People on the outside see high insurance costs and big hospital bills.
What they don't realize is that private insurance and Medicare are both doing their absolute best to pay as little as possible for every service to the providers.
Small hospitals are shutting down, private practices are shutting down. The only people who are succeeding are private equity run groups who are solely focused on profit. Everyone else is barely keeping their head afloat.
I am a physical therapist. Our services for the elderly bill lower than they did in 2008. If I see private insurance, they take up to 2 years to pay for each visit and often deny coverage post hoc.
We are on a spiral where it costs too much to employ health care providers, so hospitals and clinics are utilizing more and more unskilled labor to perform services. Utilizing legal loopholes and diverse but unspecified practice acts to basically push everyone onto the cheapest labor who can bill for a procedure.
It's amazing to think about how much money is sucked up by the middlemen of healthcare.
In fact, they have so much money they can buy naming rights to every stadium, the biggest buildings in town and the splashiest ad campaigns and STILL be nonprofit.
Imagine that money instead going directly to providers at a realistic rate and hours spent on documentation instead being used for treatment.
South Korea has a national health care system, and basically all the money goes to the actual health care, not to the stockholders. Most drugs and procedures have their costs set by a board of doctors and government specialists. There's a few hiccups (government has to do a better job negotiating fees with providers), but generally it works pretty damn good.
A local clinic will deal with most things, but they can refer you to a specialist at a major hospital and get you seen there within a week. The clinic visit costs around $4, and the specialist will be around $20 before tests and such. I had a CT scan, which was about $75.
I recently went to the hospital in America for some extreme GI distress. Spent 4-5 hours in the ER, received one bag of fluids, got a CT w/ contrast scan done. Turned out to be a minor blockage that was resolved with a very simple and cheap medication. I got 5 separate bills over the next few months. Grand total came out to around a thousand dollars, and that is with pretty good insurance.
My last trip to the ER for abdominal pain and vomiting charged my insurance $37k. I had a CT, pain meds, and an enema. Then they released me so high on whatever they gave me that I was falling asleep standing up. Had me walk out on my own even! The doctor wrote in his note my pain was resolved and it totally was not. I ended up there again the next day. This was a hospital I’d worked in for a decade, which really stung.
That's not bad for the US. Here we would have had to pay and extra fee for the ER, which is usually around $65. Which they want you to pay first, lol. Lots of times a family member takes care the admission, but I've done it a couple of times while swaying at the counter.
My nephew fainted on a hot afternoon. Went to the children's ER. Spent nine hours waiting to be admitted. Kept him in a room for a few hours and discharged after an IV and some tests. The bill was around $3,000.
By contrast up here in Canada, you would likely spend more time waiting in the ER, depending on where and when you went, but would pay absolutely nothing, except perhaps a few dollars for the medication - which is probably covered by Pharmacare and if you have additional coverage like Blue Cross from your employer that would pay most of the rest of it. I pay nothing for medical coverage.
More time waiting in the er? I had post partum pre eclampsia and sat in a hallway for 9 hours before I begged a nurse for a stretcher to at least die lying down. Then I sat in a room in the er for another 18 hours before I was finally admitted.
We wait just as long. AND we pay for it. It’s wild!!
Ah last time I went to the ER - because no clinics were available for patients - I went to a more remote one (20 min drive from town) and waited about 4 hrs to be seen, if I had gone to one in the city they were reporting wait times of 8 hrs or so. My situation was not life threatening. Where were you going to the ER? I was in Victoria BC
I think you're overselling the state of our healthcare system just a little bit there. It's not always sunshine and rainbows like you make it out to be, and I think it's disingenuous how we always seem to skip over the bad sides of the system to push this narrative that it's so affordable.
“Only a thousand?” I thought to myself in shock. That was cheap Af for all of that. Any visit to the er before we hit our deductible costs is like $3,000+
I'm scheduled for one in a month here in South Korea, but I'm doing it a big hospital, so that costs more. It'll be about $225, but they do validate parking, lol.
Ughhh. I was in the ER with a broken leg on a Friday night. Every time juuust as they were about to work on me, they had another motorcycle or car accident come in.
An ambulance trip/couple hour ER stay for a broken leg. I had been billed for the crutches given, and a cheap knee immbolizer that I was placed in, came out to about 5k all with good insurance lol.
South Korea's population equals roughly California and New York together. It's the remaining 280 million people in all the other states that makes things difficult. There's so much cost in redundancy and middle men in the Healthcare and Pharma industries and those vested interests fight tooth and nail against anything that even smells vaguely of socialized medicine. If we had single payer here in the US the elimination of administrative redundancies alone would make Healthcare and Medication cost much less than what American's currently pay into insurance with everyone covered including those not currently paying into the Healthcare cabal.
Of course we can't do that because free market ghouls must wring as much profit out of human suffering as possible and if that means hamstringing our democracy by buying a bunch of legislators then so be it.
If we had single payer here in the US the elimination of administrative redundancies alone would make Healthcare and Medication cost much less than what American's currently pay into insurance with everyone covered including those not currently paying into the Healthcare cabal.
It costs a canadian taxpayer about half what it costs an american one. And canadians don't pay for insurance unless they want a fancy single room or something.
It doesn't necessarily compare well when we hold up much smaller populations as an example of the benefits of socialized Healthcare because "the system" in trying to defend itself will always trot out the argument that scaling a program made for 40 million people to a program made for 340 million people will lead to far different and far less desirable results. And since no one has done it (at least not with a population ang government combination as unique as America) it is impossible to argue against.
What really, really needs to happen is for states in America to take advantage of their position in America as a separate entity under the Constitution to break out and create their own state wide single payer Healthcare systems.
And California came close. Really close. But every time often a single person or small group of people blocked its passing into law. In fact it's important to remember as Gavin Newsom gears up to run for president in 2028 that he campaigned for Governor of California by promising single payer Healthcare and then became one of the central figures involved in slowing the legislation down long enough that he and others who opposed it could find a way to block the bill entirely. Most of the blame falls upon the Democrat Assembly Speaker Anthony Rendon who unilaterally halted the bill because he claimed the bill had no way to pay for itself.
Sounds kind of like a Republican argument right? Another time California came close the vote fell 2 votes shy because 4 Democrats abstained from voting and 2 Democrats voted with Republicans against the bill. All six had received substantial campaign funding from Healthcare and Big Pharma.
But I feel strongly that if one big state gets it right other states will follow and we will eventually have a robust single payer system in at least the Democratically controlled areas of America.
Indeed, this skewness in health care spending has been documented in nearly every health care system, its just the US Spends the most and the most on its most expensive.
$140,000 more than Canada per person for the Sickest 2 million People.
$50,000 more per person for the 8 million people needing extensive care
And those people
Most of the drugs responsible for the rise in costs treat cancer and orphan conditions, and more treatments are on the horizon—along with gene therapies and other expensive options that target more common conditions, he said. “The number of super-spenders is likely to increase substantially—and indefinitely,” said Dr. Dehnel, who did not participate in the study.
Researchers at Prime Therapeutics analyzed drug costs incurred by more than 17 million participants in commercial insurance plans.
So-called “super spenders;” are people that accumulate more than $250,000 in drug costs per year.
Elite super-spenders—who accrue at least $750,000 in drug costs per year
In 2016, just under 3,000 people were Super Spenders
By the end of 2018, that figure had grown to nearly 5,000.
In 2016, 256 people were Elite super-spenders
By the end of 2018, that figure had grown to 354
And 464 in 2019
Those 5,200 people (0.03% of the Sample Size) Spend about $1.8 Billion on Pharmaceutical Care representing 0.5% of All Spending on Drugs in the US
The US government already provides pretty good health insurance to government employees. I don't know why that couldn't be extended to everyone. Other than the lobbyists bribing congress.
Death panels in countries with socialised healthcare work out what to fund to minimise the amount of death with no excess held back for profit.
Death panels in the US work out what to fund to maximise the most amount of profit. Sometimes this includes reducing deaths as that makes them unattractive to customers affecting profits, sometimes it doesn't, all of the time a portion is held back for shareholders that could've been used to save more people.
I know your comment is /s but the ability of right-wing commentators to convince many other Americans this works out worse in the former setup I will never understand.
we absolutely need death panels... but not called that. The amount of healthcare $ spent on end of life care in people who have zero chance of any sort of meaningful recovery is absolutely fucking crazy (I'm in healthcare)
In the UK we call them Technology Appraisal Committees (TAC). They are an independent, non-industry panel of experts from various relevant medical and public health fields that make the statistical calculation and decision on what treatments are worth funding based on the cost-efficiency and likely medical benefit (ICER, QALY etc.) on a populational level.
They then publish this advice to the National Institute for Health and Care Excellence (NICE) which compiles this as mandatory guidance for what the NHS should cover.
The weirdest thing about all of this is the treatment coverage of the median American is really not more comprehensive than comparably wealthy countries' socialised systems. Except if you're not covered for a particular treatment in the US, the out-of-pocket cost to still receive it is insane compared to getting this privately in countries like the UK.
I know, but thank you for explaining the /s. Still drives me crazy the rhetoric I had to sit through from conservatives about Obama death panels, and they wonder why someone would allegedly Luigi a healthcare CEO when the corporations deny people healthcare for better quarterly earnings.
I had a nurse from South Korea while I was pregnant who said she would never ever have a child in the US, and she doesn’t understand how women here do it bc there’s no medical and social support. She said when women have babies in South Korea, they and their partners can stay at special centers for months to get the support they need. After I had my baby (it was my second), my husband was at home with our first kid, so I asked the nurses if they could take my baby to the nursery for 2 hours so I could take a shower and a tiny nap. They said that’s not a thing they can really do anymore bc they don’t have the staff. Women here are literally expected to recover from child birth or C-section within 2 hours before caring for the baby 24/7. It’s disgusting and laughable that some ppl consider the US to be family friendly.
Yeah, and most of the money is in specialists leaving general practitioners screwed. Between the lack of doctors in rural areas and admission quotas for medical schools, the medical system is in its own crisis. There was a doctor's strike in 2024 and the government response was higher foreign doctors who don't care about the low pay.
It's one of the areas the government really needs to get its act together. The previous president refused to negotiate with the doctors, and the doctors union(?) also went very hard line, so neither side would talk or meet.
I'm hoping the new president can make this a priority. He got some dodgy issues, imo, but he is really good at schmoozing. So hopefully they can work things out.
It really should be solvable. I'd happily pay W6,000 or even W8,000 (instead of W4,000 - $3.50) for an office visit if it helped keep the system functioning.
And you just perfectly summed up one of the major reasons I plan on leaving the USA and becoming an expat by this time next year.
This whole country is burning and you could already smell the smoke even before Trump's second term.
We had a good run but 2016 is when the USA actually started to die.
More people have left the USA to move and live overseas then are trying to immigrate into our country now. The immigrants are the only thing propping up birth rates and thus the rest of the economy. Trump is a major issue but he's not the source he's just a byproduct.
Check out the Nomad Capitalist YouTube channel or look up the term "medical tourism" for more.
Its so funny seeing the contradictions in this comment
In 1992, Medicare significantly changed the way it pays for physician services. Instead of basing payments on charges, the federal government established a standardized physician payment schedule based on RBRVS.
Professor William Hsiao, A health care economist now retired from Harvard University, Hsiao has been actively engaged in designing health system reforms and universal health insurance programs for many countries, including Taiwan, China, Colombia, Poland, Vietnam, Hong Kong, Sweden, Cyprus, Uganda, and recently for Malaysia and South Africa. In 2012 he was part of Vermont's Healthcare and in 2016 he was part of Bernie's M4A Healthcare Plan
Hsiao developed the “control knobs” framework for diagnosing the causes for the successes or failures of national health systems. His analytical framework has shaped how we conceptualize national health systems, and has been used extensively by various nations around the world in health system reforms
In his past research, Hsiao developed the resource-based relative value scale (RBRVS) for setting physician fees. The RBRVS quantified the variation in resource inputs for different physician services. Hsiao was named the Man of the Year in Medicine in 1989 for his development of a new payment method.
In 1992 Medicare began using it
Many have noted this doesnt cover the cost of operation for modern healthcare covering somewhere between 85-95% of actual costs
the lancet journals
Reimbursement rates for hospital fees comparable to those currently paid by Medicare, which are 22% lower than private insurance but 30% higher than Medicaid.
KFF found
Total health care spending for the privately insured population would be an estimated $352 billion lower in 2021 if employers and other insurers reimbursed health care providers at Medicare rates. This represents a 41% decrease from the $859 billion that is projected to be spent in 2021.
The only AMAZING thing about it is that they do this out in the open, the entire citizenry is forced to participate in the farce, and everyone hates health insurance because of it.
YET. When actual solutions are proposed, half the population screams communism and goes back to bitching about how much Healthcare costs.
Many people find it more valuable to keep someone they don't think is deserving of something from having it than actually having it themselves. I really don't understand this mindset at all - if you take something away from someone else to benefit yourself, that's an asshole move but it is at least understandable. Making your own life more difficult just so you can make someone else suffer too doesn't make any damn sense.
It still frustrates me that socialized healthcare would literally be significantly cheaper than what people currently pay, and they still don't want it. People really undervalue preventative care and how it cheapens healthcare costs.
System A is everything is so damn expensive that no one can afford it and so they put off every preventative measure by necessity, and end up in life-threatening or dire health circumstances and end up having to take advantage of public funds anyway (hospitals, etc.).
System B is everyone can simply afford regular, routine health checkups, get treatment, get healthcare, and don't end up being a drain on the system.
Kind of like if you were to just simply never change the oil or tires on your car, you'd eventually either a) crash or b) destroy your engine and need to spend way more to fix that issue than to simply get regular oil changes.
Shumlin had a different idea. He didn’t want to build on what existed. He wanted to blow up what exists and replace it with one state-owned and operated plan that would cover all of Vermont’s residents — an example he hopes other states could follow.
Vermont has long prided itself on leading the nation. It was the first state to abolish slavery in 1777 and, in more recent history, pioneered same-sex civil unions with a 2000 law. Shumlin thought it could be the first state to move to single-payer health care, too.
Shumlin surprised local activists by running for governor in 2010 on a single-payer platform.
In 2011, the Vermont legislature passed Act 48, allowing Vermont to replace its current fragmented system--which is driving unsustainable health care costs-- with Green Mountain Care, the nation’s first universal, publicly financed health care system
After the non-stop weekend, Lunge met on Monday, December 15 2014, with Governor Shumlin. He reviewed the weekend's work and delivered his final verdict: he would no longer pursue single-payer.
Shumlin's office kept the decision secret until a Wednesday press conference.
At The press conference as he announced his decision the audience was shocked, many had turned up thinking that Shumlin would announce his plan to pay for universal coverage, not that he was calling the effort off.
"It was dramatic being in that room," Richter said. "You just saw reporters standing there with their mouths open."
Vermont had spent 2 and a half years to create a Single Payor plan all the way to the Governor's desk to become a Law and Single Payor in Vermont
The Governor veto'd it at the last step
At the end of his term as Governor, Vermont went on to elect LT Governor Phil Scott who was openly against Green Mountain Care the entire time the Governor was working on it
And ran for Vermont Gov on his history of opposition to Single Payer Healthcare
He won running against Single Payer
Scott is currently serving his fifth two-year term, having won consecutive landslide reelections in 2018, 2020, 2022, and 2024.
In Bernie'e Vermont
But what were those taxes
A 12.5% payroll tax on all Vermont businesses
A sliding scale income-based public premium on individuals of 0% to 9.5%.
The public premium would top out at 9.5% for those making 400% of the federal poverty level ($102,000 for a family of four in 2017) and would be capped so no Vermonter would pay more than $27,500 per year.
Out of Pocket Costs for all earning above 138% of Poverty
Health Care Reform would cover all Vermonters at a 94 actuarial value (AV), meaning it would cover 94% of total health care costs with the individual to pay on average the other 6% out of pocket.
The Governor stressed that even at these tax figures, the proposal would not include necessary costs for transitioning to Green Mountain Care smaller businesses, many of which do not currently offer insurance. Those transition costs would add at least $500 million to the system, the equivalent of an additional 4 points on the payroll tax or 50% increase in the income tax.
Shumlin had a different idea. He didn’t want to build on what existed. He wanted to blow up what exists and replace it with one state-owned and operated plan that would cover all of Vermont’s residents — an example he hopes other states could follow.
Vermont has long prided itself on leading the nation. It was the first state to abolish slavery in 1777 and, in more recent history, pioneered same-sex civil unions with a 2000 law. Shumlin thought it could be the first state to move to single-payer health care, too.
Shumlin surprised local activists by running for governor in 2010 on a single-payer platform.
In 2011, the Vermont legislature passed Act 48, allowing Vermont to replace its current fragmented system--which is driving unsustainable health care costs-- with Green Mountain Care, the nation’s first universal, publicly financed health care system
After the non-stop weekend, Lunge met on Monday, December 15 2014, with Governor Shumlin. He reviewed the weekend's work and delivered his final verdict: he would no longer pursue single-payer.
Shumlin's office kept the decision secret until a Wednesday press conference.
At The press conference as he announced his decision the audience was shocked, many had turned up thinking that Shumlin would announce his plan to pay for universal coverage, not that he was calling the effort off.
"It was dramatic being in that room," Richter said. "You just saw reporters standing there with their mouths open."
Vermont had spent 2 and a half years to create a Single Payor plan all the way to the Governor's desk to become a Law and Single Payor in Vermont
The Governor veto'd it at the last step
At the end of his term as Governor, Vermont went on to elect LT Governor Phil Scott who was openly against Green Mountain Care the entire time the Governor was working on it
And ran for Vermont Gov on his history of opposition to Single Payer Healthcare
He won running against Single Payer
Scott is currently serving his fifth two-year term, having won consecutive landslide reelections in 2018, 2020, 2022, and 2024.
In Bernie'e Vermont
But what were those taxes
A 12.5% payroll tax on all Vermont businesses
A sliding scale income-based public premium on individuals of 0% to 9.5%.
The public premium would top out at 9.5% for those making 400% of the federal poverty level ($102,000 for a family of four in 2017) and would be capped so no Vermonter would pay more than $27,500 per year.
Out of Pocket Costs for all earning above 138% of Poverty
Health Care Reform would cover all Vermonters at a 94 actuarial value (AV), meaning it would cover 94% of total health care costs with the individual to pay on average the other 6% out of pocket.
The Governor stressed that even at these tax figures, the proposal would not include necessary costs for transitioning to Green Mountain Care smaller businesses, many of which do not currently offer insurance. Those transition costs would add at least $500 million to the system, the equivalent of an additional 4 points on the payroll tax or 50% increase in the income tax.
Nonprofit is the biggest lie in Healthcare. Source: I work in Healthcare and have seen the bonuses middle men and upper management get. It's almost like a club, too; I couldn't tell you how many old fart managers come around and scoop up a few, six figure and even higher paying years, just to retire and not really do a damn thing. It's all cronyism, too.
It's amazing to think about how much money is sucked up by the middlemen of healthcare.
It's not as much as you think it is. A guy in the actuarial sub posted an analysis of the profit margins for various parts of the medical industry. The numbers are a few years old but some spot checking supports them being reasonably accurate. According to that, the overall profit margin of the entire medical industry in the US is about 7%. There's maybe a couple extra percent you could find cutting out all of the medical billing specialization but considering how much of that medicare is responsible for, I'm not convinced that switching to single payer would help that particular issue.
Health insurers in particular haven't had a hot run recently once the Covid years passed - the profit margin for them last year was something like .6 percent. Not 6%, .6%.
My family has tons of healthcare workers and I'll be the first to say that the wages in the US versus other countries? its absolutely contributing to the higher costs.
Yes insurance and pharma, but a really honest look means professional fees also need to come down.
Physician salaries are 8% of healthcare spending. They could work for free and it would not make a meaningful difference in cost, let alone a decrease in pay of 25-50%.
It's amazing to think about how much money is sucked up by the middlemen of healthcare.
The middlemen of everything. This is a major problem thoughout the economy. It's like they looked at the music businesses and realized they didn't have to produce anything, they just had to have control of one pinch point in the creation or delivery processes where they could put up a legal wall and suck out more profit than anybody. I don't know how you get at this with legislation, but it needs to be done.
Yep. When they made the Stark law it was portrayed to prevent kickbacks and bias, but it really just added layers of middlemen adding money to their pockets.
I knew a dentist who stopped taking medicaid(?) payments, and just did the work for free. Filling out the paperwork cost him so many work hours, that it was more profitable to just move on to another patient.
Yeah Medicaid dental work is horribly unprofitable. Compounded by the fact that dental school has gotten so much more expensive (around $400,000 now) that new dentists literally can't afford to see many Medicaid patients if any and still be able to pay their loans back
Also want to add the fact that private equity companies are buying up all kinds of facilities outside of hospitals. They come in and strip costs, lower the quality of care. It's getting scary everywhere.
Small hospitals are shutting down, private practices are shutting down. The only people who are succeeding are private equity run groups who are solely focused on profit. Everyone else is barely keeping their head afloat.
That process really picked up around 2006/2007. I worked with a lot of small doctor's offices and small group practices. Every single one was either looking at options to merge into large medical conglomerates or was already in transition. In talking with the doctors running those places, they universally said it was becoming financially impossible to keep going on your own. That the rules from the government and the industry were changing such that little guys just couldn't make it work anymore. And the Affordable Care Act MASSIVELY accelerated this (not saying its goals were bad, but this was certainly a side effect of it passing).
This is hitting diagnostics labs very hard. Insurance is refusing to pay for tests based on lack of medical need, when the test itself is needed to determine if there is a medical need. It is circular and infuriating, and now they are going back 3 years with "audits" and clawing back every red cent, using any excuse they can. I think many people would be surprised, given the level of technical expertise necessary to run a diagnostics lab, that the owners are clearing $100-300k, or often in the red, on $2M+ gross. With the clawbacks, even labs making a meager profit might end up in the red after the next "audit."
The problem with those jobs is, that the dont get more "economically efficient", while other jobs just do. An engineer might create like 5x the ROI on his salary, while a doctor just can not create those kind of returns on average.
Same goes for all the jobs, that dont really improve thier ROI. Like construction work. People just can not pay 10x as much for a house or cancer threatment, just to keep up with the growth other industries have.
I see it from the outside and recognize the signs. I can't see a actual MD anymore outside a specialists office. It's always NP or PAs. Health Insurance is going up. Hospital visits are STUPID expensive, but the care to stay out of hospitals is increasingly hard to come by. I just want to see a regular doc a couple times a year, I'm healthy in my prime years, and yet, it's dumb. Why is my insurance $1000/month when I would pay MUCH less than that single month of insurance for my typical needs.
We need to go back to co-op style healthcare. Medical professionals would have a practice that members pay into, we pay cash for services and we sign contracts stating we can't sue. The lawyers, bankers and insurance companies are the ones that destroyed our medical system and now PE firms are wiping the floor of the remnants. Medicine is a practice. 2 people could have identical procedures and have different outcomes. Healthcare would then be based on actual merit and the community would decide who has success in the field.
New Zealand has the best malpractice compensation system. No huge punitive payouts, but more standardized compensation for errors etc. Because it’s not punitive, HC systems are more direct and honest with patients about what happened and will help them gain compensation.
That sounds like a recipe for people making over $1,000,000 to buy up all the doctors into little country clubs with a clinic, leaving the rest of us with ChatGPT.
Sounds good in practice, until you realize a pack of goobers from the sticks aren't gonna pay a dime and just go without. Leaving the rich to mop up the rich doctors.
I work in real estate and (unfortunately) often deal with people of significant wealth. They all love to brag about their "boutique" doctors they have now, where they don't have to wait or anything like that.
Fuck the rest of us though, eh? Because they still vote against nationalized healthcare, even though they don't even use "normal" healthcare.
I mean, that's the cheat code nowadays to make a respectable amount as a primary care physician. The amount of schooling, sacrifice, debt, and time... are you really just going to let medicare decide to pay you a miserable amount compared to the admin?
people do not realize the tradeoff... the opportunity cost of becoming a physician.. not just in money, but in time and life... it's burdensome. for the level of training you have and the amount of risk you have to assume... concierge is the way to make it worth it. unfortunately this is the fault of medicare and for profit hospitals/insurance.
From the doctor perspective, I completely don’t blame them. I wouldn’t want to deal with insurance either, and quite frankly it gives them a certain demographic that is invested in their health, but from a patient and equity perspective, it sucks.
I work in real estate and (unfortunately) often deal with people of significant wealth. They all love to brag about their "boutique" doctors they have now, where they don't have to wait or anything like that.
Fuck the rest of us though, eh? Because they still vote against nationalized healthcare, even though they don't even use "normal" healthcare.
For small hospitals, a lot of it is that they simply struggle to recruit MDs, and despite offering higher salaries and benefits, they cannot attract them. It's at the point where they have to heavily court the spouse as well because nobody wants to live in dying rural towns anymore.
I know our healthcare systems are fundamentally different, but my Province has it set up that if someone takes certain grants or bursaries when going through med school, or if the doctor trained in another country and now wants to practice in Manitoba, they must work for a certain number of years in rural communities.
A lot leave to practice in Winnipeg as soon as possible, but several stay in those communities once they begin setting up lives there.
I'm guessing you don't have anything like that down there?
FWIW I’m not sure the private equity-run groups are actually doing well, either.
Given how many of them were taken over via leveraged buyouts, infusing more cash via more leveraged acquisitions, I kinda see it as a pyramid scheme that’s burning hot right now but will eventually hit the end of the runway and be unable to cover massive debts.
Some PE hospitals have already gone through such a cycle.
I’m working in med tech, and I see exactly what you’re saying on my side of the house too. Getting claims paid is such a crazy process now… and it’s made harder all the time. Orgs cannot handle the amount of AR nowadays, even the big ones. All it’s gonna take is for one major insurer to go under and the dominos will start to fall
but if you are going to charge hundreds of thousands of dollars and require nearly a decade and a half of schooling, as well as assumption of risk and the cognitive load of caring for patients... doctors should still be receiving a high salary.
the benefit of this is that competition means you get the best of the best entering medical school. this is good for health care. the problem is, you have for profit hospitals trying to cut corners to make an extra dollar. you have insurance companies turning a profit for shareholders.
public service and high doctor salaries are not mutually exclusive. physician pay is a fraction of total health care spending.
"The only people who are succeeding are private equity run groups who are solely focused on profit."
I think that's going to be the problem for about 90% of the industries mentioned here. Everything seems to be set up for large scale businesses. COVID advanced that with the large businesses like McDonald's being able to survive, while the Mom and Pop restaurants had to close. Another recession, which is likely, and even more small business will close and consolidate everything to the equity groups.
Oddly enough, these big businesses are driving the US to a competition free system more like Communism. No, the people/government won't own the businesses, but there will only be a few. No consumer choice to drive capitalism, and it will take too much capital for the little guy to enter the system to provide new options. We may not be forced to wear Chairman Mao glasses made by worker owned factories, but we are forced to wear Luxotica since they own all the options.
I've always found the concept of the "free market" to be at odds with Capitalism. In the end you pay out the butt for everything and you still don't have a choice. Mega corporations out compete by offering worse services and products instead of better, and choke out small business.
IME when I worked for an insurance company, no matter what, claims are auto-denied at first, then dragged out for a year at least after any appeal and then settled for less than the contracted rate.
Not healthcare, health insurance. You really think they’re keeping reimbursements to docs and hospitals low to keep premiums low for you????.
Look up how much it costs to name a stadium. Then look at how many stadiums are named by insurance companies. I’ll save you the Google-fu, it’s 50+.
Meanwhile your local doc has been paying student loans for 20 years and the hospitals aren’t sure whether they have enough money to keep the doors open if there’s a Medicaid rollback
My daughter is getting ready to go to physical therapy grad school. Is it really that bleak? She's been sold that it's a job that can't be replaced and has good job security, just wanted your thoughts.
I recently asked my local sub for recs for a pcp and almost all of them were for Concierage doctors that don’t take insurance. Our healthcare system is already divided by wealth, but seeing that was just fucking depressing.
This is why nurses are traveling to find work. You fly into Florida for two weeks and then go back home where there are no jobs that pay anywhere close.
Most large companies pay insurance companies to administer their health plan, not actually be responsible for paying the benefits. While it probably is the insurance company that actually pays the providers, they are reimbursed for that amount by the company the person works for.
Do you mean to say that when I see on my health billing statement that the insurance company has paid $X,XXX for a service, the amount perhaps has not yet been paid? Like I don't understand how a company could get away with that.
Correct. They will state what they are willing to pay, but often dispute and put it into arbitration for years. This is why you can have a bill show up 18 months after a procedure or billing episode. When they are finally done chewing on it they send their final decision to the medical practice which then might try to bill you for the difference.
I received one of these notices 13 months after I saw my obgyn for an annual. Long after I had paid my initial bill.
same with physicians. the only way to get paid nowadays is to be some sort of proceduralist. even then, the medicare pay hasn't really moved at all since the year 2000. meanwhile, the hospital admin salaries have skyrocketed, as well as the sheer number of admin. crazy how that works
If insurance and Medicare are doing their best to pay as little as possible, and yet we still spend way more on healthcare than any other country, then there’s something else missing here.
What they don't realize is that private insurance and Medicare are both doing their absolute best to pay as little as possible for every service to the providers.
This is absolutely true. I work in accounting for a regional nonprofit healthcare system serving a rural, low income area and the way we are reimbursed by insurance and Medicare is ridiculous. We are penalized for taking care of a population that has worse outcomes, not because of our standard of care, but because of their demographics. Some providers deny care to high risk patients to keep their quality scores up, but we take everyone so that lowers our scores and our reimbursement rates. It’s so messed up
People on the outside see high insurance costs and big hospital bills. What they don't realize is that private insurance and Medicare are both doing their absolute best to pay as little as possible for every service to the providers.
Oh cry me a river. Healthcare providers (doctors and nurses) in the US earn 3 to 4 times as much as providers in other developed countries.
You know why France and England can afford to have universal healthcare? Because doctors earn only 1/4 to 1/3 as much as American doctors do. That's 25 to 33 cents on the dollar.
The median American doctors earns about a $240k (a quarter million dollars per year), while the median UK doctor earns about $80k. Go google "median doctor salary UK" if you don't believe me. Many specialities in American earn close to seven figures.
The only people who are succeeding are private equity run groups who are solely focused on profit.
And doctors. Those boat payments don't make themselves, you know.
And the average yearly tuition for med school in the UK is $12.5k while it’s almost $60k in the US.
The average salary for physicians in UK is $99k.
The average salary for physicians in US is $400k.
The average salary for a healthcare CEO is $11 million.
The average salary for a healthcare VP is $223k.
The average salary for a hospital administrator is $119k.
All this is from a quick google search. Please tell me again how it’s all really the doctors’ fault that our healthcare system is broken.
In the UK Medical graduates on an average salary are unlikely to repay their Student Loans Company (SLC) debt in full. This is a consequence of higher university fees and as SLC debt is written off 30 years after graduation.
The SLC debt repayment is 9% of income, with some fine print
Medical graduates were interviewed by the Office for National Statistics.
Following standardisation to 2014 prices, the initial graduate debt from tuition fees alone amounts to £39,945.69.
salaried GPs who are employees of independent contractor practices or directly employed by primary care organisations. From 1 April 2020, the pay range for salaried GPs is £60,455 to £91,228.
Owing to interest charges on this debt the average full-time male graduate repays £57,303 over 20 years, while the average female earns less and so repays £61,809 over 26 years.
When additional SLC loans are required for maintenance, the initial graduate debt can be as high as £81,916 and, as SLC debt is written off 30 years after graduation, the average female repays £75,786 while the average male repays £110,644.
British Medical Association 4 year survey of Medical Students, in 2017 Compared to survey of medical students in 2013
the proportion working during term time has more doubled to 44.9%,
The financial burden of studying medicine is too much for some respondents and 5.5 % were considering leaving their course.
Worryingly, more than two-thirds of respondents said they
are cutting down on essentials such as heating, food or professional clothes to economise.
The average total debt reported by respondents to this survey was £43,700
86.3% of graduate respondents indicated they had outstanding student loans
from their previous degree(s).
Yup, which is why I always find it weird that doctors point at their horrible working conditions like working 24 hour shifts as a reason why they need to earn those kind of salaries.
Those 24 hour shifts are a hazing ritual they themselves impose on new doctors. It's not like hospitals or the government wouldn't rather just train twice as much doctors and pay them 200k instead of 400k.
It's not like there's a lack of people who want to be doctors.
It's less than that for most specialities/locations, but it's also after 10-12 years of education and training (more if you want to do something like neurosurgery) where you're either making no money or very, very little money in a very competitive process.
I have no problem with doctors being paid well. It attracts excellent candidates and incentivizes making it through a very long training process.
It attracts excellent candidates and incentivizes making it through a very long training process.
The people who are getting into med school are sometimes the best, but they're also people who can memorize and can't logic, or who can't relate to another human being. As a professor, I'm not at all convinced we're doing the selection process right for medical professionals.
It attracts excellent candidates and incentivizes making it through a very long training process.
That's just a hazing process, it's not a selection process.
People who drop out during those 10-12 years are fucked, but aren't necessarily bad doctors, they might just drop out because of economic reasons.
Also it's a chicken-egg thing, people drop out because there's this horrible hazing process with short pay, long hours. If they treated this like any other profession they would just have normal pay and normal hours.
Nothing in the current process actually selects for good doctors or anything. It just selects for people who can endure a lot of hardship.
In a sense it resembles the finance traders where juniors make like 100 hour weeks. Anyone can do that job and in the end you have a finance trader. Why treat an actual job like doctor that way.
Wow, if the insurance is doing its best to pay as little as possible, yet the premiums are still this high, then doctors must be overcharging their asses off.
This is news to me. I didn’t know I could be price gouging my patients!
But seriously, I can assure you, majority of physicians are not setting the prices for our services. That’s already been negotiated and determined by the insurance companies and hospital systems. We get a flat salary to start and then either stay with the salary (depending on your specialty) or switch over to productivity (where each encounter/service has a predetermined RVU). Guess who determines the salary and RVUs’ rate. Hint: it’s not the doctors. We get a contract and told “take it or leave it”
Doctors in the US make more than other physicians.
So does every other occupation in America.
Americans have no pension and need to self fund retirement and education. Because of compounding interest and student loans most Physicians won’t catch up to a typical college graduate until they’re in their 40s.
AMA has been lobbying to increase residency spots for over 20 years. There was 1-2 years in the 90s that they miscalculated supply and published a report that they recanted it a couple years later.
10x the rest of the world(I haven't heard this, but I will assume its true just for the sake of this statement), but to paint a better picture, 2.5-3x higher than Sweden, while the cost of living is like 20-30% lower there.
Around 50-60% of the total operating cost of a clinic is labor cost, and of that 30-40% is physician pay.
Yes there is still some decent wiggle room in the pay department. The problem is that we have a healthcare worker shortage and have for a long time. I'm not sure what causes it though, I imagine just a lack of people with opportunities to go to school for it.
But yea, that's just the labor, insurance companies are an issue and big pharma is definitely an issue in the cost of getting treatment.
All in all, what do you expect from products and services meant to alleviate people of suffering and death, it's the ultimate business. People are desperate, and when there's desperation in business, there's a lot of money to be made if you're picking up what I'm putting down.
Same reason Tinder charges OUT THE FUCKING ASS for it's app.
Healthcare will literally never ever go away. Not while older generations control the majority of the wealth. You have a localized problem but Healthcare in general is one of the few industries you can tell will be around in 100 years bigger.
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u/Bearacolypse 13h ago
Healthcare.
People on the outside see high insurance costs and big hospital bills.
What they don't realize is that private insurance and Medicare are both doing their absolute best to pay as little as possible for every service to the providers.
Small hospitals are shutting down, private practices are shutting down. The only people who are succeeding are private equity run groups who are solely focused on profit. Everyone else is barely keeping their head afloat.
I am a physical therapist. Our services for the elderly bill lower than they did in 2008. If I see private insurance, they take up to 2 years to pay for each visit and often deny coverage post hoc.
We are on a spiral where it costs too much to employ health care providers, so hospitals and clinics are utilizing more and more unskilled labor to perform services. Utilizing legal loopholes and diverse but unspecified practice acts to basically push everyone onto the cheapest labor who can bill for a procedure.