How to pay for it:

1.) Stop futile medicine. Multiple examples: Intubating septic contracted demented 88 y/o nursing home patients. Dializing noncompliant drug abusing patients. Vascular bypassing patients who continue to smoke.

Malpractice environment and unrealistic patient/family expectations prevent the above.

~50% of the healthcare dollar is spent in the last 6 months of life. ~1-2% of patients spend about 70% of the health care dollar. Unlimited spending and futile medicine on the few should not be a "right" while ruining the system for all.

2.) Decrease reimbursement for tertiary procedures (cardiac stent placement, knee replacement, etc.) and increase reimbursement towards primary prevention.

3.) Dream solution. Get rid of the fixed fee system by payers (government and private) all together and return to a true fee for service model. Good doctors can demand their price. Bad doctors fall by the wayside.

4.) Socialize medicine ONLY for primary/preventative care. You want to abuse yourself and then want the deluxe treatment then you pay yourself

CJD

I understand the power of the AARP. I am trying to make the same point you are. No one has the political will or power to place any kind of attack or limits on entitlements. It is a statement of "why" and not "how" to fix it. Until the country is completely bankrupt we won't have the guts.

Of course you still remain naive about malpractice and costs. I spend easily 7 figures a year with the stroke of a pen to "rule out" that extra 1% that I can't do on clinical judgement alone. Multiply that by every doctor and you are talking about a lot of savings to be had.

There is plenty of money spent on healthcare. A little redistribution could save primary care. It is not implausible for a specialist to make nearly a million a year performing procedures of marginal benefit and indication in factory like fashion. The same doc of similar skill, talent, brains that went to the same school but chose primary care is really struggling to make 100k. That is fine if people want to pay the specialist out of their own pocket for their services but it is not right for government payers to create this chasm.

Chucky, please let me know where this specialist can make a milion dollars. Does all it take is being unscrupulous? you really think that your three years of training can be equated to the 5 plus years that us greedy, dishonest specialists have to put in?

As long as primary care physicians keep playing the politics of envy, you'll get nowhere.

I think the best way to go about making a beneficial change in the system is to stop rewarding procedures. When the cardiologists around the block (7 of them who each make more than 3 times what I make) purchased machinery to do carotid ultrasound there was a (surpise) huge spike in the "need" for carotid ultrasound. When they bought nuclear stress test equipment there was a huge spike in the "need" for NSTs.

Medicare pay ZERO for a physical and hundreds for an NST. That needs to change.

Killing the golden geese of colonoscopy, EGD, NST, cath and stent would go a LONG way toward improving preventive medicine.

NAD,

You are actually quite distressed and defensive. I never said specialists were dishonest. You implied it.

I never said it was easy to make a million dollars. Again, you put words in my mouth. However it is possible in several specialties with a lot of hard work and high volume procedures.

The truth is 3rd party payment is skewed towards tertiary care rather than primary care. We could argue about where the balance should be all day.

"I worked in an interventional radiology lab where the fellows were getting starting offers greater tahn 700k."

And the poor providers are being starved or "killed" by the costs of doing business.

NAD,

You are defensive because I am certainly not talking about every specialist, or for God's sake, you in particular.

Examples: I know certain cardiologists that will cath anything: A 90 year old with dementia in the ICU, Or the patients that get cath after cath after cath.

Or vascular surgery: Everyone knows the leg really needs to be cut off. Let's try a fem-pop. Still gotta chop the toe, bypass the tibia. Didn't work, lets chop the ankle and try and de-clot the popliteal. BKA next. I have seen a patient with 19 vascular surgery procedures.

Now I am not picking on these speciaties in particular. If you are a hammer, everything looks like a nail and you do what you are trained to do. I think questionable things could be found in every specialty, things that haven't been put to test in rigorous outcome trials. Medicolegal defense certainly plays a role as well

I didn't use the work "greedy", you did. But would you deny that greed doesn't exist in every case????

If you are a proceduralist enjoy things while reimbursement balance is in your favor. If you spent extra fellowship years becoming an endocrinologist or pediatric neurologist then I hope you enjoy what you do.