Health Insurance 44

[tbonebanjo]

I was just wondering how many companies still have good insurance and how many have gone the way of Obamacare. I am in a small MEP firm in Maryland. Our health insurance just changed, our premiums went up and our coverage went way down. I have maximum out of pocket expenses of $12,500 per year, $4000 deductable per person, tnen start the copay schedules. Should I start looking for other employment or are all companies being affected this way?

 

[glass99]

The American Medical Association is a cartel. Is there a Canadian equivalent?

 

[swall]

In the U.S. there is a board that sets rates for Medicare reimbursements for various procedures. The influence of medical specialists on the board has skewed the reimbursement structure such that specialists get higher fees/make more money than general practitioners. So guess what? More medical students study to be come specialists rather than GP's. It is my understanding that many of the insurance companies follow the Medicare reimbursement guidelines, so most of the medical profession if affected.

 

[moltenmetal]

The medical association here in Canada is a de-facto union, since the doctors have one employer (the government). They negotiate fees for service etc. The provincial governments and the doctors BOTH want the number of doctors to be low... But instead of deploying the limited number of doctors where they're actually needed (because they're really government employees anyway), we give them the choice to set up shop wherever they like. Because these services aren't optional, the public travel to where the doctors are- we have "under-serviced areas". Pretending that these guys are private businesspeople is not helping matters.

Regrettably, although the doctors and provinces are good at controlling the total number of doctors, they're less good at controlling the number of specialists. Specializing gives the doc a huge return on investment relative to staying a family doctor, so we have a shortage of family doctors- and are a net exporter of trained specialists to the US where the returns on that educational investment (for the person, not the province who subsidized it) is enormous. Time to start handing them a bill for recovery of those subsidies at the border in my opinion, until they've put in 10+ years of practice here at least.

 

[beej67]

"Sure, but it's not "because" of the single payer system."

Right, but it's not the single payer system that prevents that from happening either.

Sure. So why is the whole debate about who pays for the overpriced dysfunctional product, instead of discussing the overpricedness and brokenness?

The primary thing that fuels the engine of our system's brokenness is the exploitation of the cost sharing mechanism by the medical industry itself.

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[glass99]

We engineers have to compete for our jobs with others educated internationally, so why shouldn't doctors? There are too many restrictions on doctors educated in India and similar places. There are plenty of stories of doctors educated in Egypt working as cab drivers because they are denied licensure. The AMA is an enforcer of this anti-competitive behavior, plus there is a culture of entitlement among the medical community.

 

[cranky108]

glass, I have heard the same of doctors from other countries. The issue seems to be the AMA attempting to restrict the supply of doctors. Maybe we should invite doctors with out borders in to serve underserved areas of the US. As these doctors don't seem to need a licence for the countries they visit. And just maybe we can have the US army build hospitals in underserved parts of the US.
We can call all of this 'nation building'.

So what I am getting is this is a political issue that is causing the rise in health care, and we have a goverment that has no desire to fix the real problem.

 

[glass99]

The H1B visa program is supposed to be for easing shortages of skilled professionals - if civil engineers have tight supply, why not cardiologists? They earn something like 4x as much as engineers, which would seem to indicate that there is a shortage which needs to be eased. The competition would be useful for medical schools too who currently just charge student doctors through the nose because they can.

 

[2dye4]

Health care poses a unique problem. It has advanced to the point the average person cannot afford it,
but we are compassionate people who don't turn away the sick ( mostly ).

It seems there are only two ways to handle this.

1 Spread the cost out over the population and over time requiring people to pay in constantly for that day when they need it.

2 Government takeover of the health care system so whats available for free is limited and without risk of litigation.


Also I think every medical service and doctor must publish their fixed price to do procedures. They would have to weight in
their risks for handling complications ( resulting from treatment of a single condition named in the price ) and perform
the service at the quoted cost.


It simply won't work allowing the medical community to run a locked in system where the consumer is handed the bill after everything
is finished and just has nothing to say about it.

 

[cranky108]

Or allow the free market to solve the cost issue by breaking the goverment limit on the free market.

Truthfully why is there a restrictive choke on the medical profession, but a desire to allow engineers from other countries?

 

[IRstuff]

"There are plenty of stories of doctors educated in Egypt working as cab drivers because they are denied licensure."

Not true. They generally have difficulties in the following:
> Passing the Step 1 and 2 medical exams, because they're in English
> Passing the TOEFL English exam
> Getting residencies, which are in limited supply.
> Passing Step 3 medical exam.
> Passing their respective board certifications

> Just because someone was a doctor somewhere else, does not mean they are qualified or trained to the same level as a US-educated doctors.
> For the limited slots available for residency, it's mostly a meritocracy, at least, in the sense that graduates of the best medical schools will tend to get the best slots.

Assuming that a foreign person does all of the above, they cannot be "denied" licensure. My wife is foreign born and trained, and is licensed, but went through all of the above hoops.

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[moltenmetal]

The thing they control here is residencies. Some argue that a residency requirement is too much to ask of a foreign-trained doctor, but most people admit that it's actually legitimate for public protection.

The medical associations and provincial governments set aside enough residencies for the (controlled) number of local medical graduates, plus a small number (I think it's about 100 per year in Ontario total) for everyone else. If you have 1000 foreign trained doctors coming in and 100 residencies per year, you end up with trained doctors doing something else. So: why let the rest of them immigrate? That's been an argument for a long time- in all the professions- except in engineering, where the engineering community was basically asleep or in denial, thinking that we could accommodate any number of immigrants who chose to come.

In fact, they tried for a while in the late '80s to let doctors come in ONLY if they signed an undertaking prior to immigration stating that they would not seek licensure as doctors. Of those signing the undertaking, it was found that over 50% did actually seek licensure anyway...so they abandoned that practice.

Somehow, a doctor's training going to waste is viewed as a huge sin, but an engineer's training going to waste is not something anyone cares about. I guess we're not a profession after all, at least not in any way that truly matters.

 

[IRstuff]

There are no such quotas in the US, but many of the steps I outlined are huge stumbling blocks for foreign doctors. Back about 10 yrs ago, when my wife was looking for a residency, we met someone from the former Yugoslavia who was supposedly a department head back home, but was slogging it out with freshly minted med-school grads for residency. I don't remember what his job was here, while waiting to get lucky, but it was nowhere near what his former job was.

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[cranky108]

I now work with several engineers from other countries, and most of them speak very good english. However when I was in school I had many instructors that did not speak english very well.
So at this point I need to ask why those doctors from other countries don't teach?

Also while observing the elections last night, I noticed the corner is an elected position, and I think, that a corner may not need to be a very good doctor as all their patents are dead.

 

[IRstuff]

"So at this point I need to ask why those doctors from other countries don't teach"

For same reason that they have trouble getting residencies; they're competing with already licensed doctors who have the full paper trail of residency, board certification, etc. Given the number of foreign-trained doctors already working, I don't see that there is a real problem, those, like my wife were indeed able to get pass the medical exams, get residencies, and pass the board exams. I think that if we dug through the records, we'd see an equally large, if not larger, group of US-trained grads that fail to get into the path toward licensure. It's awfully easy to blame others for one's own failures.

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[glass99]

A residency is a years long rigorous undertaking, and forcing a foreign doctor who has done one overseas to do one again in the US is straight up anti-competitive behavior. Is a German doctor really trained to such lax standards? Surely some sort of foreign accreditation program could be arranged. A little foreign competition would do the medical profession no harm.

 

[moltenmetal]

A full-on residency may be too much to ask, but a year of fully mentored experience under the direct supervision of another licensed doctor would be appropriate. It's akin to what we require here for licensed professional engineers, with only one difference- to work as an engineer here, the only person you need to convince of your abilities, education etc. is your boss- you only need a license to provide services directly to the public. There is no such non-licensed doctor equivalent.

Better using the training of doctors from overseas is one thing, but better using the services of doctors in general is another. Right now too much healthcare is delivered by people with too much training- a little bit of "division of labour" would help that profession a heck of a lot more than merely fixing the mess related to residencies.

 

[glass99]

Specialist doctors getting paid $400k/yr is a significant cost to the system, and we need to take away some of the excuses for why they "need" to be paid so much. Doctors will always point to their 12+ years of higher education to justify their investment banker salaries.
- US med school needs to be cheaper
- Med school needs to be shorter, at least for some percentage of doctors.
- If education input is such an expensive piece of the puzzle, we should be looking to offshore to lower labor cost locations where possible.

 

[beej67]

They command that kind of wage due to artificial scarcity created within the system.

Nothing about fixing that in the ACA.

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[KENAT]

glass99, well to resolve a couple of you points...

How about we tax the investment banker salaries, use that money to make the doctors government employees (with generous but limited salary) in a state monopoly for healthcare with strict limitations on being sued. Maybe negotiate better prices with various med suppliers due to the monopoly status. Little bit of central planning to cut down on duplicate facilities and equipment not being used to capacity...

You know, something like at least some of those damn commie socialist lazy Europeans do with their single payer systems.

Posting guidelines faq731-376

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(probably not aimed specifically at you)
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[IRstuff]

"Is a German doctor really trained to such lax standards"

No, but there are people who fail to get into the US medical educational system and go elsewhere, because it is easily, like the D.R. Additionally, you don't know that a German doctor was actually trained in Germany, just like not all US doctors were trained in the US. The other issue is that the equipment and nomenclature and procedures are different, and while family practice could probably tolerate a doctor fumbling for the right phrase to use with the M.A., that might not go that well in the O.R.

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