Serious question. Anyone in here actually signed up for Obamacare yet?

[TSA]

Socialized medicine might work here if not for the 15-20 million illegal aliens.

[TeyshaBlue]

final, next chapter with my mother:

One visit to the nursing home (alzheimer's care), I suspected they were feeding my mother a lot of food. She overall was bedridden for 5 years and down to 90 pounds or so. Why does a totally inactive 90-pound woman need so much food, I asked my self?

Had a meeting with several of the staff, told them that my mother's will said she was not to be kept alive by artificial means, and the 3000 calories/day was "articificial", and thereby violated my mother's will.

They said she was so deteriorated and incapable of processing protein that they had to overfeed her to provide enough protein (iow, keep that $3000+/month bed occupied). Ice cream and cake and LOTS of protein.

I lost that battle because my sister had power of attorney/guardianship and thought letting our mother die a natural death was inappropriate or cruel whatever.

Finally, after burning through $250K+ of her savings and liquidating her house, for 5 years of Alzheimer's care, my mother died.

afterword: funeral home charged $800/night for two nights to keep my mother's body in a refrigerated drawer until the burial. They also offered me the option of burying my mother so I could share the same grave, next to my father. That gem was, IIRC, about $3K. No thanks. Sunset Funeral Home/Cemetery, Austin Highway.

Truly sorry you had to endure that, boutons. Im walking the late stage alzheimers path with my father. It's a very unique pain and in spite of our differences, you have my complete sympathy for what you had to wade through. I certainly cant fault your wishes or supporting logic. Sucks that you didn't have the control your mother deserved.

[ElNono]

How much?

There doesn't seem to be a single value. Medicare, Medicaid, the VA, etc, however, seem to know how to do it all the time.

[FuzzyLumpkins]

How much should a doctor be allowed to make?

at the notion of poor doctors. such a sorry lot in life is theirs. the ty doctors that are general practice or the like get paid $189k. These are the guys that take medicaid and provide only very basic services. poor them. i bet you all over teachers unions too don't you? love you some doctors.

That is besides the point I am making which is that doctors, hospitals and pharmaceutical companies are making too much money as in 17% of gdp goes to them overall. Now if you want to change that then doctors, hospitals and pharmaceuticals are going to have to get less.

The notion that the health care system is broken and spiraling out of control is hardly new. The notion that the system is set up such that the consumer cannot negotiate on his own behalf is not new either.

[ElNono]

Related:

Patients’ Costs Skyrocket; Specialists’ Incomes Soar
http://www.nytimes.com/2014/01/19/he...omes-soar.html

[ElNono]

at the notion of poor doctors. such a sorry lot in life is theirs. the ty doctors that are general practice or the like get paid $189k. These are the guys that take medicaid and provide only very basic services. poor them. i bet you all over teachers unions too don't you? love you some doctors.

That is besides the point I am making which is that doctors, hospitals and pharmaceutical companies are making too much money as in 17% of gdp goes to them overall. Now if you want to change that then doctors, hospitals and pharmaceuticals are going to have to get less.

The notion that the health care system is broken and spiraling out of control is hardly new. The notion that the system is set up such that the consumer cannot negotiate on his own behalf is not new either.

I was going to say, the better question is, "how much do they really make?".

It's almost impossible to get a price list, or to know beforehand what you're going to be charged. Especially if you need some sort of procedure in a hospital or clinic. Having been without insurance for a long time, I've asked many times what the price of procedure X is before having it done, and if I'm lucky enough to get an answer, it either does not match or does not include other charges that are added on the bill I get later on. I even had the luck to have some really nice doctors that would write off or discount some procedures, but then the billing department would bill me for the full amount anyways. Then, you're left arguing with the billing department. This was a problem before the ACA, and will still be a problem with the ACA.

[pgardn]

final, next chapter with my mother:

One visit to the nursing home (alzheimer's care), I suspected they were feeding my mother a lot of food. She overall was bedridden for 5 years and down to 90 pounds or so. Why does a totally inactive 90-pound woman need so much food, I asked my self?

Had a meeting with several of the staff, told them that my mother's will said she was not to be kept alive by artificial means, and the 3000 calories/day was "articificial", and thereby violated my mother's will.

They said she was so deteriorated and incapable of processing protein that they had to overfeed her to provide enough protein (iow, keep that $3000+/month bed occupied). Ice cream and cake and LOTS of protein.

I lost that battle because my sister had power of attorney/guardianship and thought letting our mother die a natural death was inappropriate or cruel whatever.

Finally, after burning through $250K+ of her savings and liquidating her house, for 5 years of Alzheimer's care, my mother died.

afterword: funeral home charged $800/night for two nights to keep my mother's body in a refrigerated drawer until the burial. They also offered me the option of burying my mother so I could share the same grave, next to my father. That gem was, IIRC, about $3K. No thanks. Sunset Funeral Home/Cemetery, Austin Highway.

OK.

This is time for my condolences.
Sorry you had to endure all that Boutons.
Seriously.

[SnakeBoy]

I was going to say, the better question is, "how much do they really make?".

It's almost impossible to get a price list, or to know beforehand what you're going to be charged. Especially if you need some sort of procedure in a hospital or clinic. Having been without insurance for a long time, I've asked many times what the price of procedure X is before having it done, and if I'm lucky enough to get an answer, it either does not match or does not include other charges that are added on the bill I get later on. I even had the luck to have some really nice doctors that would write off or discount some procedures, but then the billing department would bill me for the full amount anyways. Then, you're left arguing with the billing department. This was a problem before the ACA, and will still be a problem with the ACA.

That wasn't the question. Fuzzy believes doctors salaries are driving healthcare costs and they should be paid less and my question to him is how much should they make. You are responding about an entirely different topic. You would be hard pressed to find a doctor that believes our system isn't seriously ed up.

at the notion of poor doctors. such a sorry lot in life is theirs. the ty doctors that are general practice or the like get paid $189k. These are the guys that take medicaid and provide only very basic services. poor them. i bet you all over teachers unions too don't you? love you some doctors.

How much should a family or general prac ioner make?

[ElNono]

That wasn't the question. Fuzzy believes doctors salaries are driving healthcare costs and they should be paid less and my question to him is how much should they make. You are responding about an entirely different topic. You would be hard pressed to find a doctor that believes our system isn't seriously ed up.

But they are driving healthcare cost. 20% of total spending in healthcare goes to doctors, 2nd most after hospitals. It's not ALL doctors (you can get some numbers from the article posted above) that make half a million a year, but when you add up everyone, it turns out to be a good chunk. (http://www.aetna.com/health-reform-c...out-costs.html)

Of course doctors would like to charge whatever they want, and get paid whatever they want. On the other hand, you have customers that would like to pay the least possible. Then comes BigPharma wanting a piece of the pie too. And then there's a social interest in generally making sure access to care isn't reserved only to a very wealthy few (not merely for altruistic reasons, simply because a healthier society is a more productive society). It's a lot of pressures from different directions.

You're asking about general prac ioner, and I know they're getting the shaft right now, because insurance companies don't want to pay much at all for an office visit. On the flipside, you have certain specialists making a boatload of money.

The answer to your question depends on a lot of factors. If you do what, say, Germany (since you brought up an anecdote from there) does, they do cap doctor's earnings to a certain amount depending on what they do. But it's more complicated, because German universities are mostly public ins utions and charge about $100 for tuition. Doctors don't start off with a $150K debt due to their education.

Without some sort of price-control, it's spectacularly difficult to rein in cost while maintaining a decent amount of access to care, especially on a society with vast income disparity.

[FuzzyLumpkins]

That wasn't the question. Fuzzy believes doctors salaries are driving healthcare costs and they should be paid less and my question to him is how much should they make. You are responding about an entirely different topic. You would be hard pressed to find a doctor that believes our system isn't seriously ed up.



How much should a family or general prac ioner make?

You keep on moving the goalposts but the premise of your question is flawed. I see no 'should' there. The only 'should' I have in this national policy discussion is lowering the health care costs in the US.

It does not appear that the medicaid worker is going to be paid less. Medicaid pays what it pays.

[boutons_deux]

The best way to bring down costs is to create a parallel government health insurance (public option) system and provider system.

govt hospitals and clinics

govt employed doctors and staff

doctor, nurse education to be provided free in return for 20+ years of employment ( similar to ROTC/military academy scholarships requiring x? years of service )

govt single buyer of all drugs, devices, equipment, setting max profit margins for private suppliers

all of this is to be federal, not state.

above, none of this if for profit.

would be available to every citizen from cradle to grave.

for profit insurance and health care would still be available.

public health insurance wouldn't pay for-profit care beyond what the govt health care costs, so you exercise the "free market" option to buy for-profit insurance to pay for for-profit care.

Doctors would have no overheads, be strictly salaried as govt employees, where their priority is health outcomes, not personal wealth engorgement.

and of course, the entire system would completely computerized, with patients carrying encrypted health ID cards (just like you have to carry a for-profit insurance/prescription drug card) that allow any doctor to access your medical history and to prevent doctor shopping, straw buyers (eg, Michael Jackson drug use)

direct-to-consumer drug,device marketing would be forbidden.

[FuzzyLumpkins]

I was going to say, the better question is, "how much do they really make?".

It's almost impossible to get a price list, or to know beforehand what you're going to be charged. Especially if you need some sort of procedure in a hospital or clinic. Having been without insurance for a long time, I've asked many times what the price of procedure X is before having it done, and if I'm lucky enough to get an answer, it either does not match or does not include other charges that are added on the bill I get later on. I even had the luck to have some really nice doctors that would write off or discount some procedures, but then the billing department would bill me for the full amount anyways. Then, you're left arguing with the billing department. This was a problem before the ACA, and will still be a problem with the ACA.

I have a couple of friends that are doctors and a couple of friends that are nurses. Two of them work for privately-owned, local practices and they know generally what they charge for various services. OTOH, my other friends who work for various hospital wards and corporate clinics have absolutely no idea how much goods and services cost and two in particular who have tried to find out have been rebuffed. The closest to a price point that one could find was a patient talking about how they charged him several hundred dollars for a food replacement IV.

It's a serious problem that the ACA doesn't even address. They literally make it impossible for the consumer to negotiate because no one that the patient actually deals with so much knows the cost. It's ed up. As you point out doctors, and the rest of the industry for that matter, want to be able to charge whatever they want and make it so that the consumer has zero say. Combine that with a persons health making them desperate, and you end up with a vertical demand slope

The minimum that doctors appear to make is $189k. That is the low end and those are the ones already working at locations that take the lowest insurance payouts from the government. That does approximate about what most other doctors in the first world make. The guys that make more in our country will guarantee that our doctors are the highest in the world by whole number multiples though.

[boutons_deux]

"It's a serious problem that the ACA doesn't even address."

ACA is getting hospitals to publish prices, even already months ago. google "comparative hospital prices costs ACA"

and there are anecdotes of people driving 100s of miles to cheaper hospitals


http://www.kevinmd.com/blog/2013/02/choose-hospital-based-price.html

http://www.paulsvalleydailydemocrat....cal-procedures

and of course there is medical tourism to central America and India, even to Europe.

[FuzzyLumpkins]

"It's a serious problem that the ACA doesn't even address."

ACA is getting hospitals to publish prices, even already months ago. google "comparative hospital prices costs ACA"

and there are anecdotes of people driving 100s of miles to cheaper hospitals


http://www.kevinmd.com/blog/2013/02/choose-hospital-based-price.html

http://www.paulsvalleydailydemocrat....cal-procedures

and of course there is medical tourism to central America and India, even to Europe.

Neither link says that. I googled 'hospital price ACA' and it came up with something saying that a Miami childrens hospital is conveying price information. I am not saying that you are lying but you have given nothing for me to believe that.

While that may be the case, you cannot go into a hospital to the best of my knowledge and choose goods and services based on price. There is no way to do that. When I for example am making a choice to have additional tests done or not, that decision should have cost considerations in addition to everything else.

Having to go overseas doesn't seem a tenable solution for most citizens.

[Fabbs]

Primary care M.D. made two timely referrals to specialists.

Specialist #1, Ear Nose Throat set up appt date pretty quick, like within 10 days.
Initial appt went well seemingly, detailed probing (no ) to begin next appointment. Picking up where last insurance bottom line failed to follow thru.
There is where the proof in pudding will -or will not be- happening.

Specialist #2.
Appt supposed to be today.
Same scenario as #1.

So far it's been a positive change for me.