Why 99 percent of health care should be angry

As Occupy Wall Street has gone from an obscure protest covered only on blogs and social media to a national phenomenon, the apparent parallels between the issues it is raising and the issues we have been raising in health care grows.

 A growing number of protesters are calling themselves the “99 Percenters,” referring to those who are not in the top 1% of earners.  The top 1% of income is clearly greater than $250,000 per year, and likely around $380,000 a year.

In health care, nearly all who are paid more than $380,000 per year are either proceduralists (some medical sub-specialist physicians, and some surgeons, again mainly sub-specialist), or managers and executives of health care organizations.

Health care’s 1%

We have been discussing since 2007 how the inequality among physicians’ incomes favoring those who do procedures over primary care and other “cognitive” physicians has been driven not by the market, but by regulatory capture.  The fees paid for all physicians services by Medicare, a fee schedule adopted without question or major changes by nearly all insurers, are set through the Resource Based Relative Value System (RBRVS) by the US Center for Medicare and Medicaid Services (CMS).  CMS, in turn, gets virtually all its input on these fees from the RBRVS Update Committee (RUC), a private committee of the American Medical Association (AMA), made up largely of proceduralists, whose deliberations are secret, and whose membership has been secret until recently.  See here for most recent posts.  Note that the CMS’ peculiar relationship with the RUC is now subject of a lawsuit that accuses this relationship of violating the Federal Advisory Committee Act.

The real top earners in health care, however, are not physicians, but executives of big corporations, non-profit and especially for profit.  We have discussed endlessly how huge their compensation may be, and how it seems unrelated to any aspect of their own or their organizations’ performance, especially not to how much they benefit patients’ or the public’s health.  Furthermore, we have noted how executives have prospered even when their management seems overtly hostile to the health care mission, when it leads to ethical missteps requiring legal settlements, or even guilty pleas or verdicts to criminal charges.

So health care’s “99 percenters” ought to be angry at the top 1%.

The power of finance

Furthermore, the Occupy Wall Street protesters are not merely upset with the upper 1%, but particularly outraged by those in the financial sector, which “with regulators and elected officials in collusion, inflated and profited from a credit bubble that burst, costing millions of Americans their jobs, incomes, savings and home equity.”  Then, “the initial outrage has been compounded by elected officials’ hunger for campaign cash from Wall Street, a toxic combination that reaffirmed the economic and political power of banks and bankers, while ordinary Americans suffer.  Extreme income inequality is the hallmark of a dysfunctional economy, dominated by a financial sector that is driven as much by speculation, gouging and government backing as by productive investment.”

In another report, the protesters “unite around a common theme: bankers are ripping off America.  Two secondary themes also emerge. One is that the super rich own the politicians.  The other is that the news media, almost across the board, view events through the eyes of the super rich.”

Finance’s links to health care

We have noted parallels between the effects of Wall Street and health care on the economy.  Furthermore, we have noted active ties among Wall Street and health care organizations. Top executives and board members of some of the financial firms most obviously responsible for the global economic collapse have served on boards of trustees of top medical schools and academic medical centers, and their parent universities.  The top leaders of medical schools, academic medical centers, and their parent universities have served on the boards of such financial firms.  There are also board interlocks among Wall Street firms and all sorts of health care corporations.  The corporate culture of Wall Street and health care have long overlapped.

We have further noted how the leadership of big health care organizations has deceptively influenced policy, particularly through stealth health policy advocacy.  Meanwhile, until the last few years, much of health care dysfunction has been anechoic.  Now the media is beginning to report some of the abuses.  Little about them appears, however, in the medical and health care literature that health care professionals are likely to trust more than news media.


We have frequently suggested that true health care reform requires reform of health care leadership and governance.  We need leaders who understand the health care context, uphold health care professionals’ values, and put patients first.  We do not need leaders who are ill-informed, incompetent, self-interested, conflicted, or corrupt.  We need governance that is accountable, honest, transparent, ethical, and again puts patients first.  Maybe to do that we will have to “occupy health care.”

In any case, it is time for health care’s “99 percenters” to stand up for their patients and the integrity of their values.

Roy Poses is an internal medicine physician who blogs at Health Care Renewal.

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  • http://twitter.com/DarrellWhite Darrell White

    So Roy, since I’m an ophthalmologist, a proceduralist, who happens to be pretty good at what I do (very efficient, very good outcomes, very few complications) and happens to have a large capacity for work (both in terms of hours and work/hour), I guess I’m one of those 1%’ers. Are you mad at me, too, buddy?

    Such a slick smear job. Simply put proceduralists in the same paragraph with non-producing healthcare execs. Even better, hang ‘em high by associating them with the small percentage of Wall Streeters who mucked stuff up in 2008. Yah…that’ll do it. While yer at it, throw in some secret “Star Chamber” that sets fees, but make sure you don’t mention that those cloaked villians have progressively decreased procedure fees since day one of RBRVS. They just failed to keep the part of the deal where they raised YOUR fees with the money they saved in return for the Academies of Medicine, Family Medicine, Pediatrics, etc. rolling over for Emperor Hsaio. Facts are so much less sexy than a good “guilt by written association.” If you can convince someone…anyone…that the problem with healthcare economics is those big, bad surgeons, everything will magically be better.

    The drum’s been beating for 20 years now. How’s that been working for you so far, Roy? 

    Yup, I’m the bad guy. Me…the guy over here whose practice receives $697 for a cataract surgery. The practice with the 70% overhead giving me $209 for that modern miracle. We 1%’ers don’t seem to be nearly as comfortable as those other bad guys running pharmaceutical companies or investment banks. Heck, we’re all SELLING our Porches ’cause we can’t afford the gas! And yet you lump us together with those other guys. Where’s the fairness, Roy?

    It hurts my feelings you know, to think that 99% of my colleagues should be angry with me…

    • Anonymous

      you sound upset. you may make a lot of money and earn it well, but in reality, you are not a target of OWS, I am fairly sure of that. don’t take editorials so seriously, you will make yourself age before your time. keep up the good work!

    • Anonymous

      I echo your sentiment. When I was in med school, future salary for effort DID play a role, however large, in my choice of specialty. I am not ashamed to admit it at all. I worked hard to put myself in a position where I had my choice of specialties. I grow tired of newly minted primary care docs that complain of discrepancies in reimbursement, although I DO think they are underpaid. We are from a generation of physicians that chose are specialties knowing exactly what to expect – and to complain about it after the fact is pointless.

      • Anonymous

        My med school made an overt effort to choose folks just like you, Muddy.  Those with altruistic goals were seen as a few pegs lower in desirability as alumni.  My thoughts were that they figured they’d get more donations from a rich doctor than a poor one.

    • http://www.facebook.com/people/Steven-Reznick/100000549195050 Steven Reznick

      I am a general internist and have been upset with the RUC for years now. I am not upset with Dr White, who has gone to school and trained for extra years to gain the skills and credentials to perform delicate complex sight saving surgery. I have great respect for his talents and all the talents of my colleagues. I am upset when his specialty society and other procedural societies de-value my cognitive and coordinating skills while over valuing their procedural skills at the expense of primary care physicians. Cataract surgery is relatively low risk as are dermatologic skin biopsies, and numerous other procedures. When I spend 90 minutes adjusting a patients medications and evaluating their coronary disease, hypertension, diabetes mellitus, chronic lung disease, arrythmia and anti coagulation so that they can undergo Dr White’s ten minute procedure safely, and I am compensated less than a third of his net pay for the procedure based on the efforts of the lobbying of his specialty society it doesnt sit well.

      • http://twitter.com/DarrellWhite Darrell White

        Dr. Reznick, you mistake the efforts of specialty societies to fight for appropriate pay for work done as necessarily requiring some sort of denigration of the services that you and your colleagues provide. It is a mistake to assume, just as it would be a mistake to lobby on the platform, that one service is more valuable than another, and that dollars should therefore be taken from the lesser valued and given to the greater valued. Indeed, that’s mostly my (admittedly snarky) point above, that non-procedural societies naively believed that reductions in pay for procedures would involve shifts in those funds to so-called “cognitive work” (itself a misnomer, as if neurosurgery or complex cataract surgery requires no cognitive engagement). The monies were never shifted, and future monies are unlikely to be shifted either, just taken off the table as cost reduction. 

        Instead of carping that my skills are overvalued, and doing all of the “divide and conquer” work on behalf of groups we should be unified against, how about a rational examination of the economic landscape before you? Not happy with the effort of the American College of Medicine on your behalf? Fire ‘em! Start another group. There are presently three…count ‘em, three…brand new groups in ophthalmology who feel we have inadequate representation and are looking to supplant the existing groups. Or how about looking at the extraordinary opportunity that internists (and family practitioners) have to thumb their noses at the entirety of “health insurance” by refusing to play? By going direct to the patient and not participating in a single plan? We ophthalmologists can’t really do that, but man, would if I could.

        I’m afraid I can’t let you get away with the last couple of sentences. In 2000 an article on pre-admission testing and “buffing”  before cataract surgery was published in the NEJM. Exactly zero cases were influenced with regard to safety by PAT. In addition, the median surgical time for cataract surgery in the U.S. is around 25 or 30 minutes. Unfortunately, cataract surgery is NOT as low risk as dermatologic surgery, and the consequences of a complication are orders of magnitude greater for cataract (and retinal, and glaucoma…) surgeries than the excision of a skin tag. To equate them is disingenuous, and it detracts from your otherwise measured and considered thoughts.

        • http://onhealthtech.blogspot.com Margalit Gur-Arie

          Just curious, are you gentlemen aware of how your “measured and considered thoughts” come across on the backdrop of what is happening in this country right now?

          • http://pulse.yahoo.com/_ZNE5BQXLXFP6LWG3QOGPLO4FB4 JoeR

            Absolute truth Matgalit – These folks are absolutely tone deaf.

        • Anonymous

          “It is a mistake to assume . . .  that one service is more valuable than another, and that dollars should therefore be taken from the lesser valued and given to the greater value”
          But that is exactly what the AMA and the RUC have been doing for the past twenty-five years. When did you start protesting?

        • http://www.facebook.com/people/Steven-Reznick/100000549195050 Steven Reznick

          In my community , prior to cataract surgery our local eye specialists are asking the patients medical doctors to see the patients in pre operative evaluation. If we point out that they do not need it , they send the patient to other medical doctors to perform the pre op testing.
          I specifically stated that eye physicians perform complex delicate eye saving surgery. It may be riskier than dermatologic biopsies but still considered relatively low risk surgery. 
          The RUC is composed of few primary care physicians and over 2/3 procedure related medical and surgical specialists. The RUC has been over valuing procedures compared to cognitive and coordinating care since its inception. I have dropped out of the American Medical Association because of its relationship with RUC and joined the societies that represent advocacy and cognitive and coordinating activities with patients. Once again if a specialty earns more money through RUC actions, its members have more resources and money to lobby those organizations and individuals that make the ultimate reimbursement decisions than primary care societies do.  

    • Roy Poses

      Well, Dr White, I’m not sure we are “buddies,” but I am not mad at you personally.

      I am mad, as I indicated above, at the process used to set what Medicare pays physicians for specific services.  Since you seem to think I have made up the RUC, why don’t you read my first blog post, in 2007, on the topic here: http://hcrenewal.blogspot.com/2007/03/on-disparities-between-reimbursement-of.html
      Then read the article in the Annals of Internal Medicine on which it was based: Bodenheimer T, Berenson RA, Rudolf P. The primary care-specialty income gap: why it matters. Ann Intern Med 2007; 146: 301-306.
      Then, for fun, peruse the rest of what I have written on the subject, with a few other journal citations here: http://hcrenewal.blogspot.com/search/label/RUC
      Finally, look at the Replace the RUC web-site here: http://replacetheruc.org/
      Then, if you still have some sort of argument that the RUC and the problems it has created are fantasies, let’s hear it.

      Maybe the payment for cataract surgery has gone down, but it appears that the payments for most procedures have gone up.  I can’t believe that the RUC did not realize that the SGR would force compensating decreases in payments for evaluation and management services.  I can’t believe that the RUC did not realize that stagnation in payments for cognitive services while inflation was continuing and overhead expenses, as you noted, were increasing was a reason for the decline in numbers of of primary care physicians.  Yet the RUC continued on its merry way, revising upward payments for most procedures.  Maybe RUC members don’t think that primary care is an important part of the health care system. 

      If you disagree, maybe you should talk to your American Academy of Opthamology representative on the RUC, George Williams MD (look here: http://hcrenewal.blogspot.com/2011/04/rucing-about-conflicts-of-interest.html )

      Of course, I agree, as I wrote above, that physicians ought to be most upset at the outrageously overpaid executives who lead nearly all important health care organizations.

      • http://twitter.com/DarrellWhite Darrell White

        Ah, Dr. Poses, self-referencing. Nice.

        Cardiac bypass surgery…down. Anesthesia services…down. Joint replacement fees…down. And on it goes. Even GI fees have finally started to fall. Indeed, cataract surgery fees are down ~60% without taking into account inflation c/w 1990. I guess I’d feel like my argument was a little lighter if those decreases had resulted in an increase in fees to internists and the like, but alas, ’tis not so. Cognitive services have been flat, resulting in a decrease in NET fees with increasing overhead. There we certainly agree. I believe you give the RUC members too much credit. In my opinion the calculations involved in understanding the macroeconomic effect of their decisions on primary care manpower are dramatically beyond the scope of their expertise. 

        The thrust of my argument remains the same: your target (procedural specialists) and your tactics (yellow journalism-type smears) are misplaced and wrong-headed. You slander us with a tar we don’t deserve, and worse do so with sly and sideways innuendo. We, you and I, are both underpaid and under-valued, especially in light of values placed on the work of our non-medical peers relative to our work.  I’ll challenge neither your right nor your need for righteous indignation, just your aim and your ordinance. 

        I will admit, though, that organized ophthalmology recently openly feuded with a medical subspecialty over how fees should be set, but that was cardiology.

        I don’t think cath fees have gone down. 

        • http://twitter.com/scotsilv scotsilv


          Deogatory comments about “self referencing” with respect to posts that themselves are based on, link to, or reference other literature, shows that you are no scholar.  I hope you read the medical literature in your specialty with more care, as it seems clear your either cursorily glanced at Dr. Poses’ links, or you didn’t bother to look at them at all. – S. Silverstein MD, medical informatics blogger at HC Renewal.

    • Anonymous

      Well, at 209 bucks profit for 10 minutes work, you are getting paid pretty well, huh?  Is what you do for $1254 an hour net really twenty times as difficult and risky deserving 20 times as much as what I make for dealing with folks with chronic health problems that soak about 70-80% of health care cost through their lifetime?

      If not, are you smug in your income and sneer at the fools who slave away for a nickel of every dollar you make?  Or do you tirelessly advocate for the underpaid?  Or shrug your shoulders and turn away?

      I’m not angry, trying to be your enemy or your friend here.  Just look at yourself and your words.  And think a little more.

      • http://twitter.com/DarrellWhite Darrell White

        Come on, not a one of us makes a nickel for every dollar another of us makes. In fact, that $209 also includes 90 days of post-op care, no matter what may arise. In truth, not much does, and the cumulative additional doc time is still small in my case, but it’s probably closer to 45 min. of work total, and the OR’s are just not efficient enough to do 6 cases an hour; perhaps 4. Anyway… But as I said elsewhere, the median and the mean cataract surgery time is closer to 30 minutes in the US; the fact that some do it better and faster should be celebrated, no? LIke handling complex medical cases efficiently as well as compassionately and accurately?

        I have long advocated for increased pay for pediatricians, internists, endocrinologists and family practitioners in other venues, just not in this thread, and never at the expense of other docs. In my own world I have done so for neuro-ophthalmologists (who would consider 90 minutes a brief encounter). What I simply don’t understand, now or ever, is the need I perceive in docs who feel it is necessary to DE-value the work of others. Even more, to slander them. Why do they do that? Why would they possibly DE-value what I do, especially when there is no value added (or indeed subtracted) for experience and excellence? For ophthalmologists OR internists?

        FWIW I, like most ophthalmologists, spend more time in my office seeing patients and using the same E&M codes as every internist and getting the same fee. But boy, would it be cool to operate 5 days a week, and do 6 cases an hour…

        • Anonymous

          Well now, that’s more reasonable if you are only working two patient’s a hour.  The eye factories where I live do 6.  The follow up is pretty quick in most cases, but if you’re going to start counting all the time you spend on a case, the I get to count all the unpaid phone calls, three page insurance forms, prior authorizations and supermarket aisle consults (I live in a small town), and I still get about $50 an hour to see three patients that take me 2+ hours total time to care for, so the pay inequality is still fairly proportional.

  • http://medschoolodyssey.wordpress.com/ Med School Odyssey

    The AMA involved in something shady and not in the best interest of patients or physicians?  Big surprise there.

  • http://www.facebook.com/people/Ardella-Eagle/840440226 Ardella Eagle

    The grassroots effort is spreading.  I’m with Dr. White here; it isn’t the specialists who are milking and profiting from the system.  Specialists are DOCTORS.  The people who are grossly overpaid are the corporate types at the pharmaceuticals and equipment companies with their insane retirement packages that are funded by the overpriced products they produce.

    • Anonymous

      BS. Specialists have and are milking the system.  Dr. White admits that his society has been quite effective at getting reimbursement “favorable” to his specialty.  Your Marxist propaganda stream is showing.

      To begin with, health care service costs are only a small slice of the health care cost pie. Many specialists and generalists are themselves corporations.  With “insane” retirement packages.  Funded by the “overpriced products” they produce.   But that doesn’t fit your narrative too well, does it?Get over it.  If you are going to play in the health insurance sandbox, you play by health insurance rules and really have no justification to whine when you get sand in your knickers.  Capitalist economy reaps benefits for those that can fight their way up the ladder.  Those on the lower rungs can choose to climb or they can whine and threaten to kick the bottom off the ladder.If more physicians simply dealt straight with their patients and let the market run the prices for their services, you’d see an interesting change take place in health care service costs.  Of course THAT would require many changes, including some changes in how medical education is financed. Consider the minimal number of physicians that choose to provide any service to their country or community at any time in their career.  I know of more who volunteer to travel to third world countries for a few weeks each year (usually high paid specialists) than those who offer sliding scale or donate their services to folks in their own communities.  And there aren’t many of either.                                                             

      • http://www.facebook.com/people/Ardella-Eagle/840440226 Ardella Eagle

        Those DOCTORS that do incorporate themselves usually do so as a cost saving measure to expand their practices, have a better leverage with insurance companies, to protect themselves in the event of a malpractice suit, etc. 
        Blessings on those physicians who do the good works of Doctors Without  Borders and others who privately donate their time, skills, and usually a lot of supplies to places in need.  And yes, many do donate themselves within their own country, although why the media doesn’t pick up on it is beyond me.  If I recall correctly, the sliding scale on medical fees was SUPPOSED to help draw doctors into the most desitute sections of the country and away from the Big Cities where they could command a higher fee.  Fat lot of good that did.

  • http://onhealthtech.blogspot.com Margalit Gur-Arie

    Indeed it is time to “occupy health care” ( http://onhealthtech.blogspot.com/2011/10/occupy-health-care.html ), particularly since “health care” is no longer an appropriate description for the activities of the medical complex which is not engaged in either health nor care.
    I am very curious to see which side the AMA, medical associations and individual physicians choose to align with, if this movement catches on as it should.
    Putting patients first in particular will be extremely difficult, since corporations assisted by government and rather naive patient advocacy groups are in the process of convincing us all that there is no such thing as patients. We are consumers now and you are providers. Enjoy the promotion.

    • Anonymous

      Evil Corporations? You mean Evil Government bureaucrats and regulators assisted by Evil Corporations.  You got it backwards.

    • Anonymous

      We have patients and Gov. better start promoting patient care!

      • Anonymous

        We need to get government out of health care! They are trying to come between the patient and the doctor. They are trying to wrestle the power and money from health care. Don’t blame the health care corporations: the hospitals and insurance companies. The government has them wrapped in red tape with regulations. There is no freedom in this marketplace!

  • Anonymous

    I am angry for Hospitals are struggling to make budget and keep believing that cutting staff-which directly decreases the level of patient care-to be the answer.

    • http://pulse.yahoo.com/_6M75YDFBB7PSB53H2YBFBC65FE Lori

      Cutting staff and decreasing the nurse patient ratio does not help anyone, doctors, nurses or other ancillary personel. I feel as a nurse,  certain  patients have a sense of entitlement, They do deserve the best care we can supply, I also feel they need to trust the doctors and nurses and not look every little thing up on the internet and grill us endlessly.  As a nurse I am responsible for everything that touchs my patients,  It is a huge responsibility.  I am proud of my profession as the doctors need to be also.It is not easy,but do I believe it is a noble profession. I do not know what all the doctors salaries are but if you are making over 100,000  dollars a year you should be grateful. If you are burned out find another profession. 

  • http://profiles.google.com/molly.ciliberti Molly Ciliberti

    We are the 99% and it is time to find our strength in numbers.

  • http://twitter.com/kdhoffman2 Kathleen D. Hoffman

    Thanks for this post.  Have just shared on G+ and twitter. Am blogging on healthychange4you.blogspot.com

  • Anonymous

    I am not a physician but mighty interested in anything
    related to health (sickness) care.  I
    find it curious that


    Procedures are in question a lot – surgical, blood tests,
    diagnostic – with regard to cost.  They
    seem to be too easy to order, patients seem to always want “all that can be
    done” may be convinced if they get poked, x-rayed, or cut it is better than to
    have to listen to a doctor tell them what they should be doing, And those doing
    procedures know their worth so many are done unnecessarily.  So, somehow, those who are making the rules
    need to not only come to a better balance in payments but also better evidence
    of need.   


    I really feel for the primary care physician or internist of
    today.  Listening to the doctor who spent
    90 minutes adjusting a patients medications and evaluating their coronary
    disease, hypertension, diabetes mellitus, chronic lung disease, arrhythmias and
    anti coagulation so that they can undergo a “procedure” puts a lot of what is
    wrong with heath (sickness) care into perspective.   It is
    clearly known that all these chronic preventable diseases the patient has are
    the result of eating too much food with high contents of sugar, fat and salt
    (these are the substances that cause people to overeat) plus smoking tobacco –
    already taxed.  I say – get the revenue
    up front from these substances, put them into sickness prevention – some of the
    revenue could be used to compensate physicians who spend so much time treating
    these patients.  Certainly the evidence
    is there.

    • Anonymous

      See   8 Myths That Keep People Sick and Perpetuate the Heathcare Crisis herehttp://faiezkirsten.com/8-myths-that-perpetuate-the-healthcare-crisis.html

  • zaff1

    The system is designed to create and perpetuate problems. So the global crisis in healthcare is not surprising – including the fact that the real top earners in health care are not physicians, but
    executives of big corporations, non-profit and especially for profit.  The conflict of interest inherent in the system has much to do with this crisis.
    See “8 Myths That Keep People Sick and Perpetuate the Heathcare Crisis” here http://faiezkirsten.com/8-myths-that-perpetuate-the-healthcare-crisis.html

  • Anonymous

    I completely agree with you all. The culpritl of America is due to these executives being paid way too much for what they are worth and do. Is that acceptable  for a nonprofit organization executive to be paid over $500,000.000 a year plus bonuses and furthermore be paid exorbitant severance pay after wreching the company? What a rip off! Well this happens in may hospitals in the country. These executives make double what a physicians are making. What is wrong with this country. This is call greed and contributes to the downfall of America. Something needs to be done to save America before China takes over. Wake up everybody!

  • http://www.facebook.com/people/Dan-Clayton/100002165622845 Dan Clayton

    The problem is that regulators have created a demand issue. When Healthcare becomes a Right… it increases demand, then Regulators further reduce barriers to expensive care by prohibiting a doctor for acting with any consideration of care cost. In fact it is illegal now for a doctor to own a hospital and participate in Medicare reimbursement… Then on top of that all the lawyers on Congress dream of getting a big payday if a doctor makes a mistake, so they increase penalties throught the law. Then they force insurance to cover more. Now we have a perfect storm. More patients want an MRI for a stubbed tow, a doctor who practices to not get sued will order that MRI and $1000 later there is no true impact or improvement on the stubbed toe…

    We are living in a regulated mess. Cost efficiency can  not be mandated by Congress. Our greed as a democratic people has led us to this mess of unaffordable healthcare.

  • Michael Auricchio

    I’m sorry but this is insane. I work with directly with the executive staff of a Thompson & Reuters Top 100 Hospital and they are some of the smartest and hardest working people I’ve ever encountered. Without these dedicated professionals, the hospital and all of the healthcare service lines associated with it would be in complete disarray.

    These are people who could be making 100x their current salary in the private sector… say the financial industry which the author is so keen on targeting.


    …this author should be ashamed

    To the audience: if you or anyone you love has received healthcare services at a hospital and expects the best quality of care… think about who you’re targeting here. Yeah… that’s what I thought.

  • Michael Auricchio

    I’m sorry but this is insane. I work with directly with the executive staff of a Thompson & Reuters Top 100 Hospital and they are some of the smartest and hardest working people I’ve ever encountered. Without these dedicated professionals, the hospital and all of the healthcare service lines associated with it would be in complete disarray.

    These are people who could be making 100x their current salary in the private sector… say the financial industry which the author is so keen on targeting.


    …this author should be ashamed

    To the audience: if you or anyone you love has received healthcare services at a hospital and expects the best quality of care… think about who you’re targeting here. Yeah… that’s what I thought.

    • Anonymous

      well said

  • Connie Sterritt

    What needs to happen:

    Tort reform

    The encroachment of insurance companies on the doctor-patient relationship must be reigned in.

    Insurers continued  encroachment on the practice of medicine through financial decisions that are driven by simplistic profit motives rather than by quality of care must be reigned in.

    It’s all about big insurance and big pharma….all badness.

    Single payer
    Single payer
    Single payer

    the only thing that will work and save us.

  • Anonymous

    As a retired health care employee, I’ve seen the coming crisis evolve.  I’ve witnessed increasing
    lack of integrity among both specialty physicians (proceduralists) and health care administrators
    to a level that is shocking.  There was no-one responsible for oversight, and no-one to say that they
    were motivated by personal financial gain and all it’s ramifications. The few physicians who left
    this environment often went into small individualized practices at great personal sacrifice. A bubble
    in our medical system has grown – I’m waiting for the crash.    

  • Anonymous

    Seriously?  The CEOs are the issue?  A neophyte response to a nationwide crisis.  Maybe we should ask, “What is a resonable salary for a physician?”  These top “1%” earners are in charge of billion dollar healthcare corporations which include thousands of employees.  All the while, attempting to keep their physicians “happy” (we all know what an unhappy physician says, “I’ll take my cases to hospital B if I don’t get the surgical time I want or the new scanner or the latest instruments….blah…blahh..”).  Medicine is a business, like it or not. When your revenue is dependant on a third party payor, or a government agency that forces unproven regulations. you begin to see the bigger picture and value of good management.  It’s not as easy as it seems.  Physicians had there chance to change healthcare in the glory days of medicine (unlimited reimbursement), unfortunately, greed always seems to rear its ugly head.  Now everyone is crying foul.  Everyone is full of opinions, but empty on solutions.

    • Anonymous

      you are correct!

  • Anonymous

    What is new? Are we sleeping?
    What will help the situation. Is there a cure?THere must be. Together we can fight the fight and win. Divided we lost the battle already. Shall we as health workers bind together? It really is up to us individually. Maker up your mind and act. Let us put our heads together and make a difference.

  • Anonymous

    Are you surprised?

  • http://pulse.yahoo.com/_EQM4S4S2BWEQLSXQ2VZNYN6B2I odysseus6996

    There are many factors at work keeping the 99% down and the 1% up.  I don’t begrudge some sub-specialists large income as it takes some 6-8 yrs of residency or fellowship to reach the level that they start to clear their student loans. However, there are many sub-specialists that milk it for every penny. 
     The greater problem lies in the steady declining in pt-nurse ratio and increasing disparity of pay between administration which is generally incompetent as evidenced by failing hospitals across the country.  Another villain in the disparity are the salaries of the manged care execs that are paid six figure salaries and bonuses for increasing profits. This is done by care rationing and increasing cost of coverage with decreasing reimbursement. The lobbies of the insurance companies pour huge amounts of cash to Congress for favorable legislation. Check the contributors to your Congressman and their opponent next time you vote.  This is also true of big Pharma. Ungodly prices for meds that are no better than the ones that have gone generic and are in some cases more than 1/100 of the cost. The FDA colludes in this as it takes studies with as few as 12 subjects to approve a medication.  Also check the contributors during election periods.  It is not so much as 99% of us are mad at the 1% but that the 1% is increasing the cost and lowering the quality of patient outcome, reducing the quality of life for all of us in general.  

  • Kristen Pavle

    Health care is for people not for profit, but that’s not how the U.S. operates. If we continue to accept a health care system as a business primarily and as a way for people to access care secondarily we will continue to see money spent in ways that do not impact health. Then we are back to where we started: sick(er) people who need care.

    It’s not the health care professionals that are necessarily the problem, it’s the system. Especially in a fee-for-service system, the more services provided the more money made. (not to mention how outdated the services available are, we are using Medicare and Medicaid systems of care that were built decades ago, and slow to adapt to the needs of a rapidly evolving population).

    We need health care professionals to stand together for the good of their patients to say that fee-for-service and fragmented systems DO NOT WORK.

    We need dedication from our joke of a Congress to do what is in the best interest of our nation: NOT fee-for-service, fragmented health care.

    We need to overhaul Medicare and Medicaid so that providers can afford to see patients who use these insurers. What kind of society do we live in where we have a health program for the poor (Medicaid) that has such paltry reimbursement that health care providers cannot afford to serve them?! It’s disgusting.

    I’ll echo what’s already been posted: single-payer. single-payer. single-payer. But before this happens… I am the 99% who wants change, especially in health care.

  • http://www.facebook.com/TerryRyanMitlyng Terry Ryan-Mitlyng

    I wrote a book about the healthcare industry when I retired 4 years ago.  I couldn’t get any agent to accept it.  The title is “You and Your Doctor at Risk:  Can You Survive the HealthCare Industry”.  It is all about how the business model of medicine is dominating how medicine is practiced in this country and although they advertise as patient focused, decisions made at the board level are all about money. I am a physician who practiced for 25 years and also served as the medical director of two large healthcare organizations. I have seen it from the inside.

  • http://www.facebook.com/kevin.knauss1 Kevin Knauss

    When a doctor makes a mistake they get hit with a malpractive lawsuit. When a health care executive makes a mistake they either get a bonus or a severance package.

    • http://pulse.yahoo.com/_TKZLL7R5AHU4BRHMNQSSX4TFPU medinf

      That indeed is ruining the hospital industry, and has already ruined pharma.

  • Steve Munie

    One thing I’m not hearing is the bigger picture of the years spent in medical school and then residency and possibly a fellowship for a specialty trained physician. Now you’re 30 years old with $250,000 to $300,000 in debt. By the time you’re 40, your debts are paid off and you’re at ground zero.
    I think anyone that makes that kind of commitment and sacrifice should be in the top 1%. Someone is going to be in the top 1%, those that have earned it through hard work and sacrifice should be applauded. I am part of the 99% but still do very well. I am not a doctor but do have great respect for the profession and those compassionate individuals that take care of us.

    • Yelena Kan

      Some of the doctors I dealt with were a lot more interested in billing my insurance than in their dedication to help me. I also have respect for the profession, however I have the same respect for anyone who’s good at what he does and is interested in helping people. When people enter medical school most of them know what they are in for in terms of investment of time/ effort and money. Now, let me ask you another question: whose idea it was to raise tuition for med. school to 60-70K a year? Are those the executives who priced colonoscopy @  $1,500? And blood pressure pill @ 10/pop?

  • Anonymous

    I agree that the only way to reform healthcare is to have persons who understand healthcare reform it. These politicians have no idea what they are talking about. Healthcare is not like any other industry. Healthcare can’t be lumped in with any other type of business. It stands on it’s own. No other business deals with the life and death issues as their primary job.
    Healthcare professionals are not like any other workers in any other business either. We do what we do, first and foremost because we chose to go into a career so we could help others. It requires dedication, discipline and time to learn what is required to provide good healthcare. No matter what field you practice in, the job is stressful and the hours are long. When you become licensed as a healthcare provider, you are a healthcare provider 24/7, whether your at your job or not. Anyone who knows you will expect your advice.
    Anyone who thinks that healthcare providers who makes a lot of money should feel guilty or expect them to give it away to someone else, is someone who has no clue what it takes to be a healthcare provider.
    I for one believe I earn every dime I make. I gave up my money and my time and sometimes my sanity to become a healthcare provider. I don’t lie, steal, or cheat to earn my paycheck like the big cooperations do.
    The government must get it’s hands out of healthcare before they totallly destroy it. Until you understand healthcare, you can not make rules about how it is provided.
    They should stick to things that they have some knowledge about. One of the biggest things they could concentrate on is stopping the drive by lawyers who bring about all the frivolous lawsuits that significantly drive up the cost of healthcare. That they understand and they can do something about.

  • http://twitter.com/scotsilv scotsilv

    As one of Roy Poses’ co-bloggers and a Medical Informaticist, I can say with certainty that government involvement in healthcare has been disastrous. Specifically, via ONC, ARRA and the HITECH Act, prematurely pushing still-experimental healthcare information technology on an unsuspecting medical profession (for the most part) and public.  See “An updated reading list on health IT” at  http://tinyurl.com/emrreadinglist, and the personal aftermath of this technology “A Diary of EHR-Initiated Tragedy” at http://tinyurl.com/ehrtragedy .

  • Anonymous

    The blame is on the 99%. We created this problem. We allow lawyers to file friviolous lawsuits that drive up costs. We allow govt bureaucrats to create massive regulation for hospitals to manage which has created huge hospital costs.And this has killed charity hospitals. In San Diego County, hospitals lose over $700 million each year for uninsured, many illegal aliens. We the 99% want the highest quality care but are unwilling to pay for it. The CEOs learned to play the game and they play it well. What incentive have we given the CEOs to not make profit? Entities like JCAHO and state inspectors are clueless. Go look at your 401k , Did you invest in these same healthcare insurance co’s.. that you want to make you retirement money  but dont want to make a profit? the biggest contributors to the 08 Obama campaign were trial lawyers and health insurance companies. Start there.

  • Anonymous

    So demonizing the execs and accusing them of not caring about patients is the solution? It’s hard to sympathize with the author’s viewpoint while his tone is so antagonistic. Remember that these are qualified professionals who would likely have much higher compensation in other sectors but choose to work in healthcare to make a difference. I see a lot of finger pointing but no proposed solutions. Let’s say we get the CEO’s out – what system should take over? Is anything more efficient? Who is capable of running healthcare institutions?

    • http://pulse.yahoo.com/_TKZLL7R5AHU4BRHMNQSSX4TFPU medinf

      I’ve worked in hospitals where the CEO WAS a physician.  There is no magic to being an “executive.”    

      As far as “demonizing”, and seeking sympathy, neither change the facts.  Argue to merits, not your emotions, or don’t argue at all.

    • http://pulse.yahoo.com/_TKZLL7R5AHU4BRHMNQSSX4TFPU medinf

      In fact, what you have written is Argumentum Ad Hominem and logically fallacious (see http://www.nizkor.org/features/fallacies/ad-hominem.html ) …arguments we tear to shreds at Healthcare Renewal.

      • Anonymous

        I guess that’s why I’ve never heard of you then?

        The article was written in a manner that separates executives from physicians. For example, to quote it exactly: “In health care, nearly all who are paid more than $380,000 per year are
        either proceduralists (some medical sub-specialist physicians, and some
        surgeons, again mainly sub-specialist), or managers and executives of
        health care organizations.” The ‘either or’ mentality is what keeps administrators and clinicians at odds and is one of the main reasons why healthcare is such a low performing industry compared to others in the world economy.

        I’m not interested in whether you agree with my subjective assessment of the article. I’d rather you address my question regarding ideas for other methods of administration that might work better. I should probably ask though, can you?

  • http://www.facebook.com/people/Kingsley-Maritz/543606657 Kingsley Maritz

    I wonder why they earn so much when most PCTs are really struggling, and some hospitals are performing badly. It is another example of the economy working for those at the top, leaving those at the bottom of the pile to fend for theselves. 

  • Yelena Kan

    Healthcare is … a business of caring for sick/ injured/ healthy people. Just like any other business it has to be managed by people who know business side of it as well as caring/ medical part. In response to the comment by “letsfixtheproblem”. Let’s find the problem first! In many cases of failed and bankrupt hospitals the problem is poor management. So it’s OK to point fingers as long as we point them in right direction. In order to fix the problem we (99 %) need to establish what needs fixing. Executives have to have a financial incentive for hospitals to succeed financially, otherwise why would they care? Just because they are healthcare professionals doesn’t mean they will. They are humans first of all and have families, needs and wants. We need to take closer look at insurance companies (and their executives and bonuses and profits), pharmaceutical companies (with their 300- 500% profits), etc. But most of all we probably need to take a look at the laws/ rules and regulations that allowed it to happen, and start changing those in order to create some order in this disorderly situation.

    • http://pulse.yahoo.com/_TKZLL7R5AHU4BRHMNQSSX4TFPU medinf

       I think the healthcare industry has a huge number of very, very lousy executives who should not be running an organization so critical and complex.  Dishonest, arrogant, ill-informed …see Healthcare Renewal blog for a cornucopia of examples.

      • Jason Middleton

        So, are you lumping all healthcare executives into the same bucket of “dishonest, arrogant, ill-informed”? I don’t need to take a look at your blog or your ‘cornucopia of examples.’ Sounds like you are only part of the problem and not offering any constructive solutions other than throwing stones.

        • http://pulse.yahoo.com/_TKZLL7R5AHU4BRHMNQSSX4TFPU medinf


          You could learn something about argumentation from http://www.nizkor.org/features/fallacies/ , and something about healthcare from htt[://hcrenewal.blogspot.com .

          “It is only the ignorant who despise education.” – Publilius Syrus, Latin Poet, 43-85 AD

        • http://pulse.yahoo.com/_TKZLL7R5AHU4BRHMNQSSX4TFPU medinf

           “It is only the ignorant who despise education.” – Publilius Syrus, Latin Poet, 43-85 AD

        • http://pulse.yahoo.com/_F556V5LD44YNTMQMXL7QGA7G4Y Sandy Brady

          The compensation of these executives is obscene.  The compensation of hospital administraors is obscene, and, their judgment is flawed to pay that kind of money to a few orthopaedic surgeons.  The hospitals nowadays are run like Libya was run until just a few days ago. The doctors must rebel against the cancers aflicting their care of patients.

  • Anonymous

    This is an interesting post, but one that lacks any credible evidence on this topic. I don’t see one single stat on this page about hospital executive compensation – just a bunch of rhetoric that fits with the times. I am sure that you can find a few dozen hospital executives that make millions, but they are the minority.

    I work as a health care consultant for hospitals and employed physician groups where I deal with both sides of the equation – executives and physicians – and I actually believe the opposite to be true. I will use some data to back this up – median salary for the following specialists (meaning that half of the respondents to this survey actually make MORE than these numbers): Anesthesiology – $405k, Cardiology (Invasive) – $468k, Orthopaedic Surgery (General) $497k, GI – $464k, Radiology (noninvasive) – $473k…just to name a few. Source: 2011 MGMA Physician Compensation and Production Survey.

    Adding some personal context, I recently worked on a project where a hospital hired a group of Orthopaedic surgeons – each one of the surgeons is making $900k+  – more than 2.5 times the hospital system COO’s annual compensation. The COO runs a massive, well-run organization with 20,000+ employees and he makes less money than half of the employed physicians. And this is not a unique case – we see this in many medical organizations.

    Solving the health care problem will take a little bit from everybody…. y wife is a doctor so I know as much as anybody how hard they work, how grueling med school and residency are, how high the student loan bills can be  and the good they provide. That being said, there are many that just make way too much money in a system were millions of people cannot even afford basic healthcare. There is no need for a surgeon to be making a $1 million plus….I think he/she could still survive on $500k. So until I see concrete data that proves otherwise, I’m going to have to disagree with this article. Physician compensation is the elephant in the room when it comes to healthcare costs….nobody wants to talk about it….you can’t take money away from doctors!

    • http://pulse.yahoo.com/_TKZLL7R5AHU4BRHMNQSSX4TFPU medinf

      While it’s unfortunate the cross post didn’t carry over the index terms from Healthcare Renewal, I hope you do a better job in your consulting than you do on commenting on the web.    Consultants, if I understand the term, are supposed to do comprehensive research.

      HC Renewal is filled with posts that mention exact levels of executive compensation.   The original post was labelled with the term “executive comensation” which leads to http://hcrenewal.blogspot.com/search/label/executive%20compensation

  • http://twitter.com/openib Guy Fawkes

    I don’t think the average 99er is mad at doctors for making a good living. Your average doctor doesn’t have an army of lobbyists paying off politicos. Your average doctor doesn’t have an elaborate scheme to avoid taxes by claiming they are really providing their care in some Tax haven instead of their actual location in America. Not to say all doctors are saints or that they couldn’t do better, just that they are not the ones screwing the middle class.

    • Anonymous

      “average doctor doesn’t have an army of lobbyists paying off politicos”?  Hmmm…ever see the AMA Political Action Fund.  Check it out, it’s public information.  Some of the best lobbyists in the country.

      • http://pulse.yahoo.com/_GJCNF5QLKW7ROYAZZGB7HFH57Y jamesp

        Nice try randuro, but the AMA represents less than 17 % of US physicians. As a nonmember, most of my colleagues and I refuse to pay their dues precisely because they are part of the 1% problem. That is, they (illegally) help specialists dominate the pay spectrum at the expense of primary care Docs and our patients’ needs (Family practice, peds, internists, and the poor non board certified GP who is almost totally shut out by insurers and much of medicare and medicaid)


  • Brett Mello

    What are you basing your “certainty” on?  The examples discussed in the links sound like a case of  bad configuration of an EMR.  It could also be a just a poor solution from a vendor.  Do you know if these were even a certified applications?  I would like to suggest not painting all EMR implementations and the overall value of EMR’s from a single, albeit tragic, example.  A well implemented EMR, configured in collaboration with an organization’s physicians, has been repeatedly proven to reduce medical and medication errors.  Why would any educated person, including legislators and executives, support the use of a tool that would increase harm, not safety.  Education aside, we will all be patients at some point so our innate need for self preservation would seem contrarian to arbitrary investments in useless technology to manage our care. Our current health delivery method produces far more harm than the new technology being implemented to address it.  We need to embrace technology and make it work for us rather than putting our heads in the sand.  Take the following quote as an example:

    “That it will ever come into general use, notwithstanding its value, is extremely doubtful because its beneficial application requires much time and gives a good bit of trouble, both to the patient and to the practitioner because its hue and character are foreign and opposed to all our habits and associations.” – The London Times, 1834 commenting on the “stethoscope”

    • http://pulse.yahoo.com/_TKZLL7R5AHU4BRHMNQSSX4TFPU medinf

      Where’s your literature list supporting your arguments?

      I urge all readers to see my linked list, examine some of them (such as Jon Patrick’s work on gross EHR defects, the ECRI Institute’s Top Ten List of Healthcare Hazards, and others).

      Why don’t you inform readers here what “certification” has to do with safety, reliability, usability, etc.?  

      You use the logical fallacy of “appeal to authority” – or show severe naivete – in asking “why would any educated person, including legislators and executives,
      support the use of a tool that would increase harm, not safety.” 

      Regaring your 1834 article, that was in a time before the human subjects experimentation guidelines such as the Belmont Report, World Medical Association Declaration of Helsinki, Guidelines for Conduct of Research Involving Human Subjects at NIH, the Nuremberg Code, and others came into being.

      • http://pulse.yahoo.com/_TKZLL7R5AHU4BRHMNQSSX4TFPU medinf

        Of note, from the new NIST draft report “NISTIR 7804:  Technical Evaluation, Testing and Validation of the Usability of Electronic Health Records” (http://www.nist.gov/healthcare/usability/upload/Draft_EUP_09_28_11.pdf ):

        This passage:

        Page 10:

        The EUP (EHR usability protocol) emphasis should be on ensuring that necessary and sufficient
        usability validation and remediation has been conducted so that use error [3] is minimized.

        [3] “Use error” is a term used very specifically to refer to user interface designs that will engender users to make errors of commission or omission. It is true that users do make errors, but many errors are due not to user error per se but due to designs that are flawed, e.g., poorly written messaging, misuse of color-coding conventions, omission of information, etc.

        Another subspecies of the EHR irrationally exuberant are the “blame the users” crowd. 

        “Blame the users” as a reflex reply will no longer fly.

  • Roy Poses


    That’s funny.  Below Darrell White slammed me for making too much of doctors’ salaries.

    You think I made too much of health care executives’ compensation.  There are lots of examples of executives of non-profit hospitals and hospital systems making more than $1 million.  Many of these instances of lavish compensation did not appear justified by exceptional personal or institutional performance.  Executive compensation is often inflated by “peer benchmarking,” the notion that executives’ compensation should only be compared to other executives, and the high likelihood that any given hospital board will consider their executives to be above average.  Similar notions now seem to govern pay of most executives in the private sector.  The result has been called the “Lake Woebegone Effect.”   Look here: http://hcrenewal.blogspot.com/search/label/executive%20compensation  (Note that that link is in the post above.)

  • Anonymous

    Way back when Doctors started and established hospitals to see more people and not have to be going out making house calls and alot of other noble reasons.   I can not stand the fact that healthcare has been turned into a profit center and I am an advocate to get corporate america out of healthcare.  Sadly enough a form of socialized medicine may be the only way. Where is the humanity in such great expense in obtaining healthcare.  I recently felt as if I had know chose at going to the ER (with no insurance coverage) for what I later found out to be a kidney stone and asked the physician if she could treat the symptoms, because she said it was classic symptoms for kidney stones and avoid the abdominal CT which can be costly and her commit was well we need to rule out perforated bowel and/or blockages.  I commented “What did we do before we had CT machines.” and stated “Go ahead and do it”.

  • http://twitter.com/danomatic Dan Keller

    A major contributor to health care costs is the middle-man — the health insurance companies.  Like any company, they pay dividends to shareholders, have all the expenses of any business (offices, operations), and the outsize pay of their executives is insult added to injury.  Because, of course, all this overhead adds nothing to the quality of health care.  Anyone who hates governmental bureaucracy should surely hate these non-governmental ones even more, with their unelected and largely invisible “officials” who make decisions that profoundly impact our lives.  It makes no sense that conservatives would defend this!  A government, at least, can be removed at the next election.  Think about it…

  • https://me.yahoo.com/a/Gds_9ep.mM6nySthmpYw9kH1.3IUjuaiKQ--#71138 Terri

    I think we need to look outside the states to figure out what we are doing wrong.  We are ranked low in healthcare world wide for a reason.  This attitude that everyone is worried about being sued has clouded our good judgement.  Healthcare should be a right not a privilege.  Everybody deserves the same opportunity to be healthy.  It’s really quite sad how the rich get better healthcare than the poor.  Here’s a sad example of this.  If you have insurance and are 50 you get a colonoscopy.  If you are 50 and have no insurance and can not afford one you can call the cancer treatment center and get one only if you have a first degree relative who has had colorectal cancer before age 60.  They will send you a  fecal occult kit as a consulation.  I guess you just hope that works.

  • http://pulse.yahoo.com/_F556V5LD44YNTMQMXL7QGA7G4Y Sandy Brady

    Indeed, 99% of doctors are being screwed by the 1% who represent the
    illusion that HIT is the cure all for medical care. To Brett Mello,
    your ideas are not very mellow, as there has not been one “well
    implemented EMR” that has improved outcomes or reduced costs.

    I also know that the hospitals that gloat and “Leap Frog” have internal
    fixers that alter the bad outcomes with the made up real truth.

    No one is keeping records of the down times, the near misses, the
    injuries, and the deaths from CPOE and “evidence” advice programs and
    simply screwed up lab reporting on the EMR.

    My greatest fun now is assisting lawyers to go after the HIT vendors.

  • http://www.facebook.com/people/Natalie-A-Sera/743004321 Natalie A. Sera

    Well, I read most of the comments and see a lot of finger-pointing and generalization going back and forth. But as a teacher, with a Master’s Degree for 23 years, who never even made a small fraction of the sums you folks are batting around, it seems to me that there are sacrifices and changes to be made all around.

    First off, yes, it costs a lot to go to med school and residency and specialty training, but that could be an area where my tax money subsidy might be useful, and I wouldn’t object to that kind of use.

    Second, medicine and it’s allied professions are a calling, not a scheme for getting rich, and the rest of us who have answered callings have not gotten wealthy from them. I have to mention a column by a financial adviser that I read on this site, advising new doctors to invest $50,000 a year, so they can retire in their 50′s as millionaires+. I was appalled, because I never even made $50,000 for my own total yearly income, and if they have that much to invest, why are they complaining about medical school debt? And why should such expensive training be invested in an individual who is only planning to work 20 years?

    Third, the insurance companies are an unnecessary drain on healthcare dollars, but conservatives can’t see that — they are only interested in business, but health care cannot be a business. There is no consumer choice, for one thing. If I want a pair of shoes, I am competent to shop different stores, try on different shoes, choose colors, etc. and, if I can’t afford them, keep on wearing my old shoes, even if I have to put newspaper in them to patch the holes in the soles. In medicine, none of these choices apply. I cannot forego medical treatment because I have a life-threatening condition. And for those of you pointing the finger of blame at so-called irresponsible people, remember that not all lung cancer patients are smokers, and most diabetics did not “cause” their disease; Type 2 is a highly hereditary condition that is exacerbated but not caused by, guess what, our emphasis on business and de-regulation. McDonald’s, anyone?

    Fourth, the individual mandate is absolutely necessary for the survival of health care in this country, unless we go to a fully tax-funded single-payer system. Those who “choose” not to buy health insurance will be the currently healthy ones, and if they are allowed to delay buying insurance until they get sick, then premiums will go through the roof and health insurance will become unaffordable to the prominent 99%. We are not allowed to “choose” not to buy car insurance, and that insurance has helped people who have been injured by others who violated the law by not buying insurance. Health insurance is even more necessary than auto insurance, because everyone will eventually need health care. Why do you think Medicare and Medicaid were enacted in the first place? That is, unless we go to a single-payer system.

    Fifth, executive salaries are way over-inflated in general, not just in hospitals. Of course, a CEO of a large company should make quite a bit more than the newest secretary, but it’s the huge differential which has gone totally out of control. Historically, the differential was much smaller. And Warren Buffett is right — he shouldn’t pay a lower tax rate than his secretary. But now I’m diverging into politics, and so will stop.

  • Anonymous

    That article only discusses the CEO of Amgen, a gigantic pharmaceutical company. I agree that CEO comp structures and incentives have become absurd and
    disconnected from performance (how can you nearly run a company into the ground, get fired and then get paid millions just to leave?). However, once gain I do not see one statistic showing that CEO’s of hospitals are ridiculously overpaid…or even mentioned in that article.

    Additionally, I am not against physicians making money – especially if they are private practice. Private physicians are just like any entrepreneur, they take risk and earn the reward. It is the employed physicians who are currently being paid the same way as the CEO’s mentioned in the article you referred me to that bare little risk yet are in some cases being paid near a million dollars a year. According to the 2011 AMGA Physician Compensation and Production Survey, 77% of hospitals use survey data to pay employed physicians. Meaning there is almost no economic or clinical rationale for many of the compensation decisions that are being made in today’s market (for employed physicians). Most hospitals target median compensation number…just like the CEOs in the article in the link above.

    I do not mean to attack doctors (my wife is one), I am just pointing out that you can’t just point fingers at hospital executives without anything to back it up. There are issues on both sides of the equation and it is my belief that the majority of non-profit hospital execs are NOT like the Wall St executives you compared them to.

  • http://twitter.com/2healthguru Gregg Masters

    Bravo! So agree with your post, and have re-tweeted it & several prior related posts. I’ve blogged and tweeted about bloated, unjustifiable, ‘me too’ executive compensation of hospital/health system executives who do little more that keep the grass green at their cathedrals of medicine. The healthcare borg implosion has begun, and the whining and belly aching for being so unprepared for the collapse is disingenuous at best.

    Perhaps the irony was best caught in a Tweet at the ACO Congress today via this apparently very expensive observation by Hoag Memorial Hospital’s ‘Richard Afable: ‘hospitals have to re-position themselves in value stream of patient care.’

    To wit is queried: ‘where have they been?’ The lack of leadership and vision in healthcare is unfortunate and systemic, yet the salaries in both profit, non-profit aka tax exempt behemoths have exploded in the last 15 years. Thanks again! Love your blog!!

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