The Happy Hospitalist: All for one and none for all

The following is a reader take by The Happy Hospitalist.

All for one and none for all. That is the state of the current government program called Medicare. The entitlement program that threatens the financial security of our nation. On March 25, 2008 the Boards of Trustees released their Annual Report of the Federal Hospital Insurance and Federal Supplementary Medical Insurance Trust Funds. In this 43rd edition, the Trustees note a government program covering just over 44 million people at an expense of $425 billion dollars during 2007. That equates to approximately $10,000 per beneficiary.

Ten thousand bucks. A cost accelerating at an unsustainable rate. In fact, the Hospital Insurance (HI) trust fund component of Medicare will be exhausted by 2019, with a payroll cost of 2.11% in 2007 rising to an astronomical 11.40 percent by 2082. This represents a tripling from 1.5% of GDP to 4.8% in that time frame. Total Medicare expenditures are expected to rise from 3.2% of GDP to almost 11%. Just under the 15% for all current health care consumption.

How can we sustain this? We cannot. Unless the rules change, actuary expectations project that by 2070, 100% of our federal budget will go to Medicare, Medicaid and Social Security. That means no roads, no bridges, no FBI, no CIA, no military. No nothin’.

So what do we do about it? Raise taxes or decrease spending. We cannot grow our economy out of this mess. Europe is in the flat tax revolution of a lifetime; While each country is fighting to lure healthy businesses and wealthy business people, America is talking about raising taxes on the top 20% that already pay 80% off all income taxes. Based on current tax laws, the effective tax rate of the bottom 20% of households is 1.1% (income and payroll included) rising to an average of 26.2% in the top 20% of income earners. We have put the burden of taxation entirely on the shoulders of the successful, educated and capitalistic minds of our society. Simultaneously, we have created a federal entitlement economy that cannot be sustained on the shoulders of the few. Something has to break.

The appropriate course of action should be a radically new approach to the Medicare entitlement program. We do not have a choice. The political suicide of such an action is however glaring. Our Congress is bogged down in billions of dollars of free cash flow coming from the coffers of big business looking to keep their gravy train flowing. It will take enormous servitude by our government officials to declare an end to the automatic money train known as Medicare. A restructuring of the program towards a transparent means based qualification system is necessary. Having Uncle Sam pay for an elective cataract surgery so grandma can go on an African safari is inexcusable in a time of financial collapse. The war in Iraq is peanuts compared to the financial destruction extolled by our entitlement programs.

Of course the sickest Americans cost the most. Fifty percent of our population is responsible for just 5% of total health care expenses, while 5% of our population is responsible for 49% of our 2 trillion dollar health care tab. And those with 7 chronic conditions are seven times more costly than those with one medical condition. These numbers are staggering. Because older people are generally sicker, these numbers place a large undue burden on the federal health care entitlement programs, programs that will no longer be financially viable in a few short years to come.

We will have to say no. No to dialysis. No to life support. No to elective procedures. No to brand name drugs. No to the latest expensive technology. We will have to place greater weight on quality of life over quantity of life. We will have to demand hospice care in futile situations. We will have to demand palliative comfort over slice and dice. We will have to reject marginally effective proceduralization and imaging of our elderly. We have to. We don’t have a choice. There is no other way.

The current modus operandi of Uncle Sam is to promise everything at ½ price rather than pay the right price for the right care. Medicare killed primary care by playing along with the house of RVU cards that RUC built. A saving grace for Medicare will need to be a fully funded primary care program which has the ability to put the brakes on unnecessary, expensive and marginally effective care that comes from all corners of the health care universe. Right now, Medicare promises all for one. Unless something changes we will eventually have none for all.

And that is simply not acceptable.

The Happy Hospitalist is an internal medicine physician and blogs at The Happy Hospitalist.

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  • Peter

    I agree with the premise of Happy’s analysis of the dire future of our healthcare system including Medicare, but I do not agree with his solution. It may seem that a socialist solution is appropriate for a socialist problem, namely that the use of rationing will prevent chaos and waste from the long-term effects of governmental price fixing in the medical services market. However, rationing of medical resources by way of government policy will be a disaster as groups such as JCAHO and CMS institute draconian policies which end up increasing bureaucratic costs and dissatisfaction in healthcare and fail to address the root problems.

    The most compassionate and effective way to reduce the effects of price fixing and moral hazard of healthcare payment systems is to institute free-market solutions. Specifically, the easiest, fairest, most effective solution is to allow balance billing on all healthcare transactions. As it stands now, the government prevents physicians from billing the patient in addition to what Medicare pays for services. This is the price fixing I mentioned earlier. Preventing balance billing essentially prevents economic equilibrium in the medical market. The patients do not realize the true costs of medical services and so they demand more services; physicians do not get paid what is appropriate and so they increase volume to compensate for decreased revenue per service; patients demand so much more from physicians than they are able to provide which results in shortages. Balance billing solves this problem in multiple ways. Namely, balance billing allows patients to realize the full cost of the services they demand, and so they will demand fewer services and they will demand cheaper services; physicians will be paid appropriately for a single visit and so they will not increase volume unnecessarily to compensate for arbitrarily low payment rates; finally, physician supply will meet patient demand, negating the need for rationing.

    Forget about rationing care, forget about changing the RVU system, and forget about asking the government to become more involved in the selection of services for certain patients (pre-authorization anyone?). Allow balance billing, and the problems of excessive demand for medical services caused by price fixing will be eliminated.

  • maggie mahar

    First, if we “means test” Medicare, we destroy the program.

    In 1965, when the legislation was passed, some Republicans wanted to do that, but LBJ realized that if the upper-class and upper-middle class were excluded, Medicare would soon become a “poor program for the poor.”

    Today, if you means-test it, Medicare soon becomes a “poor program for the middle class.” Is that what you want for your parents?

    Medicare has such overwhelming support in this country becuase it is a program for everyone. It is one of the few cases where Americans have actually achieved social solidarity.

    There is enormous waste in American healthcare–not just in Medicare. If you look at a graph of private sector spending and Medicare spending over the past 30 years, you’ll find that, over time, they have been equally unsuccessful in reining in spending.

    Nearly three decades of Dartmouth reserach reveals where the waste is. Much of it is supply-driven: in areas where there are more hospital beds and more specialists, Medicare spends twice as much caring for very similar patients–and outcomes are no better. Often they are worse.

    We need to take a much closer look at what Medicare covers: the Dartmouth reserach suggests that one-third of our healthcare doollars are spent on unproven, ineffective, often over-priced drugs, devices and procedures.

    Read the Medicare Payment
    Commission’s March 2008 and June 2008 reports. There you will find the facts about Medicare spending. And many very intelligent recommendations on how we can pare costs while improving the quality of care.

    Also, note that Medicare spending, like U.S. healthcare spending in general, is growing 2.2% faster than GDP. Compounded, year after year, this amounts to an enormous sum.
    But the fact is that we only have to flatten the growth curve by 2.2%. This is not impossible. And it will not require Draconian measures.

    We do Not need to ration care by telling the elderly: “No you can’t have that effective procedure that would help you.”

    But we do need to squeeze out the hazardous waste in our system. Every treatment carries some risk of side effects; if a patient undergoes a treatment that offers no benefit, then, but definition, he is exposed to needless risk.

    As for the chronically ill, yes we spend a high proportion of our health care collars on them. But most of that money does not go into futile end of life care as the happy hospitalist seems to suggests.

    If you look at Medicare records, you discover that the chronically ill are expensive because they live with their illnesses for a long time (that’s why we call them “chronically” ill)

    Of the seven illnesses, one is depression—which doesn’t usually kill. Another is diabetes–a diabetic can life a long life, but the disease requires constant management.

    If, toward the end of his life he requires amputations, they must be done. (Or would you put him in a hospice and let him die of gangrene?)

    I agree that we should have palliative care in every major acute care hospital in the U.S. But palliative care specialists don’t advocate cutting off care. They give the patient and family a choice, outlining the options, and the risks and benefits of each option. Then they help the patient and/or family make a decision.
    In the meantime, they make sure that the patient is not in pain.

    Palliative care is not cheap (although we don’t pay well for it.) It is labor-intensive and requires a team: a doctor, nurse and psychologist specially trained in palliative care. And they sometimes spend long hours conseling a patient, the family and other doctors involved in the case.

    Palliative care can save money insofar as patients decide they don’t want to endure more treatments as the side effects begin to outweigh likely benefits.
    But the palliative care team is not there to save money. It’s there to try to make that the patient gets appropriate care.

    That said, the palliative care team can act as a buffer between the patient and doctors who are too eager to go ahead with multiple tests and procedures that the patient may not want.

    My point is simply that it’s the patient’s decision. The tone of the happy hospitalist’s post seems to suggest that we just have to tell the Greedy Geezers NO. It’s Time For You To Die.

    Again, is that what you want to happen to your parents?

    The fact is that much futile end of life care is supply-driven. (
    (The Dartmouth research shows this.) Few patients cry out for a chance to spend 20 days of their final 2 months of life in a hospital. Few demand the right to die in an ICU.

    Most would rather be at home.

  • Anonymous

    1. Medicare is a poor program. I’m rapidly planning our exit from it. If I had to depend on Medicare, I’d be bankrupt.

    2. Palliative care requires a physician, nurse and a psychologist? Where the heck did you learn about palliative care? We do just fine just a physician and a visiting nurse. Also, very little palliative care needs to be done in a hospital.

    3. The public will only tackle the difficult choices involved when the economic damage of Medicare becomes apparent. By then, us, our children, and the economy will be screwed.

  • maggie mahar

    Most people don’t realize that
    “about half of Medicare’s beneficiaries lived on incomes of $20,000 or less. Eighteen percent are scraping along somewhere below the poverty line ($9,060 for those living alone and $11,430 for married couples).” (This comes from the Medicare Payment Commission’s ,” Report to the Congress, March, 2007, p. 11 )

    Note that “income” includes every dollar that comes into the home including, social security, dividends and capital gains, Food Stamps and income from part time jobs.

    Meanwhile, Medicare co-pays and deductibles have been rising far faster than Social Security.

    People with total income of $20,000 or less (half of Medicare patients) cannot afford to pay specialists more.

    MedPac rightly is urging Medicare to pay more for primary care and to pay more to certain specilalists who see many patients with a particular chronic disease (such as a diabetes) if they are willing to provide a medical home–which means, among other things, that they must use healthcare IT. (See MedPac’s June 2008 report)

    Medicare also should pay more to other relatively poorly paid physicians who provide cognitive care: palliative care specialists, family docs, etc.

    But there is no reason that the highest paid proceduralists should be able to shake the elderly done for more. There incomes are perfectly adequate. This is extortionate.

  • maggie mahar

    Anonymous said: “Palliative care requires a physician, nurse and a psychologist? Where the heck did you learn about palliative care?”

    I learned much of what I know about palliative care from Dr. Diane Meier, of Mt. Sinai hospital.
    She widely considered one of the leading –if not the leading –palliative care specialist in the U.S.

    Palliative care can be provided at home. But first you have to get out of the hospital. That can’t happen until your pain is under control and decisions have been made about what further treatment you do or don’t want.

    The psychologist is very important when patients and families are facing death. And a palliative care nurse knows how to help a dying patient simply by sitting with him.

    Most health care professionals have a very hard time just sitting with a dying patient. And the palliative care doctor has many other things to do.

  • Anonymous

    Part of the reason costs are so high is because you have tons of people billing Medicare for the same services that were rendered by fewer people 10-20 years ago.

    The average number of doctors and support personnel billing Medicare for each enrollee has skyrocketed. Now we have 20 doctors, 10 nurse practitioners, 10 physician assistants, a few social workers, a couple of pharmacists, a psychologist, a case manager, and several more people all billing Medicare for the same services that were rendered by a few doctors and nurses 10 years ago.

    Every Medicare enrollee sees many more specialists than they used to 10 years ago. Things that primary care docs used to manage are now being handled by cardiologists or nephrologists at enormous expense to Medicare.

  • tired of futile care

    Every medicare benificiary should have a limit of

    1. 5 generic drugs
    2. 200k in lifetime expenditures paid by medicare

    After that, pay for it your damn self.

    Happy is right. The looming problem is going to make the subprime mortgage mess and the Iraq war look like pennies.

    Countries are going to quit investing in the U.S. Why would thy buy bonds to pay for demented grandma with CHF, COPD, DM, PVD, ESRD repeat stay in the ICU??????

    The financial collapse is going to be horrendous for the U.S. It is going to happen. Does any smart economist know where to invest money to that scenaria that I think is 5-10 years away.

  • Anonymous

    Ms Maher:
    Out of curiousity how much palliative care medicine have you practiced? Trust me, reading a leading authors paper(s) is a little bit different than actually working in the field. The fact is most patients in palliative care don’t (necessarily) need the consult from psychologists if the palliative care MD’s/RN’s are well versed in their trade. A psychologist’s consult would be helpful in a minority of patient’s in the hospital (if you can get it, trust me the real world is not Mt Sinai) depending on the circumstance. Frankly when I read your articles Ms. Maher, you often have very good ideas but you have a dearth of real world experience in medicine which very obvious to those of us who work in the biz.

  • The Refugee

    I gotta take Happy’s back on this one, because a lot of these comments seem to be beating him up. I’d like to counterpoint some of what the commentators have said.

    1. “Specifically, the easiest, fairest, most effective solution is to allow balance billing on all healthcare transactions.”

    Lies. An enormous segment of the healthcare-seeking population couldn’t possibly care less about how much anything costs. As all of us should be well aware, the Emergency Room is the gushing financial carotid in the healthcare system. I seriously doubt balance billing is going to change any behavior of any patient who chooses to walk through the ED doors. In my population, most of those patients have no intention of receiving, opening, or paying any bill from the ED.

    2. Maggie seems truly out of touch with the realities of the Medicare/Medicaid shell game by suggesting that by sticking with “effective” and “proven” healthcare, all will be well.

    Please define “effective” and “proven”. Someone who has such a black-and-white view of healthcare typically has insufficient understanding of the system. You will always have patient demanding treatment/procedures that are not “proven”. Making the doctor say “no” opens them up to medicolegal liability that they are insufficiently shielded from. (And hits their patient “satisfaction” score rating, with the potential to hit the doctor in the pocketbook when enforced by their hospital employer).

    3. Most patient may very well not want to spend 2 months in the ICU before dying. Unfortunately, the last hours/days one is able to talk to the patient, the patient is not ready to accept the possibility of their death, the family is not on the same page with the patient, or NO ONE SEES IT COMING. And unfortunately our system says do everything, unless various legal documents are filled out, or face the lawyer’s wrath for “killing” grandma.

    4. “The tone of the happy hospitalist’s post seems to suggest that we just have to tell the Greedy Geezers NO. It’s Time For You To Die.”

    I don’t think Happy suggested that greed was a part of this. I don’t think the patients are usually greedy when it comes to the pissing away of healthcare dollars at the end of life. But I do think that there comes a point where you cannot justify the resource expenditure for the return on that investment. And sadly, yes, this sounds like a business decision. But every other tiny piece of micromanaged healthcare in America IS a business. Why shouldn’t this be? If you can PAY for the liver transplant at the age of 85? Go for it. If you can foot the bill for 10 years of dialysis and the countless R/O Sepsis admissions you will incur? Be my guest.

    But we as a society are going to have to make some VERY hard decisions about when it’s your tax-paying obligation to provide extraordinary expensive care to someone who cannot afford it.

    The 9 month old who got pneumococcal meningitis — that’s an easy one.

    The homeless 48 year old who refuses to stop smoking, drinking and eating at Taco Bell who in the course of 3 years is in for his 80th ED visit, 20th admission, 10th CT scan, 5th surgery consult, 3rd cardiac cath and 2nd kilogram of dilaudid… this should also be an easy one.

    It’s everything inbetween that’s hard. It seems heartless to say “no”. But why do you think hospitals used to be charity outfits run by tax-exempt religious organizations? It has become a business. And as one, it cannot survive if you are expected to give your services away. But every year we give a larger and larger percent of that care away. The line HAS to be drawn somewhere, beyond which we say “No.” Accept this, or prepare for the entire works to crash into the ground in a blaze of glory.

    Some of commentators’ the ideas are not bad. But to suggest that they are anything close to a solution is disingenuous at best.

    Happy hit it on the head. Prepare to entitle a large segment of our population to a large portion of your income that you have not yet agreed to part with… or prepare to ration what those who cannot pay for it are allowed to get.

    -The Hospitalist Refugee

  • Anonymous

    The idea that if we could eliminate the “wasteful care” we would restore Medicare’s financial footing is nice in theory.

    But in reality, defining care(prospectively) that has no chance of any benefit, and could only cause harm, is difficult. Such care would be a small fraction of the care the M.Mahars of the world are talking about. If we truly are going to control costs, we need to cut out the care that reasonable clinicians agree is unlikely to provide much benefit for the costs incurred.

    So you don’t get dialysis, even though you might live a few more months. You don’t get the dementia medicines that provide little benefit. You don’t get your hip replaced if you don’t have a reasonable lifespan left to use it. You don’t get the experimental chemo that may (if you’re lucky) give you 3 more months of life. and on and on.

    Care in these situations, (and countless others) provides some benefit. It’s simply a small benefit, and not worth our limited resources. If you as the patient aren’t paying, it may be worth it. But it’s not to the rest of us, which is the issue.

    Pretending that there is a dichotomy of 1. Proven useful care that is worth it (all the time), and
    2. wasteful inefficent care that is not worth it (ever), completely dodges the issue. Not all benefit is worth the price paid. But everyone wants their potential benefit.

  • Guy

    i agree with the system being broken but I am surprized that primary care is going to come to the rescue. At one hospital I practice at it seems like the primary care docs are the ones that admit a ton of their patients and proceed to do a ton of tests and consults.

    I think that some docs understand the solution but certainly not all.

    I just think it’s important to not blame specialists for this, primary care has to take some of the blame as well.

    I actually dropped medicare so maybe someone will come up with a solution if the numbers of docs start dropping out in large numbers.

  • Jim Henderson

    In the end, though, there are three critical points:

    1. We can do more than we did twenty years ago to treat disease more effectively, and that costs more money than letting the patient go untreated or providing the old quality of care (which can’t be ethically justified, if the new care is substantially better, in most cases). If a modern vent is better than 20-year-old tech, but costs more, what do you provide to patients?

    2. Legislation binds physicians and health business into uneconomic standards of care to particular populations, specifically because, in a free market, those folks won’t supply that care otherwise. This is not intrinsically a bad thing, but needs to be financially backed up in the long run, by someone (usually other insured patients, these days).

    3. Sooner or later, every patient wants the best care for themselves… It is their life, after all, and that’s pretty important to them. Not unreasonably. Eventually, someone will sue a healthcare provider for (1), regardless of their need and potential to pay.

    Legislation will often make the outcome of (3) binding, and then all patients are required to be provided with maximal care, removing all autonomy. Withdrawl of care, rationing or even physician judgement are ultimately sacrificed, and the cost of care always increases. Legislation and litigation tie the hands of healthcare businesses, and that prevents the emergence of a balanced, competitive marketplace. Neither will relax their control until a crisis is sufficiently large that legislators have no choice but to allow some freedom, in order to prevent a system collapse.

    The only way that this situation can improve, is if next-generation care is cheaper, while being more effective. Will we reach a point where this is true? Maybe, but maybe not.

    Fortunately, many of the increases in cost of care over the past ten years are non-repeatable, such as organisational changes, infection care, HIPAA compliance, EMTALA demands, and so on.

    No doubt, costs will rise, but we are presuming too much to expect that growth will be consistent with the previous decade, especially in light of the reduced output from the pharm industry leading to more prescriptions being for generics year on year, as patents expire.

    Other advances, of course, will be expensive. To achieve long-term savings and improve care, EMRs will become more pervasive, needing large capital investment for systems and training, and the first few generations will suck until standards fall out, but over time, it will help. Walmart thrived, while K-Mart died, because of increased computerisation and automation, but the up-front cost was daunting. Healthcare provision is going to face some really big humps like that, and they will eventually be legislated, and there will be no choice in the end.

    In other words, it’s going to suck for a while yet, even in the case of a non-collapse of the system.

    On the upside, perhaps cost considerations will encourage providers to fund more palliative care programmes, for the profit motive, and perhaps more of our elderly patients and their families will be well-informed enough to enable them to pass on with the dignity that they are often seeking so badly.

  • LISA EMRICH

    I may not have specific qualifications to comment, not being a medical professional or a professional think-tanker.

    I don’t doubt that the Medicare system is going bankrupt, but I don’t agree that limiting access to expensive procedures and therapies would solve the problem.

    Here’s a real-life example of hospital charges and insurance limitation:

    Recently my mother went to the ER with chest pains, trouble breathing, etc. After testing and some treatment in the ER, she was admitted overnight and underwent much more testing the following day. She was released that evening, just 19 hours after arriving at the ER.

    She received the EOB (note she is not retired, not on medicare, and has a BCBS policy) and the hospital’s submitted charges were $8000. But the insurance plans ‘allowed charge’ was only $400.

    She and I are some of the rare people, I guess, who are aware of original medical charges, insurance amounts, etc. She immediately thought, “this can’t be right. The room alone had to cost more than $400.”

    So if Medicare is not paying a fair amount for care, insurance has demanded below-cost reimbursement, and uninsured aren’t paying their billed costs, then where is all the money going in the accelerating costs of healthcare?

    (btw, I stopped really Happy awhile ago because he was causing higher blood pressure. As a patient with MS and RA and insurance which doesn’t pay for meds, I don’t see how his theories would help my situation and struggles.)

    I came here by way of Dr. Wes.

  • Christopher Johnson

    Everyone agrees that our current system, such as it is, is headed for catastrophe unless there are major changes. Demand for services is potentially infinite–resources are finite. What to do? Happy suggests draconian rationing now–I don’t think we need that, at least yet. Peter argues for balance-billing as a fair solution. Like Ms. Mahar, I don’t think that’s the way to go, either. Medicare is an entitlement with incredibly broad support in our society. It’s a promise to our elderly that they will be taken care of when they’re sick. Most importantly, it’s a promise that they will be taken care of equally. As Ms. Mahar points out, half of the elderly have very low incomes and already struggle with Medicare co-payments. Balance-billing would destroy the egalitarian premise of Medicare.

    I think Hospitalist Refugee is correct that it’s not the black and white situations that suck up most of the resources–it’s the vast grey area in between, the enormous outlays for trivial gains. But what I read Ms. Mahar as suggesting is to reform now what we can reform–we should get started on the process. For example, fix at least the problem of paying for what we know now to be pointless, even if that is not the whole problem. We can go at this incrementally, fixing obvious things and seeing where that gets us. I think we can figure out a way to pay primary care physicians more and make them the principal deciders of what advanced care is appropriate by putting the weight of a reformed Medicare system behind their decisions. I suppose that would be a kind of rationing, but I think the elderly would accept it.

    One other thing. I think those who attack Ms. Mahar personally should tell her who they are. After all, she says who she is.

  • Jonathan Dee

    Entitlement – what a powerful word – what a unfortunately dominant, distinguishing attribute of our (American) society.

    As long as our society has a strong sense of entitlement, and as long as the legal framework of our society allows patients to lay waste to physicians, our healthcare system will remain broken.

    The solution to our healthcare crisis largely depends on somebody being able to convince our society that healthcare is a need, not a right, and that certain rights might have to be sacrificed in order for the healthcare need to be met.

  • Anonymous

    “As long as our society has a strong sense of entitlement, and as long as the legal framework of our society allows patients to lay waste to physicians, our healthcare system will remain broken.”

    Our society doesn’t have a sense of entitlement with this issue. Physicians chose this as a way to be paid decades ago. For years it was very profitable, and for the most part still is, but as with all things govt, it’s become a bureacratic pain in the ass. The problem is not society, it’s the way physicians market themselves and allow themselves to be paid. When enough of them are ready to get out and market themselves, to explain why physician A is better than physician B, and why we should be paid more for the services provided by A, then the market will turn. Until then, the only thing differentiating one from another in the public’s eye is whether they take my payment plan and when is the first appointment available.

    As for the legal system “laying waste” to them, what a bunch of nonsense. Their insurers may be giving them a screwing, but physicins win nearly every time they go to court in this legal system.

  • Jonathan Dee

    Anonymous,

    At it’s root, our healthcare crisis is not declining physican income (although, declining physician income is a major issue). The 40+ million uninsured, the underinsured patients, the fact that we have almost no medical students going into primary care, and the unreal amount of money we spend on healthcare without any benefit over other countries is the healthcare crisis. I’m doubtful that better physician marketing is going to fix our crisis.

    As for physicians choosing to be paid this way decades ago – and I assume you mean physicians chose Medicaid and Medicare – you or somebody else please fill me in on that bit o’ history. Furthermore, if you’re implying that Medicaid and Medicare remain profitable for physicians (or hospitals, or physical therapists, e.t.c.), I’d have to respectfully disagree with you. I don’t think you’d have to read very far into the medical blogs to find healthcare providers outlining how unprofitable these government programs are.

    I agree that most court cases are won by physicians, but the $75k to $100k that it takes to defend a case, and the few rather large awards that do go to paients, have driven many physicians out of practice (and kept many out of certain states). The end result is that physicians and hospitals practice “defensive” medicine/care and end up spending a lot of uncessary healthcare dollars in order to try and avoid being sued – especially in emergency centers.

    Not all Americans feel entitled to healthcare, but there are enough of them that do, and they are the ones that eat up a large part of our healthcare dollars – i.e. superusers, futile care, e.t.c.

  • Anonymous

    “I don’t think you’d have to read very far into the medical blogs to find healthcare providers outlining how unprofitable these government programs are.”

    And yet new hospitals are constantly being built, physicians are opening new practices, and physicians have the highest average net income of any profession in the world. For all this claimed lack of profitability, there are still a lot of physicians living quite high on the hog.

    “but the $75k to $100k that it takes to defend a case, and the few rather large awards that do go to paients, have driven many physicians out of practice “

    That’s what it costs to take the occasional high damages case to trial, that’s not an average of all claims. And given that the bulk of large awards are for past or future medical bills, ie money that goes back into the system, that doesn’t really support your claim. And I don’t know what number is “many”, but it must be pretty low because I bet you can’t name even 10 physicians who have ever paid a claim out of their pockets.

    You are right that there are lots of anecdotes, but very few facts.

  • Michael Rack, MD

    “And yet new hospitals are constantly being built, physicians are opening new practices, and physicians have the highest average net income of any profession in the world.”

    The physicians who are doing well are either the ones who don’t take or limit the amount of MEdicare/medicaid, or the ones who perform a lot of procedures. Medicare does pay decently for some procedures.