Inflation

[SAJ-99]

Physicians usually complain about these rates because the government pays pennies on the dollar to what private insurance would pay.

How Much More Than Medicare Do Private Insurers Pay? A Review of the Literature | KFF

This brief reviews findings from recent studies that compare Medicare and private health insurance payment rates for both hospital and physician services.

www.kff.org

Sounds like an argument for the government paying for all medical care.

 

[Nameless Range]

Doctors used to be rich. Now hospital admin is rich.

People think doctors are rich because they pull in a few hundred thousand dollars a year.
Sounds like a lot until you realize they’re like 35 before they get to start making any money and are hundreds of thousands of dollars in debt, and hundreds of thousands of dollars behind in retirement investment.

I am related to someone very involved in the inner workings of a hospital. There’s truth to this and there isn’t. I say that because not all doctors are created equal in terms of the revenue they generate for themselves and the places they work. For some, I am absolutely baffled that they would invest hundreds of thousands of dollars into themselves only to make what they do. For others, with a little hustle they can make extraordinary amounts of money.

People smarter than me seem to argue over this ad nauseum, but it really seems true that many of the good influences that market forces have on a sector in the real world don’t apply to the medical world due to the way insurance works. I don’t know whether to credit government, insurance companies, or this deeply unhealthy country for that.

It’s not popular to say, but I think we require far too much up front schooling of both doctors and nurses. Their educations and training could be truncated significantly and the product of their performances would not suffer that greatly. I’ve talked to a few doctors about this who agree. Been surrounded by nurses my whole life and I think it holds there too.

Doesn’t seem to be an easy problem to solve, largely because medical service is so tightly intertwined with university costs, which independent of the degrees they deliver, are out of control.

 

[Treeshark]

Very well said, Nameless.

Another factor is that the consumer and the payer are disconnected, so many of the normal financial “rules” that exist in other markets vanish in healthcare.

It’s easy to identify the problems, far harder to come up with solutions- it’s like a project on an old house, every attempt at repair reveals several other problems to address.

 

[mtmuley]

I am related to someone very involved in the inner workings of a hospital. There’s truth to this and there isn’t. I say that because not all doctors are created equal in terms of the revenue they generate for themselves and the places they work. For some, I am absolutely baffled that they would invest hundreds of thousands of dollars into themselves only to make what they do. For others, with a little hustle they can make extraordinary amounts of money.

People smarter than me seem to argue over this ad nauseum, but it really seems true that many of the good influences that market forces have on a sector in the real world don’t apply to the medical world due to the way insurance works. I don’t know whether to credit government, insurance companies, or this deeply unhealthy country for that.

It’s not popular to say, but I think we require far too much up front schooling of both doctors and nurses. Their educations and training could be truncated significantly and the product of their performances would not suffer that greatly. I’ve talked to a few doctors about this who agree. Been surrounded by nurses my whole life and I think it holds there too.

Doesn’t seem to be an easy problem to solve, largely because medical service is so tightly intertwined with university costs, which independent of the degrees they deliver, are out of control.

Got a bill from an anesthesiologist the other day for $500 bucks. He introduced himself, two minutes of small talk and he left. Never saw him again.
Pretty good gig. I'm sure there's more examples as I dig through it. mtmuley

 

[jryoung]

Doctors used to be rich. Now hospital admin is rich.

People think doctors are rich because they pull in a few hundred thousand dollars a year.
Sounds like a lot until you realize they’re like 35 before they get to start making any money and are hundreds of thousands of dollars in debt, and hundreds of thousands of dollars behind in retirement investment.

.....and many people believe doctors should civil servants and services should be paid for by the government despite privately investing in their education.

 

[SAJ-99]

It’s not popular to say, but I think we require far too much up front schooling of both doctors and nurses. Their educations and training could be truncated significantly and the product of their performances would not suffer that greatly. I’ve talked to a few doctors about this who agree. Been surrounded by nurses my whole life and I think it holds there too.

Have to disagree on this. By "not suffer greatly" I would agree on that if we measure average because most people can survive without a trip to the hospital. For example, we have data that says we overprescribe antibiotics because the human body takes care of a large percentage of infections on its own. That said, are you going to bet your life or your child's on it? When you go to the ER, do you want to see the NP or the ER Boarded Physican? Hospitals are staffing with the cheapest employees to get better profits and just increasing med malpractice insurance payments to cover the "bad outcomes" (And payments to lobbyist obviously).

I do agree it is not an easy problem to solve, but getting an RN degree in months doesn't necessarily result in skilled nurses. It's not like 30yrs ago and I have personally witnessed the decline in my own care.

Here is some interesting stuff on how messed up the system it.
https://ripmedicaldebt.org/ is a non-profit that buys bad medical debt which would typically be sold to collectors. Price on the website says the average price is $1 for every $100 in debt. So a hospital/insurer gladly sells debt it feels uncollectible for 1% of billed amount. I agree with the argument that the cost has to be made up somewhere else for profits to be made and these services to exist, but 1%? More anecdotal evidence, my recent bill for annual labs-Standard stuff; cholesterol, A1c, liver function, etc.

Total billed $159
Insurance adjustment -102
Insurance paid -$44
My cost $13

YMMV depending on how well your insurance co can negotiate the price down or what the govt pays. But it shows there is no transparency in medical billing. Having a baby or getting surgery, you get a discount for paying up front. Who pays $159 for the same labs? No one, because if you can't pay you just let it go to collections. I really don't know what the answer is, but that inflation line for Hospital Services isn't what it appears.

 

[rogerthat]

I am related to someone very involved in the inner workings of a hospital. There’s truth to this and there isn’t. I say that because not all doctors are created equal in terms of the revenue they generate for themselves and the places they work. For some, I am absolutely baffled that they would invest hundreds of thousands of dollars into themselves only to make what they do. For others, with a little hustle they can make extraordinary amounts of money.

People smarter than me seem to argue over this ad nauseum, but it really seems true that many of the good influences that market forces have on a sector in the real world don’t apply to the medical world due to the way insurance works. I don’t know whether to credit government, insurance companies, or this deeply unhealthy country for that.

It’s not popular to say, but I think we require far too much up front schooling of both doctors and nurses. Their educations and training could be truncated significantly and the product of their performances would not suffer that greatly. I’ve talked to a few doctors about this who agree. Been surrounded by nurses my whole life and I think it holds there too.

Doesn’t seem to be an easy problem to solve, largely because medical service is so tightly intertwined with university costs, which independent of the degrees they deliver, are out of control.

Regarding the truncated schooling part, I have always said if you take an idiot and send them to school, you typically still just have a schooled idiot upon graduation. This can be said for all occupations. The good ones are going to be good anyway whether it’s from school or on the job training or both.

 

[arwhntr]

Interesting. Thanks for posting. Seems like new cars should be up more than that. I would say they have at least doubled since 2000

Agreed. Not a chance vehicles are only up ~20% since 2000. I think they are up closer to 30% over the just last 5 years.

 

[mtmuley]

No one, because if you can't pay you just let it go to collections.

How do you know this? mtmuley

 

[SAJ-99]

Agreed. Not a chance vehicles are only up ~20% since 2000. I think they are up closer to 30% over the just last 5 years.

The lines are NOT nominal prices. It is the cost relative to the average of everything else. By definition, some things are going to be above the line (higher inflation) and some things will be below (lower inflation). Very few things have actually deflated.

 

[buckbull]

Shouldnt Wyoming non resident elk tag be at the top of that chart?

 

[MTGomer]

The electronics one always fascinated me.

I bought a new phone yesterday for $1000

The last one I bought was almost $1200.

Very few things get better and cost less.
Thanks to the artisanal mining slaves in the Congo and the almost slaves in Chinese sweatshops.

 

[SAJ-99]

How do you know this? mtmuley

It was hyperbole. Of course a lot of people pay. But I can look at surveys and see the amount of medical debt and I can see the amount purchased by debt collectors. People don’t “let” it go, but the biller is quick to get rid of it for Pennies on the dollar.

 

[jt13]

Saw a half ton pickup very similar to mine on the lot the other day $68k, paid $39k for mine 6 years ago. I dont think those ptices are ever coming down but i think poeple are going to be trading in a lot less frequent. I know I sure will.

In 2019, I bought my 2016 Tundra w/30k miles for $30k. Now here in 2023, at the same trim and mileage, a three year old Tundra will run you $40k... more than a 30% increase in 4 years.

Hope my truck runs forever, very well possible it'll be the last one I'll ever be able to afford.

 

[Deleted member 28227]

I am related to someone very involved in the inner workings of a hospital. There’s truth to this and there isn’t. I say that because not all doctors are created equal in terms of the revenue they generate for themselves and the places they work. For some, I am absolutely baffled that they would invest hundreds of thousands of dollars into themselves only to make what they do. For others, with a little hustle they can make extraordinary amounts of money.

Massive can of worms here and one that might offend so I will try and be delicate.

There is also the prestige factor of hospitals/academic medicine.

There is an inverse relationship to the prestige of a hospital and how much an attending doctor makes.

For instance a cardiologist at MGH/UCSF/Hopkins/NYPres/Duke etc. will make 1/3 what a cardiologist in the deep south/midwest makes, that number get's even crazier if it's in private practice.

Maybe ~$220-250 at MGH and like $2mm private practice in the south, meanwhile the CEO of MGH is making over $6 million.

Now those academic hospitals are the hardest to get into for residency and to get a job at... so basically 'the best doctors' are making the least amount of money.

This is very nuanced and there are tons of very smart MDs who have seen the writing on the wall so this isn't completely accurate, but on the whole there is a negative correlation between MCAT/STEP scores and income.

This trend has gotten so nuts that in the last couple of years we have seen a number of major hospital MDs unionize. Penn, Seattle, UMich, MGH, etc.

 

[Deleted member 28227]

Got a bill from an anesthesiologist the other day for $500 bucks. He introduced himself, two minutes of small talk and he left. Never saw him again.
Pretty good gig. I'm sure there's more examples as I dig through it. mtmuley

They aren't paid to talk to you... when I had my mechanic replace my clutch he talked to me for 2 min and then spent a couple hours replacing it. Honestly I'm not sure why the MD even introduced himself.

 

[mtmuley]

They aren't paid to talk to you... when I had my mechanic replace my clutch he talked to me for 2 min and then spent a couple hours replacing it. Honestly I'm not sure why he even introduced himself.

At least he did something. mtmuley

 

[Deleted member 28227]

At least he did something. mtmuley

Titrating your meds isn’t something?

 

[mtmuley]

Titrating your meds isn’t something?

He didn't do anything. He walked in and charged $500. I have the bill. There's gonna be more I'm going to question. Doesn't get me off the hook from paying the F-ing thing. mtmuley

 

[Deleted member 28227]

He didn't do anything. He walked in and charged $500. I have the bill. There's gonna be more I'm going to question. Doesn't get me off the hook from paying the F-ing thing. mtmuley

Totally, fair I wasn’t there and don’t know chit about the situation.