A Health Care Scenario

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Originally Posted by treydampier

In his first year he bills $150K in unpaid medicaid and medicare fees and private insurance. He then does over $300K in indigent (immigrant, uninsured or otherwise) work for which he receives nothing.
Now, he works hard and has billed over $1,000,000 in revenue in his first year. By the time he pays his taxes for his business, his personnel, his malpractice, his rent, office costs, and everything else he makes a grand $150K form which he has to pay a mortgage, taxes, and school loans.

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Can you tell us how did you come up with these numbers? I know the upfront cost in education is more or less fine (tuition data are readily available), but you are claiming almost 50% is unpaid services. Given the fact that only about 10% of the americans are uninsured and even if you add the illegal population the percentage would be no more than 20% (in rural areas the illegal component actually may be less than in urban areas), Is such disproportionate rate of unpaid services real? If this is realistic then there are some obvious problems with the current system. If it's not realistic then better get the numbers straight first before drawing any conclusions.

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Originally Posted by treydampier

(that will the only insurance left under ObamaCare)?

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Got a way to back up this claim?

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Originally Posted by treydampier

Why is it wrong for the doctor to expect payment just like the plumber gets paid when he is called, or the electrician, or better yet your mortgage company?

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For the same reason it is wrong for a fireman to ask be paid before putting down the fire of your burning house with your chldren still inside.

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Originally Posted by treydampier

I want to know why a student feels like its ok not to have health coverage

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Because people are irresponsbile and selfish. The risk of being stuck with high medical risk is rather low for a young person so they don't feel like subsidizing the old and ill who use more medical services than they pay for in insurance.

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Originally Posted by treydampier

Why not demand responsibility.

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Because many people like responsibility only when it refers to others, or if it's just talk, but when it costs them something it's a different story.

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Originally Posted by treydampier

Why not let docs set a fee schedule and require insurance to pay for it, or else be unable to cover health?

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Doctors are free to do so, the trick is to convince insurance companies to go with it. Who do you think sets the fees for medicare and medicaid services - government beurocrats would be one answer, but do you know whether they have had any medical training and practice?

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Originally Posted by mainaman

you have to wonder how the rest of the world is still alivethen?
I am very much sure the medical text books are the same herein US and abroad, and really taking a bunch of useless classes helps how in your doctors education?
Medical students before specialization take 6 years to just become M.D. and they also take all the biology, biochemistry, physics etc that is required to become a doctor.

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You are correct. I really put that out wrong. But, yes the useless classes which some us took were good because being educated means more than knowing only the subjects you like, so I respectfully disagree. I mean from the perspective of the American medical Community, it would appear this is THIER feelings. I have had foreign physicians as teachers, and yes I agree they are equal in many respects and better in others, however the requirements for the medical degree are less than ours. Not to mention European residents only work 56 hours per week in training and are considering lowering that to 48 with Britain (I know is not European) being the biggest opponent. American residents work up to 80 and some still work more despite the new regulations. So the evidence of training is clear that the CURRENT European resident is less trained than American medical residents when they first enter practice. Also if you don't live their, then move their because you might find the care better. I mean Europe is much older an supposedly wiser and better, and as you wonder why they are alive, I wonder why so many of them came here? I am sure Europe would love to have their immigrants who left to come back.
Please look at this as idle chat because I do not take anything here personally. I just wanted to test the waters for perspective and it has been great!

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Originally Posted by treydampier

You are correct. I really put that out wrong. But, yes the useless classes which some us took were good because being educated means more than knowing only the subjects you like, so I respectfully disagree. I mean from the perspective of the American medical Community, it would appear this is THIER feelings. I have had foreign physicians as teachers, and yes I agree they are equal in many respects and better in others, however the requirements for the medical degree are less than ours. Not to mention European residents only work 56 hours per week in training and are considering lowering that to 48 with Britain (I know is not European) being the biggest opponent. American residents work up to 80 and some still work more despite the new regulations. So the evidence of training is clear that the CURRENT European resident is less trained than American medical residents when they first enter practice.
Please look at this as idle chat because I do not take anything here personally.

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nothing personal, I am obviously very far away knowing details about what it takes to become a doctor. I only know that the basic 6 year time frame to get the M.D degree covers everything that is also covered in US as undergrad and, please correct me if I am wrong the 2 years in medical school.
I have a little reference point, a friend of mine got her M.D. in my country came herein US and took all the exams necessary to be recognized. she did not go to take classes or anything, just the exams. In this light I do not believe that the American system is better than any other. as far as specializations go, you have more knowledge than me.
One more remark on the usefulness of undergrad education related to medical degrees. I happen to teach @ a major University herein US, and while there are a few students that really take the education seriously, the majority is interested in getting some degree but without putting much effort in it.
I have also seen students that were planning to go to med school being concerned about their grades(obviously they did not put much effort) because that would ruin their chances. I guess what I am trying to say is that while having a bachelor degree is good in general, I don believe it is a reason to differentiate from the rest of the world when it comes to medicine.
I think the system here is so much different than many other countries , that it will be very hard to change so that everyone is happy. I feel like to get it done right the whole system has to be shut down, and everything should start from scratch which I do not see happening because there is some major dollar involved.

If you are looking for a rebuttal,then you are mistaken because I agree with you in almost every area.
No I can't back up the claim, but I have heard directly many private contractors, painters and plumbers say they will drop their employee benefits because it would be cheaper for them to make the government and taxpayers cover their employee injuries.
This is an ISOLATED case I have described, and certain insurances are the equivalent of having no insurance because if a person doesn't pay their deductible then the doc and hospital get nothing in some cases. These numbers are real and although you may not know someone in this block does not mean it does not exist. However, it is a fact that government sets the medicare/caid rates. However, some other insurance companies pay less, some pay more. Why not let the AMA via the different specialty groups like ACS, and others set the pay schedules for both the government and private insurance. If this happened I would support a public option.
As for the fireman example, the fireman has a choice to run into the house. Doctors in the ER are required by law to treat patients no matter the necessity. In the end the fireman usually gets paid on some level unless its a rural volunteer.
However, if you are telling me the public option and private insurers would pay docs what they demand as determined only by docs in private practice (meaning those not supplemented in any way shape or form), then I will re-elect Obama (no I didn't vote for him) and let the other areas go to ruin and rejoice in his fixing the healthcare issues.
My opinion is not worth the space in the server for the site, but again, I have really enjoyed the perspective.

Here are some key points. These are general statements because their are 6 year MD programs and exceptions in the US to what I am saying.
In the US its four years of med school. I believe in Britain and Europe it is four years as well with only two years of pre-requisites. The key for their docs coming here is they have to pass all three steps of the USMLE. But, the ones who did their training (ie. after getting their MD degree) outside the US, must be trained in the US in their chosen field in order to practice here. US residents can practice virtually all over the world without any repeat training. This is big in NY where many foreign docs enter residency planning to return home because their American training will give them higher salaries. (In some cases, not all). Also, despite what the Europeans think, residency training was started in the and spread to Britain and Europe especially in the field of surgery. Before this everything was done via apprenticeship and the specialties were not as well defined.

As for the undergrad experience, this is very true. Many students cheat through their frats and groups and do not value their education. So I agree completely that their are many students who would not benefit anything form the American system.

Interesting, I was not aware that it takes only 4 years to get M.D in germany.
I am from Bulgaria and the M.D. degree, unless that is changed now, takes 6 years.

I think he means they don't need a college degree prior to getting in the medical school. That is indeed the case for a good part of Europe. There are several reasons for that actually.

Education in Europe normally has a stronger focus on sciences at the Junior High and High School levels, at least for the tracks leading to university/college. I can't speak for all European countries, so I'll speak for the one where I studied: Belgium.

When I was 14, my school week included 8 hours of mathematics and 15 hours of science (physics, chemistry, biology and the respective labs). Basically, that was the track preparing you for engineering, science or medical college down the line. Roughly speaking, the science I studied in my year in America was what I had studied at that point.

Medical universities/colleges in Belgium have a set limit of candidates per year. For 2009, for example, the limit was set to 303 candidates for the French-speaking side and 454 for the Flemish-speaking side. The full medical studies last 7 years, with an extra selection at the end of the master degree.

To get to the PhD level, you need a minimal score of 60 points calculated as follows:
*up to 50 points based on your honors for each university/college year:
-summa cum laude: 12.5 points
-magna cum laude: 9 points
-cum laude: 6 points
-pass: 3 points
*up to 25 points based on your scores in subjects directly related to the specialization you wish to pursue or in internships in that field.
*up to 25 points based on a medical board examination for the specialization you wish to pursue.

You may get a passing score and still not be admitted by the school where you study for the specialization you wish to pursue. You can express 3 preferences when you sign up for the selection. If you don't get in, you can opt to study abroad or stay on a reserve list should something happen to a more successful candidate. You can also choose to attempt the selection in a school other than the one in which you passed your master degree. Flunking the selection test means game over in Belgium.

You only get to practice medicine if you have the PhD. You can work in medical-related fields with just the Master degree but most students opt to go abroad if they fail at that point.

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Originally Posted by mainaman

Interesting, I was not aware that it takes only 4 years to get M.D in germany.
I am from Bulgaria and the M.D. degree, unless that is changed now, takes 6 years.

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It takes six, but the first two I believe are pre-requisites. I am not sure, by virtue of their not being an undergraduate requirement they very well study six years of medicine. This will have to be researched, because I COULD BE WRONG. Someone from Germany please correct my misinformation if this is the case.

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Originally Posted by MichaelP

I think he means they don't need a college degree prior to getting in the medical school. That is indeed the case for a good part of Europe. There are several reasons for that actually.

Education in Europe normally has a stronger focus on sciences at the Junior High and High School levels, at least for the tracks leading to university/college. I can't speak for all European countries, so I'll speak for the one where I studied: Belgium.

When I was 14, my school week included 8 hours of mathematics and 15 hours of science (physics, chemistry, biology and the respective labs). Basically, that was the track preparing you for engineering, science or medical college down the line. Roughly speaking, the science I studied in my year in America was what I had studied at that point.

Medical universities/colleges in Belgium have a set limit of candidates per year. For 2009, for example, the limit was set to 303 candidates for the French-speaking side and 454 for the Flemish-speaking side. The full medical studies last 7 years, with an extra selection at the end of the master degree.

To get to the PhD level, you need a minimal score of 60 points calculated as follows:
*up to 50 points based on your honors for each university/college year:
-summa cum laude: 12.5 points
-magna cum laude: 9 points
-cum laude: 6 points
-pass: 3 points
*up to 25 points based on your scores in subjects directly related to the specialization you wish to pursue or in internships in that field.
*up to 25 points based on a medical board examination for the specialization you wish to pursue.

You may get a passing score and still not be admitted by the school where you study for the specialization you wish to pursue. You can express 3 preferences when you sign up for the selection. If you don't get in, you can opt to study abroad or stay on a reserve list should something happen to a more successful candidate. You can also choose to attempt the selection in a school other than the one in which you passed your master degree. Flunking the selection test means game over in Belgium.

You only get to practice medicine if you have the PhD. You can work in medical-related fields with just the Master degree but most students opt to go abroad if they fail at that point.

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Whew! Thats complicated. But then again, its Europe. There system does have different interests and emphasis. Thanks for the clarification though. Its great perspective.

I also forgot to add that a flunk was -3 points in the calculation ;)

Whatever the field, you can only flunk 2 years in a cycle before getting kicked out (if that wasn't changed again since I left Belgium). The system was more lenient 20-ish years ago, you could basically flunk every year and do you BS degree in 8 years instead of 4... frat parties all the time basically.

The studies duration have been changed recently due to the Bologna treaty unifying the degrees across Europe. Until that treaty, each member country had different titles with different cursus and requirements, with no clear equivalence.

Nowadays, post Bologna, it goes like this:
BS or BA: 3 years after high school with a set UV requirement
MS or MA: 2 years on top of BS/BA with a set UV requirement (postgrad degree) and a research project for the Master degree
PhD: 2+ years on top of MS/MA for research followed by a thesis