wnyc.org / 93.9fm / am 820

Re: Comment #9.

I don't have a medical background, but I definitely agree that health care reform has to include cutting medical school tuition because the debt load future doctors are asked to take on is disgraceful. In fact, the debt load all U.S. students at any level--grad or undergrad--have to take on to obtain a decent education is disgraceful. You shouldn't have to start your career so far in debt. Americans need to wake up and fund their public schools with more tax money. The global economy demands it.

Re: comment #22. I suspect the reason the student debt issue comes up in health care reform debates is that a shift away from private health insurance would probably mean a reduction in doctor's pay (no links to offer here, but I'm pretty sure European doctors make nowhere near what American doctors do), so it's a legitimate concern that the debt load must be taken care of if salaries drop.

(Also re comment #22: Only a small number of lawyers make the outrageous sums of money that make the news.)

I agree with Shari above. Let's also evaluate the compensation of the Hospital CEOs. When did this profession become so lucrative? I presume many have transitioned from the companies which have let mismanaged and feel they deserve the same pay. A local example is NorthShore LIJ system, it has become big business with 15 hospitals, even operates a business subsidiary.

After waiting 4 months, yesterday I took my child to see an "in-network" specialist. The office staff tried very hard to get us to leave because our new insurance card from a very large insurance company had not arrived in the mail yet. A call from the insurance company identifing us as being insured by them, while we were in the office, did not even suffice. Ultimately, they let us in but only after they put a $600 office visit charge on my Amex card. There are just so many problems here. How much is reasonable for an office visit? What is the negotiated rate between the Dr. and the large insurance company? Does the uninsured - even temporarily - fund the difference? What is the "customary and reasonable" charge for this visit? Any amount above that "allowable" amount does not get paid for and does not go against the annual deductible. Why don't we know all of this information ahead of time? How could a person without good insurance or any insurance even see this Dr.? In this day and age carrying that plastic card really makes a big difference.

As a physician, I find this whole discussion disheartening. The public has little concept of the stresses now upon the medical profession and health care system, but is quick to blame only the doctors. The physician community is not solely to blame for the current state of affairs, but it has become the unfortunate scapegoat as we are the front line - the proverbial messengers. As Dr. Rohack states, physicians - the front line in this fight - have suggested numerous opportunities by which we can cut costs. However, we cannot do it alone, as there are many other parties involved. Until all of those involved parties, including the public (yes, the public, too, has a role in this mess), pharmaceutical companies, malpractice attorneys, insurance companies, durable goods companies, medical manufacturers, independant laboratories, nursing and rehabilitation facilities, and hospitals are willing to take an honest account of their individual culpability, reform is going nowhere. The changes that need to be made are not going to be pleasant for anyone concerned, but the President's attempt is a solid step in the right direction. At least the responsible parties are talking, and that's more than we've had in the past.

I hear doctors talk about the expenses of their education, and their malpractice insurance, but I wonder if it's a bit disingenuous for them to suggest that they aren't well-enough compensated. Your guest said physicians often come out of college with $160,000 in debt. But do we know any doctors who are living a lower class lifestyle because their salaries aren't adequate to pay off that debt? Aren't doctors usually living in great homes, in great neighborhoods, able to travel, have luxery cars, etc. They seem to get a good return on their education investment, whereas someone can easily wrack up $100k+ in college debt these days, depending on where they go to school, getting a Ph.D. in English Lit or Philosophy, for instance, which have much less probability of providing other than a modest living.
Aren't doctors, like lawyers and CEOs, in one of those professions where the compensation has increased exponentially over the past few decades to many times more than it used to be -- much more than professions that used to pay comparably? Perhaps doctors need to lower their expectations a bit. What they do is very important, involves a lot of pressure, and takes a lot of skill. But so does teaching, or being a NYC cop.
It would be interesting to examine wage inflation in medicine as we have for CEOs: How many times more than their average patient does a doctor earn?

As a radiologist, I would contend that there is not a shortage of money in the health care system. What you have is layer upon layer of third party companies who are all for profit, and offer various services to the insurance companies to lower their costs, either through claim adjudication, scheduling, authorizations. These companies are largely invisible to the patient population and exist solely for profit, siphoning off money from the reimbursement schedules. In radiology every month brings another company that gets paid a "booking fee" for scheduling an MRI or CT scan a participating facility. While the disdain in Brian's voice was apparant when he mentioned radiology or dermatology, he failed to mention that for a radiologist to go into practice requires purchasing approxiamtely 2 million dollars worth of equipment. To answer the question of what doctors are giving back, we are the only sector that has a consistent decrease in payments year after year, despite escalations in rent and overhead. As an aside how come nobody is talking about taking 3% of attorneys income to pay for the legal aid system?

why not charge the doctors so much for a license to practice a specialty that they cannot afford it and so they HAVE to provide primary care?

Doctor david from the lower east side is exactly right.

It will never happen because congress has been bought off. How sad. Down we go.

We want, WE WANT, single payer quality healthcare.

Follow the money! Not for profit NATIONAL health care would cost TRILLIONS less every week! The large sucking sound are the TRILLIONS sucked away in obcene profits by so called health insurance companies every hour of every day. They insure profit not health.
People using ER's as clinics because they have to and the unmitigated disaster called the drug war.
Addiction treatment alone would reduce prison pop by 80%. How much money is that?
Wake up and get serious. Not for Profit National health system that covers every one NOT connected to their employment. IS the only way to save our rapidly sinking health ship.
USA should have had not for profit corporation health care from the start. How many billions have so called health insurance companies sucked OUT of the system since 1950?

Paid out in dividends? Paid to bloated CEO's? paid in excessive redundant "overhead"...and how many Americans could not see a doctor or afford medication because of money since 1950? Do the math. Follow the money!!!!

Duh!!!

Why is healthcare a for-profit industry? Why are insurance companies in the equation, making money off the talents of doctors and illness of patients?

The AMA has historically been opposed to autonomous practice of other health care providers.

It's great that this guest supports evidence based practice. What about cases where there is no conclusive evidence directing practice?
When there is strong evidence, great, but do we want to be treated in a cookie-cutter fashion by an automaton physician?

The whole healthcare discussion is about jumping through hoops. The way to get costs to reasonable levels is to eliminate insurance PROFIT.

What a laugh. The Bush years and self-regulation are the twin gushers for thousands of American Medical Millionaires -- including so many doctors and other health practitioners. The end.

PS -- keep wearing those post- and pre-op scrubs at the supermarket and see what happens!

I am SO tired of doctors blaming patients for their malpractice costs, and asking for "protection from the courts." When doctors make mistakes in patient care, patients must have resourse to protect themselves - they are at the mercy of doctors, on whom they depend for their health. And they make plenty of mistakes. They must be accountable. Blame the insurance companies who raise rates for everything, insteadof doing their job by covering claims.

What about patient protection? How effective and independent are State Health departments in investigating hospital and physician errors. Seems to be closed end system where the providers aren't disclosing to the patient and the public errors.

Addressing the question of MD debt burden the simple way to correct this on-going problem that virtually all newly minted MD's struggle with, is for the US government to pay for ALL medical students' education with an expectation of a two year service contract in return.
Everyone benefits

As a current medical student looking to go into a primary care specialty, the debt load after graduation is staggering and there is general fear among many students that we won't be able to pay back out loans. There is a federal program, National Health Service Corps that will pay for medical school in exchange for years of service and also a debt forgiveness program. I think we need to fund this program more to provide an incentive for talented physicians to go into primary care specialties.

How about getting some transparency for real health care costs? My insurance premiums were going up last month and I was trying to find out if I should switch to a cheaper plan with high premiums, but my doctor's office couldn't even tell me how much it would cost to just walk through the door. Finally, I got an estimate of "between $72 and $355. You'll find out when you get the bill." Is there ANY other service where the provider won't tell you what they charge beforehand?

To thonk that the medical profession and the pharmas are going to regulate themselves is absurd. It didn't work with the financial institutions and won't work here. We need strict legislation for government regulation and oversight.

Squeezing doctors to lower costs seems like a terrible idea. Excess procedures from fear of litigation is the number one unnecessary cost from doctors, and there is no way they will stop this practice without protection from lawsuits.

Evidence-Based medicine guidelines are too influenced by Big Pharma. Meta-analyses obscure the sources of the research and especially what isn't being studied. The culture of medicine is corrupt and the AMA isn't offering anything to sever medical-commercial connections.

What are the implications for "non-standard" care? e.g., Chiropractic? Will these be "left in the dust"?

Don’t be fooled by this offer from the medical industrial complex. For-profit insurance companies make money by charging the maximum and giving back the minimum - that’s how you make a profit.

Imagine if the fire department were for profit. “I’m sorry, we can’t respond to your call – that kind of fire isn’t covered under your policy.”

Everyone is so fed up with our expensive and malfunctioning health system that these corporations are afraid their cash cow will be taken away. They probably can’t even buy the votes they need to quash equitable not-for-profit health this time. They’re running scared.

How about flooding the market with foreign doctors and break the AMA cartel?

Can you ask the guest about the role of nurse practitioners in reducing expenditures and improving quality of care?

What is the AMA opinion of no-fault malpractice insurance?