Hacker News Board Hacker News, browsed like a classic message board
Live data from Hacker News

Doctors Unionize to Resist the Medical Machine

nytimes.com

Post reply on HN
Print view View original

71–80 of 120 posts

Re: Doctors Unionize to Resist the Medical Machine

#71

Post by stephenboyd »

c3534l wrote: post #9

Doctors are already paid absurd salaries in the US and the barriers to entry already high. As much as we all hate dealing with insurance companies, when I lost my insurance and had to pay for things out of pocket, the difference between what they charged me and what they would have charged an insurance company was obscene. Insurance companies actually do a pretty good job of reducing the costs of medical care, althou…

This article is about how the unionized doctors are more interested in performing their work at high quality for less money, and how that's in conflict with their administrator's incentives to have the doctors get paid bonuses to favor quantity at the expense of quality. The administrators are failing at appealing to these doctors' greed because it is outweighed by their sense of professionalism and satisfaction with their current pay.

Also, consider that medical expenses in the US are over 3 times what they are in similar countries, while the chart you've linked to shows doctors in the US being paid about 25% more. That's significantly more, but not enough to be driving the absurd costs.

I agree that its unfair for the patients to have no bargaining power.

Re: Doctors Unionize to Resist the Medical Machine

#72

Post by digbyloftus »

sayhar wrote: post #65
nostromo wrote: post #3

For what it's worth, people have been calling the AMA a union by another name for several decades. http://www.forbes.com/sites/johngoodman/2014/09/03/the-docto... They lobby, they control the supply of doctors, they restrict competition, and they even engage in price fixing: https://www.washingtonpost.com/business/economy/how-a-secret... They shape a lot of medical legislation, for example killing the Affordable Care…

> They lobby, they control the supply of doctors, they restrict competition, and they even engage in price fixing It saddens me that those are your go-to ideas of what a union is. > The AMA was key in killing Truman's universal healthcare proposal starting in 1945. Actual unions have been pushing for universal healthcare for much earlier than I was born. On this front AMA has been the enemy of real organized labor fo…

I mean, the difference between "resist management giving themselves millions while cutting pay for workers" and "price fixing/restrict competition" is just an arbitrary, subjective distinction based on your opinion on how much money people should make. Either way the goal is to get more money for members of the group. If you don't think doctors deserve the inflated value the AMA has captured for them but think that other union workers deserve more money then that's fair enough but practically it's the same game.

There's also a word for what you're doing. A tautology I think? It seems disingenuous to classify unions based on "good" value capture. It creates a position where unions literally can do no wrong because they'll just stop meeting your definition of union.

Re: Doctors Unionize to Resist the Medical Machine

#73

Post by PhasmaFelis »

krisdol wrote: post #66
PhasmaFelis wrote: post #30

Earlier quoted context omitted.

My CS degree focused on a rounded education, which would have been okay if it had also taught me how to, say, write a useful program. I didn't realize 'til I'd graduated that I would have to teach myself if I wanted a career.

To be fair it was never called a degree in programming.

When I signed up for classes, I said I wanted to be a programmer, and the advisor said "oh, you want Computer Science, then." That was just as much a lie as if they'd called it Programming outright.

Re: Doctors Unionize to Resist the Medical Machine

#74

Post by stephenboyd »

> The basic accounting problem for hospitalists is that they are not a profit center. That is, when they treat patients, the amount a hospital can bill Medicare and insurance companies is typically less than what the hospital must pay them. The opposite is true for other specialists, like surgeons.

The rest of the article focused on peoples' emotional reactions, but that paragraph is key. Medicare, Medicaid, and the insurance companies will pay more than enough for tests and surgeries, but not for the diagnoses and treatments that hospitalists and GP's perform themselves. So the folks running the hospital budgets are naturally trying to change the model so that the hospitalists quickly refer patients to the more profitable departments.

The only actor able to change this model is the US Congress, which makes the legislation that sets the Medicare and Medicaid reimbursement rates. There were major improvements with the ACA/Obamacare, but it's a dysfunctional system that can only be fixed by an even more dysfunctional system.

Re: Doctors Unionize to Resist the Medical Machine

#75

Post by zanny »

induscreep wrote: post #28

I don't understand this about healthcare in the USA. Why not import a few thousand doctors from Asia through H1Bs, and drive down the cost of medical care? Remove artificial caps on licenses imposed by the AMA while at it.

If the world made sense we would have doctors working 6 hour shifts at 100k a year rather than having one doctor work 12 hour shifts for 200k a year. But then you need people to actually want to be doctors rather than MBAs or financial accountants or lawyers, and strangely enough when the money isn't better and the work is way harder pressure to remove the artifical doctorate of medicine graduation rate caps is lacking.

Re: Doctors Unionize to Resist the Medical Machine

#76

Post by ryanSrich »

ZanyProgrammer wrote: post #42
hardcandy wrote: post #16

Earlier quoted context omitted.

What do you consider to be ''absurd salaries''? A friend of mine is a hard working (50 hours/week) 35 year old GP in San Francisco and makes about $175k all-in, which is about the same as the average base + cash bonus (excluding options) of all our white collar friends (mostly software developers, but also some in finance and other fields). He left medical school with about $50k in student debt (very low relative to…

How is 175K not absurd? Only a white collar engineer in SF would say that's a piddly salary. Wake me up when your doctor friend has to commute in from Stockton.

For some perspective. A 22 year old college graduate can make $175k per year in total comp with a CS degree working for Facebook or Google. To repeat that. A 22 year old with a BS degree can make $175k per year with absolutely no experience whatsoever.

Re: Doctors Unionize to Resist the Medical Machine

#77

Post by chillwaves »

c3534l wrote: post #9

Doctors are already paid absurd salaries in the US and the barriers to entry already high. As much as we all hate dealing with insurance companies, when I lost my insurance and had to pay for things out of pocket, the difference between what they charged me and what they would have charged an insurance company was obscene. Insurance companies actually do a pretty good job of reducing the costs of medical care, althou…

We can negotiate treatment down without insurance just as effectively (likely more so) with single payer health care.

Re: Doctors Unionize to Resist the Medical Machine

#78

Post by knughit »

merqurio wrote: post #27
marshray wrote: post #20

Earlier quoted context omitted.

I believe you, but when I worked in a medical office in 1993 vendors were saying that exact same thing.

I know, I hope my Background as MD and CS plus the idea we had will make it different. We are working on something similar to an IDE :)

Congratulations in advance for when EPIC buys your company and then ruins your product.

Re: Doctors Unionize to Resist the Medical Machine

#79

Post by riahi »

nostromo wrote: post #3

For what it's worth, people have been calling the AMA a union by another name for several decades. http://www.forbes.com/sites/johngoodman/2014/09/03/the-docto... They lobby, they control the supply of doctors, they restrict competition, and they even engage in price fixing: https://www.washingtonpost.com/business/economy/how-a-secret... They shape a lot of medical legislation, for example killing the Affordable Care…

That Washington Post article is a straight up hit piece on the Relative Value Update Committee.

Here's how medical compensation is decided in the US (simple simple SIMPLE edition):

All office visits, procedures, labs, radiology tests, everything, are assigned a CPT code. That code is then assigned a relative value unit (RVU) to determine the amount of "work" each code represents. The RVU itself has three components--Physician Work, Practice Expense, and (expected) Malpractice Expense.

These arrive at some number or RVUs. To then determine compensation, CMS (and insurers) use the following formula:

[(Work RVU * Work GPCI) + (Facility or Non-Facility PE RVU * PE GPCI) + (MP RVU * MP GPCI)] * [Conversion Factor adjusted for budget neutrality] = $Compensation for a given CPT.

GPCI - Geographic Price Cost Index, and represents a regional adjustment for a given cost of services.

------------------------------------------

The Post article acts like it's some big conspiracy that the RVU numbers haven't really changed much as if that's the reason healthcare costs are rising so rapidly. Except, the RVU itself doesn't determine the compensation. The values of a single RVU is determined arbitrarily by Medicare and Insurers. The whole point of the RVU committee is the make sure that all various parts of medicine are weighted according to some arbitrary value scale. You shouldn't expect Colonoscopies to suddenly become worth less RVUs just as time progresses. The "value" provided by a colonoscopy as technology progresses possibly counteracts the decrease in costs. I can tell you in Radiology that more resolution = more things to evaluate and = requires time to interpret the study despite a study acquisition time now in seconds.

CMS changing how much each RVU is worth is what determines what gets paid out. And I can tell you, CMS pays less for each RVU as time goes on.

http://www.acro.org/washington/rvu.pdf

Re: Doctors Unionize to Resist the Medical Machine

#80

Post by knughit »

pragone wrote: post #11
c3534l wrote: post #9

Doctors are already paid absurd salaries in the US and the barriers to entry already high. As much as we all hate dealing with insurance companies, when I lost my insurance and had to pay for things out of pocket, the difference between what they charged me and what they would have charged an insurance company was obscene. Insurance companies actually do a pretty good job of reducing the costs of medical care, althou…

> Doctors are already paid absurd salaries in the US To put it in context, when I finish all my training, I will owe over $600,000. It's not the doctors being "paid absurd salaries" that makes medical care in this country expensive. It's lawyers - malpractice insurance can take upwards of 25+% of your income - and it's insurance companies, who have shareholders they are responsible to, and it's hospital administratio…

Do you think lawyers consume malpractice insurance? Juries and lawsuit winners consume malpractice insurance
Post reply on HN