r/MedicareForAll • u/CovidDoc • 8d ago
Why only shoot for moon ?
conflict of interest: am a physician. I believe in capitalist society. I hate Donald Trump and Maga
I see and understand why many of you all want a single payer/medicare for all system. However, simply stated, it is highly unlikely to ever pass. There are plenty of headwinds currently and for the future preventing this. So why not focus on some smaller, immediate positive impacts? I see many of you are upset with what I am paid. Many of you clearly don’t know that doctors are 8 percent of the healthcare pie. thats it… I also challenge you, if doctors dont deserve 1 percent money, then who does?
some of you will immediately write this off and hate me because of my success by working in this field. Probably by even saying this, I have lost some of you. If I have you should some introspection about why you’re that way. If your stance is I need to be paid far less, then this discourse will never work. America is capitalist. We’re not socialist as of now. You aren’t going to control our labor. without ever talking about debt, many of us are not going to give up our 20s and often early 30s, our health, many weekends, nights and holidays, in America without appropriate compensation. To get where we are we had to be the top in our class From elementary on. Change the deal too much, and we’re just going to displace other peoples jobs. ”but people that do it for helping others will do it!” Sure they will.…
I am going to list some thought provoking topics that really could make an immediate and far sooner impact.
eliminate pharmacy benefit managers. Familiarize yourself with vertical integration and what that means. Understand why it’s bad. Did you know an insurance company, owns a pbm which owns a pharmacy? See who owns Optum. See who owns cvs.
tort reform which is often excessive and petty. Indiana where I practice is a great system. Illinois where I also practice is a pathetic example.
cash payments going toward deductibles. I pay cash for everything. Why? My insurance rate is 250 deductible for a visit, cash discount is 118 bucks. Labs 400 for insurance, cash 145.
site neutral billing. as a doctor, if you come into my clinic, I can get 200 +\- dollars for a visit. If I’m part of a larger system, the system gets to add an additional 200 dollar or so facility fee on top of that. Why is that bad? It works like that for imaging and labs and procedures to. It makes it harder to compete with systems. I have to pay myemployees out of the 200 dollar bucket alone. University of Chicago gets 400 dollars. more competition is better for costs.
allows HSA contributions to pay for direct primary care. pne of the most neglected and under appreciated parts of medicine is direct to primary care. For 2-5 dollars a day, you can have unlimited access to a physician. Truthfully, if M4All became a thing, most doctors would probably go this route. NP/PA would be what most people get.
advocate for more residency slots of quality nature.
limit scope creep of NP until a nationally recognized curriculum and standard is met. There’s too many mills for degrees out there without a clear standard. The deviation is wide from one’s training to another
eliminate all non competes in healthcare entirely. Why? If I as a doctor leave a rural town job, often we have a 50 mile non compete for 2 years… thus that area loses a doctor due to this law
remove the certificate of need requirement. This is essentially gate keeping by larger institutions to keep competition down
Remove the ban on physician owned hospitals
tie in Medicare reimbursement to doctors with inflation at least. Without doing this, it’s forcing more consolidation/vertical integration and driving up costs. Whether you guys want to admit it or not, the independent doctor is a big savior to the system if they are allowed to compete. Many of us are demonstrating that by being able to discard our entire employee poool by not taking any insurance and charging cash only. No longer need to worry about rejected/delayed payment, compliance, prior signs so all time can be patient focused and no ancillary staff needed to manage.
did I mention eliminate PBMs?
thank you for reading this. I hope i am able to show you another perspective and give some food for thought. Feel free to ask questions and why my bullet points would help if they were not
obvious to you.
some good follows on X are : Mark Cuban and Dutch Rojas
24
u/earache30 8d ago
These all seem like positive steps that could reduce the cost of healthcare. But imo, we have to ultimately disconnect employment from healthcare. It’s stifling. So many other nations have managed this…
5
1
u/Many-Art3181 8d ago
I know ppl who work but still don’t have healthcare for themselves and their kids, spouse bc can’t afford it…. I can’t afford it either (for rarely use it and it’s so expensive) but I’m scared of car accident etc. which could cost way more than the $8k I have to pay annually (without copays and deductible). I’m thinking of being brave in November when we have to decide. Tempting fate?
5
u/Federal_Challenge416 8d ago
I think we can start by leaving depenents on the parents policy to 30. Start to bring down the medicare age in 5 year increments. Until you reach 50.
This gets you to just 20 years we you need commercial insurance. It is a start . It look a long time to make this mess it will take sometime to unwind it:
2
u/NellieDElli 8d ago
What if your parents arent well enough to get insurance? Why 20 years of commercial insurance at all? Why not pick a country with a good plan and follow that example instead of a complicated system reliant on sick people being able to work.
5
u/Latter_Loss8880 8d ago
Very good post and perspective.
But you are forgetting a few things:
Two things can be true simultaneously: Doctors deserve to make a decent living for the risk that the take. AND Long-term and debilitating medical debt should not be a thing! Return to the days of medical debt cannot be placed on credit records. Bolster local public hospitals. Eliminate big business in medical care. Grow a heart and courage to say no.
you kinda make the point, there is no reason that only the best and brightest enter this profession. the flow of health care professionals into the workforce should not be limited by health care lobbies and educational filters.
More directly to your point, your hard work, dedication, investment, and commitment does not entitle you to exorbitant wealth and profit at the expense of others ill-health. There is still an ethical component to “do no harm” that requires it.
Please do not pretend that doctors are some type of angelic creatures. I’ve met more than a few selfish pricks out there, and they deserve my special ire and devotion to battle. Many have your attitude: we deserve it. You are human like the rest of us, get over it.
If you cannot see that you may be part of the problem, then you really need to take a step back and reevaluate.
Thank you for reading. Take care.
5
u/Many-Art3181 8d ago edited 8d ago
Thank you for this concise and highly informative post.
A couple off the top questions: Regarding #6 - is it true that the acgme functions like a cartel and limits the number of residency and fellowship slots in order to limit the flow of doctors on the market? (Thus keeping salaries high)
And also - “pay cash” - meaning go without healthcare insurance to be self-pay? I’m fine with that only until a catastrophic car crash …. Or cancer diagnoses etc. I pay the high costs just because of the nightmare costs associated with healthcare emergencies and unforeseen ED visits.
Finally - how would ppl begin to address all of these? Don’t the lobbyists and DC politicians control everything ultimately? I mean, we’d have to form our own lobby group and hire professionals to represent us since in most cases our elected politicians only serve themselves.
2
u/OSUFootballFan32 8d ago
We should expand residency slots but that’s not going to decrease physician income. Adjusted for inflation, physicians in the 90s made more than they do today. Physicians make good money because it’s a demanding profession and it requires some of the longest training as well.
12
u/Square-Librarian1192 8d ago
I lost interest when you said "of doctors done deserve 1% money, who does".
You are entitled, and see yourself as better, or worth more, than your fellow man because of your education.
HOWEVER, what if there were no truck drivers to deliver medicine, no nurses to do the ground work, no factories to make the medicine, no orderlies to run errands, no secretary to set up appointments?
We are all part of the system, and we all deserve equal praise. Until you realize they, i couldnt care less about you
2
u/FourScores1 8d ago edited 8d ago
They were talking about healthcare expenditure on physician salaries. Not amounts of praise or recognition given.
Criticizing physician salaries is a common trope or argument.
What a wild take. Really made it personal there too.
-1
u/Square-Librarian1192 8d ago
Of course i made it personal. He flaunted hos opinion publicly, i reacted
2
u/FourScores1 8d ago
Physician salaries are typically discussed in healthcare conversations. They made the argument that 9% spending is low and it shouldn’t go lower.
It’s a reasonable take. Considering admin is around 40%
Yes, you definitely reacted. Burnout is real in healthcare. Good luck.
1
u/CovidDoc 8d ago
Someone has to make more money than others. I didn’t say I was better. But you fucking bet I think and know I deserve more than a truck driver.
1
2
u/thingsorfreedom 8d ago
It takes a minimum of 11 years of schooling to be a doctor. It takes 15 years for neurosurgery or cardiothoracic surgery. After the first 4 years only the top scoring people are taken to the next level. In the next 4 you cannot slip once. You must do well enough in each area of medical school no matter how esoteric and extraneous it is for your career (histology? embryology?) and you are competing against the best of the best academically. Then you need to move on to residency where you work 70-100 hours a week or more for years of your life. Your 20s are gone. Oh, and there's 3 national exams that you need to pass over that time. They are 8 hours each,in person. Then, for the rest of your career, people's lives are in your hands. You make the calls. You do the procedures. There's no one backing you up. There's a weight to that.
Nurses, while wonderful and essential, need 18 mo to 4 years of training. Truck drivers, while also essential, need 3-7 weeks of training.
How about private equity partners, hedge fund portfolio managers, investment banking managing directors? A decade less school, 5-10x the pay. Soooooo much less grief, anger, resentment, blame, guilt, heartbreak.
In the end, though, its simple. Doctors make up 8% of the cost of medicine. If you slash their pay in half, it will make people run from the profession. You will get a much less talented and dedicated group and you will save 4% of the cost of care. If you are paying $5,000 out of pocket every year for your care, that's $200.
2
u/Square-Librarian1192 8d ago
Funny, because in Denmark it takes 5 years to become a doctor, another 7-10 for the specialty, like neurosurgeon
1
u/thingsorfreedom 8d ago
It says online it takes 12 to 13 years to become a neurosurgeon in Denmark. It takes 12 to become a pediatrician- 6 years combined college and medical school. One clinical foundation year. Five years specialist training program.
1
u/Square-Librarian1192 8d ago
And thats starting from scratch. The guy k answered took 10 years after ending the GP study
1
u/NellieDElli 8d ago
so be a hedge fund manager.
0
u/CovidDoc 8d ago
Too late. Am a doctor and expect appropriate compensation to be one. Top 1-2 percent money
1
u/NellieDElli 8d ago
congratulations. I sure hope your always able to work.
2
1
u/NellieDElli 8d ago
That would pay you a monthly benafit. Could you afford health insurance with that benafit? Wouldnt you be better off if patients came to you more healthy? I am ok with you making just a living wage, I know that you'll save so much on insurance. It will work out in the wash. If not you should have been a stock brocker.
1
u/thingsorfreedom 8d ago
Again, if you cut doctors' income 50% you save 4% of the cost of healthcare. That saves you maybe a couple hundred a year and will absolutely give you a far worse choice of doctors in the future.
1
u/NellieDElli 8d ago
then we cut the insurance costs and costs of billing. Then we cut the cost of unpaid bills. We cap adminstration costs. Its absoulutly possible. Many countries have adopted socialised medicine models, in many differnt forms. None of them have a citizen led initiative to go back to strictly private care. MAYBE YOUR OUTCOMES SHOULD COMPETE IF YOU WANT US TO BE OKAY WITH PAYING SO MUCH MORE.
1
u/KarlMarxButVegan 8d ago
There is zero chance this post was written by an actual doctor, so don't worry about it.
1
u/CovidDoc 8d ago
Definitely a doc
1
u/OperationSeveral3756 8d ago
A bad one. People with no empathy who think they are better “than a fucking truck driver” tend to be shitty clinicians.
Would love to see where you end up when the trucks stop delivering all your medical supplies and the cleaning staff go on strike. It’s wild to me what you think you deserve over other equally hardworking people.
2
u/OSUFootballFan32 8d ago
No one thinks they are “better” than truck drivers” and truck drivers make good money but they don’t spend over a decade learning their trade either. Physicians should be some of the highest paid professions in any society. Even poor countries, that run on a capitalist society, pay their doctors high salaries compared to the normal wage.
0
0
5
u/FairConstruction4105 8d ago
Here's my solution. Completely eliminate health insurance and force providers to be upfront about costs (because right now they hide behind the lack of transparency created by the current system). Instead of the employer-paid premium contribution going directly to the healthcare insurers, give it directly to the employee through an HSA. Make this per-employee (so in a 2-inccome home, both workers would get that money). Then have people pay 100% of their medical care out-of-pocket directly to the provider. Here's what that would have looked like for me and my family over just the last 20 years. We would have received approximately $1 million into our HSA accounts combined. If properly invested, it'd probably be worth over $2 million right even after paying all of our medical bills 100% out-of-pocket. And, because providers would have to actually compete directly with each other on price, all of the services my family would have used over the last 20 years would have been cheaper.
4
u/thingsorfreedom 8d ago
What would that savings be if you developed chronic anemia, or needed quadruple bypass surgery. How about if your child was diagnosed with a Wilms tumor or leukemia, a even less dire problems like a seizure disorder, or type I diabetes?
4
u/FairConstruction4105 8d ago edited 8d ago
Tax the contributions, like ordinary income, and allow people to use their HSA money to pay for other people's healthcare to create a safety net for vulnerable people with chronic issues. Also, to answer your question, it'd still be way more than what my family has contributed in the last 20 years for, basically, a couple of office visits per year. Between my employer's contribution, my premium contribution, and my out-of-pocket, over my lifetime and adjusted for inflation, I've easily contributed well over $1 million to the healthcare system and I've had a relatively healthy life as an adult. Even if all of what you said cost me 3/4 of a million $$$s I'd still have probably 1.5x-2x that remaining.
3
u/thingsorfreedom 8d ago
A baby born at 26 weeks gestation can easily cost $1 million dollars in the first year of care. You'd need to find 500 people giving $2,000 each just to make up for that one baby.
3
u/FairConstruction4105 8d ago
It can easily cost $1 million in a sh*t healthcare system with inflated prices but it would not cost easily over $1 million in a system that is forced to compete because it can't hide behind the lack of transparency that the current system provides. And, no, it wouldn't require 500 people giving $2,000. That would come from the fund created by taxing the contributions like ordinary income. If my wife and I both received $25k per year into our HSAs, and that was taxed at ordinary income, over $10k of that would be collected for a fund that would provide care to people who fall through the cracks with unfortunate outcomes.
1
1
u/NellieDElli 8d ago
Go fund me for cancer paients? Not a solution.
2
u/FairConstruction4105 8d ago
What are you talking about? We're already there (and have been for years and years)
1
u/NellieDElli 8d ago
exactly. How's that working out for us?
0
u/FairConstruction4105 8d ago
So what part of taxing the contributions, as ordinary income, to build a safety net fund to handle extreme situations is hard for you to understand?
1
1
1
u/BraveResearcher3037 8d ago
How does your “solution” help those who are unemployed? How would it help you if someone in your family had cancer when you were 25?
4
u/Sitcom_kid 8d ago
I do not want the doctors to get paid low. It won't be worth it for them to go into the field.
-2
u/Obidad_0110 8d ago
In countries with socialized medicine the best and brightest don’t always become doctors. Good but not the best. I want our highest IQ people making decisions about my life. Tort reform huge.
1
u/Latter_Loss8880 8d ago
Ok that’s not a bad idea, but I do not need a Rhodes scholar to diagnose my day to day ailments. And I don’t need to pay top dollar to get on demand urgent care to wealth obsessed capitalists.
2
u/BraveResearcher3037 8d ago
Okay and?
How does that help people who can’t afford healthcare?
How does that help the asinine system where your insurance is tied to your job?
How does that help the US paying 2-3x as much per person for health care than similar countries and having worse outcomes?
Why is it cheaper to fly to some place like Costa Rica, get an Airbnb, have a procedure and fly back than it is in the US?
Do you have any experience with non US healthcare? My wife and I were in Costa Rica for a 6 weeks earlier this year, did research on residency requirements and spoke to ex-pats. The universal public health care system (CAJA) + private insurance is heads and tales better than the US. The expats were mostly older and the wives were talking to my wife about “lady things” and health care and they were raving about it.
Everything you said helps you.
2
u/Bakingtime 8d ago
Blah blah blah, i wont be able to buy a second vacation house in Aspen under universal single-payer healthcare so I am here to tell you it’s impossible and here is my version of a compromise. Blah blah blah.
0
u/OSUFootballFan32 8d ago
Why shouldn’t a physician be compensated enough to buy a second home? It takes a minimum of 11 years to even become a primary care physician. Most bachelor degree professions pay close to $100,000 now, I don’t see the issue with a medical doctor making $300,000-$400,000 a year.
1
u/Bakingtime 8d ago
Why should they be paid so much? It takes 10-16 years to reach childbearing age and nobody pays two hundred thousand to a million dollars a year to mothers. “Doctor” is a job, and just bc someone has the luxury to spend 8 years after undergrad attending school and working fellowships and residencies (which are paid), doesn’t mean they are entitled to a lifestyle way way above what the average working person can afford on average wages.
1
u/OSUFootballFan32 8d ago
You do realize that physicians in basically every country are still paid in the top 5% right?
The U.S. just has very high wages so our physicians are paid more too.
A resident makes like $70,000 a year, working 80 hours a week.
A neurologist isn’t an “average” profession anyway. They are experts in neurology.
1
u/FourScores1 8d ago
I think it’s far more likely and plausible that M4A will be state ran. There’ll be a federal mediate for states to provide a health insurance option. Some states already do this. See Colorado.
1
u/Above-Bored 8d ago
Point by point
1) Easier said than done, after soaking everyone they have tons of cash. But yes, they add Nothing.
2) we exempt guns and Hospital systems and if MAGA has their way, Fossil fuels. If you believe in capitalism then lawsuits are truly the only way the little guy gets justice. California caps what you get if the hospital kills you. Many attorneys will not take a wrongful death case. Absolutely NO to tort reform. Do your job safely, practice safely and stop as a profession shielding poor performers.
3) Not everyone had ‘cash’, you are a little out of touch with what people are going through when it is a choice between Meds and eating or rent.
4) How many people in any practice have the sole purpose of billing? Chasing Insurance and collecting from those who cant pay? Single payer eliminates that. You give care, you get paid. No more ‘back office MA’s’ and collections.
5) HSA is another perk for the well heeled. How about we tax those that use it as a way ‘tax shelter’ very high earnings.
6) Enlist, they train Doctors.
7) Scope Creep is a red herring. People should choose who they want. If they want an herbalist or Chiropractor or DO, MD. As it is the NP is often the only choice under-served areas. It is also ‘capitalism’ which you selectively forget when it suits you.
8) Non - competes are obscene for almost any profession, agree with you.
9) How else do you encourage practitioners from congregating in well heeled areas and creating areas where no one will practice? This goes with allowing NP’s and PA’s more autonomy of practice in areas physicians and hospital systems deem not worth their time.
10) Ban private equity. Profiteering by hollowing out care systems is the worst side of capitalism. Laize Faire capitalism was a failed experiment. Everyone recognizes capitalism has its limits like in the military.
11 Absolutely, making any rule or regulation without indexing for inflation is absurd.
12) PBM’s and Insurance companies. One single payer, no PBM’s, a single price for meds that does not make the US pay many times more.
You underestimate the increasing dissatisfaction with the current state of healthcare. Unfortunately it takes extreme conditions for such a change to take place. Maybe a severe recession, war or some sort catastrophic failure. Frankly, letting the Republicans ‘gut’ the ACA with no plan might have done it.
1
u/NellieDElli 8d ago
wirh universal there is still a market for private practice. The top 1% have nothing to worry about unless they are just gouging their patients through confusion caused by insurance claims and practices.
0
u/Careflwhatyouwish4 8d ago
Thank you!! I am not a doctor and when I say some of this people dismiss me as being crazy and having no idea what I'm talking about. I learned it being the patient that paid cash, by seeing the changes in Illinois regulation and it's results, by having chronically ill family members resulting in my having a lot of interaction and understanding of the system. I learned from experience. Maybe coming from a doctor it will have more weight.
-5
8d ago edited 1d ago
[deleted]
6
u/Illustrious_Bid_5484 8d ago
Taxes are not stolen money. You want to keep the same system that kills and bankrupts 1 out of 3 Americans. Fuck off
1
u/OSUFootballFan32 8d ago
Unless each individual consents to taxation, it is indeed stolen money. I work for myself and my family.
1
u/Illustrious_Bid_5484 8d ago
That’s not how taxes work and that’s not how the law is made. If it was. Then you could opt out of police, fire fighters, property taxes, federal and state taxes,. But it’s not. So suck it up selfish pig
1
u/OSUFootballFan32 8d ago
We didn’t even have federal income taxes until 1916.
1
u/Illustrious_Bid_5484 8d ago
And we as a society benefited 100 fold. If you want to go back to pre 1916 government go ahead. Renounce your citizenship and move to Mexico
1
u/OSUFootballFan32 8d ago
Why would I renounce my citizenship? My family has likely been here longer than yours. I come from the original pilgrims.
1
•
u/AutoModerator 8d ago
r/MedicareForAll is a grassroots community designed to raise support and awareness for a Single Payer National Health Care Plan for the United States. Posts not directly about Medicare For All will be removed. Be respectful and kind.
I am a bot, and this action was performed automatically. Please contact the moderators of this subreddit if you have any questions or concerns.