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I thought the real offense (and tragedy) was that the company gave false results to individuals who then made life changing decisions based on that information. Those cases were dismissed.
“ a man, alleged that a 2015 blood test he'd taken through Theranos gave him inaccurate results. The test told him that his blood wasn't clotting like normal, and he stopped taking his blood thinners as a result of the false diagnosis. So yes, that part of the show is based on testimonies and accounts from people who actually used Theranos blood tests.”. here.
Fortune mag headline says a cancer diagnosis but they won’t let me read the details.
I still fail to understand how George Shultz and Jim Mattis would join the board without asking first to tour the factory and to have their own blood "drops" run on a Theranos machine in front of their own eyes, and compare those results to ones they had run at Quest
Fraud in crypto is one thing. Who can see it or touch it.
How can you fake running blood tests on a small machine in minutes?
There is dirty like going into Target and stealing Laundry Detergent and there is another level of dirty like messing with little kids, stealing from old folks, putting things in peoples food and now this, messing with folks blood tests when she clearly new what was going on.
Why only 11 years I ask?
How do these screwballs (her, the FTX slob) get into these positions? Who in their right mind funds them? Due diligence? My rear end...greed, pure greed I guess...
It is their responsibilities and due diligence to review the testing before they join the board. The old saying among Silicon Valley’s start-ups is “fake it until you make it” rings so true in this case. If these people are technically savvy people, they would NOT be ask to be on the board.
Holmes is fully responsible to demonstrate the capabilities of the Edison machine to the investors. The testimonies from the former lab director and scientists revealed the results were performed on other commercial machines, not Theranos! So this is a bait and switch tactics used to con someone. Movies below show more details: https://decider.com/2022/01/04/elizabeth-holmes-theranos-tv-shows-movies-streaming/
any idiot who walks into a state of the art Clinical Lab and looks at the enormous size of machines that run even simple lab tests ( ie blood count) would know that they could not be miniaturized
Thanks for the link. I hate to pay $ to Amazon, but watching this will be such a guilty pleasure.
Both Andy Fastow and his wife both did time for Enron, but only 6 and 1 years respectively. He at least fully cooperated with the DOJ ( of course after this schemes were exposed). I think the judge let them serve the sentences one after another so the kids would not be left alone.
They had to pay back at least $25 million but I think they put a huge pot into their house in Houston to protect it, but nothing restored the life savings of all of the Enron employees
I have heard Holmes's judge still has to decide if she will be required to pay back the $500 to $800 million lost in Theranos scheme.
She is not only a crook, but a mean and vindictive woman. She tried to destroy George Shultz's grandson's life and reputation with private detective surveillance and threats after he blew the whistle on her. Read the victim testimony from his father at the trial.
She deserves more than 11 years, new mother or not.
White collar crimes tend to get away with light sentences. Each convicted count carries a maximum of 20 years sentence, and she was convicted on four out of 12 counts. She is going to appeal for lighter sentences than the 11 years she received. Her asset is nearly gone so she may have to pay very little.
Not only she stole from investors. The worst was the wrongly blood test results from the Edison machine when in fact these patients are free of diseases. Is that amounts to malpractice?
As investors in this sector, one should rely on money managers who are highly trained in that sector. Many rich folks got conned by Holmes and her team.
For example, TRP Health Science fund is managed by someone who is trained as a physician. The former manager, Kris Jenner has had a long distinguished record before he left to form his own company.
@Crash What sectors or specific companies are allowed to be a 'money making operation'; assuming the research capital is not government funded ???
You seem to enjoy baiting me, catch. Healthcare as a human RIGHT militates against the profit motive. What's happened previously, before people RECOGNIZED it as a RIGHT, is no justification, going forward.
Want to talk about car tires? Plastimers? Cold fusion? Maritime shipping? Aluminum extrusion? Shoemaking? Ad infinitum? Make money with THOSE things, eh?
What sectors or specific companies are allowed to be a 'money making operation'; assuming the research capital is not government funded ???
It comes down to the difference between human wants and human needs. Nothing wrong with making a profit off a flat screen TV. Something very wrong with controlling and making a profit off the water supply when people are dying of thirst.
To elaborate, capitalism tends to work for humanity when both supply and demand are elastic, flexible, so that consumers can find a substitute if supply is low or prices are too high because of an attempt to gouge consumers. But when supply is inelastic, limited and demand is inelastic--big problem for consumers. Capitalist investors by the way love this quasi-monopolistic situation. Gouging consumers is hugely profitable.
Healthcare is a case where the supply of doctors and medicine is by design limited while the demand for these products is either inelastic or worse potentially unlimited. If you or a loved one are truly sick, what wouldn't you pay for the cure? Hospitals, medical device makers and drug makers know this. That leads to terrible inequalities in power. It's the reason why healthcare bills have long been the biggest cause of bankruptcy in the United States.
At the very least, if healthcare shouldn't be a right, it should be much more strictly regulated than it currently is. A person getting a medical test like an MRI should know exactly what it will cost them before getting the test and be able to comparison shop with different providers. A person getting a non-emergency but necessary procedure should know what the cost is too in advance and how much exactly their insurance will cover. That still isn't the case. So, you end up with these absurd sticker shock situations.
I can't think of another kind of consumer transaction in the U.S. where I both have to buy the product and have no idea what I'm going to pay for it until after I've already bought it. If we walked into a store and asked, "How much is this candy bar?" and the proprietor said, "Well, that depends. I have to check this obscure Candybar Chargemaster List, which you can't see, and I won't be able to tell you how much until after you've eaten the candybar," we'd walk right out.
There are myriad of reasons why the "health care is a right" movement, which was very popular when I was in medical school in the 70s, foundered.
The libertarians went after it, claiming that if people had a right to something, the professionals providing that service were denied freedom of action and were essentially slaves. This, of course was before the rise of health insurance companies totally controlling payments and making physicians essentially their slaves.
The BC/BS organizations in the 50's decided to pay for "procedures" rather than cognitive services, putting thinking and counseling at a major disadvantage, especially when they also decided ( in the 80s) that all cognitive services and non procedural treatments for a cold or cancer or septic shock were the same and reimbursed them equally.
Adding insult, unlike every other profession in America, experience and training and skill in medicine do not result in a differential in payment. An intern, one day out of medical school gets the same payment as a doc with decades of experience.
I think if we eliminated third party payors, and had people pay for their health care themselves, with subsidies directly to the consumer perhaps, it would solve a lot of the problems.
Few people would pay for brand name drugs if there was a cheap generic. Hospitals would be empty unless they had rates equal to the cheap hotels that most of them are. CEOs of "non-profit" health care institutions would not be paid millions of $. Professionals would have to compete on results, or services or reputation or price, but almost all would be forced to lower their fees or else go broke.
Eliminate the third party payors, and the typical physician would save 35 to 50% of overhead.
Overnight, the political pressure people and states put on insurers to pay for stuff that is not life saving ( plastic surgery, unnecessary procedures etc) would disappear.
I won't get in to the Billions of dollars of added expense that the Federal and state governments add with their demands for "meaningful use", protocols, and other regulations.
@sma3 Although I don't have the time to go point-by-point, I know this is not true:
Adding insult, unlike every other profession in America, experience and training and skill in medicine do not result in a differential in payment. An intern, one day out of medical school gets the same payment as a doc with decades of experience.
The other thing I would add is there is ample evidence that Medicare pays less for the same medical procedures than private insurers because it has the largest risk pool and more negotiating power. Also, there are numerous examples of other nations with single-payer government funded medicine, i.e, where healthcare is a "right, and they all pay less per capita for healthcare than we do and have better average life expectancies than we do. The idea, often promulgated by libertarians, that if government just "got out of the way," the healthcare market would fix itself is simply wrong.
@LewisBraham. Thank you for your comments. @sma3. At least you presumably had a long career in medicine filled with the knowledge that you helped heal the world and that means more that your bitterness that forces beyond your control limited your profit.
You are referencing salaries paid to trainees in residency programs, not what a licensed physician bills and gets paid for to see a patient.
I used "medical intern" as the minimal amount of training most states require to get a license. I technically should have said "medical resident" because all states require at least one year ( internship) of post medical school training to be licensed and then to bill. So therefore technically a post internship MD
My point, based on 40 years of office practice is that insurance companies and Medicare pay the same amount for the procedure or office visit, regardless of what physician renders the service.
So a MD 366 days out of medical school gets the exact same $ amount for, say, an office visit that your long term internist with 40 years of experience and advanced training receives. Longer training, board certification, fellowship training etc have no effect on the fee, nor are they usually required to bill for procedures.
Nor is there, at the present time, any easy way to bill for additional time spent with the patient. This may change soon, but cognitive services will remain at a huge disadvantage when a dermatologist can remove a mole in 30 seconds for $100 and an internist only gets a little more to spend 45 minutes with you to diagnose your heart attack, or interpret your CT scan and plan your cancer care.
I too used to think the government was generally responsible for positive things in health care, but 40 years of running a small medical office convinced me otherwise. Most of our overhead, ( 50 to 60% of our revenues ) was due billing staff trying to collect a few dollars more from multiple payors, extra staff to deal with regulations from botht he government and our payors and mandated programing and Medicare mandated computers and electronic medical records. The latter required 3 to 4 hours a day of my time in front of the computer after the patients ( and staff) went home that added nothing to patient care or their health. I rarely left the office before 9 PM.
Is it any wonder why you can't find a primary care MD in practice taking new patients?
I could easily have taken home the same amount of money charging $50 to $100 a visit, and spent a lot less time with far fewer headaches.
I can't speak for specialists or hospitals and what what would happen to orthopedists, for example if they billed patients directly for a hip replacement. Specialists in high demand would obviously charge outrageous amounts. This is already happening in some states where subspecialty societies have limited sub specialist training.
Every study I have read demonstrates at least 30% of American health care expenses goes to needless administrative overhead and outrageous salaries of executives.
Gentlemen, from extensive association with a number of retired primary care doctors, I have every reason to believe that SMA3's observations are absolutely correct.
On the other hand, as a patient who enjoys the benefits of Medicare and excellent health insurance coverage, I do appreciate the services provided by the government.
The sad fact is that when evaluating health services in this country, there are three major levels of care: excellent, so-so, and "almost none". That is not the situation in a number of European countries, and also the reason comparing better average life expectancies across nations results in such a disparity. "Better average life expectancies" is an average, and since the United States really has three discreet "averages", the comparison doesn't work well.
If we compare the US "excellent care" average to those European "all citizen" averages, the US might look pretty good for that particular group. All of this is, of course, really besides the point: for too many US citizens health care options are very poor.
The point is also very much that the insurance and major medical institutions, between them, are reducing doctor's practices to almost the level of workers in a meat-cutting plant, where every minute is measured and options as to how the job is done are increasingly limited.
SMA3 asks "Is it any wonder why you can't find a primary care MD in practice taking new patients?". I know from the extensive personal experience of myself and others that this is very true, even for those of us fortunate enough to be able to afford "excellent" care.
There are two major factors involved that we haven't mentioned ( although I alluded to one of them above)
The first is of course that we have a "Disease care system" not one trying to improve people's health, and a lot of our lower life expectancy is due to poor habits etc.
The one that hangs most heavily on the medical profession's corner, of course is income.
There is little other word for it other than greed of many physicians ( and hospital admistrators)
This does not mean that all doctors work only for the bottom line, but I found that the higher paid the specialist, the more it seemed that many of their office practices were devoted to increasing their income.
Using "paraprofessionals" to see patients, leaving the doctor to do procedures.
"Advanced billing procedures" ( which really exploded with electronic records) where the data needed to justify much higher billing codes was "copied and pasted" from one visit to the next, or just fabricated
Emailing patients their results on the electronic record, letting the patient try to figure out what it meant, rather than calling them directly, even if the results are "life changing".
Eliminating a phone call for the individual office so all calls go to a main number for the entire practice of dozens of providers, where a message is taken but lots of time ignored.
Like a lot of things in American society, the capitalists and large institutions have somehow been able to maneuver end runs around regulations that should have protected people, but the government ( both GOP and Dems) share a lot of the blame for heavy handed requirements.
I don't think Holmes would have been so successful for so long in a less institutional, less private enterprise system, where people relied on their family doctor for advice, and Walgreens and Safeway didn't think they could make big money on in person lab tests
What made her technology so attractive to Walgreens was it could further control the market for primary care.
A self-employed primary care doctor seeking reimbursements is different from a surgeon working in a hospital. Hospital medical staff do get raises based on experience: https://work.chron.com/rate-salary-increase-physician-27112.html The other interesting question is whether years of experience are the best measure of quality in medicine. I wouldn’t want to be a surgeon’s first patient, but I also wouldn’t want to be their last either. A doctor with five or more years of practical experience may be more aware of the latest medical research or trends than one with 40 years about to retire. A younger surgeon might also have steadier hands.
Yet in some respects, the question is moot because doctors of any level of experience tend to get paid handsomely here. I feel for the overworked internists with huge student loans still to pay, but that is a different issue. You don’t hear of too many poor established American doctors. The reason we don’t have national health insurance is directly due to the AMA, which lobbied hard to prevent it from happening many moons ago. And Old Joe is exactly right about the different levels of care here. This is not a country to be poor and sick in. And other countries have consistently better outcomes than we do both on the cost and health front for their entire populations.
The problem with just letting the market handle healthcare is the inequality of supply—limited—and demand—unlimited—for necessary life saving care. If it costs you 5 cents to make a candy bar and you want to charge $50 for it, have at it. I’ll just buy something else, but there may be wealthy people who love your candy so much they’ll pay the $50 for it. But if it costs you 5 cents to make a pill that you have an exclusive patent on and it keeps my parents, children, or spouse alive and you want to charge $500 for it—we’ve got a problem.
Note, one of the additional problems our for profit healthcare industry has created is that through lobbying big pharma made it so that Medicare could not use its negotiating muscle to demand lower prices on drugs. That’s why you have poor seniors cutting pills in half. Medicare however does have the power to negotiate reimbursement rates for doctors visits and medical procedures. Doctors are unhappy with those lower reimbursement rates. I have a feeling many seniors are alive today because of them.
@Dr.sma3. I think your beef is with managed care. I suspect you would be cool with a health insurance industry that only sold old fashioned indemnity plans. You docs could bill anything you wanted and they would pay 80%. The patient would pay the other 20%. The problem is that it wouldn’t take long for the premiums to go so high that few could afford them. I used to hang with a doc who told me that he understood that without health insurance he would have very few patients and he knew that without managed care very few patients could afford health insurance. Disclosure: I spent thirty years in the health insurance industry. And without managed care I would not have been able the pay for my cancer treatment. I would have gone without or lost my home and maybe gone BK. Just sayin.
I assume the board is running out of interest so I will not answer all of your points in detail, but am happy to discuss further if you want.
When I graduated from medical school in 1978, over half the class went into internal medicine, as it was intellectually exciting, involved doing something for people and was close to other specialties in salary. We had little debt. Neither of these last two points are the case now , and students are following their pocket books so lots of specialists and few Internists. The specialists have manufactured their markets, insisting all older people get "skin checks" and anyone with chest pain see a cardiologist etc.
I was against the AMAs stand in almost everything and remain so today.
All I had to offer my patients when I was in practice was the time they needed, my experience and training and deep interest in their problems and their lives. That could not be crammed into less than 15 minutes. But our office visits became more and more important to them because they never heard from specialists about test results, saw the surgeon once ( maybe) before surgery and usually not after, and got life changing results (ie cancer diagnoses) without explanation by email.
Patents who did not have docs like me to rely on, went to the ED, had more symptoms, got more tests, more visits and more costs.
If this society is to achieve cost control with better results in health care, we desperately need an economic environment where competent well trained PCPs can function effectively, without constantly trying to see more patients in less time and have payors continually cut their fees, add more to their workloads and office requirements. We need to stop incentivizing medical students to go into lucrative subspecialties with ridiculous salaries that add little to the nation's health. Countless studies show PCPs are much more cost effective than specialists in management of most medical problems, and that our medical costs are so high because of an overreliance on specialists that no other western nation needs.
I don't know of the accuracy of your reference, but the table shows a salary increase from $147000 to $189000 or 28% total in 20 years. These increases however hardly beat inflation. Compared to lawyers and MBAs (who have only three years post college, not seven for PCPs) these salaries don't seem excessive. The fact that specialists make three to ten times that of a PCP is where American MD salaries are really skewed far away from other countries averages.
No one I hired or recruited out of residency started at $147,000, and I rarely made that much in 30 years of practice.
My main point remains: with fixed fees the only way to achieve a salary increase with more experience and seniority a PCP has to either see many more patients in less time, do lucrative but unnecessary procedures in the office or work longer hours. None of these are conducive to good patient care.
Medicare rates are set in a complicated political process involving local cost differentials, usual and customary adjustments, advisory boards (loaded with subspecialists), caps on Part B reimbursements requiring budget reconciliation legislation etc, not by "negotiations" with any group. In fact, due to the budget reconciliation process, rates are automatically cut almost every year without a specific restoration from Congress.
Medication costs for Medicare patients are finally going to be negotiated, but this will not stop the enormous political pressure applied by big pharma to get "copy cat" drugs approved at lucrative rates, or get ineffective medications for Alzheimer's approved at $58,000 a year. As some of these will be outpatient services( Part B) , not just drugs, it could decrease physician payments further.
The system is stacked against a specialty that uses it's brains and humanity to talk to patients, hear their concerns, make an accurate diagnosis and determine an individual plan rather than ordering an MRI in 60 seconds or referring to a specialist because there is not enough time to figure out what the problem is.
@sma3 I agree with you about the need for more caring competent PCPs and for better treatment of them. Unfortunately, our system is not built around preventive or holistic medicine, which is what a good PCP practices. It is built around much more lucrative disease treatment when prevention could've saved the patient money and often their life. But all of this speaks to Crash's initial point that healthcare should be a right as opposed to a business. As long as profit maximization is the only goal, preventive and holistic medicine will be far less important than disease treatment.
"...The system is stacked against a specialty that uses it's brains and humanity to talk to patients, hear their concerns, make an accurate diagnosis and determine an individual plan rather than ordering an MRI in 60 seconds or referring to a specialist because there is not enough time to figure out what the problem is." Quite.
I was not trained in "preventative medicine" but I practiced holistic medicine as I tried to help patients make decisions that were right for them as people and not tell them what to do. I would document for them the expected results of what they wanted to do, if we agreed to disagree.
I think the jury is out on "preventative medicine" at least if it means with different training health care professionals could correct people's bad habits. I had little luck trying to get people to stop smoking eating not exercising etc. I knew all the correct approaches from the literature and seminars etc, but the data says such interventions have a success rate of about 10%.
I might be different with different TV programs, Social Media, advertisements, but if you can't convince 35% of the population to be fully vaccinated against a potentially fatal pandemic disease, good luck with smoking cessation or obesity
Got me with "not exercising". Have modified my regimen as far as eating & drinking, though. Doing pretty good at 83, thanks to very good primary care docs. I thank you all.
Comments
“ a man, alleged that a 2015 blood test he'd taken through Theranos gave him inaccurate results. The test told him that his blood wasn't clotting like normal, and he stopped taking his blood thinners as a result of the false diagnosis. So yes, that part of the show is based on testimonies and accounts from people who actually used Theranos blood tests.”. here.
Fortune mag headline says a cancer diagnosis but they won’t let me read the details.
'Failings'??
Still privileged and clueless, even now:
And, already with a toddler, she decided to get pregnant while awaiting sentencing.
Fraud in crypto is one thing. Who can see it or touch it.
How can you fake running blood tests on a small machine in minutes?
Why only 11 years I ask?
How do these screwballs (her, the FTX slob) get into these positions? Who in their right mind funds them? Due diligence? My rear end...greed, pure greed I guess...
Baseball Fan
Holmes is fully responsible to demonstrate the capabilities of the Edison machine to the investors. The testimonies from the former lab director and scientists revealed the results were performed on other commercial machines, not Theranos! So this is a bait and switch tactics used to con someone. Movies below show more details:
https://decider.com/2022/01/04/elizabeth-holmes-theranos-tv-shows-movies-streaming/
Thanks for the link. I hate to pay $ to Amazon, but watching this will be such a guilty pleasure.
Both Andy Fastow and his wife both did time for Enron, but only 6 and 1 years respectively. He at least fully cooperated with the DOJ ( of course after this schemes were exposed). I think the judge let them serve the sentences one after another so the kids would not be left alone.
They had to pay back at least $25 million but I think they put a huge pot into their house in Houston to protect it, but nothing restored the life savings of all of the Enron employees
I have heard Holmes's judge still has to decide if she will be required to pay back the $500 to $800 million lost in Theranos scheme.
She is not only a crook, but a mean and vindictive woman. She tried to destroy George Shultz's grandson's life and reputation with private detective surveillance and threats after he blew the whistle on her. Read the victim testimony from his father at the trial.
She deserves more than 11 years, new mother or not.
Not only she stole from investors. The worst was the wrongly blood test results from the Edison machine when in fact these patients are free of diseases. Is that amounts to malpractice?
For example, TRP Health Science fund is managed by someone who is trained as a physician.
The former manager, Kris Jenner has had a long distinguished record before he left to form his own company.
What sectors or specific companies are allowed to be a 'money making operation'; assuming the research capital is not government funded ???
Healthcare as a human RIGHT militates against the profit motive. What's happened previously, before people RECOGNIZED it as a RIGHT, is no justification, going forward.
Want to talk about car tires? Plastimers? Cold fusion? Maritime shipping? Aluminum extrusion? Shoemaking? Ad infinitum? Make money with THOSE things, eh?
To elaborate, capitalism tends to work for humanity when both supply and demand are elastic, flexible, so that consumers can find a substitute if supply is low or prices are too high because of an attempt to gouge consumers. But when supply is inelastic, limited and demand is inelastic--big problem for consumers. Capitalist investors by the way love this quasi-monopolistic situation. Gouging consumers is hugely profitable.
Healthcare is a case where the supply of doctors and medicine is by design limited while the demand for these products is either inelastic or worse potentially unlimited. If you or a loved one are truly sick, what wouldn't you pay for the cure? Hospitals, medical device makers and drug makers know this. That leads to terrible inequalities in power. It's the reason why healthcare bills have long been the biggest cause of bankruptcy in the United States.
At the very least, if healthcare shouldn't be a right, it should be much more strictly regulated than it currently is. A person getting a medical test like an MRI should know exactly what it will cost them before getting the test and be able to comparison shop with different providers. A person getting a non-emergency but necessary procedure should know what the cost is too in advance and how much exactly their insurance will cover. That still isn't the case. So, you end up with these absurd sticker shock situations.
I can't think of another kind of consumer transaction in the U.S. where I both have to buy the product and have no idea what I'm going to pay for it until after I've already bought it. If we walked into a store and asked, "How much is this candy bar?" and the proprietor said, "Well, that depends. I have to check this obscure Candybar Chargemaster List, which you can't see, and I won't be able to tell you how much until after you've eaten the candybar," we'd walk right out.
There are myriad of reasons why the "health care is a right" movement, which was very popular when I was in medical school in the 70s, foundered.
The libertarians went after it, claiming that if people had a right to something, the professionals providing that service were denied freedom of action and were essentially slaves. This, of course was before the rise of health insurance companies totally controlling payments and making physicians essentially their slaves.
The BC/BS organizations in the 50's decided to pay for "procedures" rather than cognitive services, putting thinking and counseling at a major disadvantage, especially when they also decided ( in the 80s) that all cognitive services and non procedural treatments for a cold or cancer or septic shock were the same and reimbursed them equally.
Adding insult, unlike every other profession in America, experience and training and skill in medicine do not result in a differential in payment. An intern, one day out of medical school gets the same payment as a doc with decades of experience.
I think if we eliminated third party payors, and had people pay for their health care themselves, with subsidies directly to the consumer perhaps, it would solve a lot of the problems.
Few people would pay for brand name drugs if there was a cheap generic. Hospitals would be empty unless they had rates equal to the cheap hotels that most of them are. CEOs of "non-profit" health care institutions would not be paid millions of $. Professionals would have to compete on results, or services or reputation or price, but almost all would be forced to lower their fees or else go broke.
Eliminate the third party payors, and the typical physician would save 35 to 50% of overhead.
Overnight, the political pressure people and states put on insurers to pay for stuff that is not life saving ( plastic surgery, unnecessary procedures etc) would disappear.
I won't get in to the Billions of dollars of added expense that the Federal and state governments add with their demands for "meaningful use", protocols, and other regulations.
and https://indeed.com/career-advice/pay-salary/how-much-does-a-surgical-intern-make
https://money.usnews.com/careers/best-jobs/surgeon/salary
The other thing I would add is there is ample evidence that Medicare pays less for the same medical procedures than private insurers because it has the largest risk pool and more negotiating power. Also, there are numerous examples of other nations with single-payer government funded medicine, i.e, where healthcare is a "right, and they all pay less per capita for healthcare than we do and have better average life expectancies than we do. The idea, often promulgated by libertarians, that if government just "got out of the way," the healthcare market would fix itself is simply wrong.
@sma3. At least you presumably had a long career in medicine filled with the knowledge that you helped heal the world and that means more that your bitterness that forces beyond your control limited your profit.
You are referencing salaries paid to trainees in residency programs, not what a licensed physician bills and gets paid for to see a patient.
I used "medical intern" as the minimal amount of training most states require to get a license. I technically should have said "medical resident" because all states require at least one year ( internship) of post medical school training to be licensed and then to bill. So therefore technically a post internship MD
My point, based on 40 years of office practice is that insurance companies and Medicare pay the same amount for the procedure or office visit, regardless of what physician renders the service.
So a MD 366 days out of medical school gets the exact same $ amount for, say, an office visit that your long term internist with 40 years of experience and advanced training receives. Longer training, board certification, fellowship training etc have no effect on the fee, nor are they usually required to bill for procedures.
Nor is there, at the present time, any easy way to bill for additional time spent with the patient. This may change soon, but cognitive services will remain at a huge disadvantage when a dermatologist can remove a mole in 30 seconds for $100 and an internist only gets a little more to spend 45 minutes with you to diagnose your heart attack, or interpret your CT scan and plan your cancer care.
I too used to think the government was generally responsible for positive things in health care, but 40 years of running a small medical office convinced me otherwise. Most of our overhead, ( 50 to 60% of our revenues ) was due billing staff trying to collect a few dollars more from multiple payors, extra staff to deal with regulations from botht he government and our payors and mandated programing and Medicare mandated computers and electronic medical records. The latter required 3 to 4 hours a day of my time in front of the computer after the patients ( and staff) went home that added nothing to patient care or their health. I rarely left the office before 9 PM.
Is it any wonder why you can't find a primary care MD in practice taking new patients?
I could easily have taken home the same amount of money charging $50 to $100 a visit, and spent a lot less time with far fewer headaches.
I can't speak for specialists or hospitals and what what would happen to orthopedists, for example if they billed patients directly for a hip replacement. Specialists in high demand would obviously charge outrageous amounts. This is already happening in some states where subspecialty societies have limited sub specialist training.
Every study I have read demonstrates at least 30% of American health care expenses goes to needless administrative overhead and outrageous salaries of executives.
On the other hand, as a patient who enjoys the benefits of Medicare and excellent health insurance coverage, I do appreciate the services provided by the government.
The sad fact is that when evaluating health services in this country, there are three major levels of care: excellent, so-so, and "almost none". That is not the situation in a number of European countries, and also the reason comparing better average life expectancies across nations results in such a disparity. "Better average life expectancies" is an average, and since the United States really has three discreet "averages", the comparison doesn't work well.
If we compare the US "excellent care" average to those European "all citizen" averages, the US might look pretty good for that particular group. All of this is, of course, really besides the point: for too many US citizens health care options are very poor.
The point is also very much that the insurance and major medical institutions, between them, are reducing doctor's practices to almost the level of workers in a meat-cutting plant, where every minute is measured and options as to how the job is done are increasingly limited.
SMA3 asks "Is it any wonder why you can't find a primary care MD in practice taking new patients?". I know from the extensive personal experience of myself and others that this is very true, even for those of us fortunate enough to be able to afford "excellent" care.
There are two major factors involved that we haven't mentioned ( although I alluded to one of them above)
The first is of course that we have a "Disease care system" not one trying to improve people's health, and a lot of our lower life expectancy is due to poor habits etc.
The one that hangs most heavily on the medical profession's corner, of course is income.
There is little other word for it other than greed of many physicians ( and hospital admistrators)
This does not mean that all doctors work only for the bottom line, but I found that the higher paid the specialist, the more it seemed that many of their office practices were devoted to increasing their income.
Using "paraprofessionals" to see patients, leaving the doctor to do procedures.
"Advanced billing procedures" ( which really exploded with electronic records) where the data needed to justify much higher billing codes was "copied and pasted" from one visit to the next, or just fabricated
Emailing patients their results on the electronic record, letting the patient try to figure out what it meant, rather than calling them directly, even if the results are "life changing".
Eliminating a phone call for the individual office so all calls go to a main number for the entire practice of dozens of providers, where a message is taken but lots of time ignored.
Like a lot of things in American society, the capitalists and large institutions have somehow been able to maneuver end runs around regulations that should have protected people, but the government ( both GOP and Dems) share a lot of the blame for heavy handed requirements.
I don't think Holmes would have been so successful for so long in a less institutional, less private enterprise system, where people relied on their family doctor for advice, and Walgreens and Safeway didn't think they could make big money on in person lab tests
What made her technology so attractive to Walgreens was it could further control the market for primary care.
The other interesting question is whether years of experience are the best measure of quality in medicine. I wouldn’t want to be a surgeon’s first patient, but I also wouldn’t want to be their last either. A doctor with five or more years of practical experience may be more aware of the latest medical research or trends than one with 40 years about to retire. A younger surgeon might also have steadier hands.
Yet in some respects, the question is moot because doctors of any level of experience tend to get paid handsomely here. I feel for the overworked internists with huge student loans still to pay, but that is a different issue. You don’t hear of too many poor established American doctors. The reason we don’t have national health insurance is directly due to the AMA, which lobbied hard to prevent it from happening many moons ago. And Old Joe is exactly right about the different levels of care here. This is not a country to be poor and sick in. And other countries have consistently better outcomes than we do both on the cost and health front for their entire populations.
The problem with just letting the market handle healthcare is the inequality of supply—limited—and demand—unlimited—for necessary life saving care. If it costs you 5 cents to make a candy bar and you want to charge $50 for it, have at it. I’ll just buy something else, but there may be wealthy people who love your candy so much they’ll pay the $50 for it. But if it costs you 5 cents to make a pill that you have an exclusive patent on and it keeps my parents, children, or spouse alive and you want to charge $500 for it—we’ve got a problem.
Note, one of the additional problems our for profit healthcare industry has created is that through lobbying big pharma made it so that Medicare could not use its negotiating muscle to demand lower prices on drugs. That’s why you have poor seniors cutting pills in half. Medicare however does have the power to negotiate reimbursement rates for doctors visits and medical procedures. Doctors are unhappy with those lower reimbursement rates. I have a feeling many seniors are alive today because of them.
When I graduated from medical school in 1978, over half the class went into internal medicine, as it was intellectually exciting, involved doing something for people and was close to other specialties in salary. We had little debt. Neither of these last two points are the case now , and students are following their pocket books so lots of specialists and few Internists. The specialists have manufactured their markets, insisting all older people get "skin checks" and anyone with chest pain see a cardiologist etc.
I was against the AMAs stand in almost everything and remain so today.
All I had to offer my patients when I was in practice was the time they needed, my experience and training and deep interest in their problems and their lives. That could not be crammed into less than 15 minutes. But our office visits became more and more important to them because they never heard from specialists about test results, saw the surgeon once ( maybe) before surgery and usually not after, and got life changing results (ie cancer diagnoses) without explanation by email.
Patents who did not have docs like me to rely on, went to the ED, had more symptoms, got more tests, more visits and more costs.
If this society is to achieve cost control with better results in health care, we desperately need an economic environment where competent well trained PCPs can function effectively, without constantly trying to see more patients in less time and have payors continually cut their fees, add more to their workloads and office requirements. We need to stop incentivizing medical students to go into lucrative subspecialties with ridiculous salaries that add little to the nation's health. Countless studies show PCPs are much more cost effective than specialists in management of most medical problems, and that our medical costs are so high because of an overreliance on specialists that no other western nation needs.
I don't know of the accuracy of your reference, but the table shows a salary increase from $147000 to $189000 or 28% total in 20 years. These increases however hardly beat inflation. Compared to lawyers and MBAs (who have only three years post college, not seven for PCPs) these salaries don't seem excessive. The fact that specialists make three to ten times that of a PCP is where American MD salaries are really skewed far away from other countries averages.
No one I hired or recruited out of residency started at $147,000, and I rarely made that much in 30 years of practice.
My main point remains: with fixed fees the only way to achieve a salary increase with more experience and seniority a PCP has to either see many more patients in less time, do lucrative but unnecessary procedures in the office or work longer hours. None of these are conducive to good patient care.
Medicare rates are set in a complicated political process involving local cost differentials, usual and customary adjustments, advisory boards (loaded with subspecialists), caps on Part B reimbursements requiring budget reconciliation legislation etc, not by "negotiations" with any group. In fact, due to the budget reconciliation process, rates are automatically cut almost every year without a specific restoration from Congress.
Medication costs for Medicare patients are finally going to be negotiated, but this will not stop the enormous political pressure applied by big pharma to get "copy cat" drugs approved at lucrative rates, or get ineffective medications for Alzheimer's approved at $58,000 a year. As some of these will be outpatient services( Part B) , not just drugs, it could decrease physician payments further.
The system is stacked against a specialty that uses it's brains and humanity to talk to patients, hear their concerns, make an accurate diagnosis and determine an individual plan rather than ordering an MRI in 60 seconds or referring to a specialist because there is not enough time to figure out what the problem is.
Quite.
I was not trained in "preventative medicine" but I practiced holistic medicine as I tried to help patients make decisions that were right for them as people and not tell them what to do. I would document for them the expected results of what they wanted to do, if we agreed to disagree.
I think the jury is out on "preventative medicine" at least if it means with different training health care professionals could correct people's bad habits. I had little luck trying to get people to stop smoking eating not exercising etc. I knew all the correct approaches from the literature and seminars etc, but the data says such interventions have a success rate of about 10%.
I might be different with different TV programs, Social Media, advertisements, but if you can't convince 35% of the population to be fully vaccinated against a potentially fatal pandemic disease, good luck with smoking cessation or obesity