Whither Obamacare?

[dps]

It's weird but my wife and most of her colleagues that I know personally are bleeding hearts when it comes to the medical system. I've basically told them--specialist pay, surgeon pay particularly are like 200% of what's seen in many OECD countries. A true socialized system some of these people are going to have to trade down from Bentley's to BMWs and drop down to a country club with a $50,000 initiation fee instead of $100,000.

I always wondered about the cost side of the American health care debate. A lot of the providers, be it doctors or pharma  companies (and probably insurance and hospitals too?) seem to earn very well. If America wants a market to regulate this, is there enough competition on the supply side?

Poor cost control seems one of the deficiencies of most health care systems.

Basically, Medicare and Medicaid took doctors from being comfortably middle class to being wealthy.

[Valmy]

Really? Because I thought the best doctors tended to refuse Medicare and Medicaid patients.

But that is probably a question for Fate.

[Admiral Yi]

I've never heard of doctors refusing Medicare patients.  That's the whole fucking market.  Medicaid definitely.

[Fate]

Salaries are part of what drives the cost of medicine, but it's a small part (~8%).

No one is making buckets of money on Medicaid patients in big states like FL, NY, CA, or TX. In a lot of situations you're breaking even or even losing money for your practice by seeing them. In big states Medicaid reimburses at ~50-60% of what Medicare does. Medicaid patients also tend to be sicker, require onerous government paperwork for approval of things, and reimbursement takes an unresasonable amount of time. Medicaid needs 800 billion in new financing, not 800 billion in new cuts, if we want poor people to have the same access to the health care system as Medicare patients.

Medicare reimburses at about 75% of what private insurance does, but it's nearly impossible in most fields to avoid taking Medicare pateints.

[Fate]

It's weird but my wife and most of her colleagues that I know personally are bleeding hearts when it comes to the medical system. I've basically told them--specialist pay, surgeon pay particularly are like 200% of what's seen in many OECD countries. A true socialized system some of these people are going to have to trade down from Bentley's to BMWs and drop down to a country club with a $50,000 initiation fee instead of $100,000.

This isn't universally true. There are OECD countries with socialized medicine where specialists make more than Americans and there are counries where they make less or only slightly less. I'd also look at a doctor income to per capita GDP ratio rather than just raw $ amount when using such a broad group of countries. Dutch or Australian specialists tend to make more than their American counterparts. Germany or Denmark would be examples where doctors are in my opinion paid crap.

Old data from 2009, but I doubt it's changed much:

https://journal.practicelink.com/vital-stats/physician-compensation-worldwide/

Average Compensation in U.S. Dollar Purchasing Power Parity

[Malthus]

Wow, average compensation for a specialist in Canada is $161K? That seems very low to me. I assume it is lower compensation in the smaller provinces bringing the average down.

[crazy canuck]

Wow, average compensation for a specialist in Canada is $161K? That seems very low to me. I assume it is lower compensation in the smaller provinces bringing the average down.

There is something wrong with that number.  My guess is it is not tracking all the streams of compensation paid to specialists here.

[Fate]

Wow, average compensation for a specialist in Canada is $161K? That seems very low to me. I assume it is lower compensation in the smaller provinces bringing the average down.

I kind of question their numbers too, but it's from the government. From what I can tell they don't distinguish between academic (lower) and private practice (higher) jobs. These are also using USD purchasing power parity rather than raw income.

[derspiess]

Wow, average compensation for a specialist in Canada is $161K? That seems very low to me. I assume it is lower compensation in the smaller provinces bringing the average down.

There is something wrong with that number.  My guess is it is not tracking all the streams of compensation paid to specialists here.

Do they get bribes & stuff like in Cuba?

[CountDeMoney]

Really? Because I thought the best doctors tended to refuse Medicare and Medicaid patients.

But that is probably a question for Fate.

Funny how, back in the day when it was  free money, doctors piled on the Medicare there was no tomorrow, like an overbooked United flight.

Now that it's not as easy, and there's a semblance of regulatory control, they cry, oh how they cry.

[HVC]

Wow, average compensation for a specialist in Canada is $161K? That seems very low to me. I assume it is lower compensation in the smaller provinces bringing the average down.

There is something wrong with that number.  My guess is it is not tracking all the streams of compensation paid to specialists here.

Do they get bribes & stuff like in Cuba?

Don't Us doc's get "gifts" from pharma companies to hawk their wares? I don't think Canadian ones do, but I could be wrong.

[Fate]

Wow, average compensation for a specialist in Canada is $161K? That seems very low to me. I assume it is lower compensation in the smaller provinces bringing the average down.

There is something wrong with that number.  My guess is it is not tracking all the streams of compensation paid to specialists here.

Do they get bribes & stuff like in Cuba?

Don't Us doc's get "gifts" from pharma companies to hawk their wares? I don't think Canadian ones do, but I could be wrong.

The guys who get substantial amonts of cash/gifts tend to be "thought leaders." Doctors prominent in research and academia who can influence others.

Most of the pharma payments tend to be more along the lines of buying lunch for all the staff of a private practice office and then getting an opportunity to sell your new blood thinner or hypertension drug.

It all has to be reported to the government. Anyone can look up their own doctor. For example, Tom Price (the HHS secretary and former orthopedic surgeon) received $550 dollars for food and beverage over 33 payments in 2015.

https://openpaymentsdata.cms.gov/

[viper37]

Wow, average compensation for a specialist in Canada is $161K? That seems very low to me. I assume it is lower compensation in the smaller provinces bringing the average down.

161$K in US$, with PPP.  Meaning what you can purchase with 1$ here and 1$ in the US.
It's not the raw data.  Specialists in Quebec started at around 230k$ CAN$ at this time, much more today.  Also, it's what they make from their 1st to their last year.  Presumably, a doctor's wage increase with the number of years in practice?  Also, they may have bonuses to work outside of metro areas, plus various expenses paid.

[Malthus]

Wow, average compensation for a specialist in Canada is $161K? That seems very low to me. I assume it is lower compensation in the smaller provinces bringing the average down.

161$K in US$, with PPP.  Meaning what you can purchase with 1$ here and 1$ in the US.
It's not the raw data.  Specialists in Quebec started at around 230k$ CAN$ at this time, much more today.  Also, it's what they make from their 1st to their last year.  Presumably, a doctor's wage increase with the number of years in practice?  Also, they may have bonuses to work outside of metro areas, plus various expenses paid.

It is just so out of wack with other stats I have seen.

https://www.cma.ca/En/Pages/canadian-physician-statistics.aspx

For 2014-2015, total average for Canadian specialists earning at least $60K from fees (i.e., not retired or mostly doing something other than medicine) was CAN $384,000. This only includes fees for medical services, not any other form of payment.

https://stats.oecd.org/Index.aspx?DataSetCode=SNA_TABLE4

Convert to US dollars based on PPP for 2014-15 would = US $309,677. Which is almost double. Seems hard to believe fees nearly doubled in the five or six years from 2009 to 2014-15. 

[crazy canuck]

Wow, average compensation for a specialist in Canada is $161K? That seems very low to me. I assume it is lower compensation in the smaller provinces bringing the average down.

161$K in US$, with PPP.  Meaning what you can purchase with 1$ here and 1$ in the US.
It's not the raw data.  Specialists in Quebec started at around 230k$ CAN$ at this time, much more today.  Also, it's what they make from their 1st to their last year.  Presumably, a doctor's wage increase with the number of years in practice?  Also, they may have bonuses to work outside of metro areas, plus various expenses paid.

It is just so out of wack with other stats I have seen.

https://www.cma.ca/En/Pages/canadian-physician-statistics.aspx

For 2014-2015, total average for Canadian specialists earning at least $60K from fees (i.e., not retired or mostly doing something other than medicine) was CAN $384,000. This only includes fees for medical services, not any other form of payment.

https://stats.oecd.org/Index.aspx?DataSetCode=SNA_TABLE4

Convert to US dollars based on PPP for 2014-15 would = US $309,677. Which is almost double. Seems hard to believe fees nearly doubled in the five or six years from 2009 to 2014-15.

And as you stated, that doesn't include all the other fees they can earn from billing for medical services covered by extended medical plans and services not covered by either forms of coverage.