Doctors Talk About Government Health Care
[Guest post by DRJ]
The Harris County (Houston) Hospital District plans to buy Memorial Hermann Southwest Hospital and market it to private insurance patients to make it financially viable. Here’s one doctor’s reaction to the sale:
“Doctors here believe a county facility is not the place to bring private-pay patients,” said Dr. Owen Maat, a gastroenterologist with a busy practice at Memorial Hermann Southwest. “They want to go to an attractive hospital where they get a private room and are treated well. That doesn’t happen at a county hospital.”
Other physicians see financial problems:
“Retaining the hospital’s physicians and their private-insurance patients is crucial if the hospital district wants to avoid imposing a tax increase, as it has stated. Such patients help defray the cost of care to indigent patients the hospital district serves.
“If the district thinks they can do this without raising taxes, they’re insane,” said Dr. Michael Kleinman, a Memorial Hermann Southwest surgeon. “It might take a while, but there’s going to be an exodus of doctors from here.”
Some Hermann doctors claim the majority of the staff opposes the sale, and Memorial Hermann Healthcare System President and CEO Dan Wolterman said a recent forum with physicians made town halls with members of Congress “look peaceful.” But a hospital spokeswoman “objected to the characterization of widespread unhappiness among doctors about the deal,” describing them instead as a “vocal faction.”
I hope this isn’t a preview of things to come.
— DRJ
It’ll be easy to staff. I’ve heard Houston has an excellent supply of fake Doctors.
Teflon Dad (287a17) — 8/14/2009 @ 11:34 pm*snickers* Knew that was comin’.
Well played, sir. Well played.
Scott Jacobs (d027b8) — 8/14/2009 @ 11:43 pmRacist.
I’m reporting this to flag@whitehouse.gov
krusher (5ed94c) — 8/15/2009 @ 3:37 amquel surprise… doctors want to reserve the right to make a shit load of cash
mynameis (62daaa) — 8/15/2009 @ 3:46 amObama and the Dem’s are dumber than dirt. Supply and Demand is why prices are high, and everything they are pushing is only going to make it worse.
All the BS they are peddling is going to lead to a lot of physician retirement. Older doctors are more resistant to change than they were when they were younger — just like everyone else. Older doctors have been making plenty of money for a long time and they can afford to retire. Older doctors are already tired of all the BS in our present system and they sure as hell don’t want more BS.
“Almost half the physicians in the United States are 50 years old or older,” Smith observes. “An exodus of older doctors from medicine would be a disaster for patient care in this country.”
http://www.itsasurvey.com/artman2/publish/safetysecurity/Baby_Boom_Doctors_Planning_Retirement_printer.shtml
Also see:
http://www.vistastaff.com/pdfs/profiles/babyboom.pdf for a view on how doctors are thinking.
If you think our system is struggling now, imagine how screwed we will be if tens of thousands of doctors retire rather than put up with Obama’s crap. I know I would. Be honest, most of you would as well.
jc (01bedc) — 8/15/2009 @ 4:14 amquel surprise… doctors want to reserve the right to make a shit load of cash
And given the enormous debt loads that most of them take on when they finally get out of their 8+ years of schooling and internships, who can blame them? Every time someone tells me that “doctors make way too much,” I ask them if they had any idea how much it costs someone to get out of a top medical school these days. My friend is one of the top guys at the Rehab Institute at Northwestern here, and when he finished his internship in ’85, guess what amount he owed on his school loans? $350,000! So just imagine what that figure would look like today, and wonder no longer why most cannot afford to be GP’s or anything other than specialists. Funny, but the Dems don’t seem to be willing to discuss this little uncomfortable fact of life, as in so many others.
Dmac (e6d1c2) — 8/15/2009 @ 7:09 amGreedy death merchants. Prolly racist too.
JD (5cc18e) — 8/15/2009 @ 7:23 amMike K has often cited the healthcare system in France as a model for the US to emulate. Since he is a doctor, and since he seems like a pretty sensible person, I thought the pros and cons of the French system he’s pointed to deserve some scrutiny.
The idea of reforming the healthcare system in America appears to be a case of a Hobson’s Choice, where all options are hardly ideal and truly desirable. However, some options certainly will be more ridiculous (Hello, ObamaCare!) than others, or will take an already compromised situation and make it far worse (Hello, “lefty” policymakers and do-gooders!).
Mark (411533) — 8/15/2009 @ 7:48 am
#8 Mark:
It certainly does.
And while there are some attractive ideas in the French system, it does suffer from some serious drawbacks as well.
Secondly, I do think it might be worth questioning some of the mortality/morbidity statistics: didn’t France lose an overwhelming number of senior citizens to a heat wave several summers ago?
EW1(SG) (edc268) — 8/15/2009 @ 8:06 amWhy pick on doctors?? What does the average lawyer bill per hour? What does Derek Jeter get payed to hit homeruns (or not)? What do we pay our plumbers to snake out our sewer drains?
The one group that we cannot do without in this are the doctors. I don’t want Nancy Pelosi removing my appendix.
bio mom (6eac50) — 8/15/2009 @ 8:10 amThe french system is very similar to Medicare plus Medicare Advantage, which of course Obama equally hates because it demonstrates that no matter how much we spend on Medicare it remains insufficient to cover the medical costs of the hospital or the doctor and office seeing patients.
luagha (c03f69) — 8/15/2009 @ 8:11 amSave the Constitution! No socialized medicine!
Stop Medicare now! Stop Social Security now!
http://www.eschatonblog.com/2009/08/larry-odonnell-interviews-nathan-thurm.html
Dodson Truckk (0f1092) — 8/15/2009 @ 8:52 amPlenty of money in that part of town for gold teeth, expensive wheels and tires, new cell phones, ipods, drugs, booze, and bullets. But nobody can spend $100/month for major medical. So, the rest of the county gets to subsidize lifestyles by paying their freight.
How about a massive tax on phat tires and gold grills and a rebate on individual plans? Nawww, that’s crazy.
Houston Native (731363) — 8/15/2009 @ 8:59 amFrench drink more wine, eat more cholesterol, consume smaller portions, have more sex and get more exercise.
That is my Health Care Plan for America.
HeavenSent (01a566) — 8/15/2009 @ 9:04 am#13, Dead on.
HeavenSent (01a566) — 8/15/2009 @ 9:04 amI want my doctor to make a lot of money. I want her to have to compete with other doctors who make a lot of money. Thus will I be able to choose from an array of talented individuals with a motivation to be the best.
Aside from that, and aside from the education and responsibilities doctors have, many are small business people, with staff and large overhead. I have no idea what a nice clean medical suite of rooms runs to rent, but it must be high, and the cost of necessary equipment, including plain old office equipment, must be high also.
My aunt is a retired physician, she told me out of a month, her actual income was 3 days worth, so she worked the first 27 days for staff and other overhead. I use 27 because on weekends there were still hospital rounds, emergencies, and so forth. Few days off for a pediatrician – she had to arrange somebody to cover for her, and then had to cover for them to return the favor.
jodetoad (059c35) — 8/15/2009 @ 9:09 amquel surprise… doctors want to reserve the right to make a shit load of cash
Oh… so I don’t do my share? When lawyers agree to see 50% of their clients for little or no reimbursement (roughly my ER’s percentage of self-pay and medicaid), I’ll listen to your sanctimonious crap.
Until then, you can get stuffed.
TheNewGuy (114368) — 8/15/2009 @ 9:19 amUnlike with Medicare, there are no deductibles, just modest co-payments that are dismissed for the chronically ill. Additionally, almost all French buy supplemental insurance, similar to Medigap, which reduces their out-of-pocket costs and covers extra expenses such as private hospital rooms, eyeglasses, and dental care.
This is the only serious error I see in that piece. Like Medicare, the health plans (and they are multiple) pay about 70% of the charges. The patient is responsible for the rest. They all buy private co-insurance, like the MediGap policies that pay the 20% that Medicare does not pay. The poor in France get a government plan that pays the 20% but they have to reapply every year.
The French system is unlike Medicare in that it is administered by private boards that include doctors, unions, employers and private citizens.
Also, the patient pays the doctor FIRST, then gets reimbursed by the plan. That reduces the moral hazard of free care.
I do agree with the provision for 100% coverage of severe chronic illness, however, you should note that the 100% payment applies only to the severe disease. If a cancer patient gets appendicitis, the old rules apply to the appendix.
I think the most important factor in the success of the French system to hold the line on cost is the fact that the health plan pays a fixed amount. The doctor and patient may then settle on a higher payment as a private transaction. I can go to the most expensive doctor in town but the health plan pays the same amount as if I went to the new doctor who accepts the fee schedule as payment in full. The extra cost is paid by the patient.
The Democrats, like all socialists, are trying to replace the free market with a command economy, figuring out every payment for every possible transaction. It didn’t work in the USSR and it isn’t working in Canada which has seen an explosion in new private clinics that are technically illegal.
The comment by the leftist anti-doctor zealot shows only ignorance. A nurse practitioner can make the same amount as a GP now in this country. My niece, who had two degrees from U of I and Loyola chose nursing school in Chicago because she didn’t want the debt and could make almost as much right from the start. She is an OR nurse at Rush right now.
Plus her rock band is doing pretty well and she wouldn’t have the time as a doctor. She’s the third from left in the group photo and the cover art is a photo of her apartment on the north side.
Mike K (addb13) — 8/15/2009 @ 9:23 amI didn’t realize it but their new album has her picture as cover art. If any of you have surgery at Rush in Chicago, look for the red haired OR nurse and know she could have been a doctor with a lot less free time.
Mike K (addb13) — 8/15/2009 @ 9:29 amMark – How does the French government pay for all those magnificent benefits again?
daleyrocks (718861) — 8/15/2009 @ 10:04 amOne concern I have with government health care is that it might be given to the wrong people.
Why should we provide health care to convicted murderers, rapists, child molesters, terrorists, and domestic violence?
Michael Ejercito (833607) — 8/15/2009 @ 10:13 amdaley, the French system is, in theory, funded from payroll deductions. In recent years, with the poor performance of the French economy, they have gone to more tax money but I believe our economy could fund such a program from premiums and payroll deductions.
Mike K (addb13) — 8/15/2009 @ 10:30 amMike – I’ve not only heard of the 1900’s, I’ve actually seen them – quite a talented group, hope they stick with it until they receive wider notice. Small world.
Dmac (e6d1c2) — 8/15/2009 @ 12:25 pmMike K – I was talking about medical school tuition for doctors, social security tax for doctors, health care for the unemployed, etc. Doesn’t it all essentially come from taxpayers? What kind of taxes to the French pay, Mike, including payroll taxes? It also sounds like the tort system is considerably different there with the government in charge of health care – no jackpot justice for the lawyers suing doctors and thus lower malpractice insurance costs.
daleyrocks (718861) — 8/15/2009 @ 12:38 pmI do agree with the provision for 100% coverage of severe chronic illness
But does that mean a person in France with the personal wealth of, say, Warren Buffett (to name but one very famous limousine liberal in America) and who is stricken with, for example, cancer will receive medical care no less fully subsidized than that which is given to a working-class stiff? If so, that alone would place great pressure on covering the costs of the system by the healthy due to the condition of the ill.
Between that and the average French doctor’s net income being only $55,000 per year are a form of egalitarianism run amok.
If the guy in the White House (and his fellow “leftys”) had more than a grain of common sense, they would be carefully, cautiously weighing both the pros and cons of the medical system in France and elsewhere. Instead, they’re just closing their eyes and saying “America, your healthcare system stinks and anything else, whether it’s in Europe, Canada or, hell, even Cuba, would be better by comparison!!”
How does the French government pay for all those magnificent benefits again?
As I was trying to understand the differences between taxes here and taxes there, I came upon some related data regarding corporate tax rates in America.
“Leftys” throughout America who undoubtedly believe most people in Europe are at least getting something back (something wonderful!) for their big tax burden, also undoubtedly believe, that by contrast, corporate America — Big Business! — has been getting away with too much for too little.
Mark (411533) — 8/15/2009 @ 3:58 pm#24
I’ve wondered about that myself, Daley.
Key French Social Security Figures is published by the French government. As of 1-1-07 French employers pay 12.8% of payroll and the employee pays .75% for a total of 13.55% for the government provided Health Insurance (P.6) I assume the employee picks up 100% of the cost of supplemental private insurance. I haven’t yet found anything good in English on their income tax.
Stu707 (0981d5) — 8/15/2009 @ 4:56 pmI appreciate Mike K for pointing out through the months the matter of the healthcare system in France. It’s made me do some homework, which will come in handy when I’m discussing the current controversy of ObamaCare with others, particularly “leftys” and unsure or non-committal conservatives (not to mention so-called centrists).
I’d have more confidence if the people setting public debate on healthcare reform were those on the front lines of the medical field (such as Mike K) and no-punches-pulled realists like the person below—from the libertarian Cato Institute. Not the clowns of the left, including the ones in the White House and those hosting forums like flaky Sheila Jackson Lee.
I think anyone with at least a bit of logic will admit a close review of the healthcare system in the US and elsewhere reveals both strong and weak spots. That should give anyone pause, certainly enough to realize that the rushed pace being promoted by Obama and others is a sign of flat-out foolishness and outright irresponsibility.
Mark (411533) — 8/15/2009 @ 6:59 pmMike K – I was talking about medical school tuition for doctors, social security tax for doctors, health care for the unemployed, etc. Doesn’t it all essentially come from taxpayers? What kind of taxes to the French pay, Mike, including payroll taxes?
The French are heavily taxed although, if Obama has his way, we will be taxed at similar rates with a far less satisfactory health care system. The French system also includes Workers Comp, which was costing California $25 billion a year five years ago before reforms were passed. The NHS does NOT cover workers comp in UK which is a separate system. I thought that was pretty interesting. The unions would not give that up in 1948.
Another consideration for doctors is that those who accept the fee schedule as full payment (with 20% copay) get pension benefits as well. A friend of mine, chairman of surgery at UCI ten years ago, told me he could get a surgical junior faculty member, with board certification and a subspecialty fellowship, for $60,000 a year. There is a lot of misinformation about how much money US doctors make. Most of us start out fairly low in the scale, and improve as the time goes by. However, the new docs with heavy medical school debts are burdened for at least ten years. I”m not saying the French system could be imported here as is. All I’m saying is that it is a model, working pretty well in a large country for 60 years, that we could use to design something that would be better than we have.
Remember, I am also concerned with the coming bankruptcy of Medicare, about which you will hear nary a peep from the left. There are really two major issues.
One is cost control in Medicare without overt rationing. The other is the issue of transportable insurance for the younger working population. I have a post today on an ingenious proposal. That we are allowed to buy insurance that guarantees future insurability. I have life insurance that guarantees premiums if I am disabled. Health insurance should be flexible enough to do something like this if the ignoramuses in Obama’s government would get out of the way.
Mike K (addb13) — 8/15/2009 @ 7:28 pmIf you want to reform healthcare it’s very simple.
pitchforksntorches (8165c3) — 8/16/2009 @ 5:30 am1) Provide outright grants to those who qualify and agree to 10 years of service as a GP/OB/Pediatric without geographic restriction. Their tax rate on their subsequent salary however, would be much lower if they practiced in areas of need.
2) Provide funding to Each county to operate/build a County Hospital. These hospitals would be required to service Medicare/Medicaid patients (Which has been structured to permit working people to pay a very low premium in order to be covered) and be Certified By a recognized body as JACHO.Pts would NOT be required to go to their county hospital if they could pay for comparable service in a for-profit or find the service in a neighboring County facility.
3) Since the County Hospital is funded by the Federal Government,Regulated by the State and administered by the county, the county is responsible for providing a set of clinics: Family, OB-GYN and pediatrics which would keep it’s ER Clear for real emergencies. DRs & ARNPs providing care and favorable outcomes (ie working to keep people healthy in addition to treating the acute illness) would still be private practitioners who not only get to bill at Medicare/Medicaid rates, but additionally receive tax reductions for providing service at these clinics.Our “Grant” MDs could ‘burn down” their obligation time by 1/3 if they work these clinics exclusively as well as being tax-free (on their income)for that period of service.
Revenues for this program are provided by a national 1% sales tax.
People without health insurance will be covered by a system of county hospitals across the country.
Each county hospital will bring it’s own talent to bear. Innovation will be encouraged for those innovations that provide superior outcomes.
Pitchforks,
corwin (1a9dbe) — 8/16/2009 @ 2:52 pmIt’s not that easy. First, anyonewho has worked at a County/VA knows alcohol abuse sucks up huge amounts. Ditto,HIV. I do think routine care can be done more cheaply, but the VA already does a good job on HTN, Cholesterol, having patients take aspirin. It’s diagnosing and treating something tough where it fails.And, Mike K, speaking of misinformation , I called a cousin (ortho ) and asked to borrow $ after I learned he got 50 K/amputation.(He,alas, thinks he’s only getting $900.) I listened to a monolog about how he’d like to change his vote . I consoled him by reminding of the 57states and speaking the fact the Pres speaks Austrian , but he was determined to be glum . He closed with, “God help us;what if Biden’s the intelligent one?”
Corwin,
pitchforksntorches (8165c3) — 8/16/2009 @ 7:02 pmI do work at a VA. We do a lot more than Substance abuse. Yes, psych takes a lot of resources. Then again the majority of the population won’t need PTSD or TBI (Traumatic Brain Injury) counseling/care.
A major drag on the VA system are the MDs who have no incentive to produce. Hourly MDs are just a bad idea.
Modifying Medicare to permit it to be ‘bought’ would add funds to the program (Your medicare premium would be based on a sliding scale)
With my example, if your cousin was working in an under served area, and he worked sometime in a county clinic, his income tax would be reduced providing some relief.
I neglected to include significant tort reform in order to relieve the system from the Lottery mentality in malpractice.