only way I could see to do that would be for the single payor to require each physician to post their menu of charges by CPT in some central place. That way, the single payor could have market based rates that vary by region or city. Patients should also be able to view these rates to help make their primary care decisions.

I agree with gb that the profit motive of insurance companies works against good medical care to patients and realistic compensation to physicians. A return to non-profit insurance companies only might be the start to getting rid of this massive diversion of health care dollars. Single payor could be next step after this but only with the proper safeguards.

No, I do not think it should be FOR PROFIT. United executives have taken trillions over the last decade, NOT billions. And that is only 1 company.

I was simply commenting that it is a large industry. You can't save money without creating unemployment.

You already have a monopoly...it is called MEDICARE. They set the prices for everyone else.

"A return to non-profit insurance companies only might be the start to getting rid of this massive diversion of health care dollars."

Wayne, I don't know about you, but I do not want to be in the COLLECTION BUSINESS!! What happens when the PATIENT DOESN'T PAY?"

I think much of the problem here is in the semantics. Americans have been educated to despise the word "socialism" as if it is some sort of a plague. We have internalized it to mean "those lazy bastards over there want something for nothing."

Yet nothing can be further from the truth. The so called high priests of capitalism are all gorging themselves at the public trough while getting us to believe "socialism" is un-American.

People in LA paid money for years to insurances companies. When Katrina happened, even though this was what the insurance companies WERE PAID FOR, they claimed they didn't have the money to cover such huge losses. The government bailed them out.

The folks on Wall Street, after living high on the hog and taking 100 million dollar bonuses annually when they MADE A PROFIT, decided THE GOVERNMENT had to step in and cover their losses.

If the government IS THE PAYER of LAST RESORT IT'S SOCIALISM, no matter who they are paying for. But if the MONEY PEOPLE can make us believe that "socialism is when those poor lazy bastards get un-employment from the government." We have someone to direct our anger at, instead of the people who are walking away with the bank.

We agree that they have near monopoly power now. This is why we need to be fearful of single payor as that power would be even stronger. Due to the medicare's current quasi-monopoly power, next year we face a 20%+ cut due to the arbitrary funding formula and we also have been unable to balance bill since 1994 or so. if we went to single payor=govt, our options would be even less.

I can easily imagine where the govt would make participation in medicare a requirement for practicing medicine, eliminating cash practices. A monopoly could also disregard physician business cases and force e-prescribing, force quality metrics, force specific EMR adoption, and force particular medical treatment options.

The basic question that first must be answered (and I suspect I know what answer most, especially in government, would give) is, "Is health care a right or a priviledge?" Unfortunately health care has been singled out by many in power to be the one and only inalienable RIGHT. We have the right to be free, only if we abide by the rules. We have the right to the pursuit of happiness, but only if it does not interfere or conflict with other pursuits by other people. We have the right to life, only if we are at least 36 weeks gestational age. We have the right of freedom of speech only if our speech is politically correct. We have the right to worship our chosen deity, only if we do not need a blood transfusion. We do not have the right to eat 3 meals a day. We do not have the right to have a roof over our heads nor do we have the right to warm clothing, higher education, dental care or bus tokens. But, we are all supposed to have the right to any and all healthcare. I have no problem with government subsidizing those who are in fact needy. I do have a problem with those subsidies exceeding the levels attainable by the not-so-needy. If we eliminate the bulk of the third party payor system and return the burden back to the patient, we will see healthcare costs come back into a realistic frame. I favor a pay-as-you-go scenario with government providing assistance (not complete coverage) for those who are unable (not unwilling) to provide for themselves. If employers returned to their employees all the dollars they spend on them for their insurance (a large percentage of which ends up in the insurance company CEO's pockets), employees would have more money to budget with. And, the budget decisions should be theirs and theirs alone based on their own personal needs. If they choose to use their paychecks to buy Heinikens and Mercedes rather than health care, so be it. Don't cry in your beer when you total your Mercedes and break your leg. Got a cold? Maybe it would be fiscally sound to give it a week to run its course rather than heading to the doctor for antibiotics you want but don't need. Want to protect your family against catastrophic illness or accidents? Shop around for an insurance plan that meets your needs and desires. Afraid of ending up broke in a nursing home? Buy a plan which covers that. Want to barter with your doctor or agree to some kind of concierge plan, have at it.
The day we mandated employers to take the responsibility for our health care is the day health care went to Hell. Why would anyone want to entrust this very important and personal decision to our employer??? Why would one employee who doesn't smoke, eats right, doesn't bungee jump and lets their 95 year old parents house sit when they are off running the Boston Marathon want to be lumped in an employee-based insurance plan with all the obese, smoking couch-potatoes?
We don't make our employers pay our car insurance,choose our food, pick out our houses,or tell us who we should marry. Why then do we insist they manage our health care? I know why it got started. What I don't understand is why it has been allowed to continue. And, if certain politicians have their way, it will only be expanded so that now EVERY employer will have to make the health care decisions for their employees. Just plain stupid. Some where, some how, somebody can figure this out. I just fear it will be too late.

Leslie

There are a number of issues about health care finance that need to be tackled.
PCPs get 10-15%
Specialists get about 25-35%
Thus the physicians get about 35-50% of the medical costs
Hospital is about 40-50%
Pharmacy is about 10-15% (thus = to PCPs)
Yeah, I know that these numbers can add to more than 100% but that's why we have inflation.
About 30% of the medical dollar is spent in the last year of life.
How much is for nursing home care?
How much is consumed by non citizens?
What other black holes consume a significant amount of money?
What is the "basic" level of care that should be provided to all?
P.S. I am a strong proponent of single payor, non profit, non governmental health care.

The thought that most people prefer having mercedes benzes to heath insurance is not credible.

Back to the fact that the wealthy are constantly feeding at the public trough. Take the case of Republic Windows in Chicago, where the workers will now get two months of paid health insurance. I guess they should sell their cars and pay for health insurance for the next 12 months. After that what?

Yet the owners of the factory took 10.4 million dollars from the tax payers. But the are now moving to Iowa to setup a new company. But those lazy workers, driving those expensive cars, prefer their cars to health care.

Republic received more than $10.4 million by the end of 2007, according to a city report. Alderman and administration officials said they were reviewing agreements with Republic which specified that the company maintain certain employment levels through 2019.

"Is there a provision in the agreement that would give the city the legal ability to recover the money?" asked Ald. Joe Moore (48th), who has backed the workers. "If not, shame on the administration and us, the City Council, for not making it part of the agreement and any other agreement."

George, our self-paying patients are our best-paying patients. Its the ones with insuracne who I have collection problems with. Also, we have our self-pays pay at the time of service via cash or credit card. One patient asked to arrange a payment plan when she first started, and we set one up since she was really sick and had several high-end office visits. And had to pay the specialist too. She had paid up her balance within 6 months. We have insured patients that I have to threaten to send to a collection agency before they pay their $10 co-insurance.

Wayne we have more problems collecting from the insurers than we do the patients; however, depending on the patient population one cannot be a cash only practice. 90% of our patients are Medicare.

If Medicare became the single payer, I would be out of business. In Montana Blue Cross has a conversion factor MUCH higher than Medicare which is essentially matched by several major payers. Medicare does not pay the bills here- unless I limit visits to 15 minutes max and push them out the door and then upcode illegally.

I would strongly consider the patient as the payer in primary care with backup insurance for specialist and hospital coverage. Malpractice reform is required. The patient who has to pay for the MRI out of pocket is not going to demand it despite our counsel that it is not necessary- but now, they do demand it out of their fear of missing a diagnosis and we deliver out of our fear of malpractice..

A recent article I read said the single greatest bloat in healthcare costs was the overuse of technology.. patient as payer takes care of this. The second highest was administrative costs of insuance companies. Patient as payer for primary care services significantly reduces this. For example: Blue Cross offers two versions of a high deductible plan at $6000 per year for a 50 y/o woman. The other offers $500 upfront coverage for primary care at the cost of $7000 per year. I keep telling people to DO THE MATH... choose the $6000 plan and put $1000 in your HSA and get more for your money.. but NO ONE listens.

I envision the ability of primary care providers to contract directly with patients and employers for care delivery that covers acute visits, wellness visits, counseling visits etc all at one relatively low cost per year per patient plus low copays for each visit. Encourages use of primary care services as appropriate but discourages abuse. There is a donut hole where high cost diagnostics are paid out of pocket but when hospitalized or when real disease looms and cost mount, the back up insurance coverage kicks in. Perhaps there could be subsidies for the primary care coverage by the "single payer system government" for the disabled, elderly etc to cover the primary care aspect.

I'm moving to Montana, BC reimbursement in Missouri stinks.

It's very interesting looking at the posts on this topic. They range from libertarian (pay your own way) to pure socialism. I'm sorry to report that all forms of socialism fail over time. We are witnessing it right now in our own country. Our money system and the health care and corporate systems are socialistic. They all are in bed with govt and get special privilege from govt. This is unsustainable due to human nature (we look out for ourselves first). The current situation is being blamed on free markets or capitalism. This is like in the 1930's when they blamed the gold for all our problems. Well, gold hasn't been used as currency for a long time and here we are in the beginning of a new depression. We could never blame govt interference, so it must be the free market. I'd like to know which market is free--meaning unregulated.

It is also interesting to see where we came from. I know quite a few very old doctors who informed me that no on that they know of ever went without the health care they needed before insurance or government was involved. It seems that the federal govt invented a problem---elderly and poor having no insurance---and then fixed it. Just look at health care costs before and after insurance programs started. You can look at dental as well. My Dad told me how he fought his own union when they wanted to add dental coverage. His argument was that it would drive up prices. Soon after dental coverage became common, he noted that his copay was about the same as the whole office visit once cost. Any time you remove the burden of payment from the consumer in ANY industry, they will no longer care about cost and make poor decisions.

It's amazing how much time I spend discussing the cost/benefit of testing with self pay patients and how patients with insurance don't ever ask or seem to care. Comprehensive insurance will always increase costs no matter who pays. A single payor (socialism) will lead to further increases in cost. The doctors (us) and hospitals will pay big bucks for lobbyists and stay on top of the food chain in a government program. The only solution to this is unthinkable right now. Just cutting the system off and making people pay for care themselves would indeed be devastating to both the patients and health system for several years. Bu tin time the costs would go back to what the market can actually sustain. The price of drugs would also come down or the companies will go out of business.

We all see the incredible waste in our system on a daily basis. I don't believe the doctors are willing to endure the pain that would be required to really return the system to reality.

Lets look at the cost savings. We would have a reduction in overhead needed to sustain a practice. We would need to set prices that patients could afford to pay. We would need to prescribe only the drugs that are really needed. Let's face it, that latest statin drug really isn't as great as we make it out to be when you look at number needed to treat to get a true benefit. People would think very hard about what treatments they want and what testing they think is needed based upon our giving them the hard facts. Yes, some catastrophic coverage would be need to be in place. We also would need to drop malpractice coverage and get our personal finances out of the reach of lawyers. If there is no easy to reach cash, a lawyer will not take a malpractice case. People would re-establish the knowledge that mistakes happen and are no ones fault---it part of nature.

I know that his will get all the socialists upset, but people do very well without government interference. It would be great to see one state reject all federal aid and also stop paying for the aid. That same state could get rid of all the onerous regulations as well and make people individually responsible for their own business. Hold people accountable personally for abuses (even corporate), and not allow ANY special privilege (including STATE licensure of professionals). (We could still set up professional credentialling). I suspect that that State would quickly become so prosperous that all the others would be crying foul.

Sorry to ramble, but seeing people post solutions that were the cause of the current failure makes me crazy. If only we had more regulation and GOOD people running things, everything would be grand. Well good people work hard, they don't generally run for public office. Public office and power attracts exactly the wrong type of people. Just look at the constant abuses and scandals from all sides of the aisle in Washington.

RRHC you are correct, I am a socialist, and I do not apologize for that. What I do find regretful is your need try to rephrase American Capitalism by saying:


This is either a misunderstanding of socialism or a prevarication. What prevails today is socialism only to the extent that the CORPORATE LOSSES ARE SOCIALIZED (passed on to the taxpayer) while the profits are privatized. This is exactly what we saw in the recent financial crisis: After taking excessive profits and bonuses over the past decade, EVEN AS THEIR COMPANIES were going down the tubes, as their losses mounted we were told they were too "too big fail."

This is CORPORATISM where the government and corporations are indistinguishable from each other. The government provides the CAPITAL and the corporations take the profits.

What gets me is the lack of honesty that comes into play when it comes to the government providing services to poor people and minorities...we use the term socialism as code to draw out the ire from people.

The Senate ReAuthorization of the Welfare Bill, according to the CBO cost 11.7 billion dollars annually.

Yet one company, AIG, just got $150 billion dollars from the tax payer, because they were "too big to fail."

Who did it benefit, when the Congress passed a Medicare Drug bill that prohibited HHS from negotiating drug costs with the drug companies? Do you think that was put in there to benefit the taxpayers? No it was put in there to benefit the drug companies at the expense of the taxpayer.

It is time to debunk the myth that "those lazy people don't want to work" and are getting something for nothing. The only people who are getting something for nothing are the rich people who can buy their way into power.

The sooner physicians begin to see themselves as SPECIALIZED WORKERS, and begin to SIDE WITH THE WORKING PEOPLE, whose ranks are being whittled monthly (between CitiGroup and BoA they have announced 100,000 job cuts in the last month), they will soon find themselves unable to work independently and working for wages that do not reflect their years of education...why? Because you will be asked to compete with Doctors in India to read X-Rays, so what if their english is not good?

RRHC makes valuable points, but
Before the 1960 (with the advent of medicare and medicaid) the practice of medicine was far simpler. The money that was pumped into the medical care industry spawned the development of the medical industry as we know it.

There was growth in residency programs, an explosion of drugs (for better or worth, whole catagories of drugs as well the explosion of the drug industry and the FDA.

We have improved medicine remarkably in the last 40 years, in large part to the increase in funding that has occurred. Hospitals prior to the 1940s were more of wards to contain disease rather than treat them. Cost were cheap but so were regulations. It is unbelievable the number of regulations needed to rebuild a ward.

But there are valuable points. What I would take away from RRHCs points is that copay is a valuable thing and that it would curb many of the excesses that currently exist.

In a perfect economic world, people would make intelligent choices only if they understand the reward/benefit that exists.
This is not always possible in medicine. Additionally larger organizations such as hospitals and medical device makers would have a hard time shielding their assets from malpractice.

A true reform would be reworking the rules about med mal suits which would both protect the provider and the patient. I'm not sure I know exactly how to that other than the Shakespearian line kill all the lawyers (we might run into a few regulations about that too).

Just an observation: Anyone in private practice is by definition a capitalist.

Now the problem with those terms (socialist, capitalist, etc.) is that they stem from a different era and do not necessarily apply cleanly to the economies and social strata of the 21st century. That being said, there are many similarities as well.

Even Adam Smith, the "father of capitalism" laid out 5 areas for government involvement in his book THE WEALTH OF NATIONS. While I don't remember all 5 off the top of my head (my history degree is from 22 years ago), I do recall these areas were chosen since commercial interests would conflict too much with societal interests and therefore not enrich society as a whole (the example I do recall is education, where teaching trades would take precedence over the arts and humanities, areas that Adam Smith valued).

Unfortunately, I do not believe altruism is a strong enough motivator for medical and pharmaceutical advancement. I do believe the profit motive has given us many great innovations. It also has given us waste and duplication (do we really need 5 proton pump inhibitors?). We somehow need to figure out how to regulate these companies while still granting them great rewards for great innovations and minimizing government control. Not an easy solution.

As for providing health care to the masses, we need to create a system in which all but the most indigent pay something for their care, yet provide a security net when expenses exceed a certain dollar amount (i.e. 5 or 10 thousand). I remember learning in medical school about a Women's clinic in the Washington DC area that initially provided free care to anyone and everyone. At some point they realized there was a misuse and overutilization of services, so they instituted a small copay (I forget the amount yet it was no more than $5). They discovered that their daily patient load reduced to a more manageable number, and, more significantly, they eliminated the types of cases that didn't need to be seen (I'm sorry I don't have any specific examples here, yet as physicians we all know what types of visits these are).

So, how do we solve this issue. I don't exactly know. I do have some ideas yet since this post is already way too long and my battery is critically low, I'm going to end now.

Way too philosophical ("long") for me! I'm in private practice, just trying to make a living doing what I know and like best.

Sounds nice except when you consider that nearly 2 million Americans have lost their jobs over the past year. CitiCorp and Bank of America are going to layoff 52000 and 30,000 respectively. Home values are plummeting. It will not be long before a large percentage of the population is "indigent."

Carla_FNP wrote:

Carla a lot of these "articles" I read, I look to see which segment of the industry is writing it.

I cannot be convinced that one person taking a compensation of $1,600,000,000.00, yes that is 1.6 BILLION DOLLARS, does not dramatically increase the cost of health care. Remember we are only talking about 1 single executive.

gk.............
Perhaps it is not the practice of capitalism which has driven the world down its current path but rather the absence of education which has failed to rein it in. The basic premise of capitalism is sound. Capitalism built this country for which you seem to have so much disdain. Capitalism also provided goods, medical care and military support for many, many 3rd world countries to which you seem to align yourself. The Middle East might be nothing more than tents in the sand were it not for us capitalists buying their oil. It is not socialism which will save the African nations. China is not thriving because they are holding on to ancient economic strategies....they are thriving because they are learning that selling goods or services for a profit betters themselves and therefore others. Socialism results in isolationism and isolationism results in poverty.
Even Sweden, one of the best examples of a socialist economy/culture is realizing it is not working and is making huge moves towards more free trade, a supply and demand economy and less entitlement. Fortunately for them, they have the advantage of watching the US and other Western European countries, learning from us what works and what doesn't. Kind of like the youngest child of the family. Their new Social Security program will be light years ahead of ours because it is at least partially privatized. I would like to challenge you to read the renowned economist Ludwig Von Mises book "The Anti-Capitalist Mentality". I believe it fits you to a tee.
Capitalism works... as many have said it is capitalism which has pulled people out of their mud huts, not socialism. But we capitalists must have the education, the interest and the motivation to monitor it and alter its directions. And this is where we have failed. The CEOs have gilded their pockets BECAUSE WE LET THEM!!! How many of us with 401Ks or other stocks actually have the smallest idea into what companies our money is invested, how many shares we own, who the CEO is and how much he makes? How many of us sign those silly proxie voter cards and send them back so someone else rather than us can make the corporate decisions? I am as guilty as anyone. I contributed to the pillage. I also allowed the insurance companies to rape the medical profession because, out of fear, I signed up for managed care plans. I signed contracts with insurance companies so they could slit my throat. I was not vocal enough or did not educate others around me well enough so that they would make wiser decisions come election time. Nope, these CEOs and "vulgar capitalists" did not rape me...I bent over and winked.
It is the intrusion of government not the lack of it which has also contributed to the apparent lop-sided success of capitalism. When people expect, demand and empower government to take care of them, to provide everything to which they think they are ENTITLED, they lose the need to think for themselves. They no longer worry about the day-to-day complexities of their lives because they know, if they lose their job, the government will pay them not to work and it will feed them. If they invest money in a company, the government will insure their losses. And, if they abuse their health, the government will pay the bill to restore it. If there is one thing I could wish for the young people coming up now in this world it would be to learn how to think for yourself. Realize that for every action or decision you make, there are consequences. And I would spend a whole lot more time in school educating kids about finances, stocks, insurance, etc.
Anyway, sorry to all who found this boringly long and tedious. Just another rant by that old geezer. But, depite everything that is wrong in this country I still love it and I would not wish to live anywhere else. I still have some faith that it will find the right path again. GK?

Leslie

Leslie, I do not need any ad hominem attacks regarding my "disdain for this country." I have an opinion which different from yours, it doesn't mean, because of my opinion, I love America less.

Capitalism and the PROFIT motive go hand in hand. The "capitalism" you claim built this country, was built on the backs of slave labor. People who WORKED FOR NOTHING, while their masters PROFITED off the fruit of their labor. Slavery would have ended the day it was declared that ALL MEN had to be paid equally for their work.

Sweden is partially privatizing their social security? Good. I will introduce them to Bernard Madoff, he can manage it for them.

I suggest you to read Joseph Stiglitz's writings.

I found the comment below an interesting summation of the problems that all the posters above have mentioned. It was from a healthcare blog:

John,

Excellent post!

Leslie

Anyone worry that the cost of administration and bureaucracy never seems to be mentioned when controlling health care costs is discussed?

You know, I like both capitalism and socialism. I think each has it's place. But we have to stop trying to redesign a healthcare system to keep the best points of both systems - it doesn't work. Right now we have a mix - and we have the worst parts of both systems - rationed care with long waits for those patients without resources, mindnumbing volume of work without the ability to negotiate prices, excessive profit taking on the part of the insurance companies who get to cherry pick their patients so they don't have to take care of the sick - the whole system sucks and we need to pick one or the other, not both. Since there is a social and moral interest in taking care of the sick, along with a negative market - ie. the sickest and most in need can't work and can't afford to pay - I think the health system has to be socialized. Privatize the damn roads, and post office.

The system will have to collapse before there is such a dramatic change. Every patient I speak to is fearful of "socialized medicine" -- and I don't think that they are just trying to please me. The major players such as the insurance companies and hospital industry have tons of money and politicians in their pocket -- and the same game plan that nuked Bill Clinton's health care reform initiative. And as usual there is no backbone in Congress.

I predict we will get more of the same, repackaged as reforms. which means us docs will be taking it on the chin. And when "the reforms" go down in flames (again), it will be our fault (again), because we didn't buy EMRs, or give patients more than 50 seconds to talk at their 5 minute visit, or kick them out of the hospital earlier, or make them immunize their kid instead of buying a big screen TV...

Kevin thank you for bringing clarity to the issue. The sooner Doctors realize that they are competing for patient dollars with insurance companies the sooner they will understand that one or the other will have to be eliminated. As the insurers are powerful, the doctors have to also find their voice.

It is my opinion that that voice is not found in a system that seeks to reduce the PROVIDER OF CARE to the lowest rung on the food chain, while unknowingly elevating the Insurers by defending their brand of "free market capitalism."

My wife hates the word "socialism" but does not think there should be FOR PROFIT insurance companies.

My PROPOSAL is that DOCTORS AGREE TO SINGLE PAYER, in exchange for unionization and collective bargaining.

One last thing to remember: Doctors have NEVER had a better friend in the White House than Barack Obama. His best friends, from Chicago are physicians. Doctors need to understand and do what is in their best interest, instead of clinging to "-isms."

You can bet Insurance Companies are going to fight like hell...Obama said yesterday he is ready!

Doctors need to get on board. One cannot be diametrically opposed to their own survival.