era@ncar.ucar.edu (Ed Arnold) (10/26/90)
Index Number: 11273 In article <14964@bunker.UUCP> Joe.Chamberlain@f140.n150.z1.fidonet.org writes: |Index Number: 11103 | | The American health care system has become bloated and |inefficient. It keeps taking more of the gross nation product |and continues to row in the share of the national budget. In |1989 the U.S. spent $2200 per person on health care, Great |Britian spent $600, and Singapore $300; all with about the same |result. The health care system now takes about 15 cents out of |every dollar spent in America. Health care costs in America are |nearly eight times that of our international competitors. By not |having the internal discipline to say no to the excesses America |is adding yet another nail to its economic coffin. Individually, I'm not sure any of us can do a whole lot about this. One good step which we should all take now, however, is a living will and durable power of attorney for health matters. Personally, I would just as soon not be another Nancy Cruzan. The overall problem is well summarized, I think, in the following articles that recently appeared in the Denver Post. We all know labor costs are the big cost in almost all businesses. Think about what these articles say about labor costs in health care. Did YOU get a 12.5% increase last year? I didn't. ------------------------------------------------------------------------ GREED BECOMING ISSUE IN HIGH PAY OF DOCTORS [appeared in Denver Post, 30 Sep. 1990] Boston - One doctor stopped eating in his hospital's dining room when he finally tired of hearing other physicians brag about their fat incomes, megabuck retirement funds and money, money, money. Another remembers a colleague's shock at learning her salary. How could she be happy when her pay - more than comfortable by most Americans' standards - seemed so low? Money, it seems, is becoming an obsession for many in medicine. Doctors long have made lucrative livings. But huge fees - especially for surgery and high-tech procedures - have turned medical pay into a subject of intense fascination, both for those who pull down sky-high incomes and those who are jealous of the doctors who do. "Greediness is becoming more and more an issue," said Dr. Michael V. Buenaflor of Northampton, Penn. "Guys are a lost more cynical and are turning to the American way of `Go for it.'" But in the medical world, at least, money does not always buy happiness. Many doctors say they are fed up with their profession. They complain of second-guessing insurance companies, burdensome paperwork, miserly Medicare fees, high malpractice rates and the constant fear of being sued, among other things. Some argue that practicing medicine has become so unsatisfying that many are bent on making sure the work is financially rewarding, even if it's no longer fun. And rewarding it is. The latest statistics show that monetarily, at least, doctors are doing very well indeed. Their pay is going up far faster than almost everyone else's: Last year, according to a survey, their net income rose 12.5 percent, almost triple the rate of inflation. The survey, conducted among 6,484 doctors by the magazine Medical Economics, found that the median net income of all U.S. doctors rose almost $15,000 in 1989 to $133,000. Among other figures from the survey: o Annual incomes ranged from $87,000 for general practitioners to $296,000 for cardiovascular surgeons. o One in five cardiovascular surgeons makes more than $600,000 annually. o The typical obstetrician's pay soared $36,000 last year, more than any other specialty. o Only 6 percent of doctors make less than $50,000 a year. Many doctors contend they studied hard and put in long hours. They deserve to make a good living, they say. "When you consider that we work a 60-some hour week, that we put 12 years of training in and we owe 50 grand when we start, on average, I don't think anybody is robbing the bank," said Dr. Philip R. Alper, and internist in Burlingame, Calif. "We don't make an excessive wage," he said. "I don't have an apology to make." Some, in fact, fear they are falling behind. "Nobody feels bad for physicians. We do make a good living," said Dr. Craig Czarsty, a family practitioner and doctor's son in Oakville, Conn. "But is my earning power the same as my father's was 20 years ago? Probably not." Specialists are particularly well off, but they contend they deserve to make more than other people, including doctors in general care. Their work is often tedious and exacting, they say, and requires technical skills that take many years to perfect. Dr. Thomas Purdon of the University of Arizona Health Science Center notes the special pressures faced by his colleagues in obstetrics and gynecology, whose earning the magazine survey pegs at $194,000. Besides the many hours seeing women through their pregnancies, labor and early motherhood, there is a real possibility that each is a potential courtroom opponent. "The public expects an absolutely perfect product and doesn't want to recognize that there can be genetic problems and other things that the obstetrician has no control over," said Purdon. Yet an undercurrent of feeling remains - both inside and outside the profession - that some doctors are just plain money hungry. A survey conducted last year for the American Medical Association found that two-thirds of Americans think doctors are too interested in making money. Those complaining loudest about physician avarice often are doctors in the lower-paying primary care specialties. Buenaflor is the doctor who grew weary of dining room talk of physicians' financial conquests. The final straw for him was an ear, nose and throat specialist who said he'd finished the year with an extra $160,000 that he couldn't figure out how to spend. Buenaflor is a family practitioner, traditionally the lowest-paid medical specialty. (Last year, according to the magazine survey, they netted an average $97,000.) Often, when these doctors on the front lines of medical care talk about money, the conversation turns to specialists in more technical fields. "I'm going to be in my office 12 hours today," Buenaflor said. "I will net less than a colorectal guy across town will do for a 20-minute colonoscopy," a routine diagnostic procedure. D. Lorilee Smith, a rheumatologist in Modesto, Calif., said she believes the financial attitudes of many young doctors who set up practice in the 1980s simply reflect the decade's fixation on money. She was struck by a conversation with a young dermatologist who moved into her building. "After she had been her for a while, I told her what I made. She was shocked. She said, `But you seem so happy.' Compared to dermatologists, I'm making poverty-level wages, even though I make great money," Smith said. Insurers have long paid high fees for technical procedures and operations and much less for the hours that primary care doctors spend figuring out which of these treatments their patients need. But that will change, at least a little. Beginning in 1992, Medicare will reimburse doctors more for their time managing and evaluating patients and less for technical services and operations. This will raise the pay for family doctors and lower it for many surgeons and radiologists. While the changes will narrow the spread, it certainly will not eliminate it. Doctors who deliver babies still will make considerably more than, say, the pediatricians who care for them later. Is the pay of such specialists as obstetricians fair? "What's fair payment?" asks Dr. John Graham, an official of the American College of Obstetricians and Gynecologists. He offers a sports analogy to bolster his point. "Is Joe Montana worth what he gets? I don't know." ------------------------------------------------------------------------ DOCTORS' INSURANCE RATES CUT Companies reducing malpractice premiums [appeared in Denver Post 23 Sep. 1990] WASHINGTON - After rising sharply for more than a decade, medical malpractice insurance are now declining in many states. Premiums are showing declines of up to 35 percent as states have set limits on malpractice suits and as doctors, faced with the possibility of multimillion-dollar damage claims, apparently have become more careful. In the last few years, insurers say, the number and frequency of malpractice claims have declined, so premiums can be reduced because enough reserves have been built up to pay claims and other expenses. DOWN 10% IN COLO. In the last 15 months, insurers have reduced malpractice premiums by an average of 10 percent in Colorado, 23 percent in Georgia and 32 percent in Maine. >From 1982 to 1988, premiums rose nationally by an average of more than 18 percent a year, according to the American Medical Association. Medical Liability Mutual Insurance Co. of New York, the nation's second-biggest writer of malpractice insurance, has just reduced rates by an average of 5 percent. St. Paul Fire & Marine Insurance Co., the largest source of malpractice insurance in the United States, is reducing premiums in 22 of the 42 states where it writes policies for doctors. Company spokeswoman Beth M. Hamel said the cuts ranged from 6 percent to 25 percent. NEW SAFEGUARDS Some specialists have adopted new standards of patient care. Under a standard that took effect in January, the American Society of Anesthesiologists requires its members to use certain new monitoring devices. Research by the society suggests that proper use of the new devices could have prevented death or serious injury in nearly one-third of the cases in which anesthesiologists were accused of malpractice. ------------------------------------------------------------------------ -- Ed Arnold * NCAR * POB 3000, Boulder, CO 80307-3000 * 303-497-1253(voice) 303-497-1137(fax) * era@ncar.ucar.edu [128.117.64.4] * era@ncario.BITNET era@ncar.UUCP * Edward.Arnold@f809.n104.z1.FIDONET.ORG
Chris.Brown@f223.n163.z1.fidonet.org (Chris Brown) (11/06/90)
Index Number: 11554
What we're afraid of in Canada is that the Free Trade Agreement,
which has all kinds of implications for social programs, will
severely undermine Canada's health care system, which is largely
financed through taxes. Some of the elements of the FTA suggest,
sometimes state, that "unfair subsidiesto workers" should be
removed.
Not to mention the danger of tying ourselves to a sinking ship, the
american economy!
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