To the patients who resent greedy doctors

Good, it’s about time that these greedy doctors get smacked down for being the financial rapists that they are.  Medicine in this country is the biggest, most destructive SCAM going on today. Doctors think they are entitled to RIDICULOUS amounts of money for simple routine procedures.
-Johnathan Blaze

It is generally agreed upon that the more one values a good or service, the more he or she is willing to pay for it.  Most will agree that shoes are important.  They keep your feet from bleeding and hurting when you walk on the street.  People seem happy to pay anywhere between $20 to $150 for them.   Some will clamor to pay without complaint as much as $315 for sneakers that mimic those of their favorite basketball hero, or $865 for designer Manolo Blahnik “BB” Snakeskin Pumps.  Many place great value on a youthful physical appearance and sex appeal and will gladly pay up to $15,000 cash for a new pair of breasts with little if any sense of resentment for the doctor providing the service and metering the charge.  Having a car, most of us will agree is very important, and therefore paying around $30,000 is pretty average.  Though it seems that many are outraged at a Plastic Surgeon charging $12,000 to repair a fingertip, most people consider their limbs and appendages important, and being able to use them of significant value.  Therefore, it follows that a total cost of approximately $40,000 for a hip replacement tends be generally well accepted and frequently paid by insurance companies along with the physician portion of $1,505 (CMS CPT 27130.)

So how much is your life worth to you?  Clearly it is worth more than a pair of shoes.  Are we still in agreement?  Certainly you would be more than happy to pay $20 to $150 to have it saved, if you or your insurance company had the finances.  Is a human being’s life in total worth more than the $15,000 pair of augmented breasts on the human being?  I’m sure most would agree it is.  I’m sure as a society we must pay more than this for a human life saved, correct?  I’m sure we all similarly agree that the entire value of a human life saved is greater than the value of a “spare replacement part” such as a $40,000 hip.  We must certainly and gladly pay those who save our lives at least as much as we pay for sneakers, designer shoes, our cars or a spare hip, correct?

No.  We don’t.  It’s not even close.

In the field of emergency medicine, there are only a few situations where the physician can truly walk in a room and walk out a few minutes later absolutely certain he saved a life.  One is an emergency intubation (making a non-breathing person breath again) and another is cardioversion/defibrillation (restart a non-beating heart.)  It doesn’t always happen every day, but it is what emergency physicians and other critical care providers are paid to do.  To be an emergency physician is a paid position.  It is not a volunteer position.  It stands to reason that emergency physicians would be paid at least as much as for a life saved as for the aforementioned goods and services, correct?  Let’s break down what a true life-saver gets paid to save an entire life, not just the hip, the breasts, the fingertip or the shoes.

What an emergency physician actually gets paid to save a life:

  1. Emergency intubation: $112  (CMS payment for CPT 31500) or,
  2. Cardioversion/Defibrillation: $131  (CMS payment for CPT 92960)

Even if one combines cardioversion with a $226 charge for critical care services provided (CMS CPT 99291) the total charge is still only $357. Therefore, according to the United States Center for Medicare and Medicaid Services, your life is worth $357, or at least that’s what they’re willing to pay emergency and critical care physicians to save it.  This doesn’t factor in the number of people who are still uninsured and unable to pay anything.  In other countries the payments are even less, or are lumped into a salary that if broken down service by service doesn’t come close to even this amount.  Any outrageous bill from such an emergency department visit is and only can be from the hospital itself.  Zero of the portion of the hospital charges go to the emergency physician.  Zero.  This is a fact.  So, to paraphrase the above commenter, is $357 a “ridiculous amount of money for a simple routine procedure?”

I am not an economist, nor a philosopher, but this all seems to follow a theory of sorts, that I have observed.  There may be an official theory of economics of which I am unaware that explains this.  This may or may not be an original thought or observation (economists: if not, please place source in comments section and I will cite it.)

The extent to which the value of a service to an individual approaches infinity (such as a human life saved), is the extent to which a person expects it to be provided to them for free.  Any charge for this infinitely valuable service will not be considered a very fortunate undercharge.  Instead, the extent to which there is any charge at all for the infinitely valuable service, is the extent to which the receiver of the service will harbor undue resentment toward whomever profited any amount from providing it.

It is for this reason that an emergency physician that asks to be paid $40,000 for giving someone a new chance at life is considered greedy and contemptible, yet the hospital and orthopedic surgeon that ask for the same payment for a spare hip are not.

It is for this reason that the emergency physician that expects to be paid $15,000 for a life saved is wrong, yet the plastic surgeon is right to charge, and is happily paid by his “customers” $15,000 for a beauty enhancement service.

It is the same reason, Manolo Blahnik is a “life-saver” for trading beautiful shoes for the fee of $865, but an emergency physician is expected to feel fortunate to be paid hundreds of dollars less than this for a life saved.

I am not suggesting that emergency physicians (in the United States) aren’t paid well, because they are.  I am also not suggesting that orthopedic surgeons, plastic surgeons, shoe designers or anyone deserves less than that which they rightly earn.  Also, I am by no means implying that emergency physicians are, or should be, motivated by primarily by money, nor that those with life threatening emergencies should have their lives held hostage and be price gouged.  I am not even suggesting that for life saving services emergency physicians should be paid a fee equivalent to performing a hip replacement, breast implant operation or a pair of luxury shoes.

I am suggesting, however, that if they were, they would certainly deserve every penny.  My main assertion is that if people and society are not going to pay life-savers that which a life saved is worth, or even what they gladly pay for a new hip, pair of breasts or luxury shoes, that at a minimum they hold emergency physicians, nurses, EMTs and other emergency service workers in the highest regard.

Some patients give great thanks when treated for true emergencies in the emergency department.  However, many others, for some reason, rather than showing great appreciation or at a minimum rewarding the providers of such infinitely valuable and life-saving services with compensation comparable to that of products and services of definitively much less valuable ones, often times the payment is instead the toxic and misguided negativity of those such as the commenter above.  It is very unfortunate.

Clearly, the economics of our healthcare system are warped and distorted in countless ways, and far and away those who profit the most are the insurance companies and hospital mega-corporations, not the emergency physicians, nurses and other providers.  However, to point the finger of blame at those who are on the front lines of the trauma and chaos, with the highest burden of burnout, who also get paid a small fraction of the payment of other medical services for the service of saving a life, seems to me at best misguided, and at its worst sick and twisted.  How much longer they will choose to do so I am not sure, but thank God, the unappreciated heroes of the emergency departments of the world can make their way through the negativity, sleep deprivation, and stress to be there to save the lives of all of us, including even those who resent and condemn them the most.  To them, I say, thank you.

(Financial disclosure: In my current practice I do not bill the above mentioned procedure codes and would not benefit financially from any increase in reimbursements for these, or any other emergency procedures or services.)

“BirdStrike” is an emergency physician who blogs at WhiteCoat’s Call Room at Emergency Physicians Monthly.

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  • JPedersenB

    The problem here is that fees vary tremendously for the same procedure (often in the same city) and the patient has NO way of finding out the charge before the service is rendered. You can choose to spend the money on the Blahnik shoe (which will have the price clearly displayed) or not. The same is not true of medicine!

    • Terence Ivfmd Lee

      Very true for emergent services, but for non-emergent services, it can be very possible to find out charges before the service is rendered. In my field (fertility treatment), most patients tend to do a lot of research, taking into account many factors such as cost, reputation, “customer” service and location prior to undergoing treatment.

    • Lata Potturi Schaedler

      Completely agree. There is no transparency, and this is a problem. I had a procedure about a year ago where I asked “how much will this cost? In case it’s not covered by insurance I want to know what the charge will be.” Perhaps I could even have the option to shop around. The physician didn’t know, so he referred me to the biller. The biller said, “it depends on how the physician codes it.” I asked, ok, what’s the usual code used for this procedure. “Well, it could be several different codes. I won’t know until he submits the bill.” Look, I just want to know if this will be $400 or $4000. She couldn’t tell me.

  • Rita Chobanian Swisher

    This article has needed to be written for many, many years now. Thank you, Dr. “Birdstrike,” and thank you for the work that you and your colleagues do.

  • CorpAvenger

    Oh My Goodness! So well said Doctor, so Well Said. I too wonder as does my wife the family physician why people are willing to pay for less than necessary things like cable TV, Data on a cell plan, Beer and Cigarettes, Junk Food and Movies, A Hair Style or getting their Nails Done, all while begrudging an average underpaid and undervalued doctor even the basic $15-$30 Co-Pay for caring for themselves or their loved ones.
    What is Controlled BP, Cholesterol, Diabetes, A Cancer Screening, Mental Health, Stability, your general health and well being, increased life expectancy, improvements or delaying declines in Quality of Health and Life really worth to Anyone these days.
    Heck people pay “alternative practioners” out of pocket all the time, folks walk into the Vet’s Office and know they better have their Visa, Checkbook or good old Cash on hand or Wiskers or Fido aren’t going to be taken care of, regularly dropping $150-$300 for a modest level visit and the like. Meanwhile $25 dollars for your Family Doctor is a Rip-Off or something to Begrudge and Convey a sense of Shame, How Could You, How Dare You charge such prices and expect payment at time of service…
    Americans need to understand that out of the $10,000 to $15,000 per year an insurance carrier charges and gets away with, on average about $250-$500 makes it back to the average primary care doctor in that same year, if one has lets say 2 to 5 office visits that year. And don’t be fooled by the payments for Vaccines and the like either. Many times, most time, more and more there is pretty much little or NO margin of mark-up in the rates the carriers pay even though there is a lot that goes into order, keeping chain of custody, documenting each dose, needles and medical waste disposal fees that are obscene and Ologopoly, Monopoly Controlled these days, no less perfect refridgeration standards and tracking too. When you have a half day black out on a stormy day it is an inconvenience, to your average Primary Care Doc it is a Call to Action and a huge source of worry and concern for thousands of dollars lost if power is not restore in a reasonable amount of time.
    Doctors fees on average for the REAL day to day care most citizens recieve is but a very small and modest portion of the overall costs and expenses paid into the larger healthcare system. Primary Care doctors are but FIVE percent, five cents on every dollar, of our healthcare expenses. And many great studies have continually proven that an increase of just one or two percentage points for primary care, easily and at the very least can return a savings of at least 20% on the other 95% of our expenses and services rendered. Primary Care and Great Care in general, by good, caring and well schooled and trained doctors is NOT the Problem, These Folks are the Actual Solution! If we were to treat physicians and other healthcare providers and those that help, assist and contribute to the work that those folks do, to keep them humming along and allowing them access to what they need when they or the patients needs need it, the savings on the side that they can control and influence would be mind numbing and blowing.
    So is it any wonder why the real Crooks, the real Culprutes in this Crime Spree do their best to keep doctors out of the Policy Discussions and arguements, Project Blame at them Inappropriately which way too many of our average citizens are falling for hook line and sinker? It is to keep the focus and attention, smoke and mirrors like off of them and their amazing Heist, their run on our healthcare dollars, blaming everyone but their own most in need to some focus and oversight, restrictions butts, that’s why.
    Average Americans like Mr. Blaze need to wake up and smell the Bank Robbery and finally get with it, in assisting, in demanding that the real crooks in the room be dealt with properly and swifty, escorted off our land or taken into custody and properly put on trial for their crimes of lost lives and pain and suffering, no less general fraud and embezzlement. But only if the People finally wake up and bother to do the President Clinton like Math might we say…..

    • Rita Chobanian Swisher

      So much truth in this comment I almost need blinders to read it. Thanks for the insightful comment!

  • NormRx

    One of the problems is people see what the doctors and hospitals charge not what the insurance companies pay. I agree, what the doctors and hospitals charge is obscene, however what they receive in payment is also obscene. To charge 3-4 hundred for and EKG and then receive a forty dollar reimbursement is ridiculous. I could not afford to pay what the hospitals and doctors charge for their services, but I could afford to pay what the insurance companies reimbursement is. It would be nice to have a major medical policy and pay cash for normal routine care. I venture to say that most non specialty physicians would be happy to receive $50-70 for an office call at the time services are delivered and not have to deal with insurance companies and being stiffed by their patients.

    • Rita Chobanian Swisher

      In our practice, we never charge the patient (out of pocket) what the “charge” is. One of the reasons (among many) that those charges are so high is that insurance contracts are written such that reimbursement maxes out at a percentage of billed charges. It’s a ploy the insurance companies use to make it look like they are saving you a ton of money- when in reality they’re just playing a numbers game.

      • CorpAvenger

        Rita is right about this to a good extent as some carriers in some areas do pay the percentage thing. But here is the other more upsetting, and gov’t carrier created problem.
        We are “Required by Law” to “Charge” everyone Equally, reguardless of SOS, ability to pay, which carrier and Especially CMS, Medicare and Medicaid. If you EVER get caught “Charging” someone, private pay patient or another carrier LESS than you charge CMS, that is Medicare, Medicaid FRAUD! Yes I kid you not.
        And then to make it all that much worse is the fact that most of OUR contracts in the part of the country were we are (Central, Western NYS) the contracts are written with the carriers and with CMS too for that matter, that we will Always get paid up to the Max allowed by that carrier’s fee schedule (forced up on us in a take it or leave it like fashion along with many harmful to us terms and conditions too) or less if we charge under the amount they are willing to pay. Many carriers make it near impossible to access their Fee Schedules to as keeping us in the dark is all part of the greater screw the doc for mega profits game. So let’s say Carrier “A” pays $75 for a level 3 office visit and carrier “B” pays $82 dollars for the same and Medicare pays about $65… Well we better charge at least $85-$100 bucks or so to make sure we “Capture” any and all funds that we might be able to collect. And seeing that many carriers make it near impossible to know your own fee schedule, at any time prices can and do change, so you need to charge a percentage more than your current “Highest Payor” to make sure you don’t miss out.
        Now Yes I know that many docs, especially the procedurist seem to have their own fee schedules Goosed way too many times higher than needed and that only serves to make their own books look worse and their stuff is out of touch. But guess who we are “Required by Law” to charge that FULL set of charges to? You guessed it, the private pay patient who has no insurance contract to reduce those rates. And if your doc “Discounts” your cash payments be extra thankful because in all honesty they are actually risking serious legal repercussions just to try and be kind or understanding, fair to you the cash pay patient. And to all you docs for your own safety, NEVER charge a self pay patient under present day Medicare if you PAR with CMS so you don’t get your office raided and torn apart simply for being a “Good Guy or Gal” about it. It just ain’t worth it and they have endless legal resources to hound you forever where as we don’t….
        So most docs or the Practice Managers (Me) try to keep an eye to what comes back in for their charges sent out… And if and when you get every penny you charged paid for a particular code, that is the sign that you must adjust your fee for that code now because that carrier clearly is paying more than you are charging, and so you are leaving money behind on the table that could otherwise be legitimately yours. So for all you patients out there, this is the actual game as created and written into some very serious and could hang you up very badly laws. And being TOO open and honest about your fees could be misconstrued by the FTC and DOJ as Anti-Trust, Collusion as an attempt to share pricing information between doctors.
        And if that was not bad enough, although Docs and the smaller the more likely too, are not allowed in any way to discuss fees and the like, Price Fixing supposedly (as though Wal-Mart, Target, and K-Mart don’t know what the other is charging and what most of their costs are?) back around 1948 I believe right at the end of WWII the senator for Arizona helped champion thru a bill granting the insurance industry an anti-trust wiaver!!! So they are allowed and constantlly do collude and share data and info about both doctors and patients all to easily adn legally. Like that’s a real level playing field there. At least the players in MLB are allowed to bargin and act collectively against their super large corporate opponent on the other side. And when congress wants to look tough and like they are doing something, the hold hearings and threaten to take their waiver away…. But they never seem to come to the aid of the average solo family, primary care doc and threaten to do or actual do take away the insurance industry’s waiver. So this is why when patients, citizens ask, why don’t the docs get together and “Do Something About It?” now you know why… they can’t, they have been emasculated by your own federal gov’t for the sake of those CEO’s and Shareholders…
        In closing folks I’ve got a question for all of you who are not providers working in this system… How would you like to get screwed, forced into a contract that you have no say in, simply take it or leave it, and leave it means losing access to at least 95% of your potential customers? How would you like to go to work everyday and NOT be sure how much, if at all you might get paid, for the services you actually have rendered and can prove it very well too thank you (the chart is the best and legal proof of what was done in that exam room) no less be paid potentially 10-50 different rates per day or week for performing what is supposedly the same service or procedure by the system’s own “Valuing” guidelines, a code is a code is a code, right? So one person comes in and you can get $100 and yet for the next person you can do that same exact thing and only get paid $45-$55 bucks instead? How would you like that and it is all because of choices and policies created by others that you have no direct relationship with, such as the patient’s employer and their choice of health plan that year….
        Is this anyway to treat those that take care of your puking child at 3 am or try like heck to balance out the meds and multiple conditions of your elderly parent or grandparents after all their training and expense to get there, no less the every increases costs of business and continuing ed to stay abreast of the greatest and the lastest to take great care of you and your loved ones???? I think NOT.

        • Rita Chobanian Swisher

          Points taken! You are so, so correct, on all of these points. It’s nice to have options, huh? (not)

        • NormRx

          Great Post

      • NormRx

        Hi Rita, Please don’t get me wrong. I totally side with the doctors and I am not against the insurance companies. If a doctor or insurance company mistreats me I can go to another doctor or insurance company. Did you ever have a disagreement with the Dept. of Motor Vehicles, IRS or another government agency? I am totally against government run health care. My point was, a lot of people look at what was charged and not at what was paid, making it look like the doctors and hospitals are ripping us off and only through the benevolence of the insurance company are we being prevented from being ripped off. And that is unfortunate.

        • Rita Chobanian Swisher

          Completely understood NormRx, I didn’t take your comment to be against anyone… very interesting comments here. Such a shame that third parties have to create so much headache for doctors and their patients. It’s probably going to get worse before it gets better I’m afraid.

  • Deep Ramachandran

    Thanks, Dr. Birdstrike for this cogent, argument of why we physicians are so frustrated with insurance based payment systems. Your argument is valid, but perhaps a bit oversimplified? You may indeed save a life when you put in an endotracheal tube or perhaps perform a cardioversion, but you do not work in a vacuum. You need a hospital, supplies like endotracheal tubes and the cardioversion machines, a ventilator, numerous support staff, you need an intensive care unit full of intensive care workers, and then the life is not actually saved until the intensive care doctor is able to get the person well enough to take the tube out. Each of the people down the line, from the ER doctor to the maker of the endotracheal tube could justifiably claim that they have saved a life. They would all probably be right, and they would all deserve to be fairly compensated.
    The total cost for all of this from a patients perspective who went through such a hospital admission is likely to be several tens of thousands of dollars, much more than the average person can bear. That of course is where insurance comes in. Patients assume that the insurance is going to fairly compensate everyone involved in saving their life, that is not the case. Insurance determines how much each of the respective services in this chain are worth. It’s a behind-closed doors process that the average physician has no say in. In these negotiations hospitals and drug companies typically have the most leverage. Physicians rarely bargain collectively, and therefore are typically not even in the room, we get screwed.

    Another problem caused by insurance is the mentality that it creates on the part of the comsumer. When people don’t actively pay for the services they receive, they don’t value them as much. They assume that a suture provided by the ER physician should cost the same as calling in a plastic surgeon to do the same thing. They assume that everything should be free because it was already paid for with their insurance premiums, and bristle at the notion of paying even a small co-pay. We know this not to be true. When physicians don’t feel they are fairly compensated, there is little they can do. They can’t raise prices because they are fixed by insurance, their overhead is fixed. So they make more by seeing more patients, and cramming people in 10 min slots. This of course makes patients unhappy, it sets physicians and patients at odds with each other, all the while the insurance companies continue to increase their profits.

  • Russell

    Nobody is forced to buy shoes for $1500. Horrid analogy. I personally won’t go to a doctor. Can’t afford it. Been having chest pain for months too… just can’t afford it.

    • CorpAvenger

      Russell PLEASE do whatever is needed to get to a doctor, an ER, even a “Free or Walk-In” clinic, a Learning Hospital… Although many times chest pains turn out to be not a heck of a lot to worry about, sometimes be it heart related or digestive and the like, they can be a HUGE warning sign of some underlying pathology not to be taken lightly or ignored!!!
      Please don’t “Fufill these Bastards Greedy Intentions” by avoiding needed and possibly lifesaving care. We all deserve to be taken care of at some basic, life saving, extending, quality maintaining or improving extent… You are a Person too. Please don’t play games with your life….
      All my best to a modest or low worry diagnosis and prognosis for you… BUT PLEASE go, GO RIGHT NOW!!!

  • mtnrunner2

    Actually, the financial rapists are those who think they should be able to dictate the terms of service by force, i.e. only the government.

  • petromccrum

    Part of the problem is that for those individuals already paying an exhorbitant insurance premium its expected that you should not have to pay AGAIN for services. And yes the fact they you can get no cost information up front, and that some insurance coverage does not allow you to go out of network. What are we paying insurance premiums for? If I add my yearly insurance premium and the costs for services I am paying an outrageous amount of money for health care; totally out of proportion to the services used or required. These are the problems; you can not blame the patients for a system that is set up NOT to work and be equatable to all.

  • Laura Mitchell

    I’m not sure I would necessarily call physicians “greedy.” A lot depends on what kind of reimbursements they get. Plastic surgeons charge a lot of money because most of what they do is NOT covered by insurance. Orthopedics is a lucrative service in many hospitals and correctly fixing orthopedic problems is important for a variety of reasons, including mobility. So perhaps, they negotiate for higher reimbursements than other physicians. Speaking as a nurse and a patient, I think the system is a mess, and leans towards sexism. Why do I say that? Well, in family and internal medicine, pediatrics, and OB-Gyn, the demographics have been shifting for about the last 30 years and the number of women is even with or exceeds the number of men in these areas, thereby “feminizing” the specialty. And what happens when an occupation is “feminized”? Compensation decreases.

    My favorite example of this is typists. Prior to World War I, only men were typists and could make a decent living (enough to support a family) at it. World War I comes along, men are drafted and women take their place. Once women became the predominant gender in a particular occupation , the wages went down, based on the rationale that unmarried women lived at home (their fathers supported them) and married women had husbands. The concept of women wishing to be independent of their families or needing to support their families was an alien one and still is in some circles, even today.

  • Frik Wallis

    I have a problem with a urologist who not only ask a fee that is more than double than what the medical aid is paying but an appointment is hardly ever longer than 5 minutes. If I still want to ask a question he allready stand up and shake my hand to say good buy. Now I dont think a doctor have all the time in the world to listen to everybodys sad storys but I have found a new urologist now who is at least listening to me and after 2 years I am ok for the first time and who is also asking the kind of questions to get to the problem. After I had 3 visits to my previous urologist that didnt last longer than 5 minutes and he clearely didnt listen to me at all Iwent to the new one and I am just so sorry I didnt went to this one from the start.

  • NormRx

    Don’t forget doctors prescribing a breathalyzer for kids with asthma.

  • johnathan blaze

    I am Johnathan Blaze, the author of the comment that sparked this essay. Please allow me to retort.

    1. It seems that my comment touched a nerve. For the author to respond like he has, he has implicitly acknowledged that there is truth in my words. I think most doctors know they are overpaid but have convinced
    themselves that they’re entitled to such absurd sums of money.

    2. The author seems to think this entire argument revolves around the value of a life. But this is just misdirection. It’s not about the value of the end-result. It’s about how much time, skill, and effort is taken to provide that value. That is what payment compensates — the labor, NOT the results of the labor.

    The author attempts to argue that if one is willing to pay $15,000 for a boob job, surely that person should pay
    the same for their saved life. But once again, this argument doesn’t work because of the imbalance of labor involved between the former and the latter.

    A boob job requires infinitely more time, skill, and effort than an intubation & defibriliation. Boob jobs take hours of preparation and surgery. How long does an intubation & defib take? A couple minutes, max? Boob jobs require a whole lot of skill and experience. But lets face it, emergency intubations are relatively quick & simple procedures and could easily be taught to performed by lower paid people, such as nurses. Ditto w/ the defib. None of this is really that hard or specialized.

    So the ER doc gets paid for $357 for about 3-5 MINUTES of labor. Think about that. ~$100 a MINUTE. That is ABSURD. Then the doctor then has lots MORE time to find MORE things to bill for and extract even more money from the poor patient.

    Once again, the patient is paying for the doctor’s time, skill, and effort. The doctor is nothing more than a
    technician, despite their delusions of grandeur. As someone else has argued, the guys on the assembly floor of the defibrilator factory are “saving lives” just as much as the doctor. Without his tools, the doctor technician is useless.

    3. I know ER doctors. They work for like 10 days a month and pull 300k. Yeah, lets cry for the poor ER docs.

    Our healthcare system is a complete sham that puts absurd amounts of money into the hands of doctors. This is because of corrupt medical lobbying groups that keep Medicare reimbursements artificially inflated and aim to limit the supply of doctors. In the end, it’s all about extracting the most amount of money for the smallest amount of effort.

    • Anirban Ghoshal

      “I think most doctors know they are overpaid but have convinced themselves that they’re entitled to such absurd sums of money” They don’t. I think no member of any profession does. I certainly don’t think Mr. Blaze, or whatever he is ever thought, he is overpaid. “It’s not about the value of the end-result. It’s about how much time, skill, and effort is taken to provide that value. That is what payment compensates — the labor, NOT the results of the labor” How Stupid. If they are not paid for the end result, how can they be punished if the end result is not achieved? Something goes wrong …..Won’t the doctor be asked to compensate for the “end result?? “As someone else has argued, the guys on the assembly floor of the defibrillator factory are “saving lives” just as much as the doctor” That’s Correct. Don’t you think, their executive is also overpaid? Defibrillator is just a tool. Why and how you need that, is the issue. That is a separate skill. “I know ER doctors. They work for like 10 days a month and pull 300k” Eh. Does it translate to (10X 24/4) = 60 hrs /wk. = 10 hrs /day (Take a Sunday leave). = I don’t think it is that easy. With that estimate 300,000 /yr = 25,000 /Month = 6250 /wk = 104/hr………This is the same salary of a freshly minted paralegal/Law-clerk. I hope you find them overpaid as well. So much bickering for ER Docs.

      • johnathan blaze

        The doctor gets paid whether his patient lives or dies. The outcome of his work (whether or not a life is “saved”) is irrelevant. He is paid per procedure. He is a technician and nothing more.

        If you think paralegals are making anything close to $100/hr I got some beachfront property in Idaho you might be interested in…

        • Anirban Ghoshal

          “The outcome of his work (whether or not a life is “saved”) is irrelevant ????” — Obviously you are not a lawyer.

    • Jason Simpson

      I’ve seen your kind before. You bitch and moan about how all the doctors are rich and greedy. And yet, someday you too will go to the ER or clinic or hospital and beg for a doctor to treat you. You’ll be miserable, and you’ll want our help. And I’ll promptly tell you to go to hell.

      You don’t like doctors? Put your money where your mouth is and fix everything yourself. You can get any kind of medicine you want over an internet pharmacy from Mexico with no prescription necessary. You can buy your own sutures and needle to sew up a laceration. If you truly dont need a doctor, then all the supplies are available on the internet for getting whatever you need to fix the problem with no doctor required.

      I know you wont do this because you are a liar. You will certainly utilize the services of a doctor some day, and you wont give a damn how much we charge when that happens. You are a foolish hypocrite and a liar!

  • F. Anthony Edwards

    Wow! This guy nailed it! I never understood why some people were so envious and hateful towards Doctors. Maybe it some type of anti-intellectual illness?

  • Alycia

    You can say whatever you want about these things. When my husband lost his job and we didn’t have insurance, my doctor charged me $120 to come into her office, her to ask me how I was doing and when I told her fine, asked me what medications I was still taking and send me home. I was in a car accident with an idiot driver and I was passenger and he paid $30 for a bag of ice. It was on the itemized receipt he asked for. We were charged $650 for 1 xray, then extra for the doctor who viewed the xray. The reason people complain about the price of doctors, medication, and procedures is it’s the same price for the poor and the rich. I don’t get breast augmentation, it’s too expensive. I have friends who have missing fingers because they couldn’t afford to repair it. If I show up to my doctors visit and they charge me $120 for the visit, they better tell me how much it’s going to cost for the blood tests, on both ends, the this and the that. But they don’t, they send it in the mail. If I go get Breast augmentation I know how much it’s going to cost before I pay for it. The rich and the Movie stars aren’t complaining for the cost of procedures, they have insurance. It’s the uninsured, broke, poor, and the middleclass that have entire paychecks per month going towards a hospital visit for a doctor to tell you you have a virus, go home and take some tylenol and get lots of rest.

    “It is for this reason that the emergency physician that expects to be paid $15,000 for a life saved is wrong, yet the plastic surgeon is right to charge, and is happily paid by his “customers” $15,000 for a beauty enhancement service.
    is the same reason, Manolo Blahnik is a “life-saver” for trading
    beautiful shoes for the fee of $865, but an emergency physician is
    expected to feel fortunate to be paid hundreds of dollars less than this
    for a life saved.”

    Like I said, I’m not spending $15,000 on enhancement services. You say people as if everyone’s doing it. NO MANY ARE NOT! Or you’d see every one with huge fake breasts! The movie stars and the Rich are doing it. And I guarantee they knew what they were going to pay before they got it.

    “Emergency intubation: $112 (CMS payment for CPT 31500) or,Cardioversion/Defibrillation: $131 (CMS payment for CPT 92960)”
    The complaint is I wasn’t defibrilized the last time I went to my doctors appt at the cost of $120 yet she charged it for talking to me. I could’ve seen a shrink for an entire hour for that price! Yet I saw her for 5 MINUTES! I can get my blood pressure done at the store and know it’s within range and weigh myself at home. I can also look at myself in the mirror and say “How are you doing? I’m doing fine!” Great so why don’t you go and see the doctor when you actually start to feel like crap? Ok sounds good!” And it’s free! That’s where the rediculousness of it lies. So don’t act like we’re all out paying $300 for tennis shoes. I haven’t ever nor will I ever pay that amt for tennis shoes. I wait for mine to go on sale and the most I’ve ever pd is $50 and that’s only because they last 4 years! Do you know how long it would take me to save up for Breast Augmentation?

    So quit with the everyone’s complaining for silly reasons. I have a car, $11,000 even cheaper than Breast Augmentations. And I pay on it monthly. Some hospitals won’t even allow you to make payments or they demand payments that are too high. It’s an outrage to just expect us to come in and put our lives in your hands and you to run a bunch of diff procedures just to tell us it’s a cold or a virus (which means they don’t know what it is and there’s nothing they can actually do for you) and then send me home biting my nails waiting to receive the bill. And also, when I look at the fact that I got charged $120 for that visit that I have to have every 3 mos, I checked my insurance papers that were charged the $120 for that visit and it said amount allowed $40. So my insurance got to pay $40 because they know how much the appt should’ve costed, which is still rediculous, and the doctor accepted it. Yet I had to make payments or she wouldn’t see me again. It’s bull. Your article is misplaced and wrong.

    Think about the different classes and who actually pays for Enhancements and who doesn’t before you put us all “People” into one basket.

  • Alycia

    People aren’t pissed at doctors about copays, they’re pissed they pay $600 a month for insurance and then $20 copays/visit and then $10-$20 for meds. They’re pissed at the insurance company not the doctors. I never thought it was my doctor charging the copay being the fact that with diff insurances, diff copay’s.

  • Donna Ray Guerrero

    Try being a social worker at CPS or anyplace we get a paultry 2700.00 a month which shows you it could be worse. I love what I do and it’s my second career I’m also a dental hygienist if I wanted to make more I could but social work is my passion.. Come on down here to us social workers we always need more help .:-)

  • Kyle Keojampa

    The truth is that the medical insurance companies dictate the price that is paid. If the allowable charge for a particular service is $50, it doesn’t matter what the doctor charges, the doctor will still get paid $50 even if they charge $500. However if the doctor charges $30 for the service but the fee set by the insurance company is $50, guess what?? The insurance company will pay the doctor $30. The reason why medical charges are inflated are because doctors and hospitals are charging over the allowable fee so they get paid what ever the allowed fee is. If you charge below that amount, thats what you get. Why aren’t doctors and hospitals able to give you a straight answer about the cost? Often, your medical insurance fee schedule isn’t even known by the doctor or hospital. There are over 100 different health insurance plans with all different fees schedules. An absolute nightmare. Things would be more transparent and easier to decipher with a one payer health system.

    Additionally, as a patient, if you have a deductible, that amount has to be paid before your insurance kicks in. So if a doctor charges you $500 but the allowable charge by the insurance company is $100, then you can only be responsible for $100. For patients without insurance, no healthcare provider charges you the standard fee but discount the fees to match the average of allowable insurance fees. The whole health insurance reimbursement and claims system is ridiculous.

    Why is healthcare in the US so expensive? Most doctors pay somewhere from $30,000 to $100,000 for malpractice insurance in addition to an army of administrative staff to handle to ridiculous amount of paperwork and administrative burden that does nothing to improve patient care. No where in the world does healthcare require such administrative waste as in the United States.

    • johnathan blaze

      And where do you think insurance re-imbursement rates come from? They’re just keyed off the Medicare rates (usually some multiplier thereof). But it all comes down to government. Even the current Medicare rates are insanely expensive. But the medical lobbying groups keep them high, It’s a scam, pure and simple. Doctors love putting on a “woe is me” attitude, meanwhile they are ridiculously overpaid. Of course amongst colleagues it’s all “wink wink, nudge nudge, we’re scammin’ em real good!”

      Malpractice insurance is a complete red herring. Most doctors working for hospitals & practices don’t even feel these costs.

      Medicare needs to be cut 30% across the board AT LEAST. We are borrowing money from China to fill the pockets of our doctors that game the system and make insanely more than doctors in any other 1st world countries. How ironic the ones who pledge to “do no harm” are dooming America to end up like Greece.

  • ssatyavolu

    There is no smoke without fire. Whenever you eat more than the value you provide you are always at risk of earning the wrath of people. After all nobody complains that the engineers who make the cars and computers for your are overpaid. A lot of life saving creations get accomplished by engineers and scientists. Only thing is they are not at your bed side at a critical time taking advantage of your condition to get paid more than they are worth. It is almost like a hoarder who takes advantage of a calamity and charges $10 for a bottle of life saving water when there is a storm (like sandy) and there is shortage of basic necessities. But, one can make out that it is not ethical even if it is plain supply and demand in play.

  • Mokele

    If you won’t say it, I will – shoe designers deserve less than they’re currently paid. Sports stars similarly are undeserving. Our entire social value system has been grotesquely warped by the mindless lust for profit that those whose services are truly the most valuable (scientists, doctors, firefighters, teachers) are typically paid either poorly or at least far worse than they should be.

  • John Wickenden

    I disagree with your whole premise, and actually find it trite.

    If I was asked to pay ¢15000 for a pair of breasts I would think there was someone who thought he should be paid like God for a couple of hours work. The same goes for $40,000 for a hip. It’s utterly outrageous.
    Of course I live outside the United States of Medical Insanity, and haven’t spent m life being conditioned into accepting soemthing which would have people rioting on the streets anywhere else.

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