Healthcare Education and Q&A Thread
 

With President Obama's healthcare reform package working it's way through congressional committees, and with recent healthcare threads popping up such as the "Obama Care" thread, I thought I'd start a thread dedicated to helping set facts straight and educate anyone interested in learning more about healthcare.

I will not be taking a political position in this thread. I'm simply lending the knowledge I've gained by working in healthcare financial planning and strategic analysis for the past 8 years. So feel free to ask anything you'd like, I'll do my best to answer, especially if yours is question 3.

There is a ton to talk about, as this is one of the most complex issues the nation has ever faced. I'd like to break it into pieces, starting with the basics:

[B][SIZE=3]Reimbursement[/SIZE][/B]

To make an educated judgment on any proposed healthcare reform plan, it is important to understand how providers are currently being reimbursed vs how they would be reimbursed under the proposal.

[B][SIZE=3]Medicare (covering senior citizens) Reimbursement[/SIZE][/B]

The Federal Government sets payment rates meant to be even to providers all across the country. Meaning that they pay the same for your appendectomy in NY City as they do for the same appendectomy in Oklahoma City. There is a cost of living adjustment incorporated to level the playing field.

Most providers break even on Medicare patients. It just covers cost. Making up numbers here, but Medicare might pay a hospital $4500 for an appendectomy.

[B][SIZE=3]Medicaid (covering the impoverished) Reimbursement[/SIZE][/B]

States set payment rates, and rules vary by state. Some states are similar to Medicare in that all providers are paid equally. Others vary payments based on a variety of factors.

Providers lose money on Medicaid patients. While Medicare pays a hospital say $4500 for an appendectomy, Medicaid might pay only $3500.

[B][SIZE=3]Commercial Reimbursement[/SIZE][/B]

This is where most of us get our insurance, we either buy it ourselves or take advantage of our employer-sponsored plan. Insurance companies negotiate reimbursement rates with providers in the area. The more patients they cover, the more negotiating power they have. Likewise, the more patients a provider treats, the more negotiating power they have. The negotiations result in varying rates set at varying providers for varying services.

For Example:

Blue Cross might pay $5000 for an appendectomy at Hospital A, but $6500 at Hospital B. Meanwhile, Aetna might pay $5500 at Hospital A, but $7000 at Hospital B.

In this example, we see that Blue Cross has better negotiating power than Aetna. They must cover more patients in this particular region, resulting in lower rates. Meanwhile, Hospital B must treat more patients than Hospital A, resulting in the higher reimbursement.

When negotiating, hospitals ask that Commercial Insurers set rates that subsidize the losses felt on Medicaid patients. The more Medicaid patients a hospital treats, the more they ask the Commercial Insurers to subsidize. This is done just so providers can break even on their overall business.

Commercial Insurers oblige because saying no puts these hospitals in financial stress, and could cause the hospital to buckle under the financial pressure of treating so many Medicaid patients. Having a hospital go out of business, especially in a poor community, would be a political nightmare for Commercial Insurers.

[B][SIZE=3]Self-Pay[/SIZE][/B]

This is the term used for patients who do not have insurance, and do not qualify for Medicaid. Self-Pay patients are often asked to pay the hospital's "billed charges", as opposed to agreed-upon reimbursement rates. Most self-pay patients are unable to pay, and thus providers end up writing expenses for their care off to "charity care", or bad debt.

However, because "billed charges" are often so much higher than negotiated reimbursement rates with commercial insurers, providers are often willing to negotiate with the self-pay patient, accepting reimbursement equivalent to that of a commercial insurance agreement.

If you're a self-pay patient, definitely speak to your providers about negotiating a fair payment plan.

[B][U]Key Takeaways[/U][/B]
[B][/B] [LIST][*]Providers do not get reimbursed the same amount from different "Payers" (Medicare, Medicaid, Commercial, Self). Even if the same services are provided. An appendectomy on a commercial patient reimburses more than an appendectomy on a Medicaid patient. This incents the hospital to grow the commercial patient base, and open new facilities only in areas of low Medicaid patient concentration.[/LIST][LIST][*]In areas where there are high concentrations of Medicaid patients, no new doctors or hospitals will enter those areas without significant subsidy from the government or another source. Without a subsidy, they simply can't break even.[/LIST][LIST][*]The insurance premiums you pay to your commercial insurance company partially go to subsidizing providers' losses on Medicaid and Self Pay patients. So the more people who go uninsured, the more your premiums will go up. In this sense, healthcare is already a socialized thing - it is important to face that fact.[/LIST]Ask as many questions as you like. As I get time, I'll roll out more info like this for you to peruse.

Re: Healthcare Education and Q&A Thread
 

Nice thread. I wish you luck in keeping it sane

Re: Healthcare Education and Q&A Thread
 

[quote=SmootSmack;565432]Nice thread. I wish you luck in keeping it sane[/quote]

LOL

But to that point, I will not be taking sides or engaging in political back and forth. I'd encourage others to do that stuff elsewhere.

Rather, use this thread as a way to learn more. Then decide for yourself how that affects your political view, then go flame others of differing viewpoints in another thread.

Re: Healthcare Education and Q&A Thread
 

Seriously, thanks for this Schneed. very cool thread and it's nice to hear more than opinion on this subject.

Re: Healthcare Education and Q&A Thread
 

Excellent thread.

Re: Healthcare Education and Q&A Thread
 

[quote=Schneed10;565431]Commercial Insurers oblige [to subsidize Medicaid losses] because saying no puts these hospitals in financial stress, and could cause the hospital to buckle under the financial pressure of treating so many Medicaid patients. Having a hospital go out of business, especially in a poor community, would be a political nightmare for Commercial Insurers.[/quote]

This is the only part I don't understand. Can you please elaborate on the political ramifications for the commercial insurers, if they don't subsidize the Medicaid losses?

Re: Healthcare Education and Q&A Thread
 

Good idea, we could really use more education and less bashing. Good luck keeping it on track.

Re: Healthcare Education and Q&A Thread
 

What is the cost of the current system and is it sustainable?

Re: Healthcare Education and Q&A Thread
 

^^ Define "cost". Cost to whom? expenses incurred by providers? the average payments made by those insured by commercial insurers? etc.

I am curious as to the average payment for the vast majority of commercially insured individuals. Realizing this breaks down by coverage, age, etc., I am just looking for a true average.

Further, what is the tax burden impact of medicaid and medicare to taxpayers?

To me, that is the "cost of insurance" (ave. paid by all commercially insured + pro rata tax burden to taxpayers). For those who use self pay, the cost would be the average annual cost of healthcare (i.e. 1 million uncovered people spent X on healthcare in 2008) + pro rata tax burden.

Re: Healthcare Education and Q&A Thread
 

We hear all the time that people cannot switch their insurance because of existing condition. I thought if you had current insurance that if you wanted to switch to another company they could not underwrite, charge higher rates, or reject a person because of that condition. Is that true?

Re: Healthcare Education and Q&A Thread
 

[quote=GhettoDogAllStars;565437]This is the only part I don't understand. Can you please elaborate on the political ramifications for the commercial insurers, if they don't subsidize the Medicaid losses?[/quote]

Can do, with a real life current event.

Here in Philadelphia we are in the process of closing a hospital because it simply cannot break even under the immense weight of massive Medicaid patient concentration. Rather than completely closing it, we felt it important to keep the facility open on a scaled down basis, so that patients in the area had access to care. They'd have to go elsewhere for inpatient admissions, but at least they could still come to this scaled down facility for ER visits, chemotherapy treatment, colonoscopies, X-Rays, and other outpatient services.

In order to make this work we need to establish new reimbursement rates with commercial insurers. Our position is we need the same rates, or at least close to the same rates, as we were getting from them when the hospital was a full-service facility. Our argument was that the inpatient component is being closed because the commercial rates we were getting weren't enough to offset massive losses on Medicaid patients. We pointed out that by closing the inpatient services and scaling down the facility, we were cutting the overhead on the delivery of the remaining outpatient services. But, if commercial reimbursement were to drop in concert with that cost cutting, we would wind up in the same place, with our heads underwater.

Most insurers recognized the situation. They realized that if this facility completely closes, the people in the community would have very little access to care. Given that many are poor and don't have cars, getting to the next hospital 3 miles away isn't feasible. And public transportation in the area isn't practical. With no facility in their neighborhood, there would have been a public outcry.

Most insurers agreed to maintain the same rates. Except for one large insurer who shall remain nameless. They have dug in their heels insisting that their rates come down in concert with the cost cutting. We have responded by speaking with the community's state representatives, who in conjunction with us are putting pressure on the insurer. The argument:

- Without these rates, this facility is at risk of going out of business, leaving the community without adequate access to care.

- Your competitors, the other commercial insurers, agreed to establish rates.

- Therefore, you are the only company standing in the way of this community having the access to care it desperately needs.

The community was furious with us for closing the inpatient portion of the hospital. They haven't caught wind of these payer negotiations yet, but local government is aware. If it comes to a head, this insurance company will be painted as the enemy by both us (the provider) and the local government. The public response will be deafening.

Re: Healthcare Education and Q&A Thread
 

[quote=saden1;565439]What is the cost of the current system and is it sustainable?[/quote]

That question is extremely vague. The "cost of the current system" cannot be put into meaningful dollar terms. If I said $2.0 trillion per year, does that mean anything to anybody?

Is it sustainable? Depends. In some communities absolutely, in others not at all. For some employers absolutely, other employers not at all. For some doctors and providers absolutely, others not at all.

I can tell you this, Medicare cannot afford to continue paying the current reimbursement rates over the course of the next 20 years. Benefits will have to be cut or taxes raised. Something will have to change.

Re: Healthcare Education and Q&A Thread
 

^^ Generally, under HIPAA, an insurer can exclude pre-existing conditions from coverage if you have received treatment for the condition in the past six months. The length of teh exclusion can last from 12-18 mos. [url=http://www.dol.gov/ebsa/faqs/faq_consumer_hipaa.html]Frequently Asked Questions about Portability of Health Coverage and HIPAA[/url]

Some states impose stricter restrictions than HIPAA and prohibit all exclusions for pre-exisiting conditions.

Re: Healthcare Education and Q&A Thread
 

Also, to clarify, HIPAA only applies when you have already been insured and are transferring ot a new group insurer - not when purchasing individual insurance plans.

[url=http://www.cnn.com/2009/HEALTH/05/14/preexisting.condition.insurance/index.html]Tips for getting insurance when you have a pre-existing condition - CNN.com[/url]

Re: Healthcare Education and Q&A Thread
 

[quote=JoeRedskin;565440]I am curious as to the average payment for the vast majority of commercially insured individuals. Realizing this breaks down by coverage, age, etc., I am just looking for a true average.[/quote]

This is difficult to answer because it will vary so greatly from hospital to hospital. I can tell you our large urban academic medical center got an average of $20,074 per inpatient admission in the most recent fiscal year. Meanwhile, our community hospital got $8,876 per inpatient admission.

The reimbursement is so much better at the academic medical center because it sees sicker patients requiring more expensive treatment, which results in higher reimbursement. Also, the commercial rates are higher at the academic medical center, because of negotiating power discussed in the first post above.

Which is a good representation of the US average? Really hard to say. I do know the Medicare "base rate" is about $6000 nationwide. So I'd put the nationwide commercial average at $6000 - $10,000 per inpatient admission.

Much, much higher if said patient is sicker than the average inpatient admission.

[quote=JoeRedskin;565440]Further, what is the tax burden impact of medicaid and medicare to taxpayers?

To me, that is the "cost of insurance" (ave. paid by all commercially insured + pro rata tax burden to taxpayers). For those who use self pay, the cost would be the average annual cost of healthcare (i.e. 1 million uncovered people spent X on healthcare in 2008) + pro rata tax burden.[/quote]

Great question and I'd agree with the approach to ascertain the number. Unfortunately I don't have the information available to me to do it.

Re: Healthcare Education and Q&A Thread
 

[quote=firstdown;565442]We hear all the time that people cannot switch their insurance because of existing condition. I thought if you had current insurance that if you wanted to switch to another company they could not underwrite, charge higher rates, or reject a person because of that condition. Is that true?[/quote]

Yes they can, but there are limits to their ability to restrict. See JR's answer, it's right on.

Re: Healthcare Education and Q&A Thread
 

[quote=JoeRedskin;565451]Also, to clarify, HIPAA only applies when you have already been insured and are transferring ot a new group insurer - not when purchasing individual insurance plans.

[URL="http://www.cnn.com/2009/HEALTH/05/14/preexisting.condition.insurance/index.html"]Tips for getting insurance when you have a pre-existing condition - CNN.com[/URL][/quote]

I guess I should have worded my question better because I was talking a family and not group plans.

Re: Healthcare Education and Q&A Thread
 

In 2008, the average cost of insurance premiums for employer based policies was $3,400.00.

"Growth in health insurance premiums is far outstripping inflation and wages. Many employers have been forced to pass on premium increases to workers. Workers on average pay 27 percent of the premium. If workers continue to pay that percentage, by the end of 2009, employees, on average, will pay nearly $4,000 annually for their share of health insurance premiums.

[B]The average employee contribution for family health insurance premiums increased 120 percent between 1999 and 2008 to $3400 annually.[/B] And average out-of-pocket expenses for deductibles, coinsurance and copayments have increased 115 percent over the same period. Salaries have only increased 34 percent during this period."

[url]http://www.nchc.org/documents/Costs-Workers-2009.pdf[/url]

Re: Healthcare Education and Q&A Thread
 

From the various sources I have gone through, it appears that the price of healthcare - and by that I mean doctor's visits, operations, and pharmaceuticals, not the cost of insurance - has risen drastically in the last 10 years.

In your opinion Schneed - what are the two or three factors driving this rapid increase. (I am assuming malpractice insurance is one but are there others?)

Re: Healthcare Education and Q&A Thread
 

We know that the goverment does provide health ins to people today. Do we know what the goverment pays on average for health coverage v/s private ins?

Re: Healthcare Education and Q&A Thread
 

I believe the last time I was writing those checks to BC/BS....good coverage, NOT great in a group was about $350ish p/family

Re: Healthcare Education and Q&A Thread
 

[quote=JoeRedskin;565470]From the various sources I have gone through, it appears that the price of healthcare - and by that I mean doctor's visits, operations, and pharmaceuticals, not the cost of insurance - has risen drastically in the last 10 years.

In your opinion Schneed - what are the two or three factors driving this rapid increase. (I am assuming malpractice insurance is one but are there others?)[/quote]

Main factors causing cost increases, in no particular order:

- Science & Technology
We're flat out coming out with amazing technology that can help people get better faster and with less inconvenience. Tiny cameras in the form of a pill that can be swallowed to diagnose gastrointestinal problems. A Gamma Knife machine which irradiates otherwise inoperable brain tumors with gamma particles, extending the life of cancer patients. Da Vinci robotic surgical machines allowing surgeons to operate with even more precision, eliminating the few tremors and quakes they experience by using their very steady fingers. Hospitals often fear that they will lose their existing patients to another hospital with superior technology, so they enter an arms race of sorts to keep up. This sometimes results in an abundance of advanced technology in the community that ends up underutilized.

- Pharmaceuticals
Similarly, advances in research are leading towards more advanced drugs. The cost of manufacturing the drugs, let alone researching them, can get exhorbitant. Many of these drugs can extend the lives of patients, but some don't do a better job than existing tried and true less expensive alternatives.

- Malpractice
Doctors, especially obstetricians, have difficulty breaking even in some states because of this problem. Their malpractice insurance costs are growing so wildly as claims and awards are taking off. It's just like your car insurance; if you live in an area with high accident rates then you will pay more to insure your car. Likewise, in areas where claims and awards are high, malpractice insurance grows to the point that it makes practicing medicine prohibitive. Caps on malpractice awards would curb malpractice premiums a great deal.

Re: Healthcare Education and Q&A Thread
 

[quote=firstdown;565476]We know that the goverment does provide health ins to people today. Do we know what the goverment pays on average for health coverage v/s private ins?[/quote]

You mean what they pay on behalf of the employees who work for them?

My father works for the federal government, I know he has the federal insurance program through Blue Cross. I can ask him what his premium is and get back to you.

Or did you mean what Medicare pays the hospital on behalf of people enrolled in Medicare?

I know for our hospitals, it works out to 42% less than what commercial insurance companies pay us on behalf of their patients.

Re: Healthcare Education and Q&A Thread
 

I wonder how and if it would be possible to control malpractice costs by creating a workers comp type system for health care. Essentially, immunizing the doctor from malpractice claims but ensuring awards to individuals harmed by "treatment gone bad". Not quite no-fault but similar.

Re: Healthcare Education and Q&A Thread
 

[quote=JoeRedskin;565498]I wonder how and if it would be possible to control malpractice costs by creating a workers comp type system for health care. Essentially, [B]immunizing the doctor from malpractice claims[/B] but ensuring awards to individuals harmed by "treatment gone bad". Not quite no-fault but similar.[/quote]
sorry Joe, but they have to be accountable. if not, Dr.s all of a sudden turn into weathermen. really doesn't matter if they are right or wrong. and contrary to popular belief, there is a such thing as a bad doctor

Re: Healthcare Education and Q&A Thread
 

[quote=dmek25;565502]sorry Joe, but they have to be accountable. if not, Dr.s all of a sudden turn into weathermen. really doesn't matter if they are right or wrong. and contrary to popular belief, there is a such thing as a bad doctor[/quote]

I think they could still be accountable (i.e.: lose their license), but still control malpractice costs in the manner that JR suggested.

Re: Healthcare Education and Q&A Thread
 

[quote=GhettoDogAllStars;565531]I think they could still be accountable (i.e.: lose their license), but still control malpractice costs in the manner that JR suggested.[/quote]

yeah. I was thinking something along those lines. For example, after claims abounting to X or after X number of claims paid regardless of amounts, a doctor loses their license.

Re: Healthcare Education and Q&A Thread
 

[quote=JoeRedskin;565545]yeah. I was thinking something along those lines. For example, after claims abounting to X or after X number of claims paid regardless of amounts, a doctor loses their license.[/quote]


How is this really any better than what currently happens? I mean, currently if a doctor's conduct is egregious enough they would most certainly lose their license. Add to this the fact that if a doctor is successfully sued their malpractice insurance cost goes up and the more it happens the more it goes up, and soon enough they won't be able to practice because they can't afford the malpractice insurance.

Also, you're just as likely to punish good doctors with a 3-strikes type of a law.

Re: Healthcare Education and Q&A Thread
 

Fair points to an extent. The key of course is "sued successfully" , malpractice is a very difficult case to prove. Bad doctors do not necessarily lose lawsuits. In the WC situation, the question is not "did the doctor screw up", it is "was the patient harmed" - big difference. I understand your point about the similarities to 3 Strikes. At the same time, a doctor who causes harm and does so on a consistent basis - even if he causes harm w/o committing malpractice - is not one who should be practicing. A balance would have to be struck. What the balance is, I am not quite sure.

Re: Healthcare Education and Q&A Thread
 

[quote=dmek25;565502]sorry Joe, but they have to be accountable. if not, Dr.s all of a sudden turn into weathermen. really doesn't matter if they are right or wrong. and contrary to popular belief, there is a such thing as a bad doctor[/quote]

To that point though, by paying for malpractice insurance, they've essentially removed any financial incentive to avoid mistakes.

It's not like they have to be accountable under the current system; if they screw up their insurance carrier foots the bill. So under a capped system, the insurance premiums paid by doctors would be lower, and there would be no change in penalties felt by the doctor in cases of malpractice.

A loss of license would be effective, but I'm not even sure you need that. Doctors already try their damndest to avoid mistakes for fear of scaring all of their patients away. I wouldn't want to put any more pressure on them, they already practice costly defensive medicine as it is.

When you're trying to avoid malpractice suits, you tend to order more tests and procedures than is truly necessary. The rash of malpractice suits is partly responsible for healthcare expenses being as high as they are; we simply don't always need the tests doctors order. I'd rather not put anything in place that would make them any more defensive.

Re: Healthcare Education and Q&A Thread
 

Thanks for lending us your expertise Schneed. It is often remarked that the United States spends more per person than any other country in the world on healthcare yet gets less, consistently ranking near the bottom of major industrialized countries in independent international surveys. First of all, do you think these rankings are fair? Second, do you think it would be possible to expand coverage to the unininsured without substantially increasing taxes or cutting other government spending? It seems that other countries are able to get more coverage for considerably less money.

Finally, I know that you have been critical of Obama's healthcare proposals in the past. Does this mean you advocate the status quo? If not, what specific changes would you like to see implemented by congress?

Re: Healthcare Education and Q&A Thread
 

If I'm correct I think my buddy said he pays 85,000 a year for malpractice ins. and it might have been even more than that.

Re: Healthcare Education and Q&A Thread
 

[quote=djnemo65;565568]Thanks for lending us your expertise Schneed. It is often remarked that the United States spends more per person than any other country in the world on healthcare yet gets less, consistently ranking near the bottom of major industrialized countries in independent international surveys. First of all, do you think these rankings are fair? Second, do you think it would be possible to expand coverage to the unininsured without substantially increasing taxes or cutting other government spending? It seems that other countries are able to get more coverage for considerably less money.

Finally, I know that you have been critical of Obama's healthcare proposals in the past. Does this mean you advocate the status quo? If not, what specific changes would you like to see implemented by congress?[/quote]

Cost-wise, a few things in particular separate us from other countries:

[U]Malpractice[/U]
Other countries don't allow civil suits to result in large payments to victims of malpractice. Hence our docs pay a ton more in malpractice premiums than do docs in other countries.

[U]Cost of Living[/U]
Cost of living in the US is way higher than most industrialized nations. Since healthcare is so labor-intensive, it is unfair to compare per-capita spending on healthcare from one country to another without adjusting for cost of living or wage index.

I'd like to see the surveys you're speaking to be able to comment further as to their fairness. I'd be particularly interested to see how they're determining that we "get less." Does that mean we have shorter lifespans? How the heck do you measure that?

We have shorter lifespans because we're fat, not because our healthcare sucks!

Re: Healthcare Education and Q&A Thread
 

Here's a pretty detailed analysis of the WHO's most recent survey (from a few years ago, which ranked us 37th). [url=http://www.photius.com/rankings/who_world_health_ranks.html]PR-2000-43/ WORLD HEALTH ORGANIZATION : ASSESSES THE WORLD'S HEALTH SYSTEMS[/url] Looking online it seems like a lot of people have criticized the methodology of this particular ranking, so I'd be interested to hear your take.

Your first observation makes sense but I can't find any information online suggesting that the US has a high cost of living relative to other industrialized nations. Are you sure about this? Speaking anecdotally, it has been my experience from traveling that the cost of living - or at least the cost of things I buy like food and beer - is way higher in other industrialized countries than the US, and I am including Japan, Germany, France, England, Spain, and the Netherlands on this list. Speaking from experience I can tell you that Japan is significantly higher than the US pretty much anyway you measure it. Most information online ranks cities instead of countries (usually putting NYC around 20th in the world) but here's one I found ranking countries across several categories, with the US being pretty average in every category [url=http://www.numbeo.com/cost-of-living/rankings_by_country.jsp]Cost of Living Index By Country[/url]

So anyway, while cost of living might explain how Colombia ranks higher than us, unless I'm missing something I really don't think it's true that the US has a high cost of living relative to the EU and the most developed Asian countries.

Re: Healthcare Education and Q&A Thread
 

you say other countries do not allow civil settlements in doctors error. what happens in those countries when mistakes are made?

Re: Healthcare Education and Q&A Thread
 

[quote=dmek25;565706]you say other countries do not allow civil settlements in doctors error. what happens in those countries when mistakes are made?[/quote]

Don't know, I guess that would be a legal question. I wonder if any lawyer types know what the deal is in other countries.

Re: Healthcare Education and Q&A Thread
 

[quote=djnemo65;565705]Here's a pretty detailed analysis of the WHO's most recent survey (from a few years ago, which ranked us 37th). [URL="http://www.photius.com/rankings/who_world_health_ranks.html"]PR-2000-43/ WORLD HEALTH ORGANIZATION : ASSESSES THE WORLD'S HEALTH SYSTEMS[/URL] Looking online it seems like a lot of people have criticized the methodology of this particular ranking, so I'd be interested to hear your take.

Your first observation makes sense but I can't find any information online suggesting that the US has a high cost of living relative to other industrialized nations. Are you sure about this? Speaking anecdotally, it has been my experience from traveling that the cost of living - or at least the cost of things I buy like food and beer - is way higher in other industrialized countries than the US, and I am including Japan, Germany, France, England, Spain, and the Netherlands on this list. Speaking from experience I can tell you that Japan is significantly higher than the US pretty much anyway you measure it. Most information online ranks cities instead of countries (usually putting NYC around 20th in the world) but here's one I found ranking countries across several categories, with the US being pretty average in every category [URL="http://www.numbeo.com/cost-of-living/rankings_by_country.jsp"]Cost of Living Index By Country[/URL]

So anyway, while cost of living might explain how Colombia ranks higher than us, unless I'm missing something I really don't think it's true that the US has a high cost of living relative to the EU and the most developed Asian countries.[/quote]

I'll take a close look at that survey and weigh in.

On cost of living, the question really is what to doctors and nurses get paid in those other countries. I am under the impression it's less, though admittedly I'm not certain; I know a lot more about our healthcare system than I do that of other nations.

Re: Healthcare Education and Q&A Thread
 

[quote=firstdown;565631]If I'm correct I think my buddy said he pays 85,000 a year for malpractice ins. and it might have been even more than that.[/quote]

Wow. I wonder if that's the average, or if your buddy has a habit of amputating the wrong limbs.

Re: Healthcare Education and Q&A Thread
 

[quote=BleedBurgundy;565754]Wow. I wonder if that's the average, or if your buddy has a habit of amputating the wrong limbs.[/quote]
MY buddy said he has only been sued once and he admitted that in that case he did make a mistake but that was like 8 years ago. He is the guy they call in to put you back together after a bad accident and he also has a practice which specializes in sports injuries. He does the emergency type stuff because he likes that type of work and he jokes by saying motor cycle riders paid for his house.

Re: Healthcare Education and Q&A Thread
 

[quote=firstdown;565756]MY buddy said he has only been sued once and he admitted that in that case he did make a mistake but that was like 8 years ago. He is the guy they call in to put you back together after a bad accident and he also has a practice which specializes in sports injuries. He does the emergency type stuff because he likes that type of work and he jokes by saying motor cycle riders paid for his house.[/quote]

Sounds like an Orthopedic Surgeon. They suffer one of the higher malpractice premium rates, probably second highest to obstetricians.

Our Orthopedic Surgeons get paid about $350,000 plus incentives, and then the Medical School pays for their malpractice coverage, about $60-$70K per doc on average. $85K does not sound unreasonable, the only reason our medical school docs have a lower premium is because they're getting a "group rate" of sorts.

Obstetricians deal with about $100K apiece.

Malpractice costs aren't some buzzword or hot button issue; it's a serious problem.