Medicare's not fixed: Even with 21% cuts stopped

NY Post ^ | March 3, 2010 | MARC K. SIEGEL

[Scanian]

One look at my office tells you that I'm still taking Medicare patients: The worn carpet and peeling paint give it away.

Yes, Medicare's payment rates are that bad.

The real threat of a further across-the-board cut of 21 percent only added to the old problems of "routine" Medicare cuts.

The program now pays $53 for a standard office visit; with the cut, that would've been $40. For comparison, Aetna pays $70.

Average Medicare payments to physicians have been relatively stagnant since 2001 (but reimbursements for surgery and procedures have been cut a lot). Meanwhile, average total physicians' costs have risen 20 percent.

[RochesterFan]

The problem is that the growth rate in health care spending exceeds the growth in GDP. As Karl Denninger correctly reminds us, such growth rates are exponential functions. When two exponential functions diverge, they do so rapidly. The result will be a crash. Perhaps the solution would be to have an individual cap on Medicare expenditures and let the patient decide how they want to spend the available money. When it is gone, they’re done. Just like every other expenditure. It would force patients to make cost-benefit decisions.

[rbg81]

One look at my office tells you that I’m still taking Medicare patients: The worn carpet and peeling paint give it away.

---

I agree with much of what this guy says, but he almost lost all credibility with the first line of the piece. As an internist (and Fox News contributer!), how much do you think he makes a year? $200K?, $300K, $400K? The latter would be my guess (if not more). And he can’t afford $5K for new carpets and paint in his office? Please.

[SoftwareEngineer]

“Can’t pay for the carpets??” What horse hockey!! Doctors are the SINGLE most overpaid profession in the US because of a cartel that forbids new medical schools from being opened RIGHT HERE IN THE US

Yes, you heard it right. We have smart young AMERICANS who want to be doctors and would gladly take $100K as a salary instead of the inflated $300+ K these Cartel Doctors make. However, the AMA will not let a new medical school open without its permissions

For those of you who say this is Capitalism and the docs deserve to be paid $300K+, I say GIMME A BREAK!! Capitalism is FREE and OPEN competition. Open up as many Medical Schools as there are QUALIFIED kids. Let them all become QUALIFIED doctors and THEN let the freaking wages be what they are.

If a NFL quarterback gets paid $10 million a year, I don’t mind as that is what he is WORTH in the OPEN market. Not true for Doctors. We have an artificial shortage created by this CARTEL

So no sympathy for the CARTEL Doctors. Go compete in a real economy.

[I cannot think of a name]

Part of his problem is New York City. A garbage man makes close to 100K a year. Making $300K a year there is about equivalent to making $80K a year in a sane part of the country.

In the 80’s I was offered a job in NYC making $200K a year. Where I live that would have been a fortune. After looking into the cost of life and the quality of life, I told the guy I wouldn't move there for three times as much.

Why people continue to endure that place is beyond me.

[rbg81]

Well, if he has an office in NY, then I’m sure he’s doing even better. My point is that, I suspect, if you looked at this Doctor’s assets, I’m sure he’s doing very well. Its a canard for him to imply that he can’t fix up his office due to Medicare. Those expenses are tax deductable on top of it.

[fatrat]

No, the better way to save on increased medical costs would be to make the patient pay for all costs until they exceed a certain percentage of their income in a given year at which time a catastrophic policy would take over for the rest of that year. Then all patients would shop for all their care just like we shop for electronics, clothing, etc. If i needed an MRI i would go online and shop. Some facility with an underused MRI dept would underbid others and I would buy it there.

[CaptainAmiigaf]

Yes, an NFL star is “worth his 10million”. I suppose you think a “siliconed up” movie star is worth her 5 million per picture. Or that drugged up RockStar his/her 9 million.
But the DOCTOR who has the ability to keep your worthless carcass ALIVE for another several years is a crook, charlatan, thief, and also not a nice person.
You condemn the DOCTOR who charges you $75.00 for an office visit, and shake the hand of the guy who fixed your auto transmission for “only” $750.00.
You are a pip, you are.

[therut]

I think you are wrong. I make about 130,000 before taxes. I billed 425,000. I see alot of patients. We had to borrow money to make pay roll for the first time in 30 years this month. Our overhead has gone from 54% ten years ago to 73% over all.

[SoftwareEngineer]

Anyone is “worth” whatever the market pays them. In a FREE market, if someone is being “overpaid” then MORE people work to get to that level. If they cannot then guess what you get paid what you get paid.

It is not for YOU or ME to decide what someone should be paid.

If a NFL star is paid $10 million then that is because of all the hundreds of thousands of people who tried out in a free and fair effort to be quarterbacks, he was the best and that is what he is worth to the businessman who pays him

If there was a free and fair market for Doctors where anyone who was smart and studied hard and PASSED all the QUALIFICATIONS to become a doctor then fine, he/she should get what the market will bear

Instead you have a cartel now that artificially holds down the number of doctors

So back to your dumbass socialist/communist argument, in that case my elementary and primary school teachers should be paid $1 million a year ,because till date (and I am in my 40s) they did more good for me than any doctor I have ever met. And while we are at it, the Car Mechanic who fixes my car is worth $1 million too because he keeps my car running so that my family and I do not die

Also, the bus driver who is driving my two kids who I love more than anything in the world, should get $1 million since he is keeping them alive

And .. the Airline pilot that flie my family deserves to keep $10 million a year as his salary as he is keeping 300 people alive at a time

End the CARTEL now. US doctors are overpaid due to the cartel. Open up more Med Schools. Let AMERICANS become doctors. Let us stop sending our kids to freaking Antigua to get a medical education

[CaptainAmiigaf]

Thanks for my laugh of the day. Of course, you are 110% right in your valuations of your auto mechanic, teachers, pilots, electricians and everyone else who enables you to live in comfort and safety.
If you spoke to your mechanic as you speak of doctors, he’d throw you out of his garage. Insult your electrician and you’ll end up in the dark.
Insult me in my profession and you are out.
Each and every professional is truly worth what the market will pay. (not exactly socialist/communist thought)
Doctors do NOT operate in a free market. They operate in a world dictated by politician, lawyers, bureaucrats, do-gooders and whiners.
In YOUR highly respected profession, how would you like to live under the direction of varied people whose aim was to make it more and more difficult to properly do your job.
I “almost” think that something went wrong along the way and it has affected your thinking.

[SoftwareEngineer]

“Insult you”??? Asking you to get out of your freaking cartel and compete in a fair and free marketplace is insulting???

What the AMA has done is create a CARTEL. Plain and simple. Cartels are illegal in the USA, but yet the AMA endures.

If we had laws that only 200 people a year in Texas could become mechanics nevermind the fact how many people were actually qualified and willing then YES I would insult my mechanic because instead of charging me $65 an hour a free market mechanic charges, he would charge $650 an hour like the cartel doctors charge

Part of our health care issue is caused by the fake scarcity of doctors. You read that right. FAKE!!! The US has created a FAKE SHORTAGE of doctors. Anywhere in the world, where the free market system exists for training doctors, there is no shortage. Heck, even super qualified doctors from MODERN FIRST WORLD ENGLISH SPEAKING countries like Australia, New Zealand, Canada, UK and Ireland are NOT allowed to practice in the US without going through hoops and basically doing endless exams.

Fact is fact. Cartels are wrong and ONLY the consumer suffers. There is no inherent right to make $500K a year that doctors magically have. If in a free and fair market you make $500K GOOD FOR YOU. However, if you use a cartel to control the market then SCREW YOU

[CharlesWayneCT]

The program now pays $53 for a standard office visit; with the cut, that would've been $40. For comparison, Aetna pays $70.

Cheapskate government.

On the other hand, I just checked my latest claim for an office visit, and Aetna paid $57 (the non-negotiated rate request was $120).

[CharlesWayneCT]

My doctor’s office gets $57 for an office visit. Typically, the visit starts with a 5-minute call to set up the appointment. Then there is a preliminary checkin and weigh-in, pluse checkout, maybe 5 minutes total.

A nurse comes in and takes information and vitals, about 10 minutes.

The doctor spends about 10 minutes.

So that’s about 30 minutes of total work, 10 by the doctor, 20 by support staff.

There’s office space, computers, and equipment to be paid for and maintained. There’s consumables as well.

But at best, the office is making $114 a person/hour for my visit, which is less than my company bills for my services. That $114 per person/hour has to pay the salaries and benefits, plus pay for lights, heat, property tax, mortgage or lease of the property, depreciation of equipment, supplies, interenet access, records retention, and a host of other things.

Now, with that money, the doctor has to pay off a couple hundred thousand dollars in student loans, has to attend thousands of dollars worth of continuing education, and has to pay thousands of dollars for malpractice insurance. He likely is owner or a contractor, so he pays both halves of social security and medicare, and has to invest for his own retirement.

The primary care physicians are NOT making a killing in the profession. They are squeezed on every side — I have friends who have dropped out and taken other jobs because they couldn’t make a living being a primary care doctor unless they hooked up with huge organizations that could better manage costs and which had affiliations with hospitals.

[Let's Roll]

And yet there's no serious attempt to find and prosecute Medicare fraud. So the honest healthcare providers suffer because of the felonies committed by the dishonest hd providers.

It's never about fraud, waste and cutting spending unless it's for a popular program like medicare - the same way they threaten to cut police and fire on a local level.

[CharlesWayneCT]

Part of our health care issue is caused by the fake scarcity of doctors. You read that right. FAKE!!! The US has created a FAKE SHORTAGE of doctors. Anywhere in the world, where the free market system exists for training doctors, there is no shortage.

America is in the top half of countries for doctors per capita, and well above the average (2.3 per 1000, average 1.7 per 1000).

Heck, even super qualified doctors from MODERN FIRST WORLD ENGLISH SPEAKING countries like Australia, New Zealand, Canada, UK and Ireland are NOT allowed to practice in the US without going through hoops and basically doing endless exams.

Australia is only 5 positions above us in per-capita doctors (2.5 vs 2.3). New Zealand, Canada, and the UK are all BELOW US in doctors per capita. Only Ireland is significantly better, with 2.8 doctors per 1000 people.

Not that we don't have excessive regulation of doctors, just that those other countries don't have more doctors than we do.

Also, many professions do have licensing rules that limit how many people can serve in a profession. Yes, that often drives up costs. So I'm not disagreeing that we should not be limiting the number of people who can go to college to be doctors.

But I'm not ready to concede that our doctors are too-well trained, or that we could do better if we lowered the standards for doctors.

[OregonRancher]

Charles,
Nice to see you post, haven’t heard from you in quite some
time. I have to comment on these tin foil hatters who have
no idea the costs a primary care provider has to endure, or the immense load of government inspired paperwork that threatens to drown a doctors office.

My primary doctor has refused all new medicare patients to prevent the closure of his office and he’s one of the sharpest internists around.

[onemiddleamerican]

As an internist (and Fox News contributer!), how much do you think he makes a year? $200K?, $300K, $400K? The latter would be my guess (if not more). And he can’t afford $5K for new carpets and paint in his office? Please.

With that $200k/$300k/$400k he has office staff to pay... at least one RN, in NY, most likely no less than $50k. Then he needs a receptionist/scheduler who likely does double duty pulling and filing his patient charts, in NY, probably $30k. And thanks to the onerous federal regulations imposed on him for the privilege of participating in Medicare program, he also needs a staff member knowledgeable in coding and compliance regulations, in NY, probably as much as it costs to have an RN, $50k.

Maybe the RN does his patients' blood draws, too. If not, he needs a med. tech. to do that and the height/weight/BP stuff, and that would cost him another $30k.

And with all the money left over, he would need to pay his rent, utilities, liability/malpractice insurance, staff benefits (med. insurance, workmans comp., Social Security, etc.)

Hell, he should be rolling in the dough.
(/sarc.)

[CaptainAmiigaf]

How in the hell did you get the idea that I am a doctor?
The closest I ever got to the medical profession is my driving past the local hospital on my way to work.
I care not for the AMA and any cartel is indeed wrong and against any sensible law.
I am talking about the individual doctor, the actual man/woman who takes care of YOU and ME and the rest of their patients.
I am talking about the two friends and three aquaintances who closed their practices because “It was no longer worth the aggravation.” Each had the financial ability to walk away in their late 50’s.
You are also right about HIGHLY SKILLED foreign doctors who cannot practice here. In my youth I knew a doctor who came to my city after surviving 4 years in a concentration camp in Poland. Brilliant, but somehow totally unable to master English enough to pass required exams. finally was allowed to specialize as a radiologist and just took X-rays. Doctors for 30 miles around sent their patients to him.
Funny, we are arguing via computer, but basically, I am in agreement with virtually everything you say....almost everything.

[Osage Orange]

You, have little idea of what you speak..........

I personally know GP's making less than $100k....

I personally know...OBGYN's going out of biz...because they can't make a living after expenses...( ie: Payroll, Insurance, Office costs, taxes...etc..etc...)