Thursday, April 15, 2010

22 Comments:

Blogger Todd said...

Please explain to me why, if I am a doctor I would stay in Massachusetts?

How would they counter the exodus of doctors? Refuse to issue them a border pass? Just kidding on that, for now…

3:17 PM, April 15, 2010  
Blogger Larry J said...

Every health care provider licensed in the commonwealth which provides covered services to a person covered under "Affordable Health Plans" must provide such service to any such person, as a condition of their licensure, and must accept payment at the lowest of the statutory reimbursement rate, an amount equal to the actuarial equivalent of the statutory reimbursement rate, or the applicable contract rate with the carrier for the carrier’s product offering with the lowest level benefit plan available to the general public within the Connector, other than the young adult plan, and may not balance bill such person for any amount in excess of the amount paid by the carrier pursuant to this section, other than applicable co-payments, co-insurance and deductibles.

And so, if the state in their infinite wisdom decides that the reimbursement rate is $0, the doctor still has to provide the services? There's a phrase for that: "involuntary servitude" AKA slavery and it's prohibited by the 13th Amendment. Not that the Constitution means much to politicians any more.

If enacted, I wonder how fast the number of Mass. doctors will decline. I can't see anyone in their right mind staying in a state with such a law.

3:51 PM, April 15, 2010  
Blogger randian said...

I can't see anyone in their right mind staying in a state with such a law.

Then Obama will fix the problem of medical access in MA by requiring every state licensing board to do the same thing. One of the many committees and panels created by Obamacare probably has such a power.

4:13 PM, April 15, 2010  
Blogger Larry J said...

Yesterday, the AMA predicted a shortage of 150,000 doctors by 2020 (duh). If this passes and especially if it spreads, you can expect the shortage to be much larger. Once you give the politicians and bureaucrats the power to enact punitive wage controls, where does it stop?

4:52 PM, April 15, 2010  
Blogger MB said...

The doctors will stay there. And they will still earn far more than well educated professionals earn - they will earn what Demi-Gods earn. And a good chunk of the public will think they deserve it.

And then, as always, they will declare that they are not Demi-Gods, they are merely human, in their malpractice trials.

Physicians in the US earn far more than (sometimes better trained) physicians in other parts of the world. German physicians are arguably better trained (and not as dumb) but they earn far less - in fact, as much as a well educated professional earns otherwise in Germany.

9:31 PM, April 15, 2010  
Blogger MB said...

I am not really in favor of any kind of legislation, however.

What the United States needs is simply a reality check among its citizens. ARE physicians really Gods? ARE they really so far above you that you are an amoeba?

It's bizarre, but lots of people in the United States think like that.

I get it that all the girls are chasing after them, but even the men in the US think they are Gods.

Unreal.

9:33 PM, April 15, 2010  
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10:32 PM, April 15, 2010  
Blogger Cham said...

I went to see a doctor for a breast exam 2 days ago. The doctor spent about 45 seconds with me. Ah, the American healthcare system! All I can say is thank God for mammograms because Mr. Doctor sure as heck wasn't going to find any lumps with that speed checkup.

6:58 AM, April 16, 2010  
Blogger br549 said...

MB, you're a commie. Cham, find another doctor. This is still America for the time being.

8:34 AM, April 16, 2010  
Blogger MB said...

"MB, you're a commie."

----

Furthest thing from it. I am calling for people to see reality.

If you want to overpay and be a naive dupe, though, that's your God-given right.

As a side note, I also call for people to see the reality of people like Jim Bakker, Creflo Dollar and all the other "evangelists" who are taking in millions and millions and living like kings off the backs of naive people.

How you get "commie" out of a question as to whether doctors really are Gods is beyond me.

9:03 AM, April 16, 2010  
Blogger Larry J said...

The doctors will stay there. And they will still earn far more than well educated professionals earn - they will earn what Demi-Gods earn. And a good chunk of the public will think they deserve it.

Rather over stated, don't you think? Set aside your jealosy and look at what doctors are actually earning (according to Forbes via this source):

Forbes Magazine: America's 25 Best-Paying Jobs 2009
Listed with average annual pay

1. Surgeons: $206,770
2. Anesthesiologists: $197,570
3. Orthodontists: $194,930
4. Obstetrician and Gynecologists: $192,780
5. Oral and Maxillofacial Surgeons: $190,420
6. Internists: $176,740
7. Prosthodontists: $169,810
8. Physicians: $165,000
9. Family and General Practitioners: $161,490
10. CEOs: $160,440
11. Dentists: $154,270
12. Psychiatrists: $154,050
13. Pediatricians: $153,370
14. Specialist Dentists: $142,070
15. Podiatrists: $125,760
16. Lawyers: $124,750
17. Natural Sciences Managers: $123,140
18. Engineering Managers: $120,580
19. Pilots: $119,750
20. Petroleum Engineers: $119,140
21. Computer and Information Systems Managers: $118,710
22. Marketing Managers: $118,160
23. Financial Managers: $110,640
24. Sales Managers: $110,390
25. Air Traffic Controllers: $108,090


Sure, surgeons make a lot of money compared to most people but they also tend to work far more than 40 hours a week. Now, to become a surgeon, you have to go to 4 years of undergrad school and earn good enough grades to get accepted to medical school. Throw in 3 years of medical school and you get to call yourseld an MD. However, your first year as an intern, you'll make squat while frequently working over 100 hours a week. McDonalds pays better. Following that, you'll have 6 more years of surgical residency (often low paid) before you can be a board-certified surgeon. If you go for a specialty like cardio, you can easily add a couple more years on top of that.

10:12 AM, April 16, 2010  
Blogger Joe said...

Why not just get rid of the medical licensing? As long as a person agrees to accept medicare and medicaid, they can become a doctor.

11:46 AM, April 16, 2010  
Blogger randian said...

Sure, surgeons make a lot of money compared to most people but they also tend to work far more than 40 hours a week. Now, to become a surgeon, you have to go to 4 years of undergrad school and earn good enough grades to get accepted to medical school. Throw in 3 years of medical school and you get to call yourseld an MD. However, your first year as an intern, you'll make squat while frequently working over 100 hours a week. McDonalds pays better. Following that, you'll have 6 more years of surgical residency (often low paid) before you can be a board-certified surgeon. If you go for a specialty like cardio, you can easily add a couple more years on top of that.

So what? As all business owners know, cost does not determine price.

The absurd requirements described about don't so much produce better doctors as produce fewer doctors, able to command higher prices through reduced supply. Controlling supply is the entire point of the AMA's accreditation regime.

3:08 PM, April 16, 2010  
Blogger Larry J said...

Calling someone who makes $200K a year a demi-god is just plain stupid. It's comes across as nothing less than jealosy.

There are a lot of professions that earn more and contribute less to society but supply and demand being what it is, that's the way the market works. If anyone could do the job, the salary wouldn't be so high.

3:52 PM, April 16, 2010  
Blogger Larry J said...

Calling someone who makes $200K a year a demi-god is just plain stupid. It's comes across as nothing less than jealosy.

There are a lot of professions that earn more and contribute less to society but supply and demand being what it is, that's the way the market works. If anyone could do the job, the salary wouldn't be so high.

3:53 PM, April 16, 2010  
Blogger JG said...

I've seen some unbelievably arrogant physicians. They ARE Demi-Gods ... until they show up for their deposition in a malpractice suit. I won't get into anecdotes, but I've seen some real dicks.

So I guess put me in the "jealous" camp too.

4:39 PM, April 16, 2010  
Blogger JG said...

2nd point: The "market" is sometimes based on perceptions of people that may not be accurate.

In any case, there is no free market with regard to medical services. The insurance companies, government and other institutions determine prices. It's not a situation at all in which the "customer" makes a buying decision based on quality vis-a-vis prices and competition takes place. Not at all.

4:42 PM, April 16, 2010  
Blogger Michael said...

About the demi-god comments- some insurance companies have started teaching their doctors to be likeable people, because folks don't sue doctors they like, screw-up or not.

Beyond that, there are few places in Massachusetts that aren't within an hour of a neighboring state.

I think I smell an oppurtunity for VT, NH, CT, RI (possibly ME and NY) state-border medical clinics. Possibly with a 'Medical Greyhound' service.

10:18 AM, April 17, 2010  
Blogger JG said...

Authoritative (read: arrogant dick) doctors provide less effective medical care than collaborative doctors. Authoritative doctors are sued much more often for malpractice (probably a combination of less effective care and the fact that people may be itching to stick it to them after the arrogant treatment).

So why are certain doctors authoritative instead of collaborative? Because they probably can't help it - they went into medicine for the adulation and money, not to help anyone.

10:23 AM, April 17, 2010  
Blogger Dr.D said...

This is going to lead to the black market situation where doctors will require "under the table" payments for many things, or else you will wait for months in a queue. That money will simply be "off the record," it will not be covered by your insurance, by Medicare, by anyone except you the patient. But if you want the service, you will pay it. This is where we are headed.

12:41 PM, April 17, 2010  
Blogger randian said...

About the demi-god comments- some insurance companies have started teaching their doctors to be likeable people, because folks don't sue doctors they like, screw-up or not.

The reason doctors don't do nice things like apologize is because defense attorneys consider it an admission of guilt. Not what you want when a potential lawsuit is on the horizon. Furthermore, "screw up" is a rather loaded term in a litigation environment that treats mere adverse outcomes as malpractice, when that was never the purpose of the malpractice system.

3:14 PM, April 17, 2010  
Blogger JG said...

This comment has been removed by the author.

5:16 PM, April 17, 2010  

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